Arthritis

Overview

Arthritis by definition is the inflammation of one, two or more joints. When one joint is involved, it is called monoarthritis. When two or three joints are involved it is called oligoarthritis. When four or more joints are involved it is called polyarthritis. There are more than 100 types of arthritis, but the most common type is osteoarthritis (OA) and rheumatoid arthritis (RA). Osteoarthritis (OA) is a progressive, painful joint disease that usually involves the neck, lower back, hips, knees or small joints of the hands.

The prevalence of osteoarthritis (OA) rises with age and as the world’s population continues to age, it is estimated that degenerative joint disorders such as osteoarthritis will impact at least 130 million individuals around the globe by the year 2050. Fifteen percent of individuals over the age of 60 are believed to suffer from this disorder. Women are more prone to osteoarthritis than men.

Osteoarthritis is thought to be the most prevalent of all musculoskeletal pathologies, affecting an estimated 10 percent of the world’s population over the age of sixty. Osteoarthritis ranks fifth among all forms of disability worldwide. Women are more prone to osteoarthritis than men. One in twenty men and one in twelve women will develop an inflammatory autoimmune rheumatic disease during their lifetime.

Types of arthritis

Osteoarthritis

It is the most common type of arthritis. It is most often seen in adults over 40s or older. It is more common in women and people with family history of this disorder. However, it can occur at any age, due to injury or due to any other joint-related conditions, such as rheumatoid arthritis or gout. In osteoarthritis, the smooth cartilage lining of the joint is primarily affected. Due to which movement becomes more difficult leading to pain and stiffness. Once the cartilage lining begins to thin out and roughen, the tendons and ligaments need to work harder. Due to which swelling and the formation of bony spurs occur. Severe damage to cartilage leads to bone rubbing on bone, changing the shape of the joint and making the bones out of their normal position. The most commonly affected joints are spine, hands, hips and knees.

Rheumatoid arthritis

It usually starts when a person is between the ages of 40 and 50 years. Women are three times more prone than men. Rheumatoid and osteoarthritis are entirely two different disorders. Rheumatoid arthritis happens when the body’s immune system targets affected joints causing pain and swelling. The outer covering (synovium) of the joint is affected first. Then the disease spreads across the joint, leading to further swelling & change in the joint’s shape. This causes cartilage and the bone to break down. The tissues and organs in the body are also affected by rheumatoid arthritis

Other types of arthritis and related conditions

  • Ankylosing spondylitis: This is a long-term inflammatory condition causing stiffness and joint fusion. The bones, muscles and ligaments of the spine are affected. It can also affect eyes and larger joints.
  • Cervical spondylosis: is a degenerative osteoarthritis that affects the joints and bones in the neck causing pain and stiffness.
  • Fibromyalgia: The body’s muscles, ligaments and tendons become painful.
  • Gout: Excessive uric acid in the body causes Gout. This uric acid in joints (especially the big toe) causes intense pain, swelling and redness.
  • Psoriatic arthritis: This is an inflammatory joint arthritis which affects people with psoriasis.
  • Enteropathic arthritis:  Individuals with inflammatory bowel disease (IBD), ulcerative colitis and Crohn’s disease develop this form of inflammatory and chronic arthritis. Enteropathic arthritis is seen among one in five people with Crohn’s or ulcerative colitis. The peripheral limb joints and the spine are the most common areas affected by inflammation.
  • Reactive arthritis: It occurs after an infection of the genital tract, bowel, or throat. It presents as inflammation of the eyes, joints and urethra.
  • Secondary arthritis: Arthritis which develops after injury to a joint after several years of injury.
  • Polymyalgia rheumatic: This is a condition that affects people over 50 years of age. The immune system leads to muscle stiffness and pain and joint inflammation.

Causes of Arthritis

The cause of arthritis depends on the type of arthritis. Common causes include

  • Injuries
  • Hereditary factors
  • Metabolic abnormalities like gout and pseudogout
  • The direct & indirect effect of infections (viral and bacterial)

RA and SLE are due to immune system dysfunction. Genetic markers increase the risk of developing RA.

Most types of arthritis are a result of a combination of factors. Some people are genetically more prone to certain arthritic conditions. Additional factors like infection, smoking, previous injuries and physically demanding occupations, interact with genes to increase the risk of arthritis.

Diet and nutrition play a very important role in the treatment of arthritis. Foods which increase inflammation like refined sugar and animal-derived foods can make symptoms worse.

Gout is a type of arthritis which is linked to diet and is caused by elevated levels of uric acid. High-purine foods like red wine, seafood and meat, increase the gout symptoms.

Symptoms of arthritis

Arthritis limits the functions of the affected joints. Arthritis causes joint inflammation and results in swelling, joint stiffness, pain, redness, and warmth. The inflamed joint can be tender with or without pain. When large joints like knee joints are involved, there is a limitation of movement due to cartilage loss and joint damage. When smaller joints in the fingers are affected by arthritis, there will be loss of strength of hand grip.

Rheumatic disease is not limited to the joints. It can affect various other organs of the body. Symptoms can include gland swelling (swollen lymph nodes), fever, fatigue, weight loss, feeling unwell, and abnormalities of organs like the heart, lungs,  or kidneys.

Risk factors of Arthritis

Certain risk factors have been linked with arthritis. Some of these are modifiable while others are not.

Non-modifiable risk factors for arthritis

  • Age: The risk of arthritis increases with age.
  • Sex: Most forms of arthritis are more common in females than men. Gout is common in males than in females.
  • Genetic factors:  Certain types of arthritis like rheumatoid arthritis (RA), Ankylosing spondylitis and systemic lupus erythematosus (SLE) are associated with specific genes.

Modifiable risk factors for arthritis

  • Obesity: Overweight and obesity hastens the onset and advancement of osteoarthritis.
  • Joint injuries: Damage to a joint can enhance osteoarthritis in the joint.
  • Infections: Germs that infect joints can enhance various types of arthritis.
  • Occupation: Professions that involve repetitive bending and squatting can lead to osteoarthritis of the knee.

Arthritis Diagnosis 

During a physical examination, the doctor examines all joints for pain, redness, swelling, warmth and movements. Depending on the type of arthritis suspected by the doctor, the following tests may be suggested.

Laboratory tests

The analysis of body fluids helps pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid (aspiration).

Imaging studies

These types of tests detect problems within the joint which cause the symptoms. Examples include:

X-rays are used to see bone, cartilage loss, bone spurs and bone damage. X-rays do not detect early arthritic damage, but help to see the progress of the disease.

Computerized tomography (CT) scan takes X-rays from various angles and combines them to produce cross-sectional views of internal structures. In CTs both bone and the surrounding soft tissues are noted.

Magnetic resonance imaging (MