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Copyright (c) 1991   Tribune Media Services, Inc.


Health Update

by Dr. Allan Bruckheim

Information for you about arthritis

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What is arthritis?

     Most people suffer various aches and pains during their lives.  Over the
years, as aches and discomforts in the joints occur, many people call it
arthritis and chalk it up to aging.  They're partly right, and partly wrong.
Pain in the joints may be arthritis, but arthritis is not just a byproduct of
aging.
     Arthritis is a condition in which one or more joint becomes inflamed
("itis" means inflammation and "arth" means joint), but it is not just one
disease and does not affect only the elderly.  It can be a crippling,
extremely painful condition that harms other vital organs as well as the
joints.  There are more than 100 forms of arthritis and it's the most common
chronic condition in the United States.
     If you suffer from arthritis pain, you are one of 36 million Americans
with the same complaint.  You may be very young; 250,000 children have
juvenile arthritis.  Several types of arthritis predominantly affect women.
It almost certainly costs you money in some way; the Arthritis Foundation
estimates that arthritis costs more than $13 billion each year in direct
medical costs or lost wages.
     Some forms of arthritis, such as tendinitis and bursitis, can be cured
completely with your doctor's advice and care.  However, most forms are
chronic, which means they last for years, usually for the rest of the
patient's life.  There are no cures for arthritis, there is only treatment and
therapy, which can alleviate pain, relieve stiffness and prevent the disease
from progressing and deformities from occurring.
     Like many chronic diseases, arthritis flare-ups may come and go.  Some
people may have an attack of rheumatoid arthritis or gout and then be fine for
several years, while others have the condition almost continuously.  Different
people with the same type of arthritis may have a vastly different range of
symptoms and so be treated quite differently by the same doctor.
     Arthritis is not a new disease; it has plagued humanity for a long time.
Skeletons from ancient mummies show signs of arthritis.  Judging from some of
their bones, even dinosaurs may have had some morning stiffness.
     All forms of arthritis affect the joints of the body, the points where
two bones meet.  While not all joints are alike, almost all have certain
structures that are affected by the inflammation and swelling of arthritis.
     A basic joint--one like your elbow or knuckle--is made up of two bones
that come together.  The tips of the bone do not touch within the joint
because they are protected by a tough layer of plastic-like cartilage.  This
smooth material acts as a shock absorber.  The area around the joint is
enclosed in a lining called the synovial membrane.  This membrane creates a
slippery liquid called synovial fluid that acts as a lubricant for the joint.
     The bones of the joint are held together and are attached to the muscles
that move them by ligaments and tendons, which are tough cord-like tissues.
Ligaments connect the bones to each other while tendons attach muscle to
bones.  Most joints have several tendons and ligaments.  To keep these
structures moving smoothly, there are small sacs of fluid called bursae (the
singular word is bursa) tucked between the structures.
     The group of conditions known as arthritis is just one part of all
rheumatic diseases, which affect the joints as well as supporting structures
like muscles, tendons and ligaments.
     In arthritis, inflammation of the joint causes swelling, loss of motion,
redness and pain.  Inflammation is the body's reaction to an injury, enabling
it to fight bacteria or viruses.  The body's immune system sends special cells
to the injured area to fix the problem and repair any damage.  When the job is
done, the inflammation dies down.
     In arthritis, inflammation may be out of control.  It does not go away
after the first attack but returns causing more inflammation and a dangerous
cycle starts.  Joints become stiff and hard to move and delicate joint
structures become swollen and pushed out of place.  If inflammation is not
stopped, the joint becomes deformed and permanently harmed.

How do I know if I have arthritis?

     The Arthritis Foundation has published the seven warning signs of
arthritis.  You should be aware of them and should consult your physician if
you spot them.

  -- Swelling in one or more joints
  -- Early-morning stiffness
  -- Recurring pain or tenderness in any joint
  -- Inability to move a joint normally
  -- Obvious redness and warmth in a joint
  -- Unexplained weight loss, fever or weakness, combined with joint pain
  -- Symptoms such as these that last for more than two weeks

What are the forms of arthritis?

     While there are more than 100 forms of arthritis, the most common are
osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, gout,
juvenile arthritis and ankylosing spondylitis.  Other forms of arthritis are
scleroderma, infectious arthritis, psoriatic arthritis, fibrositis, tendinitis
and bursitis.  Each of these diseases has a different cause and may require
different medications and treatments.  Only a physician can differentiate
between these diseases.  If you have any of the symptoms, please consult your
doctor.

