Then one day, right in the middle of a fencing match, his right knee began to hurt. “It was a deep pain, way inside my knee, a pretty intense soreness that lasted through the match and really bugged me,” Mark said. Afterward, he iced his knee, and the pain went away. But it began to bother him now and again, often during fencing, and also when he was jogging or in the bent-knee stance of karate. When the pain became present more often than not, Mark went to see a sports medicine doctor.
“Sounds to me like osteoarthritis,” his doctor said. An X-ray confirmed that the cartilage in his knee was “rough” and quite thin. “Arthritis!” Mark exploded. “But that’s for old people. I’m only 35!”
Two years later, Mark’s osteoarthritis is pretty well under control. He rarely has pain, unless he stands in line for long periods of time. And although he has given up certain knee-thrashing sports (such as football, karate, and fencing), he has found that he’s still physically able to do just about whatever he wants.
“I chalk my recovery up to two main things,” Mark says. “Losing weight and switching activities. Once I dropped that extra 20 pounds I’d been lugging around, my knee pain also dropped about 50 percent. Then I started swimming every day — a real boon to my joints since I could keep them loosened up without the slamming impact of jogging or jumping rope. Yoga has also helped me gain some flexibility while getting rid of some tension. And I’ve been taking a few supplements that seem to help. All in all, I feel like a brand new guy.”
Chapter 3
A War Within: Rheumatoid Arthritis
IN THIS CHAPTER
Rheumatoid arthritis (RA) is a case of the human body’s good intentions gone awry. Your body is equipped with a very effective immune system that fights off bacteria and other foreign bodies. Specialized immune cells attack these invaders, surround them, paralyze them, and destroy them. A strong, intact immune system is absolutely essential to your survival — without it, you would quickly become consumed by infections and disease. But if your immune system should suddenly go haywire and start attacking your body’s own tissues, it could become your worst enemy. Such is the case with RA. When you have RA, your immune system attacks the tissues that cushion and line your joints, eventually causing entire joints to deteriorate.
RA doesn’t have to be all bad news though; check out the sidebar “Overcoming RA: Lucy’s Story” later in the chapter to learn how actress Lucille Ball stayed active and healthy until the end of her life, despite having rheumatoid arthritis.
Turning on Itself: When the Body Becomes Its Own Worst Enemy
For reasons that aren’t completely understood, in rheumatoid arthritis the white blood cells of the immune system attack the joint lining (synovial membrane) as if it were a foreign object. And pain, swelling, loss of movement, and joint destruction are the unhappy results. After the immune system goes to work on the joint lining, here’s what happens:
1 The assaulted membrane becomes inflamed and painful, the entire joint capsule swells, and the synovial cells start to grow and divide in an abnormal way.
2 Almost as if they’re launching a counterattack, these abnormal cells invade the surrounding tissue — mostly the bone and cartilage.
3 The joint space begins to narrow, and the joint’s supporting structures become weak. At the same time, the cells that trigger inflammation release enzymes that start eating away at the bone and cartilage, causing joint erosion and scarring.
4 Reeling under this many-sided attack, the joint itself deteriorates, eventually becoming misshapen and misaligned.
See Figures 3-1 and 3-2 for comparison of a healthy joint to one with RA.
© John Wiley & Sons, Inc.
FIGURE 3-1: In the healthy joint, the synovial membrane is thin and free from inflammation; the cartilage is smooth, thick, and even. The joint space is well defined, and the joint capsule assumes a normal shape.
© John Wiley & Sons, Inc.
FIGURE 3-2: In the joint affected by RA, the synovial membrane is inflamed and swollen, with infected cells invading both bone and cartilage. The cartilage is thin, the joint space narrowed, and the joint capsule swollen.
Rheumatoid arthritis insidiously makes its way through the body and (in more severe cases) can eventually spread to all of the joints. But the joints are not its only targets. RA is a systemic disease capable of attacking various parts of the body, not just the joints. It can cause inflammation of the eyes, skin, heart, blood vessels, and lungs, generally wreaking havoc on the body as a whole.
Some people have RA for just a short time — a few months or a couple of years — and then it disappears forever. Others suffer through painful periods (flares) that come and go, although they can feel quite well in between episodes. Those with severe forms of RA, however, may be in pain a good deal of the time, experience symptoms for many years, and suffer serious joint damage.
Recognizing the signs and symptoms of RA
If you have rheumatoid arthritis, the first thing you may notice is a dull ache, stiffness, and swelling in two matching joints — for example, both elbows, both knees, or both index fingers. The most typical sites for RA are the fingers and wrists, but it can also settle in the hands, elbows, shoulders, neck, hips, knees, ankles, and feet. See Figure 3-3.