Laura Guglielmoni was still a teen-ager when doctors diagnosed her with rheumatoid arthritis, a chronic autoimmune system disorder that, in its most obvious symptom, inflames the body's joints until they are too painful and distorted to move. Guglielmoni felt its full force. Getting out of bed was painful and exhausting. She couldn't stand long enough to take even a short shower.

Guglielmoni had already seen the effect of arthritis on her aunt, whose hands had been stiffened and swollen by the same condition. Yet her aunt had found a way to can all her own fruit and vegetables and to raise three children. That example, Guglielmoni said, "made me more determined not to let the arthritis slow me down much."

She had to stop playing softball. She liked to run, but she could no longer do that either. She was only able to attend school part-time and had to finish her studies from home. After extensive physical therapy and with the right medication, she finally returned to a somewhat normal routine, but with new goals. "I knew I would never be a fighter pilot," she joked, but she did determine to "get in and out of college as fast as possible, get a job and start saving money" for a future that was more problematic than before her diagnosis. She earned a bachelor's degree in accounting and found full-time work. She married and had a daughter.

Guglielmoni never forgot that one day it was likely the arthritis would damage her joints so much that replacement would be her only option. About a year ago, the arthritis in her knees became so painful that she could not climb even a short flight of stairs, making the trip to work on BART difficult. She couldn't pick up her then three-year-old daughter or get down on the floor to play with her, because she wouldn't have been able to get back up again. Bit by bit, her ability to live her life was falling away. On the day she found herself standing in an elevator unable to straighten her knees, she said to herself, "I need to get this fixed."

Her physician recommended that she go to Stanford Hospital & Clinics to see Dr. William J. Maloney, Chair of the Department of Orthopaedics & Sports Medicine. The size of Maloney's team and its resources have made the Hospital one of the few facilities able to do multiple joint replacements in one surgery—and Guglielmoni did not want to go through two surgeries.

Collaboration creates unique treatment protocols

Stanford also has the advantage of a cross-disciplinary group of physicians who treat arthritis with state-of-the-art programs that combine surgery, customized therapies and sophisticated new medications for pain and disease control. Surgery is sometimes the only option, but Stanford's arthritis patients are also involved in advanced clinical trials focusing on cellular disease control and the growth of cartilage and bone.

The team has also created a unique protocol for joint replacement based on evidence that the right kind of multimodal pain management—before, during, and after surgery—has an important impact on success. The challenge is to reduce pain without interfering with the activity crucial to quick recovery. Maloney replaced both Guglielmoni's knees and her recovery was rapid. "A week and a half after surgery, I was able to stand up by myself," she said. At 33, she is a young woman given back a real life.

More than 50 million Americans currently face a daily encounter with what arthritis does—that's more than one in five of us. It is the leading cause of disability in the United States, according to the Centers for Disease Control and Prevention. As the Baby Boomer generation continues to age, case counts will rise. Arthritis appears in more than 100 forms; what triggers it is not thoroughly understood. But the end result is the same: joints fail, producing an impact as comprehensive as what Guglielmoni endures or perhaps one that's just a bit of stiffness when getting up in the morning.

Age raises arthritis risk

Guglielmoni's rheumatoid arthritis is the second most common variety. It strikes without respect to age and involves a permanent misfire of the immune system. Osteoarthritis is the type of arthritis that many more of us will come to know. Trauma or excessive use will sometimes be the cause, but generally it will appear after years of typical wear and tear. Reaching a certain age increases the likelihood of osteoarthritis by substantial amounts: More than half of us 65 or older are likely to suffer. Women have a higher risk—another phenomenon not well understood. Obesity and inactivity also increase the odds for developing arthritis.

Decades ago, people with arthritis tended to reduce their activities. But, said Maloney, "the Boomers are not the same as their parents. They are not content to sit at home." People aren't getting arthritis any earlier, he said, "but they're less willing to live with the disability."

Reversing damage in the works

Guglielmoni's knees are definitely built to last. Maloney can now offer patients replacement joints made of stronger, longer-lasting materials that remove the worry that if they don't baby their new joints, the joints will fail. "We're doing patients younger and they're able to be more active," Maloney said.

Another key development in treatment, Maloney added, has been the coordination of more sophisticated and targeted pain management with improved physical therapy and exercise as part of a successful recovery. SHC's Pain Management Center is a leader in the development of pain treatment specific to arthritis surgery and long-term management. The active collaboration among Stanford orthopaedists, pain specialists, immunologists, and even biomechanical engineers is building an exponentially more effective treatment strategy against arthritis.

At the new Stanford Medicine Outpatient Center in Redwood City, patients with musculoskeletal problems will find, all within a few steps, a time-saving cluster of resources. Orthopaedic surgeons, spine specialists, physical and rehabilitative therapists, and pain specialists are all at hand. The imaging necessary for diagnoses is also available in the same building. And, if surgery is required, the Outpatient Center has eight operating rooms and the Boswell Joint Replacement Center.

What excites Maloney and his colleagues is their growing ability to do more than a mechanical fix. Traditionally, most therapies have been aimed at pain reduction, said Mark Genovese, a Stanford immunologist. But those remedies didn't impact the disease's progress. Now, several medications are available that disrupt the cellular activity that drives arthritis. Genovese and another Stanford physician, William H. Robinson, have figured out a way to predict—at an 80 percent positive rate—which patients will respond to which medications. Clinical trials are underway at Stanford, Genovese said, with innovative biologic stimulants to regenerate the cartilage in damaged joints and significantly reduce the signs of arthritis and reduce the disability it causes.

The next big thing, Maloney said, "is identifying arthritis earlier in its process. There is no good marker for osteoarthritis. You don't see it until it is symptomatic and there is already significant joint destruction."

Patients who are treated earlier, said Genovese, have a chance at a better outcome and may be able to avoid joint replacement. Staying active is a powerful preventive. "If you sit around and say, 'Poor me,' you'll never get anything done," Guglielmoni said. "I keep moving and keep active."