Ask the Doctors May 2012 Issue

Ask The Doctors: May 2012

Differentiating Arthritis Symptoms...Women as Arthritis Victims...Athletes and OA

Q. What are the first signs of arthritis? How can I differentiate these signs or symptoms from similar symptoms that are associated with other conditions?

A. The term arthritis refers to the symptom of inflammation of one or more joints, and there are over 100 types of arthritis. In general, early signs of arthritis are swelling, warmth, redness of the skin overlying a joint, pain, and restriction of motion. The early symptoms of arthritis are often very slight and gradually increase in intensity over the course of many years. At first, early symptoms might produce pain or stiffness only after strenuous work or exercise, but these early arthritis symptoms can deteriorate to constant and chronic pain. With rheumatoid or other inflammatory arthritis, joint involvement tends to be symmetrical, occurring in the same joints on both sides of the body. Although pain and stiffness can be brought on by a minor injury or overuse, these usually abate with rest and recuperation. There is no single test that can determine if you have arthritis; diagnosis requires a combination of medical history, physical examination, x-rays, and possibly laboratory tests. If you have symptoms that may indicate arthritis, you should see your doctor so that the diagnosis can be made and treatment can begin early. Early treatment can help you avoid some of the more severe symptoms of arthritis.

Q. Why do certain forms of arthritis target women?

A. It is not understood why women are more likely to develop arthritis than men, but by nature, women face a triple threat of risk factors: biology, genetic predisposition, and hormones. The most prominent theory about arthritis being more common in women is associated with changes in the levels of sex hormones, including estrogen and progesterone. These hormones have critical roles in the regulation of the immune system. Researchers believe that female hormones have an effect on the cartilage that cushions the bones to prevent pain and allows the joints to move smoothly. Experts have found that the female hormone estrogen protects cartilage from inflammation. Inflammation can lead to osteoarthritis. But after menopause, when women’s estrogen levels drop, they lose that protection and may have a higher risk of developing osteoarthritis. Unfortunately, many women have another risk factor: obesity. Extra weight puts more pressure on joints and can cause the cartilage between joints to wear away faster.

Q. Why do professional athletes seem to contract arthritis earlier than others?

A. While activity is excellent for maintaining a healthy body, and moderate activity appears to decrease the risk of developing osteoarthritis, research suggests that certain types of high-level athletic activity may increase the risk of osteoarthritis. A recent study compared more than 700 retired professional athletes to 1,400 men of the same age who exercised a little or not at all: The risk of hip or knee arthritis was 85 percent higher in the elite athletes, and in athletes who had joint surgery, the risk more than doubled. Joint injury or repetitive high-level stresses on a joint are known to contribute to the development of osteoarthritis, and these are common in professional athletes. Any trauma to a joint can start a cascade of events in the joint that leads to cartilage destruction and osteoarthritis, and the very nature of high-level athletics predisposes participants to chronic or acute trauma to their joints. Athletes also frequently require surgery on their joints, especially knees and shoulders, which also can contribute to the development of osteoarthritis. Recreational sports, pursued at a reasonable level, do not increase the risk of osteoarthritis.