I am often asked, "So, what do you do for a living?" When I reply, "I'm a rheumatologist," more often than not I am greeted with a blank stare.
I continue, "I'm an arthritis doctor."
"Oh," they say. The subject then gets changed. People are generally not interested because I have no stories to tell of broken bones, gunshot wounds or split-second life-saving decisions. Any interest in what I do comes from people who are personally well-acquainted with the pain and disability associated with arthritis.
Although saying you're an arthritis doctor isn't very exciting, working with these patients is. Arthritis and its associated diseases can severely limit quality of life, but much can be done to help alleviate symptoms and restore function.
In order to understand arthritis better, let's classify the disease into two groups: non-inflammatory and inflammatory.
Non-inflammatory arthritis, also known as osteoarthritis: In normal joints, one bone slides easily against another in a painless and near frictionless fashion, separated by a thin layer of articular cartilage that caps each bone and acts as a firm, lubricated cushion.
Unfortunately, age -- coupled with overuse, hereditary factors, and sometimes prior trauma -- leads to thinning and damage of this cartilage. Unlike other body tissues, articular cartilage does not regenerate or "heal" when it is damaged. With time and use, this cartilage further degrades, causing joint instability and pain.
There are treatments available for osteoarthritis, but no known therapies that reverse its joint damage. Generally, a good primary-care clinician can manage osteoarthritis. Surgical joint replacement is recommended once the pain and disability are severe enough.
Inflammatory arthritis: This arthritis is characterized by warm, red, stiff and swollen joints caused by inflammation of the internal lining of the joint called the "synovium."
This thin layer of tissue responsible for maintaining joint health can become thickened and exquisitely painful when diseased.
Usually, inflammatory arthritis signals that there is an underlying medical problem. These could include metabolic issues like gout, viral or bacterial joint infections, or autoimmune diseases like rheumatoid arthritis.
Inflammatory arthritis commonly leads to joint damage if not treated, so aggressive and timely therapy is important. In the majority of cases, a diagnosis can be made and effective therapy started that will not only dramatically decrease symptoms, but can prevent joint damage over time.
Specialized medications have been developed to treat any underlying metabolic arthritis triggers and to eliminate overactive segments of the immune system responsible for inflammatory arthritis. This kind of arthritis can be very complicated and should be addressed by a rheumatologist.
My job may not be exciting to some, but it is truly life-saving to others. With the wonders of modern medicine, life can be returned to someone who thought they had lost it to the misery of arthritis.
Dr. Gregory T. Austad is a rheumatologist at Tanner Clinic in Layton.