Osteoarthritis generally starts giving people problems around age 55, right about the same time diabetes, if you have it, starts affecting the body as well. In fact, diabetes can affect the body by damaging the nerves that register sensation, especially in the feet. This damage can work its way up the body, affecting the nerves along the way. When the nerves get damaged, they can’t pick up the sensations, even sensations like pain.

So you see where we’re going here. If you have osteoarthritis, which is painful, and you have diabetes, which can interfere with your ability to feel pain, the diabetes could actually make it so you don’t feel the osteoarthritis pain. This could be big news for the people who have both, as well as the doctors who take care of them. We’ll use our extensive data to test this hypothesis and see if it may be accurate. But for now, we’ve got people thinking about it! You can read it for yourself on our website www.preventarthritis.org.

“Teasing apart the roles of injury versus exercise, especially participation in sports, it appears that the increased risk of knee [osteoarthritis] is not based on increased physical activity, but on increased risk of knee injury of particular sports, such as football,” says Lissa Fahlman, lead epidemiologist of the Arthritis Research Institute of America. It has been gathering osteoarthritis data on thousands of people since 1988 in the Clearwater Osteoarthritis longitudinal study.

“Similar to how weight-bearing exercise builds stronger bones, weight-bearing exercise also builds stronger knee cartilage, decreasing the chances of injury,” Fahlman says. “Other indirect effects include preventing being overweight, another important risk factor for knee [osteoarthritis] and preventing metabolic syndrome and diabetes,” both which are thought to possibly play a metabolic role in osteoarthritis.

The Warning Signs of Osteoarthritis

STIFFNESS is a joint after getting out of bed or sitting for a long time.

SWELLING in one or more joints

A CRUNCHING FEELING or the sound of bone rubbing on bone.

About a third of people whose x-rays show evidence of osteoarthritis report pain or
other symptoms. For those who experience steady or intermittent pain, it is typically
aggravated by activity and relieved by rest. If you feel hot or your skin turns red you
probably do not have osteoarthritis. Check with your doctor about other causes, including
rheumatoid arthritis.

Usually, osteoarthritis comes on slowly. Early in the disease, your joints may ache after
physical work or exercise. Later on, joint pain may become more persistent. You may
also experience joint stiffness, particularly when you first wake up in the morning or have
been in one position for a long time.

Although osteoarthritis can occur in any joint, most often it affects the hands, knees, hips
and spine (either at the neck or lower back). Different characteristics of the disease can
depend on the specific joints affected. For general warning signs of osteoarthritis, check
back later in the week for an article called The Warning Signs of Osteoarthritis. For
information on the joints most often affected by osteoarthritis, please see the following
descriptions.

Hands: Osteoarthritis of the hands seems to have some heredity characteristics; that is, it
runs in families. If your mother or grandmother has or had osteoarthritis in their hands,
you’re at greater-than-average risk of having it too. Women are more likely than men to
have hand involvement and, for most, it develops after menopause.

When osteoarthritis involves the hands, small bony knobs may appear on the end joints
(those closest to the nails) of the fingers. Ther are called Heberden’s nodes. Similar
knobs, called Bouchard’s nodes, can appear on the middle joints of the fingers. Fingers
can become enlarged and gnarled, and they may ache or be stiff and numb. The base of
the thumb joint is also commonly affected by osteoarthritis.

Knees: the knees are among the joints commonly affected by osteoarthritis. Symptoms
of knee osteoarthritis include stiffness, swelling, and pain, which make it hard to walk,
climb and get in and out of chairs and bathtubs. Osteoarthritis in the knees can lead to
disability.

Hips: The hips are also common sites of osteoarthritis. As with knee osteoarthritis,
symptoms of hip osteoarthritis include pain and stiffness of the joint itself. But sometimes
pain is felt in the groin, inner thigh, buttocks or even the knees. Osteoarthritis of the hip
may limit moving and bending, making daily activities such as dressing and putting on
shoes a challenge.

Osteoarthritis Basics: The Joint and Its Parts

A joint is the point where two or more bones are connected. With a few exceptions (in the skull and pelvis, for example), joints are designed to allow movement between the bones and to absorb shock from movements like walking or repetitive motions. These moveable joints are made up of the following parts:
Cartilage: a hard slippery coating on the end of each bone. Cartilage, which breaks down and wears away in osteoarthritis, is described in more detail below.

Joint capsule: a tough membrane sac that encloses all the bones and other joint parts.

Synovium: a thin membrane inside the joint capsule that secretes synovial fluid.

Synovial fluid: a fluid that lubricates the joint and keeps the cartilage smooth and healthy.

Ligaments, tendons, and muscles are tissues that surround the bones and joints, and allow the joints to bend and move. Ligaments are tough, cord-like tissues that connect one bone to another. Tendons are tough, fibrous cords that connect muscles to bones. Muscles are bundles of specialized cells that, when stimulated by nerves, either relax or contract to produce movement.

