HOWARD SCHATZ FOR TIME HANDS: Osteoarthritis predominates in the knuckles of the fingers and the base of the thumb

The Age of Arthritis
	We're headed for an epidemic of joint disease. What you can do to protect yourself
	By Christine Gorman and Alice Park

Posted Sunday, December 1, 2002; 10:31 a.m. EST
The first sign is often a twinge in your knee or your back or some stiffness at the base of your thumb. Or maybe you're getting out of the car and a sharp pain shoots down your leg from your hip to your calf. "Nothing serious," you think. "I must have just strained something. I'm too young to have arthritis."

Think again. If you are within even shouting distance of middle age, chances are you have osteoarthritis, a degenerative disorder in which the cartilage—the natural shock absorber that cushions the insides of your joints—begins to break down. Doctors used to think of it as a disease of old age, but they now believe that this form of arthritis, the most common of about 100 types, begins its relentless, initially painless course when you're still in your 30s, 20s or even younger. Most of the time you won't suspect anything is wrong until you're in your 40s or 50s and begin to feel those telltale twinges, signs that the disorder may be starting to affect your bones. By then the damage has been done, and even the best treatments can't do much more than ease the pain and try to maintain the status quo in what are already degenerating joints.

The situation with arthritis is about to get worse—a lot worse— and very soon. At present, doctors believe that osteoarthritis affects more than 20 million Americans. By 2020, that number is expected to reach 40 million. (More on why in just a bit.) Some experts are starting to think that even the current situation is more dire than anyone had realized. In October, researchers from the Centers for Disease Control and Prevention published the results of the first nationwide survey measuring the total burden of arthritis and chronic joint symptoms. Their sobering conclusion: one-third of all American adults suffer from some type of joint disease.

It's almost as if we were watching the formation of an epidemiological perfect storm. First you have the demographic bulge of the baby-boom generation heading into its 50s—prime time for arthritis. Add five decades of jogging (in less than perfect form), high-impact aerobics and fast-breaking sports like football, soccer, tennis and basketball, whose quick stops and sharp pivots do maximum damage to the knees and hips. (Gen Xers can look forward to the effects of video games on the thumbs, another body part that's particularly prone to osteoarthritis.) Finally, top it all off with a generation of Americans who are heavier than ever and whose weight is literally squeezing the life out of their joints.

There may be, however, some relief amid all the aches and pains. Researchers are starting to pay a lot more attention to osteoarthritis. They have discovered that what they thought was a fairly straightforward mechanical breakdown of the joints is a much more complicated process with lots of component parts. Although this means that any patients who expect a quick fix are likely to be disappointed, scientists are starting to gain the kind of insights that can lead to more effective treatments, not to mention better strategies for heading off trouble before it begins.

How complex a process are we talking about? Doctors used to think that cartilage was the beginning, middle and end of the osteoarthritis story. Now they know that cartilage is important, but so is everything that surrounds it—muscles, bones, tendons and ligaments. The damage caused by wearing ill-fitting shoes or suffering a football injury can certainly give rise to arthritic joints. But the worst problems often stem from basic differences in the body's biochemical makeup. For example, some people's cartilage seems to resist damage better than others. (Scientists are tracking several genetic variations.) In addition, researchers have discovered an array of biochemical messages that are traded between bones, muscles and other parts of the body and play a key role in keeping joints healthy. "Ultimately, we think it's the biochemical approach that's going to solve the riddle of arthritis," says Dr. Mitchell Sheinkop, an orthopedic surgeon at the Rush­Presbyterian­St. Luke's Medical Center in Chicago. "Someday you may pop a pill and your cartilage will continue to grow, but that's 10 years away—at least."

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