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Arthritis. What's the true root cause? Research suggested prevention and avoiding the big "S."



Research over the past century has brought about major advances in finding causes as well as better ways to treat arthritis. In the most recent decade, advancement in the two have seen great momentum. New findings have helped reduce deaths, correct deformities, restore movement, and reduce pain.


RESEARCH TIMELINE

Before World War II, little could be done to help people with arthritis. But during and immediately after the war a number of discoveries excited scientists and launched a new emphasis on arthritis research. Listed below shows a brief timeline of advancement.



TYPES OF ARTHRITIS


Ankylosing spondylitis

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply.

Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation can also occur in other parts of the body — most commonly, the eyes.


Gout

Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the bedsheet on it may seem intolerable.


Low levels of the enzyme HPRT result in too much uric acid build-up. Scientists have located the gene that passes on an inherited lack of this enzyme.


For over 100 years scientists have known that lead poisoning causes gout. Now they are trying to find out if exposure to small amounts of lead from jobs or hobbies such as stained glass can also cause gout.


Juvenile idiopathic arthritis

Juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis, is the most common type of arthritis in children under the age of 16. Juvenile idiopathic arthritis can cause persistent joint pain, swelling and stiffness. Some children may experience symptoms for only a few months, while others have symptoms for many years.


Some types of juvenile idiopathic arthritis can cause serious complications, such as growth problems, joint damage and eye inflammation. Treatment focuses on controlling pain and inflammation, improving function, and preventing damage.


HLA-type antigens have been associated with certain types of juvenile arthritis. Findings may help explain if some children are more likely to develop the disease.


Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of the bones decreases. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine. Researchers are looking for factors that cause changes in cartilage and bone, and why such changes occur more rapidly in some people.


Osteoarthritis symptoms can usually be managed, although the damage to joints can't be reversed. Staying active, maintaining a healthy weight and receiving certain treatments might slow progression of the disease and help improve pain and joint function.


Psoriatic arthritis

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis - a disease that causes red patches of skin topped with silvery scales. Most people develop psoriasis years before being diagnosed with psoriatic arthritis. But for some, the joint problems begin before skin patches appear or at the same time.


Joint pain, stiffness and swelling are the main signs and symptoms of psoriatic arthritis. They can affect any part of the body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares can alternate with periods of remission.


There's no cure for psoriatic arthritis. Treatment is aimed at controlling symptoms and preventing joint damage. Without treatment, psoriatic arthritis can be disabling


Reactive arthritis

Reactive arthritis is joint pain and swelling triggered by an infection in another part of the body — most often the intestines, genitals or urinary tract.

This condition usually targets the knees, ankles and feet. Inflammation also can affect the eyes, skin and the tube that carries urine out of the body (urethra). Previously, reactive arthritis was sometimes called Reiter's syndrome.


Reactive arthritis isn't common. For most people, signs and symptoms come and go, eventually disappearing within 12 months.


Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues.


Unlike osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.


Most people with rheumatoid arthritis carry a gene called HLA-DR4 or a similar one HLA-DR1. Scientists suspect other genes are related to rheumatoid arthritis as well.


About 80 percent of those with rheumatoid arthritis have an autoantibody called rheumatoid factor. People with certain chronic infections such as tuberculosis also have this factor in their blood. This suggests that an infection is involved in rheumatoid arthritis.


Septic arthritis

Septic arthritis is a painful infection in a joint that can come from germs that travel through your bloodstream from another part of your body. Septic arthritis can also occur when a penetrating injury, such as an animal bite or trauma, delivers germs directly into the joint.


Infants and older adults are most likely to develop septic arthritis. People who have artificial joints are also at risk of septic arthritis. Knees are most commonly affected, but septic arthritis also can affect hips, shoulders and other joints. The infection can quickly and severely damage the cartilage and bone within the joint, so prompt treatment is crucial.

Treatment involves draining the joint with a needle or during surgery. Antibiotics also are usually needed.


UNDERLYING CAUSES

The causes of most forms of arthritis are still unknown. Therefore doctors try to treat symptoms rather than attacking the roots of the problem. This is why so much research focuses on how the healthy body works and what goes wrong when it comes to arthritis. By understanding what causes arthritis, researchers hope to design better methods for diagnosing treating and preventing arthritis-related diseases.


Research on the cause(s) of arthritis became fast-paced in the 1980s because of the development of new techniques in molecular biology. Molecular biology is the science that studies how molecules in our cells (the smallest parts of our body) work. Research in this area has greatly advanced our understanding of how our body's defense system works and what happens when it fails. Research also looks at how four factors work alone, and together, when it comes to the disease. These four factors include how the body itself contributes to the disease process and the roles heredity infections and the environment play.


Body

Looking at how the body itself contributes to the disease process, researchers are studying how the body works and what changes accompany the specific types of arthritis. Specifically with arthritis, determining how parts of the joint work, what happens when they fail, and the connective tissues associated with the joints themselves.


