As a five year old I remember being exasperated hearing my elderly relatives complain about flare-ups in their arthritis. It was a sure topic anytime we visited them. To my mind they looked well enough, so I don’t think I really believed that they were in pain. I think I thought they just wanted attention. And I thought their claims of arthritis problems were lame.This early arthritis ‘experience’ may have coloured my view of the illness as one that affects just the elderly. That is until I met a young school teacher who suddenly was plagued by it. Turning in her bed at night was so painful that she woke others in her house in trying to do it, and things like combing her hair, were not worth the pain and so, if not done by someone else, went undone.I felt differently about her arthritis. I was actually sympathetic to her situation and wondered why she was suffering what to my mind was an old person’s disease, so young.According to rheumatologist Dr Carol Ziminski, the school teacher’s arthritis was a completely different type to that suffered as a result of aging.“Most arthritis is osteo-arthritis,” she said. This is joint pain that happens as a result of the protective cartilage coating on the ends of bones breaking down. As the cartilage weakens, the bones in joints rub against each other causing pain and erosion of the actual bones.”Arthritis broadly falls into two categories, osteoarthritis and inflammatory arthritis.Dr Ziminski specialises in rheumatoid arthritis, a form of inflammatory arthritis. The Bermuda Hospitals Board (BHB) sponsored a series of educational lectures by Dr Ziminski for local physicians and healthcare workers in May.Deputy Director of the Johns Hopkins Rheumatic Disease Unit at the Good Samaritan Hospital in Baltimore, Maryland, Dr Ziminski explained the latest methods and developments used to treat rheumatoid arthritis by physicians and other healthcare workers. While on-island Dr Ziminski also spoke with Body & Soul.Unlike osteoarthritis where bone is rubbing against bone, in the early stages of rheumatoid arthritis the cartilage is still intact but inflammation develops around the joint. The inflammation causes swelling, redness and heat at affected joints. These characteristics are not seen is osteoarthritis.“Most commonly it affects about one percent of the population,” said Dr Ziminski. And she said it typically begins with people in their thirties or older. “And it’s more prevalent in women although it’s not understood why,” she said.“Skin over the joint may be swollen and tender,” she said. “The person may have lost range of motion in that joint. Ultimately they (the joints) may become deformed if not treated appropriately,” she added.If not caught in time, rheumatoid arthritis can begin to look like osteo-arthritis. This is because the inflammation around the joints is associated with the release of chemicals in the body that eventually erode bone.According to Dr Ziminski, these agents damage the protective cartilage coating on bones.“As the cartilage weakens the bone gets eroded and joint space narrows,” she said.Paying more attention to this fact, physicians now try to counter inflammation as soon as possible, said Dr Ziminski.“Because we understand more about the cells and chemical forces at play we now have drugs that can target these components,” she said.For example a substance called tumor necrosis factor (TNF) has been found to be integral in the cascade of chemical processes in the body that result in inflammation.Stopping or inhibiting this factor has been found to prevent inflammation.Dr Ziminski said pharmaceuticals that do this are now on the market and will be joined by others soon. Enbrel and Humira are two that you may have heard about on television infomercials.Other new pharmaceuticals target specific white blood cells in the body. White blood cells are the body’s natural defence against disease. They work by attacking anything they recognise as foreign to the body. The battlegrounds they create to do this are inflammation.Medications that normalise a high white blood cell count help prevent rheumatoid arthritis.Dr Ziminski said research has also shown that significant joint damage can take place even over a few months.“Methatrexate (an anti rheumatoid drug) is now first line treatment,” she said. “We used to wait before prescribing it because we were worried about some of the side effects,” she added.“But the latest research shows that over that first six months to a year, where the physician was waiting and monitoring the disease, joint damage would have already occurred.”