Breaking down arthritis

September is Arthritis Awareness Month and raising awareness about arthritis is essential for understanding and supporting those affected.

At UHN, the Schroeder Arthritis Institute is home to Canada’s largest multidisciplinary arthritis program. UHN is also Toronto’s second-largest mental health research hospital, resulting in having the unique capability to drive the integration of physical and mental health care forward in partnership with patients, caregivers and care providers.

Many people think of arthritis as a single disease but it’s really a group of different diseases which cause chronic pain, reduced mobility, premature disability and permanent disfigurement.

More than six million Canadians suffer from some form of arthritis, and over half of those people are under 65. It is the third-leading cause of disability in Canada.

Arthritis is a group of about 100 conditions, including lupus, psoriatic arthritis, ankylosing spondylitis, scleroderma, osteoporosis and Sjögren’s syndrome. 

What we are going to focus on here are two most common forms: osteoarthritis and rheumatoid arthritis.

The joint pain associated with osteoarthritis is caused by wear and tear in joints and ligaments. It’s degeneration that is mechanical in nature and related to age, injury or repeated stress — and it typically occurs in a particular joint or just a few joints. Pain and stiffness when moving.

Osteoarthritis develops when the joint’s natural cushioning system breaks down in the body, affecting the knee, spine, shoulder, foot, ankle, hand and hip joints. Without this buffer, bones can come into contact with each other, causing pain, stiffness, and a loss of flexibility. In addition to the cartilage, several other joint tissues (e.g., synovium, meniscus, bone, fat pad) undergo changes. Its progression is caused by many factors, including inflammation in the synovium, a tissue that lubricates and protects the joint. The chronic pain and compromised joint function can have significant impacts on mood, sleep and overall quality of life.

Although physical interventions and medications can ease symptoms, there is currently no cure because it is not possible to regrow cartilage. Once osteoarthritis has progressed to the end stages, the only option is surgical replacement of the joint. Other strategies include exercise, physiotherapy, maintaining a healthy weight and medications to help manage pain and stiffness.

As opposed to osteoarthritis, which is caused by cartilage breakdown, rheumatoid arthritis is a disease in which the body’s immune system attacks itself. In the process, inflammation occurs in different organs, including the musculoskeletal system, skin, kidneys, lungs, nervous system and more — with the joints being the most commonly affected. Wherever the immune system is attacking, specifically, is where you will notice the symptoms. The common symptoms of systemic autoimmune conditions include: pain, stiffness or swelling in more than one joint, fatigue, skin rashes, and hair loss. People with specific genes are at an increased risk of developing rheumatoid arthritis.

Many experts believe there are environmental factors that can trigger the development of rheumatoid arthritis in susceptible individuals.  These triggers, which lead to the immune system attacking the healthy synovium are thought to be bacterial and/or viral.

Women develop rheumatoid arthritis two to three times more often than men. Researchers are trying to understand the effect of female hormones on the development of rheumatoid arthritis.

Medication is often prescribed as a first line of therapy and is key to controlling disease and preventing damage. Other ways to manage include physical therapy, occupational therapy and education. Individuals with rheumatoid arthritis who are diagnosed and treated early are less likely to experience long-term joint damage and functional impairments.

The Schroeder Arthritis Institute is the largest multidisciplinary arthritis hub in Canada, with a goal of making a global impact in discovery, learning and patient care. The team at the Schroeder Arthritis Institute are working hard to find ways to reverse the damage done by arthritis, autoimmune disease and injuries to the joints. They can do this because they are among the best in the world.

The Schroeder Arthritis Institute’s tissue biobank – which stores close to half a million specimens – plays a crucial role in helping researchers understand who gets arthritis, and why, and creating early detection tools of the disease to enable early intervention.

Through artificial intelligence (AI) and gene sequencing efforts, researchers and clinicians at the Schroeder Arthritis Institute are also predicting and improving patient outcomes, tailoring surgery and other treatments, and working on new models of care so those affected by arthritis can access the right specialists and get the right treatments at the right time.