Arthritis/Immune Diseases
What is arthritis?
Arthritis is a general term for
conditions that affect the joints and surrounding tissues. Joints are
places in the body where bones come together, such as the knee, wrist,
fingers, toes, and hips. The two most common types of arthritis are
osteoarthritis and rheumatoid arthritis.
What is osteoarthritis (OA)?
Osteoarthritis
is a painful, degenerative joint disease that often involves the hips,
knees, neck, lower back, or the small joints of the hands. OA usually
develops in joints that are injured by repeated overuse in the
performance of a particular job or a favorite sport or from carrying
around excess body weight. Usually, the first symptom a person has with
OA is pain that worsens following exercise or immobility.
What is rheumatoid arthritis (RA)?
Rheumatoid
arthritis is an autoimmune inflammatory disease that usually involves
the hands, wrists, elbows, shoulders, knees, feet, or ankles. An
autoimmune disease is one in which the body releases enzymes that
attack its own healthy tissues. In RA, these enzymes destroy the
linings of joints causing pain, swelling, stiffness, deformity, and
reduced movement and function. People with RA also may have systemic
symptoms, such as fatigue, fever, weight loss, eye inflammation,
anemia, subcutaneous nodules (bumps under the skin), or pleurisy (a
lung inflammation).
Does having arthritis increase the risk for bone loss?
Osteoporosis
and osteoarthritis are two very different medical conditions with
little in common. It is possible to be diagnosed
with osteoporosis if you have either type of arthritis.
However, people with rheumatoid arthritis are more likely to get
osteoporosis than individuals with osteoarthritis. People with
rheumatoid arthritis seem to have lower bone mass because some of
the chemicals produced by the diseased joints may get into the blood
and cause generalized bone breakdown. Individuals with rheumatoid
arthritis are at highest risk for osteoporosis if they need to take
certain medications that can cause bone loss (such as
long-term steroid medications or methotrexate) to treat their
condition.
Does treatment for arthritis increase the risk for bone loss and/or osteoporosis?
The
treatment for osteoarthritis will not affect your bone health in a
negative way. This usually includes pain medication, topical creams, or
non-steroidal anti-inflammatory medications (known as NSAIDs),
appropriate exercises or physical therapy, joint splinting, or joint
replacement surgery for seriously damaged larger joints such as the
knee or hip. However, if you are inactive as a result of your
condition, you may have bone loss.
On the other hand, the
medications used to treat rheumatoid arthritis,
particularly steroid medications or methotrexate, may
increase your risk for bone loss.
What about diseases related to rheumatoid arthritis? Do they also cause bone loss?
Some
diseases related to rheumatoid arthritis, which are also considered
immunologic, and fall under the heading of Connective Tissue Diseases,
can also produce bone loss. These include psoriatic arthritis, systemic
lupus erythematosis, scleroderma, and mixed connective tissue disease.
Both the underlying diseases and the medications used to treat the
disease may cause bone loss.
How do I know if I am at increased risk for osteoporosis?
It
is important for you to consider of all your personal risk factors for
osteoporosis. Using the appropriate NYSOPEP risk assessment tool, "Risk Assessment for Premenopausal Women", for "Postmenopausal Women" or for "Men" will help you better understand your risk factors for bone loss or osteoporosis.
When is a bone density test recommended for individuals with arthritis?
In general, bone mineral density testing is recommended for the following individuals:
- All women aged 65 or older, regardless of risk factors;
- Postmenopausal women under age 65 who have one or more risk factors (other than race, gender and postmenopausal status);
- Postmenopausal women who have a current and/or previous fracture with minimal trauma;
- Adults (including postmenopausal women, premenopausal women and men) on steroid medications for more than three months; and
- Men
with a current/ previous fracture or a major risk factor for
osteoporosis such as low testosterone, alcoholism, or any other
secondary cause of osteoporosis.
The decision to have a BMD test should
be made in collaboration with your medical professional and may not be
affected by you having arthritis. If a bone density test is recommended
for you, you will need a prescription from your medical professional.
When I am being treated for arthritis, how can I protect my bones?
People
with arthritis and/or osteoporosis may benefit from
exercise programs that include physical therapy and rehabilitation. In
general, exercises that emphasize stretching, strengthening, posture,
and range of motion are appropriate, such as low impact aerobics, water
aerobics, tai chi, and low stress yoga. However, people with
osteoporosis must avoid activities that include bending forward from
the waist, twisting the spine, or lifting heavy weights. People with
arthritis must compensate for limited movement in arthritic joints.
Always check with your physician to determine if a certain exercise or
exercise program is safe for your specific medical condition.
Prevention
and treatment of osteoporosis should always include a well-balanced
diet, adequate intake of calcium and vitamin D, regular exercise,
safety precautions for fall prevention, avoidance of tobacco products
and limited consumption of alcohol. You may want to discuss the need
for a bone density test with your medical professional. If osteoporosis
is diagnosed, you still must continue to make bone healthy lifestyle
choices. However, lifestyle modifications alone are often not enough.
Your medical professional may tell you that you need an osteoporosis medication to help stop further bone loss and to reduce your risk for broken bones.
For more information about arthritis in New York State, click on the NYSDOH website; http://www.health.state.ny.us/diseases/conditions/arthritis/index.htm. For more information about arthritis or to find a local arthritis support group in your area, click on; http://www.arthritis.org
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