Rheumatic
Diseases
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Rheumatic diseases are characterized by inflammation
(signs are redness and/or heat, swelling, and pain) and loss of function
of one or more connecting or supporting structures of the body. They
especially affect joints, tendons, ligaments, bones, and muscles. Common
symptoms are pain, swelling, and stiffness. Some rheumatic diseases can
also involve internal organs. There are more than 100 rheumatic
diseases.
Many people use the word "arthritis" to refer to all
rheumatic diseases. However, the word literally means joint
inflammation. The many different kinds of arthritis comprise just a
portion of the rheumatic diseases. Some rheumatic diseases are described
as connective tissue diseases because they affect the supporting
framework of the body and its internal organs. Others are known as
autoimmune diseases because they occur when the immune system, which
normally protects the body from infection and disease, harms the body's
own healthy tissues. Throughout this fact sheet the terms "arthritis"
and "rheumatic diseases" are sometimes used interchangeably.
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- Osteoarthritis--This is the most common type of arthritis, affecting
an estimated 21 million adults in the United States. Osteoarthritis primarily
affects cartilage, which is the tissue that cushions the ends of bones within
the joint. In osteoarthritis, the cartilage begins to fray and may entirely
wear away. Osteoarthritis can cause joint pain and stiffness. Disability
results most often when the disease affects the spine and the weight-bearing
joints (the knees and hips).
- Rheumatoid arthritis--This inflammatory disease of the synovium,
or lining of the joint, results in pain, stiffness, swelling, joint damage,
and loss of function of the joints. Inflammation most often affects joints
of the hands and feet and tends to be symmetrical (occurring equally on
both sides of the body). This symmetry helps distinguish rheumatoid arthritis
from other forms of the disease. About 1 percent of the U.S. population
(about 2.1 million people) has rheumatoid arthritis.
- Juvenile rheumatoid arthritis--This is the most common form of
arthritis in childhood, causing pain, stiffness, swelling, and loss of function
of the joints. The arthritis may be associated with rashes or fevers, and
may affect various parts of the body.
- Fibromyalgia--Fibromyalgia is a chronic disorder that causes pain
throughout the tissues that support and move the bones and joints. Pain,
stiffness, and localized tender points occur in the muscles and tendons,
particularly those of the neck, spine, shoulders, and hips. Patients may
also experience fatigue and sleep disturbances.
- Systemic lupus erythematosus--Systemic lupus erythematosus (also
known as lupus or SLE) is an autoimmune disease in which the immune system
harms the body's own healthy cells and tissues. This can result in inflammation
of and damage to the joints, skin, kidneys, heart, lungs, blood vessels,
and brain.
- Scleroderma--Also known as systemic sclerosis, scleroderma means
literally "hard skin." The disease affects the skin, blood vessels, and
joints. It may also affect internal organs, such as the lungs and kidneys.
In scleroderma, there is an abnormal and excessive production of collagen
(a fiber-like protein) in the skin or internal organs.
- Spondyloarthropathies--This group of rheumatic diseases principally
affects the spine. One common form--ankylosing spondylitis--not only affects
the spine, but may also affect the hips, shoulders, and knees as the tendons
and ligaments around the bones and joints become inflamed, resulting in
pain and stiffness. Ankylosing spondylitis tends to affect people in late
adolescence or early adulthood. Reactive arthritis, sometimes called Reiter's
syndrome, is another spondyloarthropathy. It develops after an infection
involving the lower urinary tract, bowel, or other organ and is commonly
associated with eye problems, skin rashes, and mouth sores.
- Gout--This type of arthritis results from deposits of needle-like
crystals of uric acid in the joints. The crystals cause inflammation, swelling,
and pain in the affected joint, which is often the big toe.
- Infectious arthritis--This is a general term used to describe forms
of arthritis that are caused by infectious agents, such as bacteria or viruses.
Parvovirus arthritis and gonococcal arthritis are examples of infectious
arthritis. Arthritis symptoms may also occur in Lyme disease, which is caused
by a bacterial infection following the bite of certain ticks. In those cases
of arthritis caused by bacteria, early diagnosis and treatment with antibiotics
are crucial to get rid of the infection and minimize damage to the joints.