     OSTEOARTHRITIS

     The most common kind of arthritis is osteoarthritis ("osteo" means bone).
It is also known as hypertrophic arthritis and degenerative joint disease.
     In ostcoarthritis, the cartilage and connective tissues of the joints
have started to break down or wear thin.  The ends of the bones start to
overgrow, become thickened and form bone spurs.  What's left of the cartilage
becomes rough and the bones themselves start to rub together, making movement
difficult.  However, there is little inflammation in the joint itself and pain
can vary from mild to excruciating.  The motion of the joint becomes more
limited as the disease progresses.  There ard no other symptoms of this
disease.
     Osteoarthritis is thought to be caused by normal wear and tear on the
joints.  That's why the symptoms--pain and stiffness--usually begin slowly,
then get worse gradually with age if treatment and medication are not
followed.  X-rays of almost anyone over age 60 will reveal some signs of
osteoarthritis, but only a few people have pain or stiffness.
     Continued injury to a joint will also bring on osteoarthritis.  Retired
football players often suffer severe ostcoarthritis in their 30's and 40's.
Older ballet dancers may have osteoarthritis of the toes and ankles because of
the stress placed on these joints over their careers.
     The joints most commonly hit by osteoarthritis are the fingers, hips,
knees and spine.  It may affect only one or two joints, or hit one knee and
spare the other.  When the fingers are involved, bony knobs may appear on the
knuckles.  These growths, which may be painful, can be unsightly, but most
people who have them will retain fairly good use of the fingers and hands.

     RHEUMATOID ARTHRITIS

     Rheumatoid arthritis is an autoimmune disease that affects the joints and
can also affect other parts of the body.  Autoimmune diseases are conditions
in which the body's immune system starts to attack healthy tissue.
Researchers believe rheumatoid arthritis may be triggered by a virus that
confuses the immune system and causes it to mistakenly attack joint tissue,
especially the synovial membrane.  This is a theory because the virus itself
has not been found yet.  Emotional stress, while it does not cause rheumatoid
arthritis, appears to make attacks worse.
     Rheumatoid arthritis is one of the most serious forms of arthritis and is
very hard to control.  This is a disease that discriminates against women;
three out of four rheumatoid arthritis sufferers are women.  The disease
usually starts when a person is between age 20 and 50, but has been seen in
younger and older people as well.
     This disease is unpredictable and highly variable.  Different people with
rheumatoid arthritis may be affected differently; some may have a very mild
case, while others are crippled.  One person may have one flare-up of
rheumatoid arthritis and never be affected again, while another has attacks
every few months.
     Rheumatoid arthritis usually affects many joints at once, with the knees,
hands and feet being commonly hit.  Often, joints will be hit symmetrically,
that is, in a matching pattern on both sides of the body.  In addition to
affecting joints, severe rheumatoid arthritis may cause problems in the lungs,
eyes, spleen, lymph glands and skin.
     The symptoms of rheumatoid arthritis are painful, red, swollen joints.
The joints may feel warm to the touch and the patient may run a fever or be
very tired.  Some people may lose weight due to lack of appetite.
     If the disease progresses--which does not always happen joint motion is
lost and the joints become twisted out of shape.  Fingers may become bent out
of shape and legs may stiffen into one position.
     Because rheumatoid arthritis can be a disease that progresses, most
physicians treat it in a systematic manner, using milder drugs at first and
proceeding to stronger medications when necessary.  In severe cases, very
strong drugs are used that may have some severe side effects.

     SYSTEMIC LUPUS ERYTHEMATOSUS

     Like rheumatoid arthritis, systemic lupus erythematosus is an autoimmune
disease.  It is called systemic because many organs in the body are affected,
including the skin, kidneys and lungs.  Lupus, as the disease is called for
short, is a leading cause of kidney failure in the United States.
     The majority of lupus sufferers are women, and the disease is slightly
more common among blacks.  There Is another related disease called discoid
lupus erythematosus, with a rash that forms discs on the skin.  This is a
milder form of lupus.
     Lupus can start in any organ and thus the symptoms and severity of the
condition can vary greatly.  One of the earliest symptoms of lupus is a rash
over the nose and cheeks that resembles a butterfly.  Arthritis is another
early symptom.  Lupus patients may become anemic and, because of a low white
ceil count, may come down with many infections and illnesses.
     Often, lupus patients are very sensitive to the sun.  Sunburn may trigger
a flare-up of lupus, so people with lupus should wear a strong sunscreen or
blocking cream when outdoors on sunny days.
     As with rheumatoid arthritis, a physician will treat lupus with the
mildest drug that will hold symptoms in check and then will proceed to
stronger medications.

