Arthritis is a term for any of more than one hundred diseases that produce swelling in a joint, accompanied by pain and stiffness. The most common forms of arthritis are osteoarthritis (the degeneration of a joint) and rheumatoid arthritis ("the great crippler," inflammation of a joint that erodes bone and cartilage). Other forms include gout (caused by too much uric acid accumulating in the blood and most often affecting the big toe joint), ankylosing spondylitis (inflammation of spinal joints, mainly affecting young men), infectious arthritis (caused by invading microorganisms), and chronic Lyme arthritis (which appears in some people who contract Lyme disease). Lupus, an autoimmune disease, also has elements of arthritis, with painful and often swollen joints.
Neanderthal skeletons show signs of arthritis, as do Egyptian mummies. Ancient Greek and Roman physicians wrote detailed descriptions of arthritic conditions and methods of treatment. In fourteenth- and fifteenth-century Europe, gout became common among members of the upper classes, and an outbreak of rheumatoid arthritis swept through the masses of Europe during the Industrial Revolution. By the early nineteenth century, rheumatoid arthritis had been recognized as a distinct condition, separate from gout. Augustin Landre-Beauvais gave rheumatoid arthritis its first complete clinical description in 1800; in 1859 Alfred Garrod (1819-1907) distinguished gout by the presence of uric acid.
While the disease had been known for centuries, its cause remained unknown. Some thought arthritis was the result of an infectious disease, such as gonorrhea or tuberculosis. In 1900 two physicians, Frederick J. Poynton (1869-1943) and A. Paine, discovered a bacteria in a group of children afflicted with rheumatism. They speculated that rheumatic arthritis could be the result of an immune reaction to an invading microorganism. In 1940 researchers found an rheumatoid factor, an antibody-like substance, in the blood of arthritis patients. Further study showed that rheumatic infections were caused by a group A streptococcus, so the rheumatoid factor was indeed an immune system response to that bacteria. Current research focuses on the relationship between specific genetically coded HLA molecules (an element of the immune system) and the occurrence of various types of arthritis. For example, the HLA-B27 molecule is common in people with ankylosing spondylitis, and HLA-DR4 gene is associated with rheumatoid arthritis. In 1990, researchers discovered a faulty gene involved in hereditary osteoarthritis.
No cure exists for arthritis, so physicians have concentrated on alleviating the pain and crippling effects of the disease. The first really effective weapon against arthritic pain and inflammation was aspirin, introduced in 1899. Frenchman Jacques Forestier established the use of gold salts for treatment of arthritis in 1929, and interest in this approach revived in the 1960s. The most significant advance in arthritis treatment came with the discovery of cortisone. In the 1930s Edward Kendall, working at Minnesota's Mayo Clinic, isolated twenty-eight different hormones, or corticoids, from the cortex of the adrenal gland. One of these, which had effects on laboratory animals, Kendall called Compound E. He reported its discovery in 1936. At the same time, a Polish-Swiss biochemist, Tadeus Reichstein, also isolated the corticoids and Compound E (which he called F-a), and the American biochemist Joseph J. Pfiffner isolated the same compound.
Meanwhile, a colleague of Kendall's at the Mayo Clinic, Philip Hench, had become interested in rheumatoid arthritis. Hench theorized that hormones might relieve the symptoms of arthritis, and Kendall agreed that Compound E should be tried. In 1948 a young female patient of Hench's was desperately ill with arthritis. Lewis Sarrett of the Merck drug company in New Jersey had succeeded in synthesizing Compound E in usable amounts, and Hench secured enough of it to treat his patient. She made a speedy and dramatic recovery after a week of daily injections. Merck quickly produced 1,000 grams of Compound E, and Hench carried out further trials, with similar remarkable results. He reported his discovery in 1949. After the press enthusiastically heralded the new "miracle" drug as vitamin E, Compound E was renamed cortisone.
Corticosteroids like cortisone remain a potent weapon against arthritis, but they must be handled carefully because of their powerful side effects. A more radical treatment for joints severely deteriorated by arthritis is surgical joint replacement. This approach was pioneered by the English surgeon John Charnley, who developed a technique and prosthesis for total hip replacement in the 1960s.
Ongoing research into arthritis treatments are developing promising new therapeutic approaches. Researchers at the University of Pittsburgh are investigating a gene therapy approach which involves removing cells from the afflicted joint or area, modifying the cells to carry a gene that blocks inflammation, and then injecting the gene-bolstered cells into the joint area. Another area under investigation is nutrient therapy. For example, scientists at the University of Arizona have studied the use of two nutritional supplements--glucosamine and chondroitin sulfate--to relive osteoarthritic pain and regenerate cartilage that has deteriorated. Considered to be the basic building blocks for joint cartilage, these substances are found in minute quantities in many foods and, interestingly, in shark cartilage, which contains chondroitin sulfate. Although many of these substances have been marketed to the general public as dietary supplements, like vitamins, more research is needed to confirm their beneficial effects.
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