Arthritis [Plural – arthritides] means inflammation in joint. The term includes all the causes of joint inflammation which are about hundred in number.
Pain is most frequent complaint in arthritis, pattern of which may differ with arthritis type . The treatment involves physical and occupational therapy, lifestyle changes, and medications. Arthroplasty may be required in advanced cases.
Accurate diagnosis and early appropriate comprehensive management are critical.
Thought arthritis has many causes, the common outcome is deterioration of joint surfaces and progressive loss of joint function.
The arthritis could occur as primary disease as in osteoarthritis or it may occur following some other disease such as infection. Former is called primary arthritis and latter is secondary arthritis.
Following are common causes of primary or secondary osteoarthritis. Primary arthritis is said to occur when the joint is primarily affected.
Secondary osteoarthritis is said to occur when the arthritis occurs as a result of the disease that does not primarily affect the joint.
- Rheumatoid arthritis
- Septic arthritis
- Juvenile idiopathic arthritis
- Still’s disease
- Ankylosing spondylitis
- Lupus erythematosus
- Henoch-Schönlein purpura
- Psoriatic arthritis
- Reactive arthritis
- Wegener’s granulomatosis (and many other vasculitis syndromes)
- Lyme disease
- Familial Mediterranean fever
- Hyperimmunoglobulinemia D with recurrent fever
- Inflammatory bowel disease.
As such musculoskeletal diseases account for more than 40% of all patients referred for vocational rehabilitation.
Cause of Arthritis
A joint is where one bone moves on another bone and is held by ligaments. The cartilage is the covering on surface of the bone that articulates with surface. A joint is covered by structure called joint capsule and the space within is filled by synovial fluid which is produced by the synovium which lines the joint cavity.
Affection of any structure may lead to joint disease and thus arthritis.
The following factors may contribute towards a higher arthritis risk.
- Genetic makeup
- Higher physical demands
- Previous injury to the joint
- Overweight or obese body
- Autoimmune disease.
Common Types of Arthritides
When the cartilage loses its elasticity, it becomes stiff and gets damaged easily and wear off leading to stretch on tendons and ligaments. Eventually the bones may rub against each other and cause pain.
This is an inflammatory arthritis where synovial membrane is affected resulting in swelling and pain. It affects more than one joint and is much more common in women than men.
Infectious arthritis is an infection of the joint caused by bacteria, fungi or viruses.
Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis is a type of arthritis that affects a person aged 16 or less.
Pain, swelling, joint stiffness, inability to use the hand or walk, malaise, muscle aches and pains and joint stiffness are complaints in patients of arthritis.
The presentation of arthritis depends on the type of arthritis. For example, osteoarthritis affects the hips, hands, knees and spine.
In osteoarthritis, the symptoms develop insidiously and progress with time. The pain in a joint occurs during or after use, or after a period of inactivity. Joint line would be tender and stiffness can be present. The severity of the symptoms increases as the time passes. Deformities in the affected joints can occur in late stage of the disease.
In rheumatoid arthritis, generally, there is symmetric involvement of joints which are 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. Fatigue can be associated finding.
Infection of the joint presents with fever and swelling of the affected joint. The joint is extremely painful to movement.
Infectious arthritis is more common in children.
Juvenile rheumatoid arthritis patient has intermittent fevers, blotchy rashes on arms and legs and anemia is also common.
Affected joint is swollen and stiff.
Cutaneous nodules, cutaneous vasculitis lesions, lymphadenopathy, edema, ocular inflammation, urethritis, tenosynovitis, Bursitis, diarrhea and orogenital ulceration are extra-articular manifestations of certain arthritides and should be looked for when relevant.
Osteoarthritis generally does not require any laboratory investigation. CBC, ESR, CRP and rheumatoid factor are required in cases of suspected rheumatoid arthritis and juvenile rheumatoid arthritis and infectious arthritis.
Joint aspiration [arthrocentesis] may be required in cases where diagnosis is not clear-cut.
Anteroposterior and lateral views of the involved joint are generally enough. The x-rays help to gauge the joint destruction, suggest the likely cause of arthritis and differentiate from other causes of joint pain.
X-rays show destruction of joint which is depicted by narrowed joint space, osteophytes, osteosclerosis, subchondral cysts, and bone erosions.
MRI and CT may be needed in selected cases.
Treatment of arthritis includes drugs, physical therapy and occupational therapy.
Drugs used in arthritis differ with the type of arthritis. For example, in osteoarthritis simple analgesics are used and in rheumatoid arthritis drugs for RA are used in addition to analgesics.
NSAIDs are the most commonly prescribed drugs for arthritis patients. They are potent analgesics but should not be prescribed in people have had a heart attack or stroke, have heart disease, have peripheral vascular disease, hypertension, hyperlipidemia diabetes, and are regular smokers.
These are steroid drugs which have very high anti-inflammatory action and can be extremely helpful when used properly in selected patients.
Hydroxychloroquine and chloroquine
Used in RA
Used in inflammatory arthritis.
It is an anticancer drug that is very effective in rheumatoid and other inflammatory arthritis.
For severe forms of inflammatory arthritis. Azathioprine also blocks the metabolism of rapidly dividing cells.
In gouty arthritis.
To treat rheumatoid arthritis and psoriatic arthritis.
Cyclosporine – an immunosuppressant drug, used in combination with methotrexate for RA patients. Although effective, this may be limited by its toxicity.
Diet and Weight Control
This is very important aspect of arthritis management. Arthritis patients should avoid foods that cause weight gain.
They should eat plenty of fruit and vegetables, as well as whole grains. Omega-3 essential fatty acids have been shown to relieve some extent the symptoms of rheumatoid arthritis.
Physical Therapy and Occupational Therapy
Physical therapy and occupational therapy help maintain joint mobility and range of motion. Severity and type of arthritis, age, and general state of health determine kind of therapy required.
Aim of the physical therapy is to help patient improve joint stiffness and provide good range of motion. Physical therapy has been shown to delay the need for surgical intervention in advanced cases.
Occupational therapy helps to manage daily activities so that you put least strain on the affected joint. This also includes modification of home and work place, use of splints and aids for activities like dressing, housekeeping, work activities, driving, washing and bathing, devise a dietary plan if you are overweight or help with decisions like buying suitable shoe.
Arthritis patients who are physically active generally enjoy better health, are happier, live longer, experience improvements in pain, sleep, day-to-day functioning and general energy levels.
It is also important to give intermittent rest to the affected joints.
Local pain can be relieved with ice packs or heating pads.
Local analgesic gels are effective in relieving pain.
Joint replacement or arthrodesis maybe needed in some cases to relieve the pain.
Get more stuff on Musculoskeltal Health
Subscribe to our Newsletter and get latest publications on Musculoskeletal Health your email inbox.
Thank you for subscribing.