     GOUT

     Gout is an unusual form of arthritis caused by the inability of the body
to properly handle a chemical called uric acid.  Unlike rheumatoid arthritis
and lupus, gout hits men almost exclusively.
     Uric acid is normally found in the bloodstream.  It is a byproduct of the
breakdown and rebuilding of proteins, especially proteins that are rich in
substances know as purines.
     Gout patients have much higher levels of uric acid than people without
gout.  Levels of uric acid in the blood become so high that crystals start to
form, like rock candy in a sugar solution. these crystals may be deposited in
the kidneys (where they can create kidney stones and cause damage) and in the
cartilage of the ears and joints.  On the ear, the deposits form painless
little lumps, but in the joints, the crystals act like sand in a fine motor.
     The prime location for uric acid crystals to form is in the joint of the
big toe.  Other joints may also be involved, including the knees, ankles,
hands and wrists.  For some reason, gout rarely causes a problem in the hips,
shoulders and spine.
     A gout attack will begin quite suddenly.  Abruptly, the toe will become
agonizingly painful.  It may swell up quickly and turn red as inflammation
sets in.  The inflammation then causes conditions that further damage the
cartilage of the joint.
     It used to be thought that gout was the result of years of overindulgence
and gluttony and that a gout sufferer deserved his suffering, but this is not
so.  Gout is an inherited condition that may run in families.  Although diet
can help control gout, overindulgence does not cause it.
     Several drugs have been developed that help control the pain of gout and
the levels of uric acid in the bloodstream.  Two drugs, probenecid and
sulfinpyrazone, lower uric acid levels by making the kidneys secrete more uric
acid.  Another drug, allopurinal, slows down the rate at which uric acid is
created by the body.
     Gout is the only form of arthritis that can be controlled with diet to
some extent.  Although the body can create uric acid on its own, certain foods
contain a lot of purines and eating them raises the blood levels of uric acid.
Foods to avoid include organ meats (liver, sweetbreads, etc.), salmon,
sardines, anchovies and gravies.  Other foods, such as meats, beans, poultry,
bran and wheat germ, have moderate amounts of purines and should be eaten in
moderation.  All other foods are low in purines and are safe.

JUVENILE ARTHRITIS

     Several forms of arthritis affect children and differ from the types that
affect adults.  Each type of juvenile arthritis has different symptoms and may
appear at any time.  Juvenile arthritis may affect only one joint or it may
involve many and, depending on the type of arthritis, may also affect other
organs in the child.
     One piece of good news about juvenile arthritis is that often the child
recovers completely and does not suffer any permanent damage to the joints.
Others, however, may have arthritis thoughout their lives.
     A major type is juvenile rheumatoid arthritis, which is relatively
similar to rheumatoid arthritis in an adult.  The symptoms for juvenile
rheumatoid arthritis are fever, fatigue, skin rash, swelling and pain in the
muscles and joints, slowed growth, and an inflammation of the eyes.
     Sometimes the first sign of juvenile rheumatoid arthritis can be seen
when the child is holding a joint still because it hurts to move it.  If the
joint is held still for too long, it may become stiff and the muscles around
it may tighten and contract.
     The various types of juvenile rheumatoid arthritis are treated
differently, but for the most part, they are treated in the same ways as
similar forms of arthritis that affect adults.  However, one type of
medication used in adults, corticosteroids, is not used often with children,
because these drugs can stunt growth and cause softening of the bones.

     ANKYLOSING SPONDYLITIS

     This condition is an arthritis that primarily affects the spine.
Ankylosing spondylitis may be inherited, but it may also be, at least in part,
an autoimmune disease.  It hits men, predominantly.  Women who are affected
have milder cases.
     In spondylitis, inflammation occurs around the joints of the spine and
pelvis, rather than inside them, as in other forms of arthritis.  In response
to the inflammation, the vertebrae and other involved bones overgrow and fuse
together, causing the spine to stiffen as the disease progresses.  The
ligaments of the ribs may also stiffen and make breathing difficult.
     Exercise and posture control are extremely important in treating
ankylosing spondylitis.  Exercise can help reduce stiffness, and keeping the
spine straight will help prevent it from fusing into a bad position.

What are the treatments for arthritis?

     The two most common treatments for arthritis are medication and physical
therapy.  Some combination of these may help prevent the arthritis from
becoming worse, while helping the patient retain as much mobility in the
joints as possible.
     It cannot be said often enough:  no two people with arthritis will
receive the same treatment.  One person's osteoarthritis may respond to hot
baths and light exercise, while another person must use strong medication and
undergo physical therapy.  One woman with rheumatoid arthritis may get
sufficient pain relief with aspirin, while another may require injections of
gold salts weekly.
     If you have arthritis, follow your doctor's advice.  Don't accept
medications from a friend or neighbor, and take their advice about arthritis
with a grain of salt.  What's good for them may be unsafe for you.  However,
if you feel your condition is not getting better with the drug or therapy you
are using, sit down and talk about it with your physician.
     You must remember that with all treatments for arthritis--especially
medications--there is what is known as the risk/benefit ratio.  All drugs have
side effects, ranging from minor to severe.  The risk of these side effects
must be weighed against the benefits of taking the drug.  This is why drugs
such as corticosteroids--which have many serious side effects--are reserved
for severe cases of arthritis that have not responded to other medications.
In such cases, the risks of the drug are outweighed by the benefits.  In a
less severe case, the risks of corticosteroids would be too great and other
drugs could provide the Same benefits with fewer side effects.
     Even something as simple as rest has a risk/benefit ratio.  Arthritis
victims should not overextend themselves and should get as much rest as
possible, but too much rest and inactivity can cause joints to stiffen and
immobilize.

