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← Why haven’t we cured arthritis? - Kaitlyn Sadtler and Heather J. Faust

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Showing Revision 1 created 11/04/2019 by lauren mcalpine .

  1. While regaling you with daring
    stories from her youth,
  2. it might be hard to believe your
    grandmother used to be a trapeze artist.
  3. However, the bad backs, elbow pain,
    and creaky knees so common in older people
  4. is more than just “old age."
  5. In fact, the source of this stiffness
    plagues many young people as well.
  6. The culprit is arthritis:
  7. a condition that causes inflammation
    and pain in the joints
  8. of over 90 million people
    in the U.S. alone.
  9. But are stiff, creaky joints
    really inevitable?
  10. What makes arthritis so pervasive,
  11. and why haven’t we found a cure for
    this widespread condition?
  12. The first hurdle is that arthritis
    is actually a spectrum

  13. of over 100 different arthritic
    conditions.
  14. All these conditions share symptoms
    of joint pain and inflammation,
  15. but the origin and severity of those
    symptoms vary widely.
  16. Even the most common type,
    osteoarthritis,

  17. is trickier to prevent than
    one might think.
  18. It’s a general misconception that
    arthritis is confined to old age.
  19. The origins of osteoarthritis can often
    be traced to a patient’s early life,
  20. from any seemingly ordinary joint injury.
  21. Following impact, immune cells rush in
    to help clean and repair the damaged site
  22. and begin pumping out enzymes,
  23. including matrix metalloproteinases
    and aggrecanases.
  24. These enzymes clear out the damaged
    tissue and contribute to inflammation.
  25. But while this rapid swelling helps
    protect the joint during recovery,
  26. inadequately healed tissue can cause these
    immune cells to overstay their welcome.
  27. The continuing flood of enzymes starts
    to degrade the cartilage,
  28. weakening the joint and leading
    to arthritis later on.
  29. Not all forms of arthritis can simply
    be traced to an old sports injury.

  30. Take rheumatoid arthritis, which
    affects 1.3 million U.S. adults.
  31. This condition is actually an
    autoimmune disease
  32. in which autoantibodies target
    natively produced proteins,
  33. some of which are secreted
    by cartilage cells.
  34. We still don’t know what
    causes this behavior,
  35. but the result is that the body treats
    joint tissue like a foreign invader.
  36. Immune cells infiltrate the joint despite
    there being no tissue damage to repair.
  37. This response leads to chronic
    inflammation,
  38. which destroys bone and cartilage.
  39. Yet another condition,
    spondyloarthritis,

  40. has similarities to both of the
    conditions we’ve covered.
  41. Patients experience continuous
    inflammation in the joints
  42. and at the sites where ligaments and
    tendons attach to bones,
  43. even without any initial injury.
  44. This leads to the flood of enzymes and
    degradation seen in osteoarthritis,
  45. but is driven by different inflammatory
    proteins called cytokines.
  46. As the enzymes eat away at cartilage,
  47. the body attempts to stabilize smaller
    joints by fusing them together.
  48. This process sometimes leads to
    outgrowths called bone spurs,
  49. which also cause intense stiffness
    and joint pain.
  50. With so many factors causing arthritis,

  51. our current treatments are tailored
    to tackle specific symptoms
  52. rather than underlying causes.
  53. These range from promising
    MACI techniques,
  54. which harvest cells from small pieces
    of cartilage to grow replacement tissue.
  55. To a technique called microfracture,
  56. where surgeons create small
    holes in the bone,
  57. allowing bone marrow stem cells to
    leak out and form new cartilage.
  58. As a last resort,
  59. people with withered cartilage can
    even undergo full joint replacements.
  60. But outside these drastic measures,

  61. the underlying drivers of
    autoimmune arthritis
  62. still present a unique
    treatment challenge.
  63. Scientists are making progress with
    therapies that block TNF-alpha,
  64. one of the primary proteins causing
    inflammation in rheumatoid arthritis.
  65. But even this approach only treats the
    symptoms of the condition, not the cause.
  66. In the meantime, some of our best defenses
    against arthritis are lifestyle choices:

  67. maintaining a healthy weight to
    take pressure off joints,
  68. low-impact exercises like yoga or cycling,
    and avoiding smoking.
  69. These arthritis-fighting behaviors
    can help us lead longer lives
  70. as we continue to research
    cures and treatments
  71. for the huge diversity of
    arthritic conditions.