- Polymyalgia rheumatica--Because this disease involves tendons,
muscles, ligaments, and tissues around the joint, symptoms often include
pain, aching, and morning stiffness in the shoulders, hips, neck, and lower
back. It is sometimes the first sign of giant cell arteritis, a disease
of the arteries characterized by inflammation, weakness, weight loss, and
fever.
- Polymyositis--This is a rheumatic disease that causes inflammation
and weakness in the muscles. The disease may affect the whole body and cause
disability.
- Psoriatic arthritis--This form of arthritis occurs in some patients
with psoriasis, a scaling skin disorder. Psoriatic arthritis often affects
the joints at the ends of the fingers and toes and is accompanied by changes
in the fingernails and toenails. Back pain may occur if the spine is involved.
- Bursitis--This condition involves inflammation of the bursae, small,
fluid-filled sacs that help reduce friction between bones and other moving
structures in the joints. The inflammation may result from arthritis in
the joint or injury or infection of the bursae. Bursitis produces pain and
tenderness and may limit the movement of nearby joints.
- Tendinitis (Tendonitis)--This condition refers to inflammation
of tendons (tough cords of tissue that connect muscle to bone) caused by
overuse, injury, or a rheumatic condition. Tendinitis produces pain and
tenderness and may restrict movement of nearby joints.
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Scientists are studying risk factors that increase the
likelihood of developing a rheumatic disease. Some of these factors have
been identified. For example, in osteoarthritis, inherited cartilage
weakness or excessive stress on the joint from repeated injury may play
a role. In lupus, rheumatoid arthritis, and scleroderma, the combination
of genetic factors that determine susceptibility and environmental
triggers are believed to be important. Family history also plays a role
in some diseases such as gout and ankylosing spondylitis.
Gender is another factor in some rheumatic diseases.
Lupus, rheumatoid arthritis, scleroderma, and fibromyalgia are more
common among women. (See next section for details.) This indicates that
hormones or other male-female differences may play a role in the
development of these conditions.
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An estimated 43 million people in the United States have
arthritis or other rheumatic conditions. By the year 2020, this number
is expected to reach 60 million. Rheumatic diseases are the leading
cause of disability among adults age 65 and older.
Rheumatic diseases affect people of all races and ages.
Some rheumatic conditions are more common among certain populations. For
example:
- Rheumatoid arthritis occurs two to three times more often in women
than in men.
- Scleroderma is more common in women than in men.
- Nine out of 10 people who have lupus are women.
- Nine out of 10 people who have fibromyalgia are women.
- Gout is more common in men than in women.
- Lupus is three times more common in African American women than in
Caucasian women.
- Ankylosing spondylitis is more common in men than in women.
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Different types of arthritis have different symptoms. In
general, people who have arthritis feel pain and stiffness in the
joints. Some of the more common symptoms are listed in the box. Early
diagnosis and treatment help decrease further joint damage and help
control symptoms of arthritis and many other rheumatic diseases.
- Swelling in one or more joints
- Stiffness around the joints that lasts for at least 1 hour
in the early morning
- Constant or recurring pain or tenderness in a joint
- Difficulty using or moving a joint normally
- Warmth and redness in a joint
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Diagnosing rheumatic diseases can be difficult because
some symptoms and signs are common to many different diseases. A general
practitioner or family doctor may be able to evaluate a patient or refer
him or her to a rheumatologist (a doctor who specializes in treating
arthritis and other rheumatic diseases).
The doctor will review the patient's medical history,
conduct a physical examination, and obtain laboratory tests and x rays
or other imaging tests. The doctor may need to see the patient more than
once to make an accurate diagnosis.
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It is vital for people with joint pain to give the doctor
a complete medical history. Answers to the following questions will help
the doctor make an accurate diagnosis:
- Is the pain in one or more joints?
- When does the pain occur?
- How long does the pain last?
- When did you first notice the pain?
