Arthritis

/Arthritis
Arthritis2019-05-28T18:45:35+00:00
Arthritis

An Overview

Arthritis is inflammation of one or more of your joints that causes pain and stiffness. While arthritis is mainly an adult disease, some forms affect children. There are many types of arthritis. Some of these include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, septic arthritis, and psoriatic arthritis. While each of these conditions have different causes, the symptoms and treatment are often the same. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in weight-bearing joints such as the knee, hip, and spine. Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active.

Anatomy

Arthritis is a disease of the joint. A joint is where the ends of two or more bones meet. The knee joint, for example, is formed between the bones of the lower leg (the tibia and the fibula) and the thighbone (the femur). The hip joint is where the top of the thighbone (femoral head) meets a concave portion of the pelvis (the acetabulum).

  • Cartilage. A smooth tissue of cartilage covers the ends of bones in a joint. Cartilage cushions the bone and allows the joint to move easily without the friction that would come with bone-on-bone contact.
  • Synovium. A joint is enclosed by a fibrous envelope, called the synovium, which produces a fluid that also helps to reduce friction and wear in a joint.
  • Muscles, tendons, and ligaments. Ligaments connect the bones and keep the joint stable. Muscles and tendons power the joint and enable it to move.

Description

Arthritis may be caused by wear and tear on the articular cartilage through the natural aging process (osteoarthritis), or may develop following an injury (post-traumatic arthritis). Other types of arthritis, such as crystalline arthritis, may come from an inflammatory process.
Still others, such as rheumatoid arthritis or lupus arthritis, are the result of a systemic disease throughout the body. Regardless of whether the cause is from injury, normal wear and tear, or disease, the joint becomes inflamed, causing swelling, pain and stiffness. Inflammation is one of the body’s normal reactions to injury or disease. In arthritic joints, however, inflammation may cause long-lasting or permanent disability.

Osteoarthritis

The most common type of arthritis is osteoarthritis. Also known as “wear and tear” arthritis, osteoarthritis occurs when the cartilage that cushions and protects the ends of your bones gradually wears away. It results from overuse, trauma, or the natural degeneration of cartilage that occurs with aging.¬†Osteoarthritis is often more painful in joints that bear weight, such as the knee, hip, and spine. However, joints that are used extensively in work or sports, or joints that have been damaged by injury may show signs of osteoarthritis. In many cases, bone growths called “spurs” develop at the edges of osteoarthritic joints. The bone can become hard and firm (sclerosis). The joint becomes inflamed, causing pain and swelling. Continued use of the joint is painful.

Rheumatoid Arthritis

Rheumatoid arthritis is a long-lasting disease. Rheumatoid arthritis affects many parts of the body, but mainly the joints. The body’s immune system, which normally protects the body, begins to produce substances that attack the body. In rheumatoid arthritis, the joint lining swells, invading surrounding tissues. Chemical substances are produced that attack and destroy the joint surface. Rheumatoid arthritis may affect both large and small joints in the body and also the spine. Swelling, pain, and stiffness usually develop, even when the joint is not used. In some circumstances, juvenile arthritis may cause similar symptoms in children.

Post-traumatic Arthritis

Post-traumatic arthritis results from an injury to the joint. If a broken bone or fracture extends into a joint it will damage the smooth cartilage that covers the joint surfaces. The surface becomes uneven and causes friction as the joint moves. Over time, the joint breaks down and becomes arthritic.

Septic Arthritis

Septic arthritis is an infection of the joint. Most often bacteria reach the joint through the bloodstream from an infection in another part of the body, such as the urinary tract. Infected joints are typically warm, red, and acutely tender. They are often swollen due to pus in the joint. An infected joint often needs surgical drainage in addition to antibiotics.

Psoriatic Arthritis

Psoriatic arthritis is associated with the skin disease psoriasis. While it may involve larger joints such as the knees it often presents with symptoms in smaller areas such as the distal joints at the tips of the fingers and toes.

Gouty Arthritis

Gouty arthritis develops as the result of uric acid buildup in the bloodstream. The uric acid forms crystals which cause acute inflammation in a joint. The big toe, ankle, knee, and elbow are the most common joints affected. A gout attack can be acutely painful. The inflamed joint becomes red and very sensitive to touch. Gout attacks are most often treated with medicine rather than surgery. Long term, many patients develop soft tissue masses (tophi) over the affected joints.

Lyme Arthritis

Lyme arthritis can be one of the side effects of Lyme disease, a systemic infection caused by a tick bite. Lyme arthritis can present acutely as pain and swelling in early stages of the disease. Lyme disease is treated with antibiotics. Left untreated, Lyme disease can lead to chronic arthritis.

Spondylytic Arthritis

Spondylytic arthritis mostly affects the spine. The most common form is ankylosing spondylitis. It often presents as low back pain with initial changes seen at the sacroiliac joints in the pelvis. Your doctor can confirm this diagnosis with a positive blood test, HLA-B27.

Lupus Arthritis

Lupus is an autoimmune disease that affects multiple organs including the kidneys, skin, blood, and the heart. Lupus arthritis can be systemic and cause chronic pain in multiple joints.

Juvenile Arthritis

Juvenile arthritis is the most common type of arthritis in children. It is estimated that more than 250,000 children under 16 in the United States are affected. There are several types of the disease and most are different from rheumatoid arthritis in adults.

