Arthritis

 

Arthritis affects the musculoskeletal system, specifically the joints. Arthritis is not a single disease – it is a term that covers over 100 medical conditions. Osteoarthritis (OA) is the most common form of arthritis and generally affects elderly patients. Some forms of arthritis can affect people at a very early age.

 Causes

 Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move.

Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly.

A capsule surrounds the joint. The space within the joint – the joint cavity – has synovial fluid. Synovial fluid nourishes the joint and the cartilage. The synovial fluid is produced by the synovium (synovial membrane) which lines the joint cavity.

Arthritis  results when the cartilage is wearing away, a lack of synovial fluid, autoimmunity (your body attacking itself), infection, or a combination of many factors.
Types of arthritis

There are over 100 types of arthritis. Here is a description of some common ones, together with the causes:

• Osteoarthritis- Cartilage loses its elasticity. If the cartilage is stiff it becomes damaged more easily. The cartilage, which acts as a shock absorber, will gradually wear away in some areas. As the cartilage becomes damaged tendons and ligaments become stretched, causing pain. Eventually the bones may rub against each other causing very severe pain.
• Rheumatoid arthritis- This is an inflammatory form of arthritis. The synovial membrane (synovium) is attacked, resulting in swelling and pain. If left untreated the arthritis can lead to deformity. Rheumatoid Arthritis is significantly more common in women than men and generally strikes when the patient is aged between 40 and 60. However, children and much older people may also be affected.

• Infectious arthritis (septic arthritic)- An infection in the synovial fluid and tissues of a joint. It is usually caused by bacteria, but could also be caused by fungi or viruses. Bacteria, fungi or viruses may spread through the bloodstream from infected tissue nearby, and infect a joint. Most susceptible people are those who already have some form of arthritis and develop an infection that travels in the bloodstream.
• Juvenile rheumatoid arthritis (JRA)- means arthritis that affects a person aged 16 or less. JRA can be various forms of arthritis; it basically means that a child has it. There are three main types:

1. Pauciarticular JRA, the most common and mildest. The child experiences pain in up to 4 joints.
2. Polyarticular JRA affects more joints and is more severe. As time goes by it tends to get worse.
3. Systemic JRA is the least common. Pain is experienced in many joints. It can spread to organs. This can be the most serious JRA.

The signs and symptoms of arthritis

The symptoms of arthritis depend on the type of arthritis, for example:

• Osteoarthritis- The symptoms develop slowly and get worse as time goes by. There is pain in a joint, either during or after use, or after a period of inactivity. There will be tenderness when pressure is applied to the joint. The joint will be stiff, especially first thing in the morning. The patient may find it harder to use the joint – it loses its flexibility. Some patients experience a grating sensation when they use the joint. Hard lumps, or bone spurs may appear around the joint. In some cases the joint might swell. The most common affected joints are in the hips, hands, knees and spine.

• Rheumatoid arthritis- The patient often finds the same joints in each side of the body are painfully swollen, inflamed, and stiff. The fingers, arms, legs and wrists are most commonly affected. Symptoms are usually worst on waking up in the morning and the stiffness can last for 30 minutes at this time. The joint is tender when touched. Hands may be red and puffy. There may be rheumatoid nodules (bumps of tissue under the skin of the patient’s arms). Many patients with rheumatoid arthritis feel tired most of the time. Weight loss is common.The smaller joints are usually noticeably affected first. Experts say patients with rheumatoid arthritis have problems with several joints at the same time. As the arthritis progresses it spreads from the smaller joints in your hands, wrists, ankles and feet to your elbows, knees, hips, neck, shoulders and jaw.

• Infectious arthritis- The patient has a fever, joint inflammation and swelling. He will feel tenderness and/or a sharp pain. Often these symptoms are linked to an injury or another illness. Most commonly affected areas are the knee, shoulder, elbow, wrist and finger. In the majority of cases, just one joint is affected.

• Juvenile rheumatoid arthritis- The patient is a child. He will experience intermittent fevers which tend to peak in the evening and then suddenly disappear. His appetite will be poor and he will lose weight. There may be blotchy rashes on his arms and legs. Anemia is also common. The child may limp or have a sore wrist, finger, or knee. A joint may suddenly swell and stay larger than it usually is. The child may experience a stiff neck, hips or some other joint.