- What were you doing when you first noticed the pain?
- Does activity make the pain better or worse?
- Have you had any illnesses or accidents that may account for the
pain?
- Is there a family history of any arthritis or other rheumatic
disease?
- What medicine(s) are you taking?
Because rheumatic diseases are so diverse and sometimes
involve several parts of the body, the doctor may ask many other
questions.
It may be helpful for people to keep a daily journal that
describes the pain. Patients should write down what the affected joint
looks like, how it feels, how long the pain lasts, and what they were
doing when the pain started.
The doctor will examine the patient's joints for redness,
warmth, damage, ease of movement, and tenderness. Because some forms of
arthritis, such as lupus, may affect other organs, a complete physical
examination that includes the heart, lungs, abdomen, nervous system,
eyes, ears, and throat may be necessary. The doctor may order some
laboratory tests to help confirm a diagnosis. Samples of blood, urine,
or synovial fluid (lubricating fluid found in the joint) may be needed
for the tests.
Common laboratory tests and procedures include the
following:
Antinuclear antibody (ANA)--This test checks blood
levels of antibodies that are often present in people who have
connective tissue diseases or other autoimmune disorders, such as lupus.
Since the antibodies react with material in the cell's nucleus (control
center), they are referred to as antinuclear antibodies. There are also
tests for individual types of ANAs that may be more specific to people
with certain autoimmune disorders. ANAs are also sometimes found in
people who do not have an autoimmune disorder. Therefore, having ANAs in
the blood does not necessarily mean that a person has a disease.
C-reactive protein test--This is a nonspecific test
used to detect generalized inflammation. Levels of the protein are often
increased in patients with active disease such as rheumatoid arthritis,
and may decline when corticosteroids or nonsteroidal anti-inflammatory
drugs (NSAIDs) are used to reduce inflammation.
Complement--This test measures the level of
complement, a group of proteins in the blood. Complement helps destroy
foreign substances, such as germs, that enter the body. A low blood
level of complement is common in people who have active lupus.
Complete blood count (CBC)--This test determines
the number of white blood cells, red blood cells, and platelets present
in a sample of blood. Some rheumatic conditions or drugs used to treat
arthritis are associated with a low white blood count (leukopenia), low
red blood count (anemia), or low platelet count (thrombocytopenia). When
doctors prescribe medications that affect the CBC, they periodically
test the patient's blood.
Creatinine--This blood test is commonly ordered in
patients who have a rheumatic disease, such as lupus, to monitor for
underlying kidney disease. Creatinine is a breakdown product of
creatine, which is an important component of muscle. It is excreted from
the body entirely by the kidneys, and the level remains constant and
normal when kidney function is normal.
Erythrocyte sedimentation rate (sed rate)--This
blood test is used to detect inflammation in the body. Higher sed rates
indicate the presence of inflammation and are typical of many forms of
arthritis, such as rheumatoid arthritis and ankylosing spondylitis, and
many of the connective tissue diseases.
Hematocrit (PCV, packed cell volume)--This test and
the test for hemoglobin (a substance in the red blood cells that carries
oxygen throughout the body) measure the number of red blood cells
present in a sample of blood. A decrease in the number of red blood
cells (anemia) is common in people who have inflammatory arthritis or
another rheumatic disease.
Rheumatoid factor--This test detects the presence
of rheumatoid factor, an antibody found in the blood of most (but not
all) people who have rheumatoid arthritis. Rheumatoid factor may be
found in many diseases besides rheumatoid arthritis, and sometimes in
people without health problems.
Synovial fluid examination--Synovial fluid may be
examined for white blood cells (found in patients with rheumatoid
arthritis and infections), bacteria or viruses (found in patients with
infectious arthritis), or crystals in the joint (found in patients with
gout or other types of crystal-induced arthritis). To obtain a specimen,
the doctor injects a local anesthetic, then inserts a needle into the
joint to withdraw the synovial fluid into a syringe. The procedure is
called arthrocentesis or joint aspiration.
