Scientists know that the destruction of joints in people with arthritis can occur without their knowledge; and at other times it seems the progression of the disease is quite obvious with swollen joints, the inability to move, pain, and disability. There have been some studies that have found that these clinical symptoms sometimes will happen without any signs of joint wear and tear.

There are studies in the Journal of Rheumatology on Rheumatoid Arthritis and Osteoarthritis that focus on the relationship of clinical symptoms with using x-rays to measure joint deterioration. These studies used different approaches and they arrived at different conclusions, they did, however, have the same common point for the doctors and patients: Keep your guard up when treating arthritis symptoms. People with OA, if they are pursuing new treatments rather than just finding ways to adapt to pain and impairment, may actually delay, for years, joint damage that will restrict your activities . People in the early stages of RA, using constant and consistent control of their inflammation may slow down the development of joint damage.

Rheumatoid Arthritis.

The RA study was part of a larger ongoing study that was done by the Finnish and it focused on the early stages of RA, when joint damage is the most rapid. Scientists wanted to see if immediate and consistent control of the clinical symptoms, like the swelling and tenderness, would result in less actual joint damage in the later years of the life of the RA. The study consisted of 195 people who were being treated with different combinations of antirheumatic drugs. The people participating averaged in age of 48 years old, and 62% of them were women. The joint swelling and tenderness in their wrists was measured at the beginning of the study and then again at three months, six months, one year, two years, three years, and four years.

X-rays were taken at the beginning of the study; and 43% of the wrist that doctors examined were swollen, and 35% were tender. Four years later and with the help of medications, there were just 15% of the wrists swollen and 20% were tender and five years later the x-rays showed that there was arthritic erosion in 36% of those wrist.

The key to these results is not in the overall numbers, but in which joints ended up with the damage. There were 82% of the wrist that were swollen during the first year of the study and during the follow-up exams they developed erosion of the joint. For those who started the study with no swelling or tenderness, theirs came up in the later years and only 11% of those showed erosion. Also, 66% of the wrists that were tender during the first year and at follow-up, developed erosion, while only 7% of the wrists that were never tender developed erosion.

The conclusion reached by the scientists for anyone with RA is that early and continuous treatment of the inflammation goes way beyond controlling the symptoms and actually it does help to slow or even prevent permanent damage to the joint over the long run. The scientists did stress however that just because the arthritis is in remission of symptoms, it is not reason to stop or reduce treatments or therapies.

There were drawbacks to this study that were small and that doesn't account for the wrists that never showed any swelling or tenderness but yet developed erosion. It can't be said whether some of the participants may have had flares of swelling and tenderness and they just missed them, although I'm not sure how that could be because when I have a flare, I always know it, or if there were instances where joint erosion was disconnected from the swelling and pain symptoms. Yet another possibility is that the x-rays just weren't strong enough to pick up on all the joint damage.
Osteoarthritis.

Now, for the study on OA, a Canadian study, also sought to explore the relationship between symptoms and long-term, objectively measured conditions of the joints. They chose people with improvement in the way they felt and who also had improvements in the actual degree of the conditions of the hip and knee joints. The studying of reasons for real improvements like this, could point to ways to help others enjoy similar healing. However, and in contrast with the RA study, the OA study did not turn up any links between the way those who participated reported feeling and the underlying progression of the disease. The 43 people who participated in this OA study had moderate to severe OA and they had participated in a previous OA study but they didn't have hip or knee replacements. The average age at the end of the seven year study was 76, and of the 43 people who participated, 77% were women.

At the beginning of the study and after the seven years, those who participated completed a questionnaire about their pain, function, and stiffness in their knees and hips and bout their use of walking aids, their general health, and health changes. The medical staff measured the range of motion and flexibility of the joints of those who participated. Tenderness, pain (when they put pressure on the joint), swelling, and warmth in the joints were also measured. Radiologists took x-rays of the knees and hips and graded the OA damage of each participant.

The responses on the questionnaire of those who participated, indicated that on the average, pain was unchanged and disability had increased over the seven year period of the study. The exception being of hip flexibility and range of motion in the left knee, which was unchanged, the averages showed that the flexibility of the joints had deteriorated. The averages of the condition of the joints seen in the x-rays showed that the joints either stayed the same or worsened.

But the averages didn't tell the whole story and for many of the measures there was a small, but significant, number of those who participated that showed some improvement. The self-reported pain showed that 25% improved, 19% said that they had improvement of their physical function and some of those who participated had some improvement in their hip or knee flexibility. In the clinical measures of swelling, tenderness, warmth, and pain there was 26% of those who participated that said they had improvement in their hip disease and 45% with some improvement to their knee disease. Even the x-rays showed up to 25% of those who participated had some improvement in a joint. But these improvements didn't show any significant associations between the changes, and those who participated, who reported improvements on their questionnaires, were no more likely than others to have improved clinical symptoms or x-ray scores.

The scientists have tried to explain why a quarter of those who participated could report improvements on the questionnaires, in the absence of any real clinical improvements, their suggestion is that those who reported these improvements had learned how to live with OA better. Some of the adaptions that the participants may have taken are steps to reduce their pain, and getting help with or eliminating painful activities like climbing stairs or sports and this also includes the possibility of higher pain tolerance.

The only caution the scientists give to doctors is that, while such coping is good, they shouldn't be complacent and ignore the wider picture and that the well-being their patients might continue, with additional medical or surgical treatment.
This study's small size, the insensitivity of the x-rays to joint changes over time, and using two sets of measurements over a seven year period of OA are the limitations of this study. OA is a condition that is notorious for flare-ups and the onset of these flare-ups can vary and are unpredictable.