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Biology and Genetics - Arthritis Risk Factors

Background Information:

All types of arthritis share common symptoms of pain, swelling or stiffness in or around the joints. If left untreated, they can affect the structure and functioning of the joints, leading to increased pain, disability and difficulty in performing everyday activities (Russell et al., 2001). Although there is no known cure for arthritis at the present time, appropriate treatment has been shown to prevent disability, maintain function and reduce pain (Russell et al., 2001). While the precise nature of medical treatment will differ depending on the type of arthritis, general management and rehabilitation strategies are similar for all forms. Typically, once started, arthritis lasts for the rest of one’s life and has a course that fluctuates between exacerbations and remissions. Thus, care should be provided over the full course of the disease (Health Canada, 2003).

Health Risks:

Arthritis is a wide-spread problem throughout the world, with many people experiencing some form of the condition. According to the 2000 Canadian Community Health Survey (CCHS), arthritis and other rheumatic conditions affected nearly 4 million Canadians aged 15 years and older. Two-thirds of those with arthritis were women, and approximately 3 of every 5 people with arthritis were younger than 65 years of age (Health Canada, 2005). Several factors appear to give rise to arthritis, although the definite causal mechanisms are not yet fully understood. In addition to ageing, the most obvious risk factor for arthritis, research has proposed that genetic, hormonal, and biomechanical or “wear and tear” influences are important as well (Health Canada, 2003). Most types of arthritis are more common in women; an estimated 62% of all people with arthritis are women (Health Canada, 2003). Although older women are disabled from arthritis and related conditions at higher rates than males, there is an incomplete understanding of the determinants that place women at greater risks. For instance, females develop arthritis at rates greater than men (the ratio of women to men having arthritis is 1.36 for those age 65 and older) (Verbrugge, 1995).

Precisely how much heredity or genetics play a role to cause arthritis is not well understood. Familial clustering is a typical attribute of several different arthritic conditions which can be described by shared genetic or environmental factors or a mixture of these (Wordsworth, 1995). It is possible that some families may pass on the predisposition for defective cartilage; others may pass on minor defects in the way joints fit together (PHAC, 2009). Furthermore, certain genes are associated with a greater risk of particular types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematous (SLE), and ankylosing spondylitis (PHAC, 2009). Individuals in some certain occupations appear to have a greater risk of developing arthritis than other jobs. These are predominantly high demand occupations, for instance, assembly line workers and heavy construction workers (PHAC, 2000).

Arthritis can develop because of past joint injuries or joint inflammation, or diseases that affect the joints (such as diabetes). Joint injury can occur when joints are put under repetitive, high impact stress for lengthy periods of time. Particular exercises or sports may increase the likelihood of arthritis (PHAC, 2000). Numerous studies have recognized an association between obesity and arthritis. Excess weight could act through two different channels to cause osteoarthritis. Firstly, being overweight increases the amount of force across a weight bearing joint. This could induce cartilage breakdown simply because of the excess force which then leads to osteoarthritis (Felson et al., 1997). Secondly, obese individuals have gait patterns that differ from thin people such as walking with increased rear foot motion and with their forefeet abducted (Felson et al., 1997).

Risk Management:

Designing preventative approaches is crucial to the development of successful interventions for arthritis. While it is impossible to modify some of the determinants which make one susceptible to arthritis, such as age, gender and heredity, it is possible to lessen the likelihood of developing arthritis by embracing a healthy lifestyle. Labour force issues, such as shortages of both rheumatologists and orthopedic surgeons, are a concern that can be dealt with through more recruitment and training of experts in these areas (Health Canada, 2003). Given the many physical and mental advantages of regular exercise, it is critical to explore what factors play a role in an individual’s sedentary behaviours. In particular, several factors may contribute to lack of physical activity found in the Canadian population and in women specifically. Many external factors in women’s lives have been self-reported as explanations for not participating in regular physical activity (Nies, Reisenberg, Chruscial, & Artibee, 2003). Work conflicts, lack of energy, lack of time, care-giving duties, lack of access to convenient facilities, undesirable environments, and lack of social support are all reported obstacles to physical activity in women (King et al. 2000). However, King and colleagues (2000) found that walking is one of the most beneficial and simplest strategies for obese women to increase their physical activity levels.

