We do not know what causes some diseases. These are known as idiopathic diseases, from the Greek idios – ‘one’s own’ – and pathos – ‘suffering’.
Very often the words ‘primary’, ‘agnogenic’ or ‘cryptogenic’ are used in clinical notes to describe a disease the cause of which, or its progression, is not known. There are many diseases that have unknown causes. Unfortunately, one of the main diseases of older age, arthritis, remains idiopathic.
In 2013, approximately one in five US adults reported some form of disability, and the most frequently reported disability related to mobility – not being able to move around or to do things for yourself. A third of all mobility issues are caused by arthritis and back and spine problems. Although being the main cause of disability among older adults, very little is known about this disease.
Even though most older people suffer from arthritis – which results in swelling, pain, stiffness and reduced motion – the majority live with it without much interest from outside.
Being a disease that causes inflammation and attacks the joints, arthritis is more than just one disease. There are some 63 different types of conditions all lumped together under arthritis. Some of these diseases are known independently, such as bursitis, fibromyalgia, gout, inflammatory bowel disease, lupus, osteoarthritis, osteoporosis, Paget’s, rheumatoid arthritis and spondyloarthritis.
We know more about some of these specific diseases than others, but we do not know what causes them. We see great variance of these diseases by geography, education, income, marital status and gender. More women than men have arthritis and generally the disease becomes increasingly more common in older age.
Although diet can be a primary contender, especially for some diseases such as gout, there are some people who cannot control their arthritis through diet.
Arthritis is a long-term disease that will not be cured. Learning to live with it will save a lot of anxiety
With other types of arthritis, we see a genetic relationship, as with spondyloarthritis, having identified 50 genetic mutations related to this disease – although there are other causes that are unclear. Some suggest infections. Especially for infectious arthritis, where a bacterium, virus or fungus enters the joints and triggers inflammation.
There can be many causes of arthritis, maybe even all of these causes combined. This makes the cause of the disease particularly difficult to determine and more difficult to manage. Symptoms of the disease are also variable.
Symptoms may come and go and they can be of different intensity and for different periods of time. However, severe arthritis can be debilitating. The constant pain might result in the inability to do daily chores, climb stairs or even walk.
Arthritis can also cause permanent joint damage. We can see some of these changes, while others remain hidden. These hidden changes can damage the joints but also the eyes, kidneys, heart and lungs.
Osteoarthritis, being the most common of the arthritis group, causes great pain. Where the joints meet, the bones have a polished soft surface called a cartilage. In osteoarthritis this cartilage wears down. This results in the two bones rubbing against each other.
The pain causes the body to protect itself by reducing the friction the only way it knows, by causing swelling and stiffness. This protective function, however, has negative consequences. Over time, joints can lose strength and pain may become chronic. The disease can be controlled in most cases by staying active, maintaining a healthy weight and by avoiding injury and repetitive movements.
Kate Lorig, a retired professor from Stanford University, developed a programme to help with controlling arthritis. The programme focuses on managing and not curing the disease. Most of the exercises are designed to reduce pain and improve mobility, using methods to reduce negative emotions such as anger, fear and depression through relaxation, visualisation, distraction and self-talk.
Exercises to ease the pain and increase movement include gentle circular movements. Some of the medications, both (cortico) steroid, as well as non-steroid drugs, can be useful, but all have some complications. Steroids work by reducing the inflammation, but they also have some negative side effects, including difficulty sleeping, blurred vison, weight gain and muscle weakness.
At the end of the day, we need to learn to live with the disease, taking pain medication when necessary, staying as active as possible without causing stress to the body, keeping our weight at an optimum to reduce the stress on the body and perhaps, most importantly, keeping a positive disposition.
A tall order. But arthritis is a long-term disease that will not be cured. Learning to live with it will save a lot of anxiety. Arthritis may have unknown origins but at least if we continue learning how to manage it, perhaps one day it will stop being idiopathic.
Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.