Urinalysis--In this test, a urine sample is studied
for protein, red blood cells, white blood cells, and bacteria. These
abnormalities may indicate kidney disease, which may be seen in several
rheumatic diseases, including lupus. Some medications used to treat
arthritis can also cause abnormal findings on urinalysis.
White blood cell count (WBC)--This test determines
the number of white blood cells present in a sample of blood. The number
may increase as a result of infection or decrease in response to certain
medications or in certain diseases, such as lupus. Low numbers of white
blood cells increase a person's risk of infections.
To see what the joint looks like inside, the doctor may
order x rays or other imaging procedures. X rays provide an image of the
bones, but they do not show cartilage, muscles, and ligaments. Other
noninvasive imaging methods such as computed tomography (CT or CAT
scan), magnetic resonance imaging (MRI), and arthrography show the whole
joint. The doctor may look for damage to a joint by using an
arthroscope, a small, flexible tube which is inserted through a small
incision at the joint and which transmits the image of the inside of a
joint to a video screen.
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Treatments for rheumatic diseases include rest and
relaxation, exercise, proper diet, medication, and instruction about the
proper use of joints and ways to conserve energy. Other treatments
include the use of pain relief methods and assistive devices, such as
splints or braces. In severe cases, surgery may be necessary. The doctor
and the patient work together to develop a treatment plan that helps the
patient maintain or improve his or her lifestyle. Treatment plans
usually combine several types of treatment and vary depending on the
rheumatic condition and the patient.
People who have a rheumatic disease should develop a
comfortable balance between rest and activity. One sign of many
rheumatic conditions is fatigue. Patients must pay attention to signals
from their bodies. For example, when experiencing pain or fatigue, it is
important to take a break and rest. Too much rest, however, may cause
muscles and joints to become stiff.
People with a rheumatic disease such as arthritis can
participate in a variety of sports and exercise programs. Physical
exercise can reduce joint pain and stiffness and increase flexibility,
muscle strength, and endurance. It also helps with weight reduction and
contributes to an improved sense of well-being. Before starting any
exercise program, people with arthritis should talk with their doctor.
Exercises that doctors often recommend include:
- Range-of-motion exercises (e.g., stretching, dance) to help maintain normal
joint movement, maintain or increase flexibility, and relieve stiffness.
- Strengthening exercises (e.g., weight lifting) to maintain or increase
muscle strength. Strong muscles help support and protect joints affected
by arthritis.
- Aerobic or endurance exercises (e.g., walking, bicycle riding) to improve
cardiovascular fitness, help control weight, and improve overall well-being.
Studies show that aerobic exercise can also reduce inflammation in some
joints.
Another important part of a treatment program is a
well-balanced diet. Along with exercise, a well-balanced diet helps
people manage their body weight and stay healthy. Weight control is
important to people who have arthritis because extra weight puts extra
pressure on some joints and can aggravate many types of arthritis. Diet
is especially important for people who have gout. People with gout
should avoid alcohol and foods that are high in purines, such as organ
meats (liver, kidney), sardines, anchovies, and gravy.
A variety of medications are used to treat rheumatic
diseases. The type of medication depends on the rheumatic disease and on
the individual patient. The medications used to treat most rheumatic
diseases do not provide a cure, but rather limit the symptoms of the
disease. Infectious arthritis and gout are exceptions if medications are
used properly. Another example is Lyme disease, caused by the bite of
certain ticks, where symptoms of arthritis may be prevented or may
disappear if the infection is caught early and treated with
antibiotics.
Medications commonly used to treat rheumatic diseases
provide relief from pain and inflammation. In some cases, the medication
may slow the course of the disease and prevent further damage to joints
or other parts of the body.
The doctor may delay using medications until a definite
diagnosis is made because medications can hide important symptoms (such
as fever and swelling) and thereby interfere with diagnosis. Patients
taking any medication, either prescription or over-the-counter, should
always follow the doctor's instructions. The doctor should be notified
immediately if the medicine is making the symptoms worse or causing
other problems, such as an upset stomach, nausea, or headache. The
doctor may be able to change the dosage or medicine to reduce these side
effects.
