Arthritis

Medically reviewed & edited by Dr. Max Trotz,
MBBS (State Examination), MRCP (Edin), DCH

Arthritis is a general term used to describe any of up to 100 disorders that cause swelling and tenderness of one or more of the joints of the body.

The most common forms are osteoarthritis and rheumatoid arthritis. The first is a degenerative joint disease and the second is an autoimmune disorder that usually affects the hands or feet.

Gout is another form of arthritis and is caused by an excess buildup of uric acid in the body and the resultant formation of uric acid crystals in the bloodstream.

Other forms of arthritis can be the result of infections in the body. Arthritis can also be a secondary effect of other, unrelated diseases such as psoriasis or lupus.

The general symptoms of this disease are joint pain and stiffness. People with arthritis also usually experience joint swelling and decreased range of motion.

Arthritis is usually a chronic disease with no fundamental cure. Instead, the treatment options aim to slow the rate of progression of the disease.  Treatment also aims to reduce the patient’s pain and discomfort and to help him or her maintain the best quality of life under the circumstances.

Causes

The precise causes of each form of arthritis are different. However, for the two most common types  of the disease (osteoarthritis and rheumatoid arthritis.), they can be described as follows:

Osteoarthritis

Osteoarthritis is the most common form of the disease. It is essentially a result of wear and tear of the cartilage of the joint..Cartilage is a tough, slick coating that covers the ends of bones where they meet to form a joint. Its purpose is to avoid direct contact between bone ends and allow them to glide frictionlessly over each other.

However, long term wear and tear of the cartilage can cause the bones to start grinding against each other. The pain can over time become severe enough to restrict joint movement.

In the past, osteoarthritis was believed to be a ‘degenerative joint disease’, a passive process associated with old age. However, it is now known that this is not the case. In addition to being a result of wear and tear of cartilage, osteoarthritis can also be a result of a previous injury to the joint, an inflammatory process that was not properly treated or even a metabolic defect. It is a multifactorial disease which can begin in middle age.

Although it begins with damage to the joint cartilage, osteoarthritis usually progresses to cause more general joint damage. Ultimately, it affects the bones themselves as well as the tissues that connect muscles to the tendons. It also attacks the lining of the joint and causes it to become inflamed. This further aggravates the pain that the patient is already feeling.

Knee osteoarthritis (and particularly patellofemoral osteoarthritis) is one of the most common forms of osteoarthritis.Other commonly affected joints include the hips and small hand joints.

Rheumatoid Arthritis

This is an autoimmune form of arthritis in which the body’s immune system starts attacking the joint lining. Rheumatoid arthritis is the most common inflammatory arthritis in adults and leads to progressive joint destruction and deformity. It causes inflammation and swelling of the synovial membranes and articular structures, which in turn leads to deformity and fusion of parts of the joint. The significant socio-economic impact of the disease is highlighted by the fact that one third of people stop working within about 2 years of its onset.

Rheumatoid arthritis is fortunately a rare disease, with only 1.5 men and 3.6 women developing the condition per 10,000 people per year. It is 2 to 4 times commoner in women than in men.

This form of arthritis affects other parts and organs of the body in addition to the joints. These are called systemic features or extra-articular manifestations (EAM). The heart, lungs and eyes are commonly affected.

Although rheumatoid arthritis can affect any joint with a synovial membrane, it typically affects the small joints of the hands and feet, with both sides usually equally and symmetrically involved in the disease process.

Similarly to osteoarthritis, rheumatoid arthritis progresses over time and eventually causes more widespread damage. It ultimately attacks and starts to destroy the cartilage and bone of the joint, thus aggravating the patient’s pain and discomfort.

Arthritis Risk Factors

The factors that can increase the risk of developing arthritis are as follows:

• Genetics – if you have a family history of arthritis, you are more at risk of developing it at some point in your life. It may be a sign that your genetic makeup makes you more sensitive to environmental elements that can trigger arthritis;
• Most of the best known forms of the disease (e.g. osteoarthritis, rheumatoid arthritis & gout) are more likely to appear in middle aged or older individuals;
• Gender is also a factor. Women are more likely to develop rheumatoid arthritis. However, for other types of arthritis such as gout, the prevalence among men tends to be higher than among women;
• If you have suffered an earlier joint injury, you may be more at risk of developing arthritis in the same joint;
• Body weight – being overweight places more stress on the joints. This is especially true of weight bearing joints such as knees and hips. This extra stress can trigger arthritis over the long term.

