Talking arthritis with U of M

Arthritis affects one in five American adults, and that number is expected to rise as the population grows and ages, according to the Centers for Disease -Control and Prevention. The chronic condition can be especially painful in the winter as frigid temperatures cause arthritis symptoms to worsen. 

Marta Michalska-Smith, M.D., with the University of Minnesota Medical School and M Health Fairview talks about the causes of arthritis, treatment options, and research to improve knowledge around this chronic condition. 

Q: What is arthritis?

Dr. Michalska-Smith: Plainly speaking, arthritis means inflammation of a joint. This causes joint pain and stiffness and, over time, damage to the joint. There are many types of arthritis, including osteoarthritis, crystal -arthritis, and autoimmune inflammatory arthritis which includes diseases such as rheumatoid arthritis and psoriatic arthritis.

Q: What causes arthritis? 

Dr. Michalska-Smith: Osteoarthritis is often referred to as “wear and tear” and “non-inflammatory” arthritis, but these are misleading terms. We used to think that osteoarthritis was caused by degeneration of the cartilage, which cushions and protects the bone, due to repetitive stress over time. However, we now know that osteoarthritis is a disease not only of the cartilage, but of the bone and joint tissues as well, and that inflammation is an important part of the disease. Although it does become more common as we age, genetics, previous joint trauma, diet, and bone alignment all factor into who develops osteoarthritis, as well as when, where, and how severe it becomes. 

Autoimmune inflammatory arthritis occurs when a person’s immune system becomes dysregulated and attacks their own joint tissue, causing inflammation and damage. In this type of arthritis, the immune system can sometimes attack other body tissues as well, such as the eyes or lungs. 

Crystal arthritis, such as gout, is caused when the body deposits crystals in and around the joint space which then triggers a strong inflammatory response. Gout is more common in men, and in those who have heart disease, kidney disease, diabetes, obesity, or high blood pressure. 

Q: How is arthritis treated?

Dr. Michalska-Smith: Strengthening the muscles that support the joint through physical therapy is a core aspect of treatment for osteoarthritis. Medications, such as acetaminophen, ibuprofen, topical diclofenac gel, and steroid injections into the joint can also be used. Many people will ultimately benefit from a joint replacement. 

Treatment for autoimmune inflammatory arthritis centers around medications that target and suppress the immune system. These medications come in pills, injections, and infusions, and require monitoring by a rheumatologist. There are many different options for treatment, and each type of autoimmune inflammatory arthritis has specific medications which work better for that disease. 

Gout treatment needs two distinct approaches. Anti-inflammatory medications such as non-steroidal anti-inflammatory medications (NSAIDs) and prednisone are used to treat gout flares, while medications which help lower the uric acid level help prevent future flares. 

In all types of arthritis, a healthy diet and physical activity are key to maintaining healthy joints.

Q: How does colder weather affect arthritis?

Dr. Michalska-Smith: Cold weather can often make arthritis pain and stiffness worse. The synovial fluid which surrounds and bathes the joints becomes thicker, and blood vessel constriction decreases blood flow to the joints. Cold temperatures can also increase pain sensitivity. In gout, areas of the body that are colder are more likely to form crystals. This is why gout flares often happen in the feet and hands as they are furthest away from our warm core. The best way to counter the effects of cold weather for all types of arthritis is to keep the joints warm and increase blood flow with movement. 

Other weather changes can also affect the joints. For instance, storms often bring lower barometric pressure fronts, causing tissues in the joint to expand and exert more pressure in the joint space. This is why many people with arthritis say their joints can tell them when a storm is coming. 

Q: How does your research support your clinical work?

Dr. Michalska-Smith: I am so excited about the advances we are making in the understanding and treatment of inflammatory arthritis and the work being done at the University of Minnesota to move this forward. I am currently involved in a clinical trial of a new therapeutic for the treatment of inflammatory arthritis – chimeric antigen receptor therapy (also known as CAR-T cell therapy). This type of therapy involves genetically engineering a person’s own immune cells to target other “problematic” immune cells which are then given back to the patient. This therapy has the potential to alter the immune system in a more permanent way, and even lead the way for a cure for inflammatory arthritis. 

Marta Michalska-Smith, M.D., is an assistant professor at the U of M Medical School, and a rheumatologist with M Health Fairview. Her academic and clinical interests include healthcare disparities, and pediatric-to-adult transitions in patients with rheumatic diseases.