A. Dear RD,

You asked seemingly simple and direct questions. I would like to be able to answer in the same manner.
Unfortunately, it is not quite as straight forward as we would all like. There is no one test to tell if you have osteoarthritis in your hands and your feet. Unlike some of the rheumatoid forms of arthritis, there are no blood tests or other tests currently available to diagnose or stage Osteoarthritis. Now, as in the past, Osteoarthritis is diagnosed clinically by a doctor asking questions and doing an exam. Some of the questions include: which joints are involved? do they hurt? when do they hurt? are they swollen? are they misshapen? have you lost strength? are there activities that you limit or avoid? did your joints change suddenly or over time? is there anything that makes them feel better? anything that makes them feel worse?

If an x-ray machine is available, a doctor might follow the physical exam with x-rays. Signs of Osteoarthritis on x-rays included joint space narrowing, , thickening of the edges of the bone, bone spurs, erosions under the edges of the bone, and bone deformities. Severe Osteoarthritis might show the ends of two bones touching. Additionally, there are now other imaging methods including CT’s and MRI’s. Both of these show about the same information as the x-rays – and then some. They provide 3-D rather than 2-D images and also show the soft tissues in addition to bone. Theoretically, MRI’s and CT’s would be able to diagnose Osteoarthritis at earlier stages than can be done in the x-rays, but to my knowledge guidelines for earlier diagnosis are not available yet.

A bone density test won’t tell you whether or not you have Osteoarthritis, it will tell whether you have osteopenia or osteoporosis. So, while it is helpful to know whether you have lost bone density, that particular test won’t tell you anything about whether you have Osteoarthritis in your hands or feet.

Part of the problem with diagnosing Osteoarthritis is that it appears to have some aspects that may be the same for every possible Osteoarthritis site in the body and there are some differences based on the specific joint(s) involved. This has complicated both the diagnosis and treatment of Osteoarthritis. That is one of the reasons that The Arthritis Research Institute of America is studying this very common disease which causes many people so much difficulty – we still just don’t know that much about it. The Clearwater Osteoarthritis Study (COS) has collected information for 20 years on hands, feet, knees, and necks as well as lifestyle information. As more data becomes available for analysis, we will be sharing the results of our findings in published papers, on our website and in our blogs.
Please see the recent and upcoming blogs for more specifics on what we are working on now.

Dr. Lissa

Who knew a self administered survey with just over 130 questions, a physical exam and a few x-rays could be such a gold mine?! As ARIA’s biostatistician, I have the privilege of working with top epidemiologists to unravel some of the mysteries of osteoarthritis. There is still is so much to be learned about its etiology, diagnosis, and prognosis. Osteoarthritis can be defined in several ways: clinically, radiographically, and/or symptomatically. Interestingly, the experts cannot arrive at a conclusion of which definition to use; there are so many factors to consider. The old paradigm that osteoarthritis is the “wear and tear” form of arthritis is making room for one that considers it a systemic disease, much like cardiovascular or coronary disease, even diabetes.

One of ARIA’s goals, as I see it, is to add to what is known about osteoarthritis and untangle the many pathways to this disease. Present and future epidemiological, clinical and genetic research may eventually provide a consensual definition for osteoarthritis. One of the challenges researchers face when sorting through previous research is trying to draw conclusions about a topic when there are multiple definitions for an outcome. Multiple definitions make comparing results difficult and obstruct definitive conclusions. Any information ARIA can add to osteoarthritis research brings the research community one step closer to correctly defining this disease. Personally, I am awed that my statistical skill provides information on the distal and proximal risk factors of osteoarthritis. Needless to say, I take
my job of analyzing this data very seriously as it could reveal modifiable and unmodifiable risk factors
that may one day eliminate or greatly reduce my own disability from arthritis.

When not investigating associations of factors with osteoarthritis, I enjoy exploring Florida’s waterways and beaches. These excursions are a family affair. I am accompanied by my husband and three small children (aged 3.5yrs, 1.88yrs, and 0.33yrs). Born and raised in the City of Chicago, I am a Romanian American and first generation college graduate. I vaguely remember the ’85 Bears and the citywide celebration… wasn’t much of a football fan at the time. I am grateful to be living in Tampa Bay… I am a warm weather lady! Two interesting coincidences: my neighbor’s house was transported down the road from ARIA’s previous directors’ grandfather’s property and Dr. Barrett, founder, has traveled to
Romania numerously. My feeling is that I am meant to be a part of ARIA.

Because we rely so heavily on volunteers (over 4000 volunteer participants and staff members since 1988) our studies are very low cost. To me, it’s exciting to be part of something important enough to 4000 other people that they’ve volunteered their time and talent to be a part of it too. There’s just nothing like being part of something this big and
impactful!

There are lots of opportunities for others who would like to volunteer. We’re headquartered in Clearwater, FL and right now we have an urgent need for people to help with our data integrity project. It doesn’t require special skills, just a willingness to learn. Call our office at 727.461.4054 if you think you might be interested. We’re open 8:30-4:30 every day but we
also have some evening shifts available if that suits your schedule.