Symptoms Of Arthritis

Arthritis mainly attacks the joints and that is where its symptoms are primarily felt and observed. The symptoms vary to some degree with the exact form of the disease that is present. However, they can generally be said to include the following:

• Pain, tenderness & stiffness in the joints;
• Joint swelling;
• Redness and warmth of the skin near the joints in some cases;
• A loss of joint range of motion due to the stiffness mentioned above.
• Weakness and muscle wasting around the joint

If you have one or more of these symptoms, you should seek medical advice as soon as possible.

Diagnosis

Before making a diagnosis, a doctor will usually conduct a physical examination of the painful joint. He or she will check for swelling, warmth and possibly redness of the joint. The patient may also be asked about any stiffness or difficulty in using the affected joint. For example, is (s)he experiencing a reduced range of motion?

Even if the doctor suspects the presence of arthritis, it is still important to identify the exact type. To do this, he or she may request:

• Analysis of bodily fluids such as blood, urine and the synovial fluid of the joint. For example, as we have mentioned above, gout is a result of excessive levels of  uric acid in the blood. A blood test can help to identify the presence of excess uric acid and can be an indicator of gout;
• Imaging tests such as X Rays, CT scans,MRI studies or ultrasound can help doctors to observe the nature of joint or cartilage damage. This can provide important clues as to the type of arthritis that the patient may be experiencing.

Treatment Of Arthritis

Commonly Prescribed Medications

The treatment used is dependent upon the type of arthritis that the patient has. Some types need treatment only for a short time, while others may need lifelong treatment.

As mentioned above, treatment usually focuses on mitigating the symptoms and slowing the rate of progression of the disease. To achieve this, doctors may suggest the following medications:

• Using over the counter medications like Paracetamol to ease arthritic pain (although these will not treat any inflammation that may be present);
• Doctors may also suggest opioids such as Oxycodone to ease the pain. However, patients should be extremely cautious about these medications. Many of them can become habit forming and lead to powerful and destructive addictions;
• Non Steroidal Anti Inflammatory Drugs such as Ibuprofen and Naproxen can help to ease both pain and inflammation;
• In the case of gout, first-line treatment is usually a standard anti-inflammatory drug like Naproxen or Ibuprofen. However, if these are contra-indicated, the patient may be prescribed specialist anti-inflammatory medications such as Colchicine;
• Other drugs can slow the rate of progression of auto-iimmune diseases and may be helpful against rheumatoid arthritis. Examples of these drugs are Methotrexate and Hydroxychloroquine.
• Corticosteroids are a class of drugs specifically designed to reduce inflammation and suppress the immune system . Patients can either take these drugs orally or via direct injection into the affected joint.

Home Based Treatments

As a home based treatment option, moist heat therapy has been shown to be extremely effective in treating some types of arthritic pain. You can read more about this form of treatment here.

In some cases, the patients can also use assistive devices such as unloader knee braces to alter the point of contact between bones of the knee. These braces will help to slow the wear and tear process that causes knee osteoarthritis.

Physical Therapy

A doctor may also refer arthritis patients to a physical therapist. The therapist can design an exercise program to improve range of motion and strengthen the muscles surrounding the joint.

Surgery

If the above treatments do not succeed in reducing the patient’s arthritis pain, there are some surgical approaches that doctors can try. They include the following options:

• Repairing the joints by smoothing bone surfaces to reduce the pain caused by bone on bone grating;
• Joint replacement – this is major surgery in which an arthritic joint is removed and replaced with an artificial one made from metal or plastic. This is a particularly common surgical option for arthritic knees or hips.;
• For smaller joints (e.g. the wrist or ankle) the joint may be fused (locked together) into one rigid unit. This prevents the bones from rubbing against each other and causing arthritic pain.