Doctor Examination

Arthritis is diagnosed through a careful evaluation of symptoms and a physical examination. X-rays are important to show the extent of any damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis. Some of the findings of arthritis include:

  • Weakness (atrophy) in the muscles
  • Tenderness to touch
  • Limited ability to move the joint passively (with assistance) and actively (without assistance).
  • Signs that multiple joints are painful or swollen (an indication of rheumatoid arthritis)
  • A grating feeling or sound (crepitus) with movement
  • Pain when pressure is placed on the joint or the joint is moved

Treatment

There is no cure for arthritis, but there are many treatments to help relieve the pain and disability that it can cause.

Nonsurgical Treatment

  • Medications. Over-the-counter medications can be used to control pain and inflammation in the joints. These medications, called anti-inflammatory drugs, include aspirin, ibuprofen, and naproxen. Acetaminophen can be effective in controlling pain.
  • Prescription medications also are available. A physician will choose a medication by taking into account the type of arthritis, its severity, and the patient’s general physical health. Patients with ulcers, asthma, kidney, or liver disease, for example, may not be able to safely take anti-inflammatory medications.
  • Injections of cortisone into the joint may temporarily help to relieve pain and swelling. It is important to know that repeated, frequent injections into the same joint can cause damage and undesirable side effects.
  • Viscosupplementation or injection of hyaluronic acid preparations can also be helpful in lubricating the joint. This is typically perfomed in the knee.
  • Exercise and therapy. Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learning methods of performing daily activities that are the less stressful to painful joints also may be helpful.
  • Certain exercises and physical therapy may be used to decrease stiffness and to strengthen the weakened muscles around the joint.

Surgical Treatment
In general, an orthopaedic surgeon will perform surgery for arthritis when other methods of nonsurgical treatment have failed to relieve pain and other symptoms. When deciding on the type of surgery, the physician and patient will take into account the type of arthritis, its severity, and the patient’s physical condition.

There are a number of surgical procedures. These include:

  • Removing the diseased or damaged joint lining
  • Realignment of the joints
  • Fusing the ends of the bones in the joint together, to prevent joint motion and relieve joint pain
  • Replacing the entire joint (total joint replacement)

Long-Term Management

In most cases, persons with arthritis can continue to perform normal activities of daily living. Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function. In persons with severe cases of arthritis, orthopaedic surgery can often provide dramatic pain relief and restore lost joint function. Some types of arthritis, such as rheumatoid arthritis, are often treated by a team of health care professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.

Research

At present, most types of arthritis cannot be cured. Researchers continue to make progress in finding the underlying causes for the major types of arthritis. In the meantime, orthopaedic surgeons, working with other physicians and scientists, have developed many effective treatments for arthritis.

Arthritis

From learning about the importance of exercising regularly to fully understanding your arthritis medications, the information contained in this section is meant to provide you with insights, information and tips that can be used by you to help make living with arthritis a little bit more manageable.

What is arthritis?

Arthritis is a general term covering more than 100 different conditions.

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body’s natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

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 localized 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 is 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 fevers 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 characterized 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 affect 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-Perthe’s 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?
There are more than 100 different forms of arthritis, symptoms vary according to the form of arthritis. Each form affects the body differently.

Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of a joint, early morning stiffness and skin changes, including rashes.

How can a doctor diagnose arthritis?
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

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.

Can special diets treat arthritis?

  • But what if you have arthritis – are diet and nutrition still such a simple matter?
  • Can what you eat cure your arthritis? Can food prevent it from occurring?
  • Are there foods that can cause your arthritis to ‘flare’ or go into remission?
  • What role do vitamins and nutritional supplements play in the treatment of arthritis?
  • Will losing (or gaining) weight help ease your symptoms?
  • Will taking powerful anti-arthritic medications affect your appetite or your ability to eat certain foods?

These are the sorts of questions that people with arthritis often ask, and they’re valid questions. Some questions (Can what you eat cure your arthritis?) have simple answers (No). Some questions (Are there foods that can cause your arthritis to ‘flare’ or go into remission?) aren’t so straightforward (Perhaps…).

Most of what you need to know about diet and nutrition is common sense; healthy eating is pretty much the same for anyone, whether you have arthritis or not. But there are exceptions.

Summary

From learning about the importance of exercising regularly to fully understanding your arthritis medications, the information contained in this section is meant to provide you with insights, information and tips that can be used by you to help make living with arthritis a little bit more manageable.

For people with arthritis, learning to make it part of your life can be difficult. But learning as much as you can about your particular type of arthritis and actively working with your arthritis treatment team are two very effective ways of regaining control over your life. There is plenty of information, some specific to arthritis and some not, that can be very helpful to someone facing the challenges associated with having a chronic or lifelong disease.

Our suggestion is – don’t let arthritis beat you. Take control. How? Arm yourself with as much information as possible. Learn from the experiences of others in similar circumstances. What we’re presenting here is a virtual toolbox of tips for living well with arthritis. Some may work for you one day and not the other. Some may work for you but not others. That’s why we’ve tried to cover several topics. There are plenty of tools or tips here. Use them or refer to them when you need them. Call upon them when you require help.