The conventional approach to treatment of patients with arthritis has been pharmacological, usually in combination with physical therapy, and sometimes with surgery.  Research has shown that educational interventions are also successful in altering outcomes especially in areas of pain, psychological well-being and knowledge; and in changing behaviours in such areas as compliance, exercise, joint protection and relaxation (Hawley, 1995). When medical therapy fails to alleviate the pain of osteoarthritis of the knee, arthroscopic lavage or débridement is often recommended (Moseley et al., 2002). In uncontrolled studies of knee arthroscopy for osteoarthritis conducted by Moseley et al. (2002), about half the patients reported relief from arthritic pain. However, the physiological basis for the pain relief remains unclear. There is no evidence that arthroscopy cures or arrests the osteoarthritis (Moseley et al., 2002).

Useful Links:

Alliance for the Canadian Arthritis Program
http://www.arthritisalliance.ca/

The Arthritis Community Research & Evaluation Unit (ACREU)
http://www.acreu.ca/

Arthritis Consumer Experts
http://www.jointhealth.org/welcome.html

Arthritis Research Center of Canada
http://www.arthritisresearch.ca/

The Arthritis Society
http://www.arthritis.ca/splash/default.asp?s=1

Canadian Arthritis Network
http://www.arthritisnetwork.ca/

Institute of Musculoskeletal Health and Arthritis (IMHA)
http://www.cihr-irsc.gc.ca/e/13217.html

Further Readings:

Badley, E.M. (1995). The effect of osteoarthritis on disability and health care use in Canada. J Rheumatol, 22 (suppl 43), 19-22.

Badley, E.M., & Wang, P.P. (2001). The contribution of arthritis and arthritis disability to nonparticipation in the labor force: a Canadian example. J Rheumatol, 28(5), 1077-82.

Felson, D. T., Zhang, Y., Hannan, M. T., Naimark, A., Weissman, B., Aliabadi, P., et al. (1997). Risk factors for incident radiographic knee osteoarthritis in the elderly: The Framingham study. Arthritis and Rheumatism, 40(4), 728-733.

Hawley, D. J. (1995). Psycho-educational interventions in the treatment of arthritis. Bailliere's Clinical Rheumatology, 9(4), 803-823.

Health Canada (2003). Arthritis in Canada. An Ongoing Challenge. Ottawa: Health Canada.

King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F., & Brownson, R. C. (2000). Personal and environmental factors associated with physical inactivity among different racial ethnic groups of U.S. middle-aged and older-aged women. Health Psychology, 19(4), 354–364.

Moseley, J. B., O'Malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., et al. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med, 347(2), 81-88.

Nies, M. A., Reisenberg, C. E., Chruscial, H. L., & Artibee, K. (2003). Southern women's response to a walking intervention. Public Health Nursing (Boston, Mass.), 20(2), 146-152.

Public Health Agency of Canada. Arthritis. 06 Feb. 2009. Http://www.phac-aspc.gc.ca/cd-mc/musculo/arthritis-arthrite-eng.php. 13 Apr. 2009

Raina, P., Dukeshire, S., Lindsay, J., & Chambers, L.W. (1998). Chronic conditions and disabilities among seniors: an analysis of population-based health and activity limitation surveys. Ann Epidemiol, 8(6), 402-09.

Russel, A., Haraoui, B., Keystone, E., and Klinkhoff, A. (2001). Current and emerging therapies for rheumatoid arthritis, with a focus on infliximab: clinical impact on joint damage and cost of care in Canada. Clin Ther, 23, 1824-38.

Verbrugge, L.M. (1995). Women, men and osteoarthritis. Arthritis Care and Research, 8(4), 212-20. Wordsworth, P. (1995). Genes and arthritis. British Medical Bulletin, 51(2), 249-266.

 

Contributors:  Jelena Ivanovic

Last Reviewed:  June 4, 2012

 



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