Introducing Dr. Michael Makover

Your hip aches, your knees feel stiff and your fingers are becoming bent at the ends. You think, "I'm getting old and my joints are wearing out."

Well, not really. Actually, you probably have a disease called osteoarthritis. It is not just "wear and tear," as old myths would have it and it is not just an effect of aging. Because it is a disease, there is great hope that we can understand it and find ways to combat and reverse it. We are beginning to uncover the molecular and genetic mechanisms by which your beautifully designed joints work and how they become damaged and painful. That insight will soon lead to definitive treatments. We are not there yet, but we can now see that real progress will come in the not too distant future, just as it did for rheumatoid arthritis and some of the other kinds of arthritis.

Arthritis, of which there are over a hundred different kinds, means change inside a joint, marked by one or more symptoms including swelling, redness, tenderness or pain. Some kinds of arthritis affect only the joint, while others affect many other parts of the body as well. Bursitis, tendonitis and some kinds of bone and muscle problems might feel as if they are arthritic, but they are different and afflict the structures that are outside of and supportive of the joint.

The joint is a capsule that envelops the meeting place of the ends of two bones. Within the capsule are structures that provide a lubricated lining to facilitate smooth and effective movement of the two opposing cartilage surfaces that cover the outer ends of the bones for which the joint provides connection and movement. The lining tissue, called the synovium, makes the oily lubricant and has many other functions. Cartilage has been thought of as akin to bone without calcium, but is actually a substance with quite different properties. It is smooth, firm and rubbery and has a cellular structure.

Most people think of joints as if they were fixed, mechanical devices made of immutable material like rubber and steel, but, instead, bone and the contents of the joint are very much living parts of your body. They are in constant flux, very much attuned to everything else that happens in your body and capable of remarkable self healing and remodeling. Like all good things, that ability has its limits and when your lifestyle, weight and other factors in your body overwhelm what the joint and bone can adjust to, then the disease osteoarthritis results. At first you are not even aware that adverse changes are occurring, but over time enough accumulates that pain nerves and other sensors begin to warn you that things are amiss.

Some treatments are found by chance, others by educated trial and error. In both cases, science may not know why it works but are happy to employ something that does the trick in providing relief. Far more effective and satisfying are those treatments that arise out of a detailed and deep understanding of the actual chemistry and physiology of the tissue and the organ system. Treatments that are developed to address the exact derangements on the molecular level are more likely to have better and more lasting benefit. That is where the exciting new research is heading. There is also insight into how we might eventually restore even badly damaged joints to near original condition.