Memories of my grandmother as I was growing up in northern Minnesota, vivid as they are, did not directly propel me into arthritis research. I spent my latter teens, 20’s, and early 30’s in exploring parts of Alaska via commercial fishing and working for the US Forest Service. I managed to earn a BS in Math during this time, as well. Next I followed my interest in health and complementary medicine, attending Western States Chiropractic College in Portland, Oregon. I began practicing in the Portland area; then bought a small practice on the Eastern Shore of Virginia. This
was a very interesting place to live and practice. In this medically under-served area, settled by whites and black slaves in the 1600’s (Martha Washington’s family had a plantation here), it was not uncommon to treat patients who were related and had problems. In treating multiple generations in some families, I was able to see what similar problems looked like in different life stages, but in real time. As would be expected, many of the older people I saw had complications due to arthritis. Many of the younger people I saw had injuries that would likely lead to arthritis. The middle-aged folks were in transition, beginning to experience some of the earlier symptoms of arthritis. This progression that I observed in my patients mirrored what I was seeing in my own family.

Although I loved my practice, in 2005 I sold it following a car accident that left me  physically unable to continue to treat patients. Combining both my educational backgrounds (math & health), health research seemed a logical next step. In 2009, I graduated from the University of South Florida in Tampa with a Master’s of Public Health in Epidemiology. I began working with the ARIA research team in 2010. I am very excited to be able to apply my professional, educational, and personal experiences and observations in osteoarthritis research. As we are able to access
more of the COS data, I anticipate new findings which may, some day, lead to preventing and more effectively treating osteoarthritis. It is my hope that the next generations of my family and your, won’t experience what my grandmother did.

My relationship with ARIA began in 1985, when I was Acting Director for Epidemiology and Biometry at the National Heart, Lung and Blood Institute at of the National Institutes of Health in Bethesda, Maryland. I had just accepted a new position as founding chairman of the Department of Epidemiology and Biostatistics in the new College of Public Health at the University of South Florida (USF) in Tampa. Early that summer, a quiet young man appeared at my door and asked for a few minutes of my time. He was Brian Burke, who had just begun working for a brand new research institute, ARIA, in Clearwater. Because I was administratively responsible for the Framingham (Massachusetts) Heart Study, upon
which ARIA was modeled, he wanted to discuss some of the study design and data management issues. He was surprised to learn that I would soon be moving to the Tampa Bay area; a happy coincidence. I readily agreed to meet with Dr. Barrett and his staff shortly after that time. Thus began a long and, though intermittent, fruitful collaboration. Sometime after my retirement (2001) from USF, Dr. Barrett informed me that “I had flunked retirement” and would I become the new director of research at ARIA? Once again, I readily agreed. There was one caveat; I would continue in this capacity as long as it was fun. Now, after 18 months on the job, it is more gratifying than I could have imagined. Although all three
of us on the research staff are part-time, we all very much enjoy working together and analyzing the valuable and voluminous ARIA data sets.

In the late 1980s, under the clear leadership of Dr. Barrett, with the advice of many scientists from around the country, the Clearwater Osteoarthritis Study (COS) took shape and became a reality. There is no question that the COS has become one of the most (if not the most) valuable data sets in the world by which to investigate the onset and natural progression of osteoarthritis (OA). Approximately 500 different variables have been recorded on over 3,700 volunteers over a 22-year period of time. Several subjects have data available for over ten years. Such longitudinal information is in persons with varying stages of OA provides the backbone of this epidemiologic study.

To date, there have been several ARIA publications adding to the scientific literature on the causes and progression of OA. However, in my opinion, the potential of the full data set has hardly been tapped. It is clear to all of us that many outstanding scientific contributions to the field are on the horizon. To ensure a scrupulously “clean” data set as we began new analyses, a project was launched a few months ago. We have labeled it the “Data Integrity Project” (DIP) and, with the unswerving, ongoing devotion of many ARIA volunteers, the entire COS data set is being re-entered and checked. A special report on the DIP will appear in a later newsletter.

The ARIA research staff consists of Epidemiologist Lissa Fahlman, DC, MSPH, Biostatistician Emmeline Sangeorzan, MPH, and me. To augment our capabilities, and taking advantage of the growing recognition of COS’s value, we have been gradually increasing our collaborative arrangements with scientists from other institutions. At this time, established investigators from the Universities of South Florida (Colleges of Medicine and Public Health), Georgia, Miami, Oxford University (UK), the National Center for Health Statistics, and The Florida Knee and Orthopedic Center, are involved in cooperative COS studies with ARIA staff. We are also ably assisted by a succession of graduate students from the
Department of Epidemiology and Biostatistics of the USF College of Public Health.

Enough of the Data Integrity Project has been completed that we are currently in the process of analyzing factors related to the early onset of knee osteoarthritis. Special reports on these and other important ARIA investigations will appear in forthcoming issues. Pardon the cliché, but it truly is an exciting time at ARIA. Every day, my staff and I are grateful for the many volunteers who are working so diligently to make possible all the current and forthcoming studies.

For additional information please visit www.preventarthritis.org.