Analgesics (pain relievers) such as acetaminophen
(Tylenol)* and nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen are used to reduce the pain caused by many rheumatic
conditions. NSAIDs have the added benefit of decreasing the inflammation
associated with arthritis. A common side effect of NSAIDs is stomach
irritation, which can often be reduced by changing the dosage or
medication. New NSAIDs, including celecoxib (Celebrex) and rofecoxib
(Vioxx), were introduced to reduce gastrointestinal side effects and
offer additional options for treatment. However, even new medications
are occasionally associated with reactions ranging from mild to severe,
and their long-term effects are still being studied. The dosage will
vary depending on the particular illness and the overall health of the
patient. The doctor and patient must work together to determine which
analgesic to use and the appropriate amount. If analgesics do not ease
the pain, the doctor may use other medications.
* Brand names included in this fact sheet
are provided as examples only, and their inclusion does not mean that
these products are endorsed by the National Institutes of Health or any
other Government agency. Also, if a particular brand name is not
mentioned, this does not mean or imply that the product is
unsatisfactory.
Depending on the type of arthritis, a person may be asked
to take a disease-modifying antirheumatic drug (DMARD). This category
includes several unrelated medications that are intended to slow or
prevent damage to the joint and thereby prevent disability and
discomfort. DMARDs include methotrexate, sulfasalazine, and leflunomide
(Arava).
Biological response modifiers are new drugs used for the
treatment of rheumatoid arthritis. They can help reduce inflammation and
structural damage of the joints by blocking the reaction of a substance
called tumor necrosis factor, a protein involved in immune system
response. These drugs include etanercept (Enbrel), infliximab
(Remicade), and anakinra (Kineret).
Corticosteroids, such as prednisone, cortisone,
solumedrol, and hydrocortisone, are used to treat many rheumatic
conditions because they decrease inflammation and suppress the immune
system. The dosage of these medications will vary depending on the
diagnosis and the patient. Again, the patient and doctor must work
together to determine the right amount of medication.
Corticosteroids can be given by mouth, in creams applied
to the skin, or by injection. Short-term side effects of corticosteroids
include swelling, increased appetite, weight gain, and emotional ups and
downs. These side effects generally stop when the drug is stopped. It
can be dangerous to stop taking corticosteroids suddenly, so it is very
important that the doctor and patient work together when changing the
corticosteroid dose. Side effects that may occur after long-term use of
corticosteroids include stretch marks, excessive hair growth,
osteoporosis, high blood pressure, damage to the arteries, high blood
sugar, infections, and cataracts.
Hyaluronic acid products like Hyalgan and Synvisc mimic a
naturally occurring body substance that lubricates the knee joint. They
are usually injected directly into the joint to help provide temporary
relief of pain and flexible joint movement.
Transcutaneous electrical nerve stimulation (TENS) has
been found effective in modifying pain perception. TENS blocks pain
messages to the brain with a small device that directs mild electric
pulses to nerve endings that lie beneath the painful area of the
skin.
A blood-filtering device called the Prosorba Column is
used in some health care facilities for filtering out harmful antibodies
in people with severe rheumatoid arthritis.
Heat and cold can both be used to reduce the pain and
inflammation of arthritis. The patient and doctor can determine which
one works best.
Heat therapy increases blood flow, tolerance for pain, and
flexibility. Heat therapy can involve treatment with paraffin wax,
microwaves, ultrasound, or moist heat. Physical therapists are needed
for some of these therapies, such as microwave or ultrasound therapy,
but patients can apply moist heat themselves. Some ways to apply moist
heat include placing warm towels or hot packs on the inflamed joint or
taking a warm bath or shower.
Cold therapy numbs the nerves around the joint (which
reduces pain) and may relieve inflammation and muscle spasms. Cold
therapy can involve cold packs, ice massage, soaking in cold water, or
over-the-counter sprays and ointments that cool the skin and joints.
Capsaicin cream is a preparation put on the skin to
relieve joint or muscle pain when only one or two joints are
involved.
