The Age of Arthritis

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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. It's almost as if we were watching the formation of an epidemiological perfect storm. Across Asia, as across the world, you have an ever-expanding population that's living longer than ever before. You have old cultural and societal habits (squatting, praying) and newer ones such as high-impact exercise and video gaming that are adding more and more stress onto the body, essentially putting a down payment on pain and discomfort later in life. Top it off with a generation of Asians who are heavier than previous ones and whose weight is literally squeezing the life out of their joints. All this on a continent where education about arthritis is limited, as is the expertise needed to treat a surging demand.

In the U.S., estimates show there are 20 million people with arthritis, a number projected to grow to 40 million by 2020. Getting a statistical measure across Asia is more difficult. And other, more deadly diseases tend to grab more attention. But when you consider the estimates that do exist for Asia's arthritis victims—150 million in India, at least 65 million in China, 10 million in Japan, 1.6 million in Taiwan—along with unanimous testimony from doctors that the number of arthritic patients is rising significantly, it creates a picture that, for Asia's nations and health-care budgets, looks a lot like arthritis itself: painful in the short term, potentially crippling down the line.

What's more, many would-be patients don't know that something can or needs to be done, or they don't have enough information to make an informed (and safe) decision about their care. "Arthritis is a huge problem in our society," says Dr. Koh Wei Howe, president of Singapore's Rheumatoid Arthritis Society. "There are many sufferers out there who are not aware of the available treatments. Some don't even recognize that they have arthritis."

There exists, however, the possibility of some relief amid all the aches and pains. Researchers are paying a lot more attention to osteoarthritis these days. 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 patients hoping for a quick fix are likely to be disappointed, scientists are starting to gain the kind of insights that can lead to more effective treatments and 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, suffering a football injury or spending day after day stooped over in a field 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'. 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 Rush—Presbyterian—St. 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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