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May 7, 2007

A University of Michigan Health Minute update on important health issues.

Aging gracefully, with a chronic disease

As rheumatoid arthritis patients grow older, they face new challenges of managing the incurable condition, U-M doctor says

ANN ARBOR, MI – For the better part of three decades, Sherrie Kossoudji has endeavored each day to manage the inflammation, chronic pain, tight joints and other types of physical strife caused by rheumatoid arthritis.

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“Rheumatoid arthritis affects my life in as many ways as you could possibly imagine, and pretty much at all times,” says Kossoudji. “It is a disease that can be manipulated with medicine, but it doesn’t ever really go away.”

Now 53, Kossoudji is dealing with a new aspect of her chronic disease: sorting out what is a normal part of aging, and what is a facet of rheumatoid arthritis, or RA. If she has a sore leg, a pain in her elbow or a kink in her wrist, is it because of RA or is there another cause?

“I have fingers that don’t work well, joints that don’t work well. I have a wrist that doesn’t flex and neuropathies in my legs,” she says. “I think it’s difficult when someone has a long-term disease to separate what happens as the body ages from what happens when you have a disease for a very long time.”

RA is debilitating for some patients as they age, so it is especially important for people with RA to see a rheumatologist to determine the best course of treatment and to gain the best possible understanding of what is happening in one’s body, says David A. Fox, M.D., division chief and professor of rheumatology at the University of Michigan Health System. Fox is Kossoudji’s rheumatologist.

Whatever the age of the patient’s RA onset – whether it is at a young age, like Kossoudji at the time of her diagnosis, or later in life – Fox emphasizes that RA is not a normal part of aging. It is a specific condition with symptoms that can’t be cured, but can be managed.

“Arthritis should not be considered just a part of the aging process or a normal part of getting older,” Fox says. “There are some elderly people who don’t have arthritis, and many people who develop arthritis when they are younger.”

Many patients are helped by some of the available treatments, including pain relievers and anti-inflammatory medications known as nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs, such as methotrexate and tumor necrosis factor (TNF) blockers. Exercise, weight loss and diet changes also can be helpful, Fox says.

RA is one of more than 100 varieties of arthritis, a wide-ranging set of conditions that affects 70 million people in the United States. RA involves a malfunctioning of the immune system that causes inflammation in the lining of the joints. With time, the cartilage and bone are attacked and invaded, Fox says, to the point that the structure of the joint can be destroyed. This can lead to deformities and disabilities.

“Patients may develop inflammation in their lungs or peripheral nerves, inflammation in the salivary glands or tear glands that prevent them from functioning normally, and they may become what we call ‘systemically ill’ – that is, the disease can affect the patient’s body as a whole,” he says.

Health Minute ImageOne very important thing that Fox tells his patients with RA is that they do not have to stop living their lives. Kossoudji, for one, has followed the advice. “My job is to make sure that rheumatoid arthritis diminishes my life as little as possible,” she says. “My goal is not to overcome the disease, but to do my best at managing the disease.”

7 facts about rheumatoid arthritis

  • What it is: Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling and loss of motion in the joints. It occurs most commonly in the fingers, wrists, elbows, shoulders, jaw, hips, knees and toes. RA often appears first in early adulthood or middle age, but sometimes does not occur until the later years. (Osteoarthritis is another common type of arthritis; it causes a breakdown of the cartilage in the joints.)
  • Symptoms: Symptoms include joint pain and stiffness, particularly in the morning; red, warm or swollen joints; deformity of the joints; mild fever; fatigue; loss of appetite; anemia; and small lumps or nodules under the skin. Symptoms can be present nearly every day, or they can come and go.
  • Diagnosis: Your health care provider will review your medical history and examine you. He or she may order blood tests and x-rays to confirm the diagnosis and measure the extent of the disease.
  • Prevention: The best ways to try to prevent arthritis, Fox says, are maintaining a good body weight and not smoking. To try to prevent osteoarthritis, he also advises that you use common sense when engaging in strenuous physical activity so you don’t seriously injure your joints.
  • Who is at risk: RA can affect people of different ages, races and sexes; it is three times more common in women than men. Genetics can affect a person’s chance of developing RA, but if one of your parents had the condition, it does not necessarily mean that you will. Being overweight is a major risk factor for osteoarthritis, and recent studies have shown that smokers may have twice the chance of developing RA as non-smokers.
  • Treatment: RA can be managed but not cured. The goal of treatment is to keep the joints working properly by reducing inflammation, relieving the pain and stiffness, and stopping or slowing down joint damage. Many drugs are used for the long-term relief of rheumatoid arthritis. One type is nonsteroidal anti-inflammatory drugs (NSAIDs) that treat pain and inflammation (aspirin, ibuprofen and naproxen are NSAIDs that are available without a prescription, and others are available by prescription only). When NSAIDs do not work, disease-modifying antirheumatic drugs (DMARDs) may be used, with careful supervision by a rheumatologist. Methotrexate and tumor necrosis factor (TNF) blockers are examples of DMARD that have been found to be helpful for many RA patients. Injections, physical therapy and surgery are other potential treatments.
  • Possible treatment in the future: Ongoing research offers significant hope that in the future, cures will be available for RA, Fox says.

For more information, visit these Web sites:

U-M Health Topics A-Z

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Arthritis Foundation

American College of Rheumatology

Written by Katie Gazella

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