Hydrotherapy, Mobilization Therapy, and
Relaxation Therapy
Hydrotherapy involves exercising or relaxing in warm
water. The water takes some weight off painful joints, making it easier
to exercise. It helps relax tense muscles and relieve pain.
Mobilization therapies include traction (gentle, steady
pulling), massage, and manipulation. (Someone other than the patient
moves stiff joints through their normal range of motion.) When done by a
trained professional, these methods can help control pain, increase
joint motion, and improve muscle and tendon flexibility.
Relaxation therapy helps reduce pain by teaching people
various ways to release muscle tension throughout the body. In one
method of relaxation therapy, known as progressive relaxation, the
patient tightens a muscle group and then slowly releases the tension.
Doctors and physical therapists can teach patients a variety of
relaxation techniques.
The most common assistive devices for treating arthritis
pain are splints and braces, which are used to support weakened joints
or allow them to rest. Some of these devices prevent the joint from
moving; others allow some movement. A splint or brace should be used
only when recommended by a doctor or therapist, who will show the
patient the correct way to put the device on, ensure that it fits
properly, and explain when and for how long it should be worn. The
incorrect use of a splint or brace can cause joint damage, stiffness,
and pain.
A person with arthritis can use other kinds of devices to
ease the pain. For example, the use of a cane when walking can reduce
some of the weight placed on a knee or hip affected by arthritis. A shoe
insert (orthotic) can ease the pain of walking caused by arthritis of
the foot or knee. Other devices can help with activities such as opening
jars, closing zippers, and holding pencils.
Surgery may be required to repair damage to a joint after
injury or to restore function or relieve pain in a joint damaged by
arthritis. The doctor may recommend arthroscopic surgery, bone fusion
(surgery in which bones in the joint are fused or joined together), or
arthroplasty (also known as total joint replacement, in which the
damaged joint is removed and replaced with an artificial one).
Nutritional supplements are often reported as helpful in
treating rheumatic diseases. These include products such as
S-adenosylmethionine (SAM-e) for osteoarthritis and fibromyalgia,
dehydroepiandrosterone (DHEA) for lupus, and glucosamine and chondroitin
sulfate for osteoarthritis. Reports on the safety and effectiveness of
these products should be viewed with caution since very few claims have
been carefully evaluated.
At this time, the only type of arthritis that can be cured
is that caused by infections. Although symptoms of other types of
arthritis can be effectively managed with rest, exercise, and
medication, there are no cures. Some people claim to have been cured by
treatment with herbs, oils, chemicals, special diets, radiation, or
other products. However, there is no scientific evidence that such
treatments cure arthritis. Moreover, some may lead to serious side
effects. Patients should talk to their doctor before using any therapy
that has not been prescribed or recommended by the health care team
caring for the patient.
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The role you play in planning your treatment is very
important. It is vital for you to have a good relationship with your
doctor in order to work together. You should not be afraid to ask
questions about your condition or treatment. You must understand the
treatment plan and tell the doctor whether or not it is helping you.
Research has shown that patients who are well informed and participate
actively in their own care experience less pain and make fewer visits to
the doctor.
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Studies show that an estimated 18 percent of Americans who
have arthritis or other rheumatic conditions believe that their
condition limits their activities. People with arthritis may find that
they can no longer participate in some of their favorite activities,
which can affect their overall well-being. Even when arthritis impairs
only one joint, a person may have to change many daily activities to
protect that joint from further damage and reduce pain. When arthritis
affects the entire body, as it does in people with rheumatoid arthritis
or fibromyalgia, many daily activities have to be changed to deal with
pain, fatigue, and other symptoms.
Changes in the home may help a person with chronic
arthritis continue to live safely, productively, and with less pain.
People with arthritis may become weak, lose their balance, or fall. In
the bathroom, installing grab bars in the tub or shower and by the
toilet, placing a secure seat in the tub, and raising the height of the
toilet seat can help. Special kitchen utensils can accommodate hands
affected by arthritis to make meal preparation easier. An occupational
therapist can help people who have rheumatic conditions identify and
make adjustments in their homes to create a safer, more comfortable, and
more efficient environment.
