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Physical farm work may increase pain of arthritis

By CINDY LADAGE
Illinois Correspondent

SPRINGFIELD, Ill. — For one central Illinois farmer, when he recently went in for a knee replacement and complained of aches in his neck and hands, the surgeon commented that this was typical for his occupation.

According to the Arthritis Foundation, arthritis is one of the most prevalent chronic health problems and the nation’s leading cause of disability among Americans older than 15. It is second only to heart disease as a cause of work disability. The Foundation estimates 27 million Americans live with osteoarthritis.

Those who labor physically seem to be more prone to arthritic pain, said Dr. Mark Francis, associate professor and chief of the Division of Rheumatology, Department of Internal Medicine at Southern Illinois University School of Medicine.

Although many in the agricultural field know arthritis affects worn joints, what they may not know is there are more than 100 variations of arthritis. Arthritis appears in many forms; osteoarthritis is the most likely culprit to attack the agricultural community.

The Arthritis Foundation has even coined this familiar type the “wear and tear” disease.

“Osteoarthritis can be characterized by a loss of cartilage between the bones and a thickening of the bones adjacent to the joints.” Francis said.

The knees and hips are the more usual places where osteoarthritis occurs. However Francis said arthritis in some joints, such as the true wrists and elbows, are not usually attributable to osteoarthritis.
While the two rows of knuckles from the ends of your fingertips can be enlarged in osteoarthritis, he said this pattern is sometimes called “generalized or nodal osteoarthritis.”

Those gnarly-looking hands often make patients nervous, but Francis said, “This enlargement very rarely affects function.”
He added many of his patients with this form of arthritis still crochet and do intricate handwork.

Another commonly recognized arthritis is Rheumatoid Arthritis (RA). RA affects 1.3 million Americans. Because of its inflammation, RA leads to joint damage more quickly than osteoarthritis. The diagnosis is made by history and physical exam, not lab tests. RA is caused by inflammation of the synovial lining of the joints.
“The lining of the joint is normally very thin,” Francis explained. “In RA, this lining is invaded by immune cells and becomes thickened.
“These cells produce cytokines that then lead to damage of adjacent cartilage and bone.”

The Arthritis Foundation stated RA can lead to long-term joint damage and over time, chronic pain, loss of function and disability. Genetics can play a part in arthritis, but Francis said the link is not always strong.

“Most cases are due to factors we don’t fully understand. Ankylosing spondylitis (AS) is the disorder with the strongest genetic link. In addition to inflammation of the synovium as seen with RA, patients with AS also have inflammation of tendons as they insert into the bone,” he said.

The key to helping patients with AS is early diagnosis and proper treatment to help control the pain and stiffness.

A different type of arthritis that most never consider an arthritic condition is Lupus, which may affect a patient in a variety of ways, such as skin eruptions. Another issue is gout.

“What happens clinically is a sudden onset of a hot, swollen joint,” Francis said. “Patients should seek medical care if this happens because it could also mean an infected joint. Gout strikes then goes away and comes back again. Over time, the attacks can come more frequently.

“If anyone in this readership has a swollen joint they think could be gout, they should have it evaluated to make a diagnosis.”
Gout is actually caused by too much uric acid in the system. It occurs when needle-shaped monosodium urate crystals build up in joints and tissues. Gout is called the “Disease of Kings” and the “King of Diseases” because too much rich meat and wine can lead to gout attacks in people at risk.

“This also has a genetic composition. The most common joint affected is the big toe,” Francis said.

Swelling next to a joint could mean an attack of bursitis. “This is a thin layer of fluid than can get inflamed,” he explained.
The Arthritis Foundation defines bursitis as the inflammation of a bursa. The good news is it can typically be treated with rest and anti-inflammatory medications.

Sometimes people need steroid injections or physical therapy.
Thinning bones are another concern Francis said must be addressed because of the increased risk of hip fracture. Many who suffer from hip fractures never fully recover, and may end up in nursing homes or grow ill with other diseases in their weakened state.

The scary thing about the thinning bones is there is no warning. “They feel fine, then bang!” Francis said.

Women over 65 should know their bone density. The DEXA is the most competent test; however, even a heel screening at a health fair can provide a glimpse into a patient’s bone health.

Besides the screenings, patients should take 500 mg of calcium three times a day (either by food or by pill) along with a multivitamin and, of course, exercise.

Start with your primary care physician for problems associated with arthritis. Osteoarthritis, for example, is often well treated by primary care physicians.

Whether you need to see a rheumatologist largely depends on how much training that physician has with arthritis problems and how comfortable they are in diagnosing and treating the problem.
“Most of the new treatments are in Rheumatoid Arthritis. We are finding we can target therapy more specifically,” Francis said.
“Prednisone is very useful to control inflammation, for example, but there are a lot of side effects with it. You are essentially controlling one disease with another disease.

“We can now target the problem with inflammation more selectively with the use of TNF-alpha inhibitors, for example,” he said.
For more information, go online to www.arthritis.org

7/10/2008