Arthritis is a silent, insidious and painful joint disorder that ruins many lives. In the United States, it is the most common cause of disability. The good news is that we have learned that many cases of arthritis could be prevented.
Arthritis covers many conditions. What they have in common is joint pain that can be chronic, activity limiting and ultimately disabling. There are two main categories, inflammatory and mechanical. Arthritis, as an inflammatory disease, is characterized by inflammation of the joints that leads to the destruction of bone and cartilage. This includes gout, lupus, rheumatoid arthritis (RA), and fibromyalgia. Arthritis as a degenerative condition is characterized by cartilage damage resulting from injury, or broken down over time by wear and tear, exposing the underlying bone. Rubbing against exposed bone produces symptomatic pain, inflammation, swelling, and stiffness. It is osteoarthritis (OA), the most common form of arthritis that affects twenty-seven million adults in the United States.
The exact causes of osteoarthritis are not known, but many contributing factors are well understood. Traumatic arthritis results from an injury that damages joint cartilage. Arthritis also occurs when a patient’s meniscus cartilage has been damaged or removed following a sports injury, leaving the knee exposed to increased forces that wear down the surface bearing the articular cartilage. The United States is approaching an annual patient toll of 1.5 million Americans undergoing meniscus cartilage removal, leaving a large population without cartilage protection and prone to arthritis. Being overweight or twisted knees are also contributing factors.
It may come as a surprise to learn that most arthritis is preventable. Sports and activity-related injuries lead to arthritis later in life. Although such injuries generally cannot be avoided, subsequent arthritis would probably not occur if the damage was repaired immediately using modern techniques of regeneration and replacement.
But that doesn’t happen often. Patients tend to ignore their injuries. Surgeons are still removing damaged tissue and telling their patients to come back when they need knee replacement surgery. Arthritis pain is unfortunately treated with cortisone instead of growth factors, and insurance companies don’t pay for up-to-date tissue regeneration techniques. How to change this?
First, don’t ignore an injury. If you twist your knee, hear a pop, and then have swelling, there’s a 90% chance you’ve torn key tissue in your knee. If left alone, the injury will cause arthritis; if repaired correctly, it may not. Obtaining an accurate and rapid diagnosis, often with confirmation by MRI, is the crucial first step. Having the damaged tissue repaired or replaced and not removing the damaged tissue, if possible, is the next step.
Unfortunately, most surgeons still remove damaged knee tissue – typically the meniscus shock absorber and articular cartilage surface – without applying the latest repair, regeneration and replacement techniques. Why? Because these repair techniques are difficult, take additional operating time, are not reimbursed by insurance, and do not have enough large-scale studies to convince the entire medical profession that they work. But here are the facts. We know that if joint cartilage is repaired or replaced when injured, the likelihood of arthritis is significantly less. In the United States, where eight hundred thousand meniscus tears occur each year, less than 10% are repaired and only about 0.25% of people receive a new meniscus. Indeed, a future arthritis problem will probably not cost the insurer much, since most people do not stay with the same insurance company for more than a few years. Surgeons tell patients to expect arthritis to settle down in ten to twenty years; sometimes it happens much earlier.
After the onset of arthritis, cartilage repair and replacement procedures can still be beneficial. They can reduce pain, improve function, and extend the time before an artificial joint is needed. Our own data shows that, on average, many severely arthritic joints can be biologically repaired (as long as it’s not bone on bone). This can delay the need for an artificial joint by at least ten years, on average. Again, biological repair is not in the interest of the insurance company. Most patients are told to live with their arthritic knee and pain until they are older. Living with pain is not a solution.
Non-operative procedures to prevent arthritis are also extremely effective and underfunded. The joints are protected by the muscles that surround them. The forces absorbed by the joints are a multiple of the weight of the body. Most people take two to three million steps a year at up to five times their body weight, depending on step height.
Optimizing your body weight is important. Being ten pounds overweight results in up to fifty pounds of extra strength, two to three million times a year. The stronger the muscles around the joint, the better they absorb some of the force, rather than the joint surfaces. Preventing self-induced injuries would significantly reduce the rate of arthritis.
Research funding would also help. Ninety-seven percent of arthritis diagnoses are the types that orthopedic surgeons treat most often: osteoarthritis or traumatic arthritis. Only 3% are inflammatory; these are called rheumatoid arthritis (or related variants). Yet 97% of the Arthritis Foundation’s funding goes to that 3% of diagnoses, for two reasons. First, because that’s where most of the money from pharmaceutical treatments for arthritis is made. Second, because rheumatologists control research funding at the Arthritis Foundation. A major effort to focus research funds on improving injury repair techniques would improve outcomes for millions of people.
Given the projected cost to society of $128 billion (or 1.2% of GDP) for the treatment of arthritis each year, one would think that a national arthritis prevention program would be a high priority. Cancer may kill six hundred thousand people in the United States this year, but arthritis ruins more lives. And it is not necessary.
The opinions expressed above are those of the author.
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