Friends and family members can help a patient with a rheumatic
condition by learning about that condition and understanding how it affects
the patient's life. Friends and family can provide emotional and physical
assistance. Their support, as well as support from other people who have the
same disease, can make it easier to cope. The Arthritis Foundation has a wealth
of information to help people with arthritis.
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The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS), a part of the National Institutes of Health
(NIH), leads the Federal medical research effort in arthritis and
rheumatic diseases. The NIAMS sponsors research and research training on
the NIH campus in Bethesda, Maryland, and at universities and medical
centers throughout the United States. Research activities include both
basic (laboratory) and clinical (involving patients) research studies to
better understand what causes these conditions and how best to treat and
prevent them.
The NIAMS currently supports three types of research
centers that study arthritis, rheumatic diseases, and other
musculoskeletal conditions: Multidisciplinary Clinical Research Centers
(MCRCs), Specialized Centers of Research (SCORs), and Core Centers. A
list of these centers and their locations can be obtained from the
Institute (listed at the end of this fact sheet).
The MCRCs are programs that focus on clinical research
designed to assess and improve outcomes for patients affected by
arthritis and other rheumatic diseases, musculoskeletal disorders
(including bone and muscle diseases), and skin diseases. Each center
studies one or more of the diseases within the NIAMS mission and
provides resources for developing clinical projects using more than one
approach.
Each SCOR focuses on a single disease. Currently,
rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis,
osteoporosis, and scleroderma are being studied. Combining laboratory
and clinical studies under one roof speeds up research on the causes of
these diseases and hastens transfer of advances from the laboratory to
the bedside to improve patient care.
Core Centers promote interdisciplinary collaborative
efforts among scientists doing high-quality research related to a common
theme. By providing funding for facilities, pilot and feasibility
studies, and program enrichment activities at the Core Center, the
Institute reinforces investigations already underway in NIAMS program
areas. Current centers include Rheumatic Diseases Research Core Centers,
Skin Disease Research Core Centers, and Core Centers for Musculoskeletal
Disorders.
Research registries provide a means for collecting
clinical, demographic, and laboratory information from patients and,
sometimes, their relatives. These registries facilitate studies that
could ultimately lead to improved diagnosis, treatment, and prevention.
NIAMS currently supports research registries for rheumatoid arthritis,
antiphospholipid syndrome (an autoimmune disorder), ankylosing
spondylitis, lupus and neonatal lupus, scleroderma, juvenile rheumatoid
arthritis, and juvenile dermatomyositis.
Some current NIAMS research efforts in rheumatic diseases
are outlined below.
Recent scientific breakthroughs in basic research have
provided new information about what happens to the body's cells and
other structures as rheumatic diseases progress. Biomarkers (laboratory
and imaging signposts that detect disease) help researchers determine
the likelihood that a person will develop a specific disease and its
possible severity and outcome. Biomarkers have the potential to lead to
novel and more effective ways to predict and monitor disease activity
and responses to treatment. The NIAMS supports research on biomarkers
for rheumatic and skin diseases, including a new initiative on
osteoarthritis. Additional studies on specific rheumatic diseases
follow.
Researchers are trying to identify the cause of rheumatoid
arthritis in order to develop better and more specific treatments. They
are examining the role that the endocrine (hormonal), nervous, and
immune systems play, and the ways in which these systems interact with
environmental and genetic factors in the development of rheumatoid
arthritis. Some scientists are trying to determine whether an infectious
agent triggers rheumatoid arthritis. Others are studying the role of
certain enzymes (specialized proteins in the body that spark biochemical
reactions) in breaking down cartilage. Researchers are also trying to
identify the genetic factors that place some people at higher risk than
others for developing rheumatoid arthritis.
