Arthritis is sometimes depicted in advertisements as a disease of inevitability. It’s something that just happens because of old age and sport injuries. You just have to live with it.
Fortunately, thanks to new discoveries at places like the Krembil Research Institute in Toronto, that mindset is changing. In fact, new research by Krembil suggests that rather than seeing osteoarthritis as an isolated disease, having arthritis actually increases your risk of other chronic conditions, including heart disease.
“It is the most common chronic disease, particularly in older people,” says Dr. Elizabeth Badley, an epidemiologist and senior scientist at the Krembil Research Institute in Toronto. She says that about 1 in 7 people in Canada have osteoarthritis, and it’s the most common cause of disability.
And when it comes to being a risk factor for heart disease, there are lot of theories.
“For example, one of the theories suggests that one of the causes of heart disease may be inflammation,” says Dr. Badley. “And even though osteoarthritis isn’t thought of as inflammatory, it does have an inflammatory component, so it could be the inflammation associated with osteoarthritis that’s causing the heart disease.”
“It also could be that people with osteoarthritis develop disabilities. They are less physically active, and that could contribute to heart disease,” says Dr. Badley. Her population studies have also found that the heart disease risk factor seems to occur mostly in women, so there could even be a metabolic or biological reason. No one knows at this point, but so far the suggestion is that the more joints that are affected, the greater the risk.
Osteoarthritis and nerves
Dr. Jason McDougall, a professor at Halifax’s Dalhousie University in the Department of Pharmacology, Department of Anesthesia, Pain Management & Perioperative Medicine, is looking at the role of nerves in osteoarthritis.
Nerves are there to sense if our joints are moving, and if the joints are moving incorrectly, that manifests in a pain response. These nerves, says Dr. McDougall, can also contribute to inflammation. “The same nerves that are sensing the pain can release chemicals that can produce inflammation.”
According to Dr. McDougall, it seems counterintuitive: pain is usually a good thing, that warns us when something is wrong, and inflammation is there to help repair any injury. But when it’s out of control, Dr. McDougall points out, the inflammation can cause joint injury. Why the nerves are still firing and sensing pain after the injury has repaired itself is part of his research.
“We find that when you look at the nerves in arthritic joints, they don’t look normal any more. There’s damage to the nervous system. We’re trying to understand what the components are of this self-feeding circuit of pain, inflammation and further damage, and what we can hopefully do is intervene with sophisticated pharmacological approaches to stop that cycle of damage and pain,” says Dr. McDougall.
An underfunded disease
Osteoarthritis isn’t an in-your-face disease, so it doesn’t get the level of funding that life-threatening diseases receive from the government or from philanthropic endeavours. “When I first came [to the hospital] in the early ’90s and I was talking to various colleagues, they would say, ‘Why are you doing research on arthritis? It’s not important,’” says Dr. Badley. “Thankfully things are changing, but there is a long way to go.”
“I think, and this is personal opinion, that we’re not allowed to talk about pain,” she says. “If someone says, ‘How are you?’ The answer is supposed to be ‘Fine.’” People with osteoarthritis seem to be expected to suck-it-up and deal with it.
“Recently my colleague, Dr. (Anthony) Perruccio, and I have highlighted that there are hardly any papers on osteoarthritis at North American public health and epidemiology conferences, even though it affects a lot of people.” says Dr. Badley. “There seems to be little interest in this very common and disabling disease. How can we put osteoarthritis on the map? We need to increase awareness of the impact of osteoarthritis and a need major infusion in research funding.”
Groundbreaking treatments
Currently, there is no effective treatment to cure osteoarthritis because the cause of the disease remains unknown. But there has been significant progress in improving symptoms and decreasing disability. Dr. Aileen Davis, a physiotherapist and clinical epidemiologist at the Krembil Research Institute, is currently studying models of care for people with mild to severe osteoarthritis and ways to improve services. One of those ways is through a study that is implementing a patient education and targeted neuromuscular exercise program, with roots in Denmark.
“There are multiple, multiple studies showing that exercise is effective on osteoarthritis,” says Dr. Davis. The GLA:D (Good Life with Osteoarthritis in Denmark) program has shown that specific exercises focusing on proper joint positioning and muscle functioning can help increase stability, reducing pain and increasing function in joints. “People say that they can play on the floor with their grandchildren again,” she notes, and they are able to increase their physical activity. This is critical as physical activity is so important for overall health and managing other chronic conditions.
This content was produced by The Globe and Mail's Globe Edge Content Studio, in consultation with an advertiser. The Globe's editorial department was not involved in its creation.