TREATMENT

Physical therapy and occupational therapy for arthritis

Physical therapy and occupational therapy help maintain joint mobility and range of motion. How much therapy you need, and what kind of therapy will depend on many factors, such as the severity and type of arthritis you have, your age, and your general state of health.

People with arthritis will often avoid moving the affected joint because of the pain. A physical therapist can help the patient work out the joint stiffness without damaging it. In order to perform your daily activity the physical therapist will help you achieve a good range of motion. This may involve building strength in the muscles that surround the affected joint – stronger muscles help stabilize a weakened joint. You will also be taught the best way to move from one position to another, as well as learning how to use such walking aids as crutches, a cane or a walker, if you need one.

Occupational therapy can teach you how to reduce the strain on your joints as you go about your daily activities. The occupational therapist can help you modify your home and workplace so that your movements do not aggravate your arthritis. You may need a splint for your hands or wrists, as well as aids for dressing, housekeeping, work activities, driving and washing/bathing yourself.

An occupational and/or physical therapist can make an enormous difference to your quality of life if you suffer from arthritis. You will learn how and when to rest – rest is crucial for treating inflammation and pain, especially when many joints are affected and you feel tired.

Local pain can be relieved with ice packs or heating pads. Ultrasound and hot packs provide deep heat which relieves localized pain and relaxes muscle spasm around the affected joint. You may find that a warm bath/shower makes it easier for you to exercise afterwards.

Physical activity can improve arthritis symptoms – doctors warn that inactivity could harm the health of most patients with arthritis or some kind of rheumatic disease. Inactivity raises the risk of cardiovascular disease and diabetes type 2. Muscles become weaker with no exercise, joints become stiffer, and the patient’s tolerance for pain decreases. Balance problems may also become worse.

Medications for arthritis

• NSAIDs (nonsteroidal anti-inflammatory drugs) are the most commonly prescribed drugs for arthritis patients.  At a higher dose – NSAIDs also help reduce joint inflammation. There are three main types of NSAIDs and they all work by blocking prostaglandins – hormone-like substances that trigger pain, inflammation, muscle cramps and fever.
• Salicylates – includes Aspirin which continues to be the preferred medication of many doctors and patients. Patients need to consult their doctor if they plan to take aspirin more than just occasionally. Long term high dosage usage of aspirin carries with it a significant risk of serious undesirable side effects, such as kidney problems and gastrointestinal bleeding. For effective control of arthritis pain and inflammation frequent large doses are needed.
• Glucocorticoidsare anti-inflammatory steroids and are very effective at combating inflammation and can be extremely helpful when used properly. The patient needs to consider the potential for undesirable side-effects with this type of drug.

• Anti-malarials, such as hydroxychloroquine and chloroquine are commonly used for treating mild inflammatory arthritis.

• Minocycline- an antibiotic that is sometimes used as antibiotic therapy for rheumatoid arthritis. Its use is controversial.

• Sulfasalazine- commonly used for many types of inflammatory arthritis. Sulfasalazine is a sulfa derivative.

• Methotrexate- works by blocking the metabolism of rapidly dividing cells. It is commonly used for treating more serious types of inflammatory arthritis.

• Azathioprine- used for severe forms of inflammatory arthritis. Azathioprine also blocks the metabolism of rapidly dividing cells.

• Gout medications- some physicians may use gout medications to treat some forms of arthritis.
• Leflunomide- used to treat rheumatoid arthritis and psoriatic arthritis. It also blocks cell metabolism.

• Cyclosporine- an immunosuppressant drug – it makes your immune system less aggressive.Cyclosporine is usually used in combination with methotrexate for arthritis patients.

Diet and bodyweight impact on arthritis

 Eating a well-balanced diet is vital when you have arthritis.Not only will you be receiving critical nutrients, you will also be either maintaining or arriving more quickly at a healthy bodyweight. If you are overweight you will be adding extra pressure on weight-bearing joints. Many patients have found that losing just a few pounds made a significant difference to their quality of life.

You should make sure you are eating plenty of fruit and vegetables, as well as whole grains. Omega-3 essential fatty acids are thought to relieve to some extent the symptoms of arthritis. A common source of Omega-3 fatty acids is oily fish, such as sardines, herring, trout, and salmon.

• Help maintain normal joint movement
• Increase muscle flexibility and strength
• Help maintain weight to reduce pressure on joints
• Help keep bone and cartilage tissue strong and healthy
• Improve endurance and cardiovascular fitness