The suffering inflicted by arthritis is staggering.
As many as one-third of adults in the United States suffer
from the disability, according to a new study from the Centers for Disease
Control and Prevention. And the economic costs are $128 billion a year, the CDC
reports — $20 billion higher than in 1997. Of that colossal amount, $81 billion
was in direct costs, including medical expenses; another $47 billion was
tallied up in lost wages by sufferers unable to work. The numbers are more
powerful since the statistics date back only to 2003 — the latest information
available.
In North Carolina alone, more than 39 percent of North
Carolina adults self-reported arthritis that resulted in work limitations.
That’s 6 percentage points higher than the national average in the first
state-by-state statistical study, according to CDC.
The most common forms of arthritis — pain, stiffness and
swelling of the joints — are osteoarthritis (degeneration of the joints) and
rheumatoid arthritis (a disease affecting the auto-immune system).
Seeking to understand and to develop improved treatments for
arthritis is the goal of the Thurston Arthritis Research Center at The
University of North Carolina at Chapel Hill.
“Arthritis is the number one cause of disability in the
United States,” said Dr. Joanne Jordan, the principal investigator for the
Center’s Multidisciplinary Clinical Research group. She is also the principal
investigator for the Center’s Arthritis and Immunology training grant from the
National Institutes of Health that trains rheumatologists and other
investigators for research careers in arthritis and immunology.
“Arthritis surpasses stroke, heart disease and pulmonary
disease,” she added. “With the graying of America, that number is going to
spike considerably.
“What’s very frustrating is that arthritis is not part of
the public dialogue.”
Jordan certainly is aware of the impact of arthritis. She
oversees a UNC-funded clinic in Smithfield, NC, in place for 20 years where
patients are treated and research data is collected from the community. She is
also involved with research in China into a particularly nasty form of
arthritis that affects young people.
Exploring the arthritis challenge has appealed to Jordan
dating back to her fellowship days at Duke before joining the UNC faculty in
1987.
“I had seen patients as an intern, and I did a rheumatology
fellowship at Duke,” Jordan explained. “I was looking for a specialty that allowed
us to really get to know our patients. Arthritis is a chronic condition, so our
patients are very, very special, and we follow them over the years to try to
make their lives better.
“There are lots of related diseases, not just those that
affect the joints,” she added, noting that arthritis exists in more than 100
forms. “The heart, the lungs and the nervous center can be affected. We need to
understand the process that affects the whole person. It’s very challenging.”
Jordan did note that “there has been tremendous progress
over the years. Rheumatoid arthritis treatment has been revolutionized over the
last 10 years, with different therapies that have provided huge improvements in
quality of life. We’re looking for that day to come for osteoarthritis. We are
still sorely lacking information that will enable us to actually get at the
cause of the disease.”
Especially effective treatments include physical exercise
and occupational therapy even though “they are under-publicized,” Jordan added.
But when it comes to pain relief, she conceded, “We need a lot more research.
We want to stop the process — that’s the big thing we would like to be able to
do. We’re just scratching the surface.”
One conclusion has become clear — depression and anxiety
“interact” with arthritis and “make the disease worse,” Jordan added.
Center of Excellence
The UNC center is a major data collection point for
arthritis research. It has received federal funding continuously for 25 years
and now receives $5 million a year in federal and other grants, Jordan
explained.
Designated as a “center of excellence” by the National
Institutes of Health, the UNC operation has grown to include a staff of 33 and
more than 70 researchers across the campus. Work continues on prevention,
treatment, potential cures, the effect of genetics, the impact of the
environment and continued involvement in the Smithfield/Johnston County project
with its focus on osteoarthritis.
Exercise Crucial to
Treatment
While research continues into prevention and better treatment,
Jordan said people with arthritis should pursue a regime of exercise. “That’s
the most effective non-pharmaceutical treatment,” she explained. But, she
added, “45 percent of those affected do not exercise.”
The Thurston Center offers a variety of exercised-based
programs, including PACE, short for “People with Arthritis Can Exercise.”
Another is ALED: Active Living Every Day. Among the suggestions: take the
stairs rather than an elevator, and park a good walking distance from work. The
growing obesity rate in the United States could make the need for exercise even
more pressing, said Jordan: “Our population is getting bigger with the obesity
epidemic, and as people get bigger that mostly affects the knees.”
Kashin-Beck Research
Jordan is actively involved in research related to
Kashin-Beck disease, a disorder that affects bones and joints of children and
adolescents. Over time, victims develop stiff, deformed joints, shortened limbs
and remain very short as growth plates of bone and cartilage die.
The disease is widely found in parts of the Far East, where
Jordan has done considerable work in China. The disease is believed to be
related to the lack of the mineral selenium, an antioxidant that helps protect
the body’s cells.
“This is all brand new stuff,” Jordan said of the potential
environmental link between the disease and selenium. She believes that a
selenium regime could some day be used to prevent osteoarthritis from getting
worse.
“The trick with selenium is that too much could be toxic,” she
explained. “We need clinical trials. The data are not there yet, but we are
excited by what we are
seeing. It gives us the potential for intervention.”
Jordan and UNC researchers are also looking into potential
links to arthritis between lead and mercury. “We have some data to support that
people who have higher levels of lead and mercury in their blood seem to have
more severe osteoarthritis,” Jordan said, “but we’re just beginning to look at
that.
“Thankfully, if we measure people’s blood now, compared to
measurements in the 1950s, ’60s and ’70s, there are much smaller amounts of
lead and mercury.”
CENTER IN JOHNSTON
COUNTY COLLECTS DATA FOR ARTHRITIS RESEARCH
Johnston County is the site for one of the largest, most
comprehensive studies of osteoarthritis. Operated by the Thurston Arthritis
Research Center at UNC-Chapel Hill, the program dates back to the 1990s and
serves more than 3000 people recruited by door-to-door visits to participate in
the study. Information — including X-rays, blood tests and other data — will be
gathered for decades to come, according to Dr. Joanne Jordan of the Thurston
Center.
“We want to diagnose arthritis earlier,” Jordan said. “The
sooner we diagnose it, the better we can treat it. We also want to study how
arthritis affects people over the years.”
Researchers are looking to measure mercury and lead, as well
as the mineral selenium in an attempt to understand potential links between the
three and osteoarthritis.
“We are looking for things we can modify, things we can try,”
Jordan explained. “What makes you change from a well person to someone who has
the disease? We are going across the gamut, looking at genes and also various
aspects of air pollution and other environmental factors, including
demographics, psychosocial and dietary factors.”
WEB SITES FOR MORE
INFORMATION
CDC Arthritis Study
www.cdc.gov/mmwr/preview/mmwrhtml/mm5640a2.htm?s_cid=mm5641a2_e#tab
Thurston Arthritis
Research Center
http://tarc.med.unc.edu