Researchers have discovered that early in osteoarthritis, chemical changes result in loss of two types of fibers, proteoglycans and collagen, which help give cartilage its resiliency. At the same time enzymes called proteases - which normally destroy old cartilage so it can be replaced by new growth - begin destroying cartilage much faster than it can be replaced. In some individuals, research has found that this process seems to develop at a faster pace. Research has yet to determine why that is exactly.


Another key question is how the immune system protects the body from the destruction of inflammatory types of arthritis. In the immune system there are specialized cells and family of proteins called antibodies, as well as other chemical substances that help control and modify how the system responds. Among these chemical substances are interleukins and gamma interferon which are made by the immune cells. Research shows these specific substances have be linked to certain types of arthritis.


Inflammation - which involves swelling, redness, and heat - is one of the immune system's responses in several types of arthritis. Studies have found that high levels of a group of chemicals called prostaglandins result in inflammation. Researchers have found that aspirin interferes with the production of prostaglandins, but rather than mask the pain with a temporary relief, the question is: What is the initial cause for the production of prostaglandins and how can we prevent the root cause of production?


Genetic makeup/DNA

Scientists are researching how genetic makeup/DNA increases the risk for certain types of arthritis. Research on DNA may help explain why some types of arthritis such as ankylosing spondylitis and rheumatoid arthritis affect people of various sexes and races differently. Specific areas of DNA may carry a set of instructions that increases the chances for developing certain types of arthritis.

For instance, people with HLA-B27 has shown to be a genetic marker linked to the develop ankylosing spondylitis and other related types of arthritis. North American Indian tribes have higher levels of HLA-B27 and more ankylosing spondylitis.


Infection

A third area of research into the causes of arthritis, looks at how infections set off or slow down the immune system's response. With some types of arthritis, infections in combination with faulty genes, negatively affect the immune system's response causing the immune system to make errors. Instead of protecting healthy parts of the body (joints specifically) the system turns against itself, creating an autoimmune response.


Autoimmunity results from the actions of substances called T cells. T cells are specialized white blood cells which help distinguish between the body's own tissues and foreign invaders. For reasons not yet clearly understood, autoimmunity antibodies (called autoantibodies) recognize healthy parts of the body as foreign invaders and attack them.

Autoantibodies may also serve as a kind of name tag to indicate people who are more likely to develop certain kinds of arthritis.


Scientists have found that bacteria and viruses may be associated with the trigger malfunctions of the immune system. Research has already linked bacteria to infectious arthritis and Lyme disease. Furthermore, research is trying to understand a process called molecular mimicry. In this process substances in the body look like or mimic an invading virus, and thus set off destruction of healthy parts of the joint.


Environment

The fourth factor in research into the causes of arthritis is the environment in which we live. When it comes to where and how we live, there may be factors that influence our risk for certain types of arthritis.


Researchers have long been intrigued by variations in disease patterns among countries, especially with rheumatoid arthritis. New findings in North American Indian skeletons, fromo over 1200 years ago, suggest that rheumatoid arthritis is a New World disease that spread to the Old World. Scientists are now looking for what caused the disease to spread. The answer may help determine what lead to the initial cause of rheumatoid arthritis.


Research has also found that past and current injuries can lead to certain types arthritis. However, more research is needed to understand the affects of injuries on the development of arthritis.


TREATMENT

Prescription and over the counter drugs have been developed to slow down the immune system's response with certain types of arthritis.


No one likes to hear it, but I feel it has become a more prevalent response of relief from our physicians - SURGERY. While this may cure negative affects associated with the pain of arthritis, it will not tackle the root cause of why the individuals are in the condition they are in to begin with. Not to mention the cost, time with preparation and recovery, and possibility of surgery creating more issues in the end.



PREVENTION

While drugs and surgery may help mask certain characteristics of arthritis, as well as provide temporary relief, there is still yet to be done when it comes to finding the root cause of arthritis. By tackling the cause from the beginning, individuals would have success through prevention, versus dealing with the affects of disease.


Diet

Dietary factors can affect the immune system's inflammatory response. When looking at the food we eat, there are some that negatively affect the bodies inflammatory response and some that positively affect the bodies inflammatory response.

*Please check back for an initial blog post on this specifically.*


Exercise

Despite being long considered a wear and tear disease, arthritis is actually inflammation rather than overuse. In fact, when it comes to proper exercise, joints do NOT wear out, but rather become healthier with exercise.


Exercise helps optimize the health of the joints, even for people that already have arthritis. Research shows that being sedentary actually causes a loss of volume in connective tissues, in and around the joints.


If you believe that your joints are simply just 'wore out', then you're more likely to avoid the exercises that can help you.


Sleep

While rest may seem counterintuitive to the above stated information about exercise, sleep however is important for decreasing inflammation and increasing your health overall. While asleep, your body is actually repairing. For optimal health, it's essential to get 8-10 consecutive hours of sleep per night.


REFERENCES

Adapted from the pamphlets originally prepared for the Arthritis Foundation by Irving Fox, MD, Frederic McDuffie, MD and Robert Rich, MD. This material is protected by copyright.


https://pubmed.ncbi.nlm.nih.gov/23194896/


https://pubmed.ncbi.nlm.nih.gov/29934429/

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