By Mary Carpenter
RHEUMATOID ARTHRITIS (RA) is two to three times more likely to develop in women—linked both to sex hormones and to stress—and is the country’s leading cause of disability. For both RA and osteoarthritis (OA), inflammation plays a major role in symptoms, and both gender and genetics can create higher risk. Peak years for the onset of RA are the 40s and 50s, with a range into the 90s; while the risk for OA increases with age.
“As you get older, almost everyone gets some form of arthritis,” according to Mayo Clinic rheumatologist Eric Matteson. Of more than 100 different kinds of arthritis—including gout and crystal arthritis—OA and RA are the two most common. Also the most common systemic autoimmune disease, RA is an ideal target for research in autoimmunity as well as in rheumatic diseases —OA, RA and others that affect joints, muscles, tendons and bones.
For rheumatic diseases, regenerative therapies (using stem cells and gene editing to stimulate and support the body’s natural healing response) are a burgeoning source of treatment. Injections of platelet-rich plasma and implantation of healthy new cartilage have become familiar treatments for OA, particularly for knee joints.
“Regenerative medicine is rapidly expanding to include gene editing and gene therapies,” according to Arthritis.org. Researchers could one day replace damaged tissue with bone-marrow stem cells re-engineered to act like cartilage or with genes carried by a virus that are injected into tissue to create new cartilage.
“At least half the clinical trials in Mayo Clinic’s Center for Regenerative Biotherapeutics involve stem cells,” states the report. But it notes, “the key words are clinical trials. The FDA has approved stem cells for treating certain cancers and disorders of the blood and immune system [but] unproven and likely ineffective stem cell therapies [are] offered at the nation’s nearly 3,000 for-profit stem cell clinics.”
“Regenerative medicine is attracting so much attention that it is fundamentally changing the paradigm of treatment [especially] for patients with rheumatic diseases with poor prognoses,” writes Yokohama, Japan stem-cell regulation specialist Ryusuke Yoshimi. “On the other hand, regenerative medicine still has issues to be solved not only in terms of technology but also in terms of society. Regenerative medicine is being actively debated in many countries, including its efficacy and ethical issues.”
In RA research on autoimmunity, one focus is the cause and prevention of flares—the periodic, rapid heightening of symptoms. During flares, persistent increased inflammation damages joints as well as blood vessels, leading to high blood pressure along with a higher risk of stroke and heart attack. RA flare research may also help in treating MS and Lupus—all on the top 10 list of autoimmune diseases and all systemic.
(Non-systemic autoimmune diseases, by contrast, attack specific organs: the thyroid gland in patients with Graves disease, the beta cells of the endocrine pancreas in patients with type 1 diabetes, or the skin in patients with vitiligo.
About 20% of RA patients fail to respond to the three principal RA drugs. For the rest, early RA treatment can prevent the worst outcomes: in stage 3, the joints become bent and deformed, with fingers often crooked, causing nerve pain; and in stage 4, the joints are destroyed and become fused, unable to move.
Genetics play a role in only about 30% of cases of RA, based on twin studies; the remaining risk is “environmental” — infectious disease, smoking and stress. And initial onset of RA often follows a viral infection, also true for other systemic autoimmune diseases. (Strep throat can precede the onset of psoriasis.)
To treat the pain of both kinds of arthritis, NSAIDs, such as ibuprofen or regular doses of Alleve morning and night, reduce inflammation—though most autoimmune conditions require corticosteroids for the most severe symptoms. For both conditions, however, what used to be the accepted truth and even the official medical prescription—to relieve arthritis pain with rest— is now seen as not just wrong but harmful. The stiffness of RA can improve with movement; and for OA, inactivity can contribute to the deterioration of joints.
Arthritis is the target of many other myths. For example, that damp weather makes symptoms worse has no support. Nor is there any evidence that heat, as lovely as it feels, works better than ice—although using heat to help relax the muscles that move stiff joints might be more helpful in the morning, while ice can ease inflammation at night.
And particular foods—especially nightshade vegetables, such as tomatoes, potatoes and eggplant — don’t aggravate arthritis. Nor is there any proof for the benefits of popular alimentary treatments, including consuming a dozen gin-soaked raisins per day; drinking cider vinegar; eating grapefruit or raw vegetables or adding spices, such as turmeric or ginger to food.
What’s surprisingly not a myth is that having a relatively shorter index finger compared to the ring finger is a risk factor. This 2D:4D ratio raises the risk of developing arthritis in the knee and hip joints, independent of other risk factors and particularly among women. Another true risk factor: flat feet. And finally, that the annoying habit of cracking knuckles and joints can accelerate arthritis damage has not been sufficiently studied to rule out—which means it can continue to be used as a threat when begging practitioners to stop.
For me, an older family member whose RA had reached Stage 4, leaving his fingers fused in bent positions, managed to do almost everything he wanted: flying airplanes, playing golf and smoking cigarettes. The only hint of ongoing threat from pain and worsening disease was his fastidious efforts to avoid certain foods—asparagus, chocolate, red wine; and the occasional flares of gout that stopped all activities for days. And finally, with enormous effort, he stopped smoking.
—Mary Carpenter regularly reports on topical subjects in health and medicine.