Arthritis

Stages of Arthritis

The cartilage is a padding that absorbs stress.

The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation.

In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

What are the different types of arthritis?

There are over 100 different types of arthritis. The most common are:

Osteoarthritis

Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people.

This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.

Osteoarthritis causes joint pain and can limit a person's normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled.

Disability most often happens when the disease affects the spine, knees, and hips.

Rheumatoid arthritis

This is an autoimmune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.

Rheumatoid arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (like both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Fibromyalgia

This chronic disorder causes pain throughout the tissues that support and move the bones and joints. Pain, stiffness, and localised tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Fatigue and sleep disturbances may also occur.

Gout

When a person has gout, they have higher than normal levels of uric acid in the blood. The body makes uric acid from many of the foods we eat.

Too much uric acid causes deposits, called uric acid crystals, to form in the fluid and lining of the joints. The result is an extremely painful attack of arthritis. The most common joint gout affects the big toe. This disease is more common in men than in women.

Infectious arthritis

Arthritis can be caused by an infection, either bacterial or viral, such as Lyme disease. When this disease is caused by bacteria, early treatment with antibiotics can ease symptoms and cure the disease.

Reactive arthritis

This is arthritis that develops after a person has an infection in the urinary tract, bowel, or other organs. People who have this disease often have eye problems, skin rashes, and mouth sores.

Psoriatic arthritis

Some people who have psoriasis, a common skin problem that causes scaling and rashes, also have arthritis. This disease often affects the joints at the ends of the fingers and can cause changes in the fingernails and toenails. Sometimes the spine can also be affected.

Systemic lupus erythematosus

Also called lupus or SLE, this is an autoimmune disease. When a person has an autoimmune disease, the immune system attacks itself, killing healthy cells and tissue, rather than doing its job to protect the body from disease and infection. Lupus can inflame and damage a person's joints, skin, kidneys, lungs, blood vessels, heart, and brain. African American women are three times more likely to get lupus than Caucasian women. It is also more common in Hispanic, Asian, and American Indian women.

Ankylosing spondylitis

This disease most often affects the spine, causing pain and stiffness. It can also cause arthritis in the hips, shoulders, and knees. It affects mostly men in their late teenage and early adult years.

Juvenile rheumatoid arthritis

The most common type of arthritis in children. This disease causes pain, stiffness, swelling, and loss of function in the joints. A young person can also have rashes and fever with this disease.

Polymyalgia rheumatica

Because this disease involves tendons, muscles, ligaments, and tissues around the joint, symptoms often include pain, aching, and morning stiffness in the shoulders, hips, neck, and lower back. It is sometimes the first sign of giant cell arteritis, a disease of the arteries characterised by inflammation, weakness, weight loss, and fever.

Polymyositis

Causing inflammation and weakness in the muscles, this disease can affect the whole body and cause disability.

Bursitis

This condition involves inflammation of the bursa, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursa. Bursitis produces pain and tenderness and may limit the movement of nearby joints.

Tendinitis

Also called tendonitis, this condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.

What Causes Osteoarthritis?

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity.

Primary osteoarthritis

 is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis

is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.

Some people may have congenital abnormalities of the joints-for example, Perthes' disease of the hips-that cause early degeneration and subsequently cause osteoarthritis.

Predisposing Factors To Osteoarthritis Of Hip

Some conditions may predispose the hip to osteoarthritis. It tends to occur in people as they get older and particularly affects joints that have to take a lot of stresses and strains.

• A previous fracture that involved the hip
• Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
• Some childhood hip problems later cause hip arthritis (for example, a type of childhood hip fracture known as a Slipped Epiphysis; also Legg-Perthes Disease)
• Inactive lifestyle- e.g., Obesity (overweight) Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles and feet.

Predisposing Factors To Osteoarthritis Of Knee

Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear - just like the out-of-balance tyre that wears out too soon on your car.

What Are The Symptoms Of Arthritis?

The warning signs of Arthritis are related to inflammation in one or more joints for more than two weeks. Typical symptoms are:

• redness
• tenderness
• swelling,
• heat and
• pain.
• limitation of motion of a joint,
• early morning stiffness
• skin changes including rashes.

How is Arthritis Diagnosed?

Doctors diagnose arthritis with a medical history, physical exam and X-rays of the hip. There is no blood test for osteoarthritis.

What You Can Do?

Consult a doctor who will determine the type of arthritis you have

• Rest the joint until the pain subsides to prevent further inflammation
• To ease the pain or stiffness of the joint, apply heat on the joint for about 15 minutes once or twice a day using a hot water bottle, towel or an infrared lamp
• Take painkillers or anti-inflammatories, as recommended by your doctor
• If you are overweight, try to reduce weight to lighten the load on weight-bearing joints
• Participate in regular exercise

What Your Doctor Can Do For You?

There is no cure for arthritis, so beware of 'miracle cures'. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment.

In severe cases, surgery may be suggested, such as a hip or knee replacement. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results.

Treatment Options

• Initial treatment for osteoarthritis of the hip or knee is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and or anti inflammatory medications. With worsening symptoms a cane or a knee brace may be helpful
• For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted and are no longer helpful, and the arthritis has become disabling, surgery may be recommended

Treatment of osteoarthritis focuses on decreasing pain and improving joint movement, and may include:

• Exercises to keep joints flexible and improve muscle strength
• Many different medications are used to control pain, including corticosteroids and NSAIDs
• Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDS
• For mild pain without inflammation, acetaminophen may be used
• Heat/cold therapy for temporary pain relief
• Joint protection to prevent strain or stress on painful joints
• Surgery (sometimes) to relieve chronic pain in damaged joints
• Weight control to prevent extra stress on weight-bearing joints

Surgery for Arthritis

When conservative measures have been exhausted, offer no relief, and have become disabling, surgery may be recommended. Surgery is usually considered if non-surgical treatment fails to give relief.

There are different surgical procedures that can be used and may include:

Synovectomy

This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion.

Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.

Arthroplasty

In this procedure, your surgeon removes the affected joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis.

The goal of the surgery is to relieve pain and restore the normal functioning of the joint. Total joint replacement can be performed through an open or minimally invasive approach.

Arthrodesis

A fusion, also called an arthrodesis, involves removal of the joints and fusing the bones of the joint together using metal wires or screws. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and when heavy manual use is expected.

Your surgeon will discuss these options and help you decide which type of surgery is the most appropriate for you.

Does Exercise Really Help Those Who Have Arthritis?

Exercise is very important because it increases lubrication of the joints and strengthens the surrounding muscles, putting less stress on joints.

Exercise in heated swimming pools-hydrotherapy-can bring enormous relief from pain and stiffness.

Also studies have shown that exercise helps people with arthritis by reducing joint pain and stiffness and increasing flexibility, muscle strength and energy. It also helps with weight reduction and offers an improved sense of well-being.