The number of people age 65 and older in the US who have arthritis or chronic joint symptoms is expected to double by the year 2030 to more than 41 million people, according to the Centers for Disease Control and Prevention (CDC). This "arthritis boom" coincides with the aging of the "baby boomer" population, but age isn't the only reason for the dramatic rise and resulting burden on individuals and the health care system.

Including those younger than 65, the number of people with arthritis alone will reach 60 million by the year 2020. Arthritis comprises more than 100 different diseases and conditions (most common are osteoarthritis, rheumatoid arthritis, fibromyalgia, and gout) and is already the leading cause of physical disability in the nation. Medical care and lost productivity costs are expected to reach a staggering $100 billion by then, so it's no wonder that arthritis prevention and treatment has become a major focus of national and state efforts.

In very general terms, Webster's defines arthritis as "inflammation of joints due to infectious, metabolic or constitutional causes." Many of those causes, such as poor diet, too much weight and not enough exercise, are under our control. And "new" causes such as too much stress on joints from over-emphasis on one sport, particularly among younger people, are becoming increasingly obvious to many physicians and researchers. (See the HealthLink article Minimizing the Risks of Organized Youth Sports for more information on this topic.)

"The fact that baby boomers are aging is obviously a major factor in the big increases we are seeing." said Mary E. Cronin, MD, Medical College of Wisconsin Associate Professor of Medicine (Rheumatology). "I think what has been in the news recently about obesity and lack of exercise are very important concerns. Obesity without a doubt contributes to osteoarthritis, so we will see more, especially with the general trend of children not exercising enough. Dr. Cronin practices at the Froedtert and The Medical College of Wisconsin Rheumatology Clinic.

"Or, in the other extreme for some children, they are concentrating on one sport. That has been in the news as well, and there is a real concern. The more you concentrate on one sport, the greater the chance of having a traumatic injury that can 'open the door' to arthritis. So, pediatricians are seeing more sports-related injuries in young people as kids overdo it, and we'll see more arthritis in them down the line because of it."

New Medications Making a Difference

All may not be lost in the battle against arthritis, as progress is being made in developing new drug therapies and public awareness about forms of prevention and treatment grows. "Right now is really a good time to be a rheumatologist," said Dr. Cronin. "For the inflammatory arthritides such as rheumatoid arthritis and ankylosing spondylitis, we have new medications that really make a difference in people's lives. They help shut off the disease.

"Many of the new medications are in the family of 'biologics'. There are several major brands that people may be aware of because of advertisements on television. They are 'anti-tumor necrosis factor' substances. Do they stop the disease so that it never comes back? No. If patients stop the medicine, the disease comes back. So we have no way of stopping the disease forever. Maybe we'll have that sometime in the future."

"There is also lot of research in osteoarthritis right now. One of the areas of research is treatment with antibiotics, specifically minocycline. There are some data to support its use in people with the disease. It appears that if you don't already have the disease it does not prevent you from getting it. But the patients with osteoarthritis who started minocycline as opposed to placebo did better over the course of about eighteen months.

Antibiotics help in the treatment of osteoarthritis not by fighting infection, which is the "traditional" antibiotic role, but by their impact on enzymes. "It is because these antibiotics also affect certain enzymes present in white blood cells that can break down cartilage," said Dr. Cronin. "It is probably the inhibition of those enzymes that helps in osteoarthritis."

Advice for Prevention and Treatment

Dr. Cronin offered three critical areas for arthritis prevention and treatment: exercise, weight control and physical therapy. "Physical therapy plays a huge role," she said, "and it is not that people need to go to physical therapy for life. They need to learn the exercises, and then do them for life.

"Weight control is a big factor. Kids and adults, be active, watch your weight, and eat appropriately." The data show that calcium intake is very important, particularly in women, for both osteoporosis and perhaps osteoarthritis as well. "People shouldn't be drinking a lot of sodas. They should drink milk or water. There is no nutritive value in sodas. I think mothers have always been right: everything in moderation. People can have some, but not too much."

For older and younger people who already have joint conditions, Dr. Cronin said, maintaining muscle strength is key. "Keep muscles around those injured joints strong to support the joint," she said. "That is the bottom line, that and keeping the weight off."

Alternatives Being Studied; Buyers Beware

Rheumatologists are not ignoring alternative therapies and nontraditional dietary supplements, said Dr. Cronin, but she cautioned against expecting too much before research is more complete. "In rheumatoid arthritis," she said, "physical therapy and weight control are important but we also need to control the inflammation. There may be something to specific alternative therapies, but we need more data."

Patients who are exploring different dietary supplements for any condition were strongly encouraged by Dr. Cronin to be very selective in their purchasing. "I suggest buying supplements made by major US companies," she said. I'd avoid products made overseas by non-US companies. Quality control and corporate concerns about reputation and quality make the bigger US companies better sources of such products, she said.

"Even with the new medicines, there are patients that do not respond," said Dr. Cronin. "The current medications are not the magic bullets that everyone hoped they would be. There is a lot of work ahead of us, but I think there is real promise in the future. We, as a society, made an investment years ago by supporting research in the basic sciences. It's really paying off for us now with the wonderful new treatments, but there is still long way to go for cures."