ARTHRITIS- A COMPLETE GUIDE


Arthritis a very common household term which is used by each one of us , either for ourselves or for someone related to us.


Arthritis is commonly known as joint pain or swelling or any kind of disability related to performance. In medical terms the word arthritis is divided in two part, arthro means ' related to joint' and itis means ' inflammation'. So broadly, arthritis is defined as inflammation of joint or bones causing pain and disability.




World Health Organization (WHO)


World Health Organization ( WHO), says that, Rheumatic or musculoskeletal conditions comprise over 150 diseases and syndromes, which are usually progressive and associated with pain.


They can broadly be categorized as joint diseases, physical disability, spinal disorders, and conditions resulting from trauma. Musculoskeletal conditions are leading causes of morbidity and disability, giving rise to enormous healthcare expenditures and loss of work. One of the major condition being Arthritis.


Arthritis is a term often used to mean any disorder that affects joints. symptoms generally include joint pain and stiffness.


Other symptoms may include redness, warmth, swelling and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.


Don't like reading, watch a quick video instead




Classification of Arthritis :


There are several types of arthritis, specifically, 100 types. The most common types of arthritis that are noted are:


1. OSTEOARTHRITIS

2. RHEUMATOID ARTHRITIS


3. Other types include:


3.1 Lupus

3.2 Fibromyalgia

3.3 Gout

3.4 Septic arthritis,

3.5 Rheumatoid disease.


Osteoarthritis affects more than 3.8% of people, while rheumatoid arthritis affects about 0.24% of people.


There are several conditions where joint pain is the primary or the main feature and based on that main feature the classification of arthritis is as follows;

  • Osteoarthritis

  • Rheumatoid arthritis

  • Gout and pseudo-gout

  • Septic arthritis

  • Ankylosing spondylitis

  • Juvenile idiopathic arthritis

  • Still's disease

These are the conditions where joint pain is the primary complaint and is noted in the patient.


The other type of classification includes that a primary condition or disease may be different but along with that there could be associated joint pain or inflammation , based on it the classification is as follows;

  • Psoriasis (Psoriatic arthritis)

  • Reactive arthritis

  • Ehlers–Danlos syndrome

  • Haemochromatosis

  • Hepatitis

  • Lyme disease

  • Sjögren's disease

  • Hashimoto's thyroiditis

  • Celiac disease

  • Non-celiac gluten sensitivity

  • Inflammatory bowel disease (including Crohn's disease and ulcerative colitis)

  • Henoch–Schönlein purpura

  • Hyperimmunoglobulinemia D with recurrent fever

  • Sarcoidosis

  • Whipple's disease

  • TNF receptor associated periodic syndrome

  • Granulomatosis with polyangiitis (and many other vasculitis syndromes)

  • Familial Mediterranean fever

  • Systemic lupus erythematosus


The symptoms of arthritis may develop suddenly or over a period of time. Mostly the symptoms are seen in people above 65 years of age but may also be seen in children or younger age group. Both genders may be equally affected.


Causes of Arthritis


  • To understand the causative factors of arthritis it is important to understand the structure of joint and surrounding structures. A normal joint consists articulating surfaces, ligaments binding muscles with joints and tendons which bind bone with bone. Cartilage is a firm but flexible connective tissue in your joints. It protects the joints by absorbing the pressure and shock created when you move and put stress on them. Primary cause of arthritis is damage to the cartilage structure due to advancing age and wear and tear of body.

  • Another cause can be trauma or infection which increases the risk of damage to joint structures or cartilage structure causing wear and tear and leading to arthritis of the joint. This is a very common type of arthritis.

  • One major cause of arthritis is autoimmune disorders. Auto immune disorders are termed as when your body's immune system attacks the tissues of the body affecting the normal wear and tear of the joints .


Risk factors for Arthritis


Risk factors means factors or causes that are responsible to put a person at risk of developing a specific disorder or disease and affecting the normal structure and function of the body systems. The risk factors for arthritis are as follows:

  1. Family history : Family history plays a major role in increasing the risk of causing arthritis. If you have a family history of arthritis there are high chances of having arthritis.

  2. Genetic factors: Some of the arthritis are gene linked and hence, genetic factors could be one of the risk factors

  3. Existing metabolic conditions: Conditions like obesity, trauma, infections or existing factors can cause arthritis.


Signs and Symptoms of Arthritis


Pain, which can vary in severity, is a common symptom in virtually all types of arthritis. Other symptoms include joint stiffness and swelling aching around the joint(s). Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. Symptoms may include:

  • Inability to use the hand or walk

  • Stiffness, which may be worse in the morning, or after use

  • Malaise and fatigue

  • Weight loss

  • Poor sleep

  • Muscle aches and pains

  • Tenderness

  • Difficulty moving the joint


It is common in advanced arthritis for significant secondary changes to occur. For example, arthritic symptoms might make it difficult for a person to move around and/or exercise, which can lead to secondary effects, such as:

Illustration of gout affected foot.

  • Muscle weakness

  • Loss of flexibility

  • Decreased aerobic fitness


Arthritis can cause disability


  • Reduced mobility, pain causes limitations in activities of daily living and also causes reduction in the functions of the body.

  • According to studies, Arthritis has increased the situations of hospitalization and dependency.

  • Arthritis can make it very difficult for individuals to be physically active and some become home bound.

  • People with arthritis are also at increased risk of depression, which may be a response to numerous factors, including fear of worsening symptoms.





Arthritis may cause deformities :


As mentioned earlier, there are several types of arthritis that can be found in a person.


However, Rheumatoid arthritis is the type of arthritis that causes major deformities in the joints.


Deformities may be found in the joints of upper limb or legs.


The deformities seen in Rheumatoid arthritis are as follows;

  • Ulnar drift: Your fingers lean away from your thumb and toward your pinky.

  • Boutonniere or buttonhole deformity: Your middle finger joint bends toward your palm. The top joint bends up.

  • Swan-neck deformity: The base and top joint of your finger bend down. The middle joint is straight.

  • Hitchhiker’s thumb or z-shaped deformity: Your thumb flexes at the bottom joint and bends back at the top joint.

  • Bunion. The base of your big toe gets larger and sticks out. It may press against the second toe, so it overlaps the third.

  • Claw toe: Your toe might bend up from the ball of your foot; down toward the sole of your shoe at the middle joint; or down at the top joint.


Deformities

Diagnosis of Arthritis


Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis.


All arthritis potentially feature pain. Pain patterns may differ depending on the arthritis and the location. The assessment is done based on following points;


History taking

Assessment of symptoms and signs

Physical assessment of the affected joints

Blood tests or other diagnostic tests.

They will perform a physical exam to check for fluid around the joints, warm or red joints, and limited range of motion in the joints. Your doctor can refer you to a specialist if needed.


Rheumatoid arthritis is generally worse in the morning and associated with stiffness lasting over 30 minutes.


However, in the early stages, patients may have no symptoms after a warm shower. Osteoarthritis, on the other hand, tends to be associated with morning stiffness which eases relatively quickly with movement and exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.


Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms.


Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.


Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritis are suspected.


These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.


1. Osteoarthritis


Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, wrists, feet, back, hip, and knee.


The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. In recent years, some joint or limb deformities, such as knock-knee or acetabular overcoverage or dysplasia, have also been considered as a predisposing factor for knee or hip osteoarthritis.


Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other.


The condition starts with minor pain during physical activity, but soon the pain can be continuous and even occur while in a state of rest.


The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight-bearing joints, such as the back, knee and hip.


Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. The strongest predictor of osteoarthritis is increased age, likely due to the declining ability of chondrocytes to maintain the structural integrity of cartilage.


More than 30 percent of women have some degree of osteoarthritis by age 65. Other risk factors for osteoarthritis include prior joint trauma, obesity, and a sedentary lifestyle.


2. Rheumatoid arthritis


Rheumatoid arthritis (RA) is a disorder in which the body's own immune system starts to attack body tissues.


The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones.


RA often affects joints in the fingers, wrists, knees and elbows, is symmetrical (appears on both sides of the body), and can lead to severe deformity in a few years if not treated.


RA occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities.


With earlier diagnosis and aggressive treatment, many individuals can lead a better quality of life than if going undiagnosed for long after RA's onset.


The risk factors with the strongest association for developing rheumatoid arthritis are female sex, family history of rheumatoid arthritis, and exposure to tobacco smoke.


Bone erosion is a central feature of rheumatoid arthritis. Bone continuously undergoes remodeling by actions of bone resorbing osteoclasts and bone forming osteoblasts.


One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the synovium, caused in part by the production of pro-inflammatory cytokines and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts. Osteoclast activity can be directly induced by osteoblasts through the RANK/RANKL mechanism.


3.1 Lupus


Lupus a common collagenvascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, lung fibrosis and constant joint pain.


3.3 Gout


Gout caused by deposition of uric acid crystals in the joint, causing inflammation.


There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. In the early stages, the gouty arthritis usually occurs in one joint, but with time, it can occur in many joints and be quite crippling.


The joints in gout can often become swollen and lose function. Gouty arthritis can become particularly painful and potentially debilitating when gout cannot successfully be treated.


