A golfer began to have trouble grasping the slender shaft of his club. The housekeeper grimaced in pain as she bent to make the bed. The office worker looked at the steps leading upstairs, thought of his aching knees and took the elevator instead.

The factor these and millions of people have in common is the often debilitating disease known as arthritis. &uot;Remember, arthritis means ‘joint inflammation,’&uot; said Marcia Passman, a physical therapist whose Natchez clinic sees numerous patients affected by the disease. &uot;And there are literally hundreds of types of arthritis.&uot;

Further, it is the disease that cripples more people than any other malady. The Center for Disease Control reports that more than 40 million people suffer from arthritis, with that number predicted to rise to 60 million in the next 15 years. Arthritis is not a disease afflicting only the elderly. In fact, the disease is most common among those 20 to 50 years old. Studies show that three out of five arthritic patients are younger than 65.

Osteoarthritis, rheumatoid arthritis, psoriatic arthritis, lupus, gout, spondylitis and juvenile arthritis are some of the more common of the hundreds of types of the disease. A sports injury can cause arthritis.

The good news? Many arthritis patients can benefit and keep the pain to a minimum by four aids recommended by the National Institutes of Health: gentle exercise, good nutrition, a positive attitude and rest. For some, surgery is the answer &045; replacement of a deteriorated joint.

The most common form of arthritis is osteoarthritis, said Dr. Carl Passman, orthopedist with the Passman-Haimson Orthopedic Sports and Rehabilitation Clinic.

&uot;That’s the wear-and-tear, trauma or old-age arthritis,&uot; he said. &uot;It affects the cartilage that keeps the joints oiled.&uot;

Joint cartilage is &uot;three times slipperier than ice on ice, and that’s slick,&uot; Passman said. The slippery cartilage allows the bones at joints to move easily over each other. Without the lubricating cartilage, bone rubs on bone, causing pain. And bone spurs can form.

For many osteoarthritis patients, the pain strikes first in the knees. And in recent years, the strides made in knee-replacement surgery have given those arthritis patients good chances to get rid of the pain and regain normal lifestyles.

Marcia Passman said much has changed for the knee-replacement candidate since she began as a physical therapist many years ago.

&uot;Age criteria has changed with life expectancy; activity level has changed and so has rehabilitation. The actual hardware has changed, too,&uot; she said. &uot;The increase in the higher rate of total knees and hips today is because the surgery has improved so much.&uot;

Carl Passman said the first knee prosthesis he used lasted for about five years, compared to 20 to 25 years today.

In general, he said, the patient with arthritis can improve his or her outlook with two important steps: maintaining muscle strength and losing weight.

But Marcia Passman said &uot;there are very few (exercises) they can do without irritating the joints.&uot;

That is why the new rehab clinic she has designed at the doctors building now under construction next to Natchez Regional Medical Center will have a pool for therapy.

Physical therapists can work with arthritis patients to increase strength, flexibility and range of motion. Some are trained to work with osteoarthritis patients; some, with rheumatoid arthritis patients.

&uot;Rheumatoid arthritis is different from osteoarthritis in that it is a disorder of the immune system,&uot; Carl Passman said. &uot;It attacks the joint tissue.&uot;

Although, like osteoarthritis, it causes pain in the joints, rheumatoid arthritis generally occurs symmetrically &045; if one wrist is affected, so is the other, for example.

Finding oral medication to attack arthritis inflammation and pain has led to many new drugs, Carl Passman said, but one problem is to find one that doesn’t irritate the stomach, as aspirin often does.

One method of easing arthritis pain is an injection into the affected joint. &uot;I give a lot of shots in the joint. There are many papers that show the injection does not cause further deterioration of joints.&uot;

The one kind of arthritis patient who can benefit from special dieting is the gout patient, Carl Passman said.

Gout comes from a buildup of uric acid caused by an internal chemical malfunction. Patients generally learn which foods trigger the gout attack, he said.