Moreover, scientists are looking at new ways to treat
rheumatoid arthritis. They are experimenting with new drugs and
"biologic agents" that selectively block certain immune system
activities associated with inflammation. Newly developed drugs include
etanercept (Enbrel) and infliximab (Remicade). Followup studies show
promise for their effectiveness in slowing disease progression. Studies
for additional new drugs continue. Other investigators have shown that
minocycline and doxycycline, two antibiotic medications in the
tetracycline family, have a modest benefit for people with rheumatoid
arthritis. Research continues in this area.
Novel studies using imaging technologies are underway as
well. These techniques help identify targets for new drugs by allowing
researchers to see changes in cells during the disease process.
The NIAMS has embarked on several innovative approaches to
understand the causes and identify effective treatment and prevention
methods for osteoarthritis. Through a public/ private partnership,
researchers are identifying biomarkers for osteoarthritis to help
develop and test new drugs. Imaging studies designed to better identify
joint disorders and assess their progression are taking place as
well.
The National Center for Complementary and Alternative
Medicine and the NIAMS at the National Institutes of Health are
currently funding a study on the usefulness of the dietary supplements
glucosamine and chondroitin sulfate for osteoarthritis. Previous studies
suggest these substances may be effective for reducing pain in knee
osteoarthritis. Researchers are also investigating whether they prevent
the loss of cartilage.
Some genetic and behavioral studies are focusing on
factors that may lead to osteoarthritis. Researchers recently found that
daughters of women who have knee osteoarthritis have a significant
increase in cartilage breakdown, thus making them more susceptible to
disease. This finding has important implications for identifying people
who are susceptible to osteoarthritis. Other studies of risk factors for
osteoarthritis have identified excessive weight and lack of exercise as
contributing factors to knee and hip disability.
Researchers are working to understand what role certain
enzymes play in the breakdown of joint cartilage in osteoarthritis and
are testing drugs that block the action of these enzymes.
Studies of injuries in young adults show that those who
have had a previous joint injury are more likely to develop
osteoarthritis. These studies underscore the need for increased
education about joint injury prevention and use of proper sports
equipment.
Researchers are looking at how genetic, environmental, and
hormonal factors influence the development of systemic lupus
erythematosus. They are trying to find out why lupus is more common in
certain populations, and they have made progress in identifying the
genes that may be responsible for lupus. Researchers also continue to
study the cellular and molecular basis of autoimmune disorders such as
lupus. Promising areas of research on treatment include biologic agents;
newer, more selective drugs that suppress the immune system; and bone
transplants to correct immune abnormalities. Contrary to the widely held
belief that estrogens can make the disease worse, clinical studies are
revealing that it may be safe to use estrogens for hormone replacement
therapy and birth control in women with lupus.
Current studies on scleroderma are focusing on
overproduction of collagen, blood vessel injury, and abnormal immune
system activity. Researchers hope to discover how these three elements
interact to cause and promote scleroderma. In one study, researchers
found evidence of fetal cells within the blood and skin lesions of women
who had been pregnant years before developing scleroderma. The study
suggests that fetal cells may play a role in scleroderma by fostering
the maturation of immune cells that promote the overproduction of
collagen. Scientists are continuing to study the implications of this
finding.
Treatment studies are underway as well. One study in
particular is looking at the effectiveness of oral collagen in treating
scleroderma.
Scientists are looking at the basic causes of chronic pain
and the health status of young women affected by fibromyalgia. The
effectiveness of behavior therapy, acupuncture, and some alternative
medical approaches for dealing with pain and loss of sleep are being
tested. Researchers are also studying whether certain genes contribute
to this disease.
Researchers are working to understand the genetic and
environmental causes of spondyloarthropathies, which include ankylosing
spondylitis, psoriatic arthritis, inflammatory bowel disease, and
reactive arthritis (Reiter's syndrome), as well as related conditions of
the eye. They are also looking at new imaging methods that will help
with early and accurate diagnosis, guide treatment, and detect responses
to treatment. Research on new treatments is also underway.
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National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS)
http://www.clinicaltrials.gov/.
American Academy of Orthopaedic Surgeons
American College of Rheumatology/Association
of Rheumatology Health Professionals
Arthritis Foundation
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Ankylosing Spondylitis