When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout.


Other


Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible joint damage.


Psoriasis can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling.


The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function.


Treatment of Arthritis


Pain is the major complaint in the cases of arthritis which then affects the activities of daily living. So to formulate the treatment protocol it is very important to understand the problem list and then decide the short term and long term management and start the treatment accordingly.


The main goal of treatment is to reduce the amount of pain you’re experiencing and prevent additional damage to the joints. You’ll learn what works best for you in terms of controlling pain. Some people find heating pads and ice packs to be soothing.


Others use mobility assistance devices, like canes or walkers, to help take pressure off sore joints.


Improving your joint function is also important. Your doctor may prescribe you a combination of treatment methods to achieve the best results.

The plan of action of treatment include following treatment measures;

  1. Medications

  2. Surgery

  3. Physical Therapy

  4. Adaptive Aids

  5. Alternative medicine


1. Medications:


There are several types of medications that can be prescribed for the treatment of arthritis. The medications may vary depending upon the types of the arthritis. A number of different types of medications are used to treat arthritis, the medications are as follows;

  • Analgesics, such as hydrocodone (Vicodin) or acetaminophen (Tylenol), are effective for pain management, but don’t help decrease inflammation.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and salicylates, help control pain and inflammation. Salicylates can thin the blood, so they should be used very cautiously with additional blood thinning medications.

  • Menthol or capsaicin creams block the transmission of pain signals from your joints.

  • Immunosuppressants like prednisone or cortisone help reduce inflammation.

If you have RA, your doctor may put you on corticosteroids or disease-modifying antirheumatic drugs (DMARDs), which suppress your immune system. There are also many medications to treat OA available over the counter or by prescription.


2. Surgery:


Surgery to replace your joint with an artificial one may be an option. This form of surgery is most commonly performed to replace hips and knees.


If your arthritis is most severe in your fingers or wrists, your doctor may perform a joint fusion. In this procedure, the ends of your bones are locked together until they heal and become one.


3. Physical therapy:


In general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.


Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited.


Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases.


Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee.


Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance.


Occupational therapy can provide assistance with activities. Assistive technology is a tool used to aid a person's disability by reducing their physical barriers by improving the use of their damaged body part, typically after an amputation. Assistive technology devices can be customized to the patient or bought commercially.


4. Adaptive Aids:


People with hand arthritis can have trouble with simple activities of daily living tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful.


There are adaptive aids or (assistive devices (ADs)) available to help with these tasks, but they are generally more costly than conventional products with the same function. It is now possible to 3-D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.


5. Alternative Medicine:


Low level laser therapy may be considered for relief of pain and stiffness associated with arthritis. Evidence of benefit is tentative.


Pulsed electromagnetic field therapy (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis. The FDA has not approved PEMFT for the treatment of arthritis. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritis.


6. Lifestyle Management :


Lifestyle management is an important aspect of treating arthritis and other related conditions. Following are few measures which can help in modifying the lifestyle which would help in relieving the symptoms.

Weight loss and maintaining a healthy weight reduce the risk of developing OA and can reduce symptoms if you already have it.

Eating a healthy diet is important for weight loss. Choosing a diet with lots of antioxidants, such as fresh fruits, vegetables, and herbs, can help reduce inflammation. Other inflammation-reducing foods include fish and nuts.

Foods to minimize or avoid if you have arthritis include fried foods, processed foods, dairy products, and high intakes of meat.

Some research also suggests that gluten antibodies may be present in people with RA. A gluten-free diet may improve symptoms and disease progression. A 2015 study also recommends a gluten-free diet for all people who receive a diagnosis of undifferentiated connective tissue disease.

Regular exercise will keep your joints flexible. Swimming is often a good form of exercise for people with arthritis because it doesn’t put pressure on your joints the way running and walking do. Staying active is important, but you should also be sure to rest when you need to and avoid overexerting yourself.

At-home exercises you can try include:

  • the head tilt, neck rotation, and other exercises to relieve pain in your neck

  • finger bends and thumb bends to ease pain in your hands

  • leg raises, hamstring stretches, and other easy exercises for knee arthritis


Conclusion


Arthritis is a condition caused by degeneration and wear and tear of the normal structures in and around joints. It is very common and there is no need to worry for that condition.


Maintaining a healthy lifestyle, exercising regularly, and even if you develop arthritis it is very important to visit the doctor and start the medications or physical therapy as early as possible.


Early interventions can reduce the effect of symptoms and also help in maintaining a healthy and better lifestyle with reduced pain and disability. Also, starting treatment early can reduce the risk of developing deformities in joint and reducing the functions further. So be healthy, and don't worry about arthritis.