Medications

     The following medications are the ones most commonly used in the
treatment of arthritis.  Bear in mind that not all of these are used for all
forms of arthritis.  For example, gold salts and penicillamine are used in
treating rheumatoid arthritis, but not for osteoarthritis.  Gout calls for
specialized drugs that reduce uric acid levels.
     You can be an informed drug consumer.  If you ever have questions about
your medications, ask your doctor or pharmacist.  When your doctor prescribes
a medication for you, make sure you know its name, whether it's a brand name
or a generic name (for example, Bayer is a brand name for the generic
aspirin). Make sure you know how often you should take the medication and how
many pills or capsules to take each time.  Some drugs must be taken on an
empty stomach, while others should be taken with meals.  Ask your doctor or
pharmacist which way to take your medications.  Your doctor should also
discuss the side effects of your medications, so you'll know what to expect.

     ASPIRIN

     Don't be amazed if your physician prescribes aspirin (acetylsalicylic
acid) for your arthritis.  The majority of all cases of arthritis will respond
to this inexpensive and easily available drug.  Aspirin, which has been used
to treat arthritis for more than 100 years, is a pain reliever and an
anti-inflammatory medication.  This means that while it relieves the
discomfort in the joint, it also reduces the inflammation.  Aspirin reduces
fever.
     Your doctor may tell you to take more aspirin tablets than you are used
to taking.  The anti-inflammatory properties of aspirin are not effective at
the dose you would take for a headache.  Because you may be asked to take high
doses of aspirin, your doctor may need to check the aspirin levels in your
blood periodically.  Large amounts of aspirin are helpful in treating
arthritis, but too high a dose is toxic.
     When you buy aspirin, check the box to see how much of the drug is in
each tablet.  The usual strength for a regular tablet is 325 mg (milligrams)
of aspirin.  An "extra strength" tablet usually contains 650 milligrams.  Your
doctor will tell you how many tablets of which size to take.
     Store brand aspirin is the same product as brand name aspirin and will
usually save you money.  It is also usually cheaper to buy the largest bottle
of aspirin tablets available.  If a bottle has a "child-proof" top that you
have trouble with, ask your pharmacist to put the tablets into an easy-open
container, but be sure to keep all pill containers out of reach of children.
If your aspirin tablets ever develop a vinegary odor, they may be too old.
Throw them out and buy a new supply.
     Check the product you buy to see whether it contains other ingredients,
such as caffeine.  Some aspirin products (such as Bufferin and Ascriptin)
contain small amounts of antacid, which may help if aspirin upsets your
stomach.  Others, such as Ecotrin, have a special coating.  Talk to your
doctor before switching products.
     Do not switch to a "non-aspirin" pain reliever, such as Tylenol or
Datril, unless your doctor approves.  These products contain acetaminophen,
which is a pain reliever but not an anti-inflammatory agent.
     Your doctor may prescribe salicylates instead of aspirin.  These drugs
are close cousins of aspirin and have many of the same properties.  But since
lower doses of salycylates are needed, fewer tablets or capsules a day may
provide the same benefits as aspirin.  There are several salicylates on the
market.
     Like all other drugs, aspirin and salicylates have side effects.  Aspirin
can irritate the lining of the stomach, causing an upset stomach or heartburn.
Try taking aspirin with meals or with a glass of milk to protect the stomach a
bit.
     Another common side effect from aspirin is ringing in the ears or a mild
loss of hearing.  Tell your doctor if you experience either of these, so he or
she can check the level of aspirin in your blood.  If the levels are correct,
and if the problem isn't too annoying, you may be asked to simply tolerate the
hearing problem.
     Aspirin also interferes with the clotting of blood; you may notice that
you bruise more easily while taking aspirin.  Aspirin will not be prescribed
for anyone who has a problem with bleeding or is taking blood-thinning drugs.
     Some people are allergic to aspirin, and may react with an asthma attack,
hives, runny nose or hay fever.  These individuals should never take aspirin
or salicylates.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

     Aspirin and salicylates are part of a group of drugs called nonsteroidal
anti-inflammatory drugs (NSAIDs).  As their name suggests, these drugs reduce
inflammation but are not related to the drugs known as steroids.  Researchers
believe that NSAIDs relieve pain and inflammation by blocking the action of
chemicals in the body called prostaglandins.
     NSAIDs are chemically related to aspirin.  A person who cannot tolerate
the side effects of aspirin often will be able to take an NSAID with no
problem.  If you are allergic to aspirin, however, you may also be allergic to
NSAIDS, so your doctor must exercise care in prescribing them.
     A major benefit of NSAIDs is that you can take fewer tablets per day and
achieve the same effects as with aspirin.  However, NSAIDs are usually far
more expensive than aspirin, and since arthritis is a chronic disease and you
might need to take medication for years, the expense could be a drawback.
     Except for the 200 mg size of ibuprofen, all NSAIDs are prescription
drugs.  Advil, Nuprin, Medipren and various store brands of ibuprofen are
available without a prescription.  The prescription-strength brands of
ibuprofen are Motrin and Rufen.  Generic ibuprofen is also available.
     Other names for NSAIDs (brand names are in parentheses) are piroxicam
(Feldene), sulindac (Clinoril), indomethacin (indocin), naproxen (Naprosyn),
tolmetin (Tolectin) and feroprofen (Nalfon). Each drug is different and may
have different side effects, although for the most part the side effects of
all NSAIDs are similar to those for aspirin.  If you do experience side
effects to one drug, your doctor may switch to another.  Because every person
with arthritis reacts differently to medications, it may take some time to
find out which drug at which dose level is right for you.

     CORTICOSTEROIDS

     Corticosteroids are drugs that are related to cortisone, a chemical the
body makes in the adrenal glands.  These drugs suppress the symptoms of
inflammation and allergy.  When they were first used in 1949, they were hailed
as miracles, but the side effects of corticosteroids were later found to be
severe.
     Over the years, the proper use and dosage sizes of corticosteroids have
been found for treating arthritis.  The effects of corticosteroids can be
amazing in reducing swelling and pain.  But these drugs are still used very
cautiously because of their side effects and are reserved for very severe
cases of arthritis or bad flare-ups of the condition.
     Corticosteroids can be given orally or by injection.  In severe cases of
osteoarthritis, a corticosteroid may be injected directly into the involved
joint.  This type of injection minimizes the side effects of the drug, but the
procedure cannot be done more than a few times into the same joint without the
possibility of causing damage.  A direct injection would be reserved for a
painful, immobilized joint, and would reduce swelling for a time.  During the
time the injection is effective, an exercise program can be started that will
keep the joint mobile.
     Because of the generalized nature of severe rheumatoid arthritis, oral
corticosteroids may be prescribed.  The side effects may include weight gain
due to water retention, increased blood pressure and a depressed immune
system.  Long-term use of corticosteroids will also cause osteoporosis,
weakening of the bones.
     If your doctor prescribes a corticosteroid drug, take it exactly as he or
she tells you.  Do not take more than the prescribed amount and do not stop
taking the drug suddenly.  Corticosteroids suppress the natural output of the
adrenal glands and to suddenly stop taking them can cause a reaction.  Your
doctor will instruct you on how to lower the dose slowly when you need to
stop.

     SPECIAL DRUGS FOR RHEUMATOID ARTHRITIS

     Researchers have created several drugs for use in treating rheumatoid
arthritis, including gold salts, penicillamine and immunosuppressive drugs.
These are all considered remittive drugs, because they can cause rheumatoid
arthritis to subside for a while.  Drugs normally used to treat malaria and
cancer have also been found to be effective against rheumatoid arthritis.  AH
of these drugs take a long time to show effect, however, so you may be taking
them for months before seeing any improvement.
     If aspirin, NSAIDs and corticosteroids do not control rheumatoid
arthritis, your doctor may prescribe the antimalarial drugs chloroquine or
hydroxychloroquine; they may be added to NSAID therapy.  However, these
antimalarial drugs can cause damage to the retinas of the eyes, so you may be
asked to go to an ophthalmologist for screening.
     Your doctor may decide to prescribe either gold salt injections or
tablets.  Gold salts take a long time to work and are not always effective.
It may be several months before you and your doctor know whether gold salts
will have any effect, so you must be patient.
     If injections are used, you can expect to require a weekly shot for up to
six months.  If treatment is effective and continues, you may need a shot only
once or twice a month.  Your doctor will test your blood regularly and watch
you carefully for side effects.
     Side effects of gold salts injections include skin rashes, sores in the
mouth, kidney problems and low blood counts.  If there is a skin rash, it may
be aggravated by exposure to sunlight.  Because gold salts can be toxic, your
doctor may treat you with small doses of gold salts for a week or two to test
for a reaction.  Bear in mind that many people who are put on gold salt
therapy must give it up because of side effects.
     There is an oral form of gold salts called Ridaura.  Here again, it may
be months before there are any signs of the drug taking effect, or it may not
be effective for you at all.  Ridaura has fewer side effects than injections,
but can cause severe diarrhea.
     Penicillamine is another remittive drug used for rheumatoid arthritis.
It commonly produces the same side effects and toxic reaction that gold salts
do, but can be used in some people who cannot take gold salts.  Here again,
the drug will probably take Some time to show an effect.
     Immunosuppressive drugs are also used in some cases.  These drugs
suppress the immune system, and since it's the immune system that causes
rheumatoid arthritis, the drugs can make the disease go into remission.
However, they have many side effects, and since the entire immune system is
suppressed, little is left to fight off colds and infections.

Rest and exercise

     You may not consider rest and exercise to be therapy for arthritis, but
they are both very important parts of your treatment.  The two go hand in
hand.  Too much exercise can cause soreness and more inflammation, but too
much rest can cause joints to stiffen.  The right amounts of rest and exercise
for you will depend on the severity of your condition, and your needs may
change as your arthritis does.
     Resting must be as regular as exercising.  Rest allows your muscles to
relax.  You don't have to lie down or take a nap.  Simply sitting down and
relaxing at some time during the day will help your joints and muscles recover
from your activities.
     Your doctor may suggest that you take short walks daily or attend an
exercise class on a regular basis.  He or she may also recommend that you swim
regularly.  Swimming is an excellent way to stay limber, since the buoyancy of
water takes some weight off your joints.  You can either swim or exercise in
the water.
     Besides keeping your joints in condition, regular exercise helps keep the
rest of you fit.  Exercise can help control weight, which in turn will reduce
the stress on arthritic joints.  Regular walking or swimming is also good for
your cardiovascular health.
     Your doctor may also suggest that you perform special exercises every
day.  These will help keep your joints limber, or help loosen joints that have
become immobile.  The purpose of the exercises is to keep your body
functioning as much as possible, while at the same time preventing further
damage.
     A physical therapist can teach you some of these procedures and determine
whether you're doing them correctly.  If you have very severe arthritis,
regular physical therapy sessions may be required, where the therapist helps
you move your limbs to help keep them supple.

     SUGGESTED EXERCISES

     One easy but helpful exercise for the hands and ringers is to simply bend
your wrist back and forth slowly several times, then make an "O" with your
thumb and index finger.  Make an "O" using the next finger, and touch each
finger to your thumb five times.  Repeat this with the other hand.  Your
doctor can recommend other hand and finger exercises as well.
     For your knees, sit comfortably in a straight-backed chair with your bare
feet on the ground.  Slowly raise your lower leg so that your whole leg is
straight, then slowly lower it again.  Do this with each leg several times a
day.
     For the ankles, do the same exercise with one extra movement.  Raise your
lower leg until your leg is straight.  Now bend your ankle until your foot
points back at you and curl your toes back and forth.  Point your foot away
from you and curl your toes back and forth.  Lower your leg slowly.  Repeat
this using the other foot and leg. (Always make sure you exercise both legs
equally.)
     You may feel very stiff the first few times you do any exercises, but
it's important to keep doing them.  After a few weeks you will probably notice
some improvement.  If any exercise is painful or makes you feel uncomfortable,
consult your doctor or physical therapist.

Heat and cold treatments

     Your doctor may recommend that you use heat and cold to treat your
arthritis.  You may already know that a warm bath or shower helps ease your
stiffness and achiness for a while; it is a good way to relax your muscles.
And because your body floats in water, a bath also takes some weight off your
joints for a while.
     Hot packs, heating pads and hot-water bottles can also be helpful in
easing pain.  Be careful not to use too hot a setting and never sleep with a
heating pad or rest on top of one.  If you have a metal replacement joint,
talk to your doctor before using any heating devices, because the metal within
you may heat up.
     You may think cold would make arthritis worse, but cold treatments can
sometimes case arthritis stiffness and pain.  The cold seems to numb the
joints and give some people a few pain-free hours.  One method for cold
treatment is to simply dip affected hands or feet into a pail of cold water.
The water should not be so cold that it is a shock.
     Another arthritis therapy consists of combining the two treatments as a
contrast bath.  This is easiest done with the hands or feet.  Just prepare two
pails of water, one hot and one cold.  Soak the pained joint in the hot water
and then switch to the cold water.

Surgery

     Surgery can be an option for someone suffering from arthritis that's so
severe it has completely damaged a joint.  Surgery used to be reserved for
only the most severe cases, but now, with better techniques and materials,
joint surgery is done earlier in the course of a disease and on younger
individuals.
     Synovectomy is a procedure whereby some of the synovial fluid and
membrane are removed.  Another procedure involves opening up the joint and
removing the diseased cartilage and bits of overgrown bone; this can reduce
pain in the joint, but the relief may not be permanent.  There are also
procedures to fuse a joint to relieve pain, but unfortunately these also
result in loss of motion of the joint.
     There are now surgical procedures for replacing hips, knuckles and knees.
In some cases, joints can be repaired rather than replaced, using either new
bone cements or pieces of bone from elsewhere in the body.
     Joint replacement has become a relatively common operation, but it is not
without risk and may be more useful for certain forms of arthritis, such as
osteoarthritis and rheumatoid arthritis.  Bear in mind that a replacement
joint does not last forever, and may need to be replaced after a number of
years.  Life expectancy for a replacement joint is now about 10 years.
     Replacement joints are made of metal or plastic pieces that are cemented
into the natural bone when the diseased joint is removed.  It is possible for
the new joint to come loose, especially in an active person.  This is why
joint replacement is usually done in less active elderly people.  A younger
person might have to go through two or three replacements on the same joint
over his or her lifetime.
     Infection is another risk of joint replacement.  An infected replacement
joint would have to be removed.
     Remember that no surgical procedure is risk-free.  If surgery is being
considered, you should sit down with your physician and the orthopedic surgeon
who will perform the operation and have them explain all of the pros and cons
of the procedure.

Joint protection

     If you have arthritis, your joints are your weak points and you must
protect them.  They are already under a certain amount of stress and there are
ways that you can avoid adding more.
     As a general rule, use a stronger joint to protect a weaker one.  If your
hands are weak, don't carry things in them for long periods of time.  For
example, a woman might substitute a shoulder purse for a clutch purse.  Push a
door open with your shoulder or the side of your body rather than with your
hands.
     Try not to sit or stand in one position for too long to avoid stiffening.
Get into the habit of changing your body position every 15 to 20 minutes.
     Make your work areas work for you.  Organize the kitchen or office so
that most items you need are within easy reach.  Make sure your work surfaces
are at a comfortable height.  Sit whenever you can, including while ironing or
doing office work.  Even better, sit in an office chair with wheels and move
around your work space in that.
     If you must push with your hands, do it right.  Don't compress your
fingers under your hand, because this puts pressure on your knuckles.  If you
are pushing up from a chair, for example, let your ringers hang over the edge
and push up with your palm.

Devices to make life easier

     There are many aids and devices you can use to make lift #i little
easier.  Some can be bought and some can easily be made to help you do your
work and live independently.
     Attach straps to drawers so you can put an arm through and pull with your
forearm rather than using your hands.  Use a button hook to help with buttons.
Put a paperclip into a zipper-pull to make it larger and easier to handle.
     Doorknobs can be replaced with levers.  Faucets and toilet handles can be
replaced with larger ones or built up so that they are easier to use.  Put a
handle or grip bar on the edge of the bathtub to make it easier to get in and
out.
     Black foam padding that is adhesive on one side (normally used as pipe
insulation) can be added to pencils and toothbrushes to make them larger and
easier to handle.  A regular clip clothespin can be attached to the controls
of small appliances to make them easier to turn.
     The Arthritis Foundation publishes a list of helpful devices and hints
for people with arthritis; the address of the Arthritis Foundation is at the
end of this booklet.

Sex and arthritis

     Any long-term ailment will have an effect on a person's sex life, and
arthritis is no exception.  Arthritis can cause pain and discomfort, can limit
movement, and can change the way you feel about your body.  All of these
changes may interfere with sexual enjoyment, but that doesn't mean that your
sex life is over.
     People with arthritis can have an enjoyable, satisfying Hf#-, that
includes sex.  One of the oldest myths around is that somehow older people,
especially those with arthritis, either should not have or will not enjoy sex.
This simply is not so.  Sex can be a wonderful way to release tension and
frustration while communicating with your loved one.
     Communicating is a key word.  Talk with your loved one about your needs
and how you feel.  Part of communicating will include the two of you accepting
the changes that have happened in your body.  If you feel resentful and angry
over your illness and how it has changed you, do not assume that your partner
feels the same way or has rejected you.  Be aware that your loved one may fear
that hugging you or holding you too tightly may hurt you.  Make sure he or she
knows how you feel.
     In order to keep sex a vital part of your relationship, try planning
ahead.  Plan to make love at a time of day when you are less tired or sore and
take a pain reliever earlier to ensure that it will provide greatest relief at
the right time.  If a hot shower or bath loosens up your joints and helps you
relax, take one before you retire to the bedroom.

Quackery

     Arthritis is a disease that has no cure.  People with arthritis spend a
lot of money for medical care, and, unfortunately, a lot of money is spent on
unproven and worthless remedies as wen.  The Arthritis Foundation estimates
that almost $2 billion is spent yearly on quack medicines and therapies.
     Sadly, people with arthritis are easy to exploit.  Too many people who
have aching joints doctor themselves.  Because arthritis tends to come and go
naturally, a person who puts on a copper bracelet and feels better, thinks the
bracelet had something to do with it.  The only benefit you can get from
wearing copper jewelry is if it looks nice on your wrist.
     Often, dishonest merchants look for ways to make a buck by selling an
arthritis cure.  They may sell herbal remedies by mail that contain nothing
more than a little aspirin, and they may back up their claims with
"testimonials" from people who have been cured.  The pills you receive won't
help you, and will definately hurt you in the wallet.
     Remember, if a remedy or therapy looks too good to be true, it probably
is.  Never believe anyone who says a drug is completely safe.  Nothing is
completely risk-free.  If you ever have any questions about remedies or
therapies that you read about in magazines, talk to your doctor.  It is a talk
that will probably save you some time and money.

Always consult your doctor

     Arthritis, a chronic disease that affects many people and causes much
suffering, is the constant focus of research and investigations.  New
therapies and new medicines to deal with arthritis are being developed even as
I write this booklet.  Every effort has been made to give you the very latest
information about this disease and to offer ideas and suggestions of a
practical nature that can help arthritis patients deal with their affliction.
     Nonetheless, it is possible, even probable that new developments will
occur as the weeks progress.  It is therefore essential that you continue to
consult your private physician, so that you may benefit from the latest
therapies or discoveries and receive the personalized treatment that is most
effective in your case and deals with your special problems and needs.

More help is available

     The Arthritis Foundation can provide more information about
osteoarthritis, as well as self-help guides and publications that tell you
where to buy devices to help you perform daily tasks when stiff joints make
bending difficult.
     The foundation can also put you in touch with other people with similar
problems.  Support groups offer a sympathetic ear when you're feeling
depressed or frustrated, as well as encouragement to stick with your treatment
program.
     Look in the phone book for your local chapter of the Arthritis
Foundation, or contact the national organization at 1314 Spring St., NW,
Atlanta, Ga.  30309.  Telephone:  (404) 872-7100.
     The National Rehabilitation Information Center (NARIC) is government
funded and provides broad-based information and referral services, as well as
computer searches, for a nominal charge.  Telephone:  1-800-34-NARIC.
     The Arthritis Information Service of Alabama is a community program
jointly sponsored by The Multipurpose Arthritis Center of the University of
Alabama and the National Institutes of Health.  Call toll-free:
1-800-345-6780


Glossary

     Ankylosing spondylitis--a form of arthritis of the joints of the spine
that can cause these joints to fuse or grow together
     Arthritis--inflammation of a joint
     Autoimmune disease--a disease in which the body's immune system is out of
control and attacking healthy tissue
     Bursae--small sacs of fluid that keep muscles, bones, ligaments and
tendons from rubbing and that help absorb shocks
     Bursitis--inflammation of a bursa
     Cartilage--rubbery or plastic-like material that covers the ends of bones
and prevents them from rubbing and absorbs shock
     Chronic disease--one that lasts for years and has no cure
     Flare or flare-up--an episode in which symptoms either reappear or become
worse
     Gout--a disease in which the body produces too much uric acid, which
forms into crystals and collects in joints.  This leads to attacks of painful
arthritis
     Immune system--the natural defense system of the body against disease or
injury Inflammation--a normal reaction of the body to injury or disease, in
which swelling, pain, redness and warmth occurs in the area affected
     Joint--a point in the body where two bones meet
     Juvenile arthritis--any of several forms of arthritis that occur in
children
     Ligament--a strong cord-like material that connects bones to each other
     Osteoarthritis--the chronic breakdown of cartilage in certain joints; it
is the most common form of arthritis and may be due to wear and tear
     Remission--a period in which symptoms of a disease are reduced or
disappear for a time
     Rheumatic disease--diseases that affect muscles, ligaments, tendons,
joints and sometimes other organs
     Rheumatoid arthritis--an autoimmune form of arthritis that causes
inflammation in the joints and may cause systems problems as well
     Systemic disease--one that can affect the entire body rather than just
one area
     Systemic lupus erythematosus--a disease that affects the joints as well
as skin, muscles and other parts of the body Tendinitis--an inflammation of a
tendon Tendon--a strong cord-like material that connects muscles to bones
     Uric acid--a chemical naturally formed in the body that, in gout, forms
into crystals that collect in the joints and cause pain and damage


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ACKNOWLEDGMENT:  Research by Valerie DeBenedette; technical review by Dr.
Gabriel Zatlin.

For additional copies of Arthritis, send $2.75 to Arthritis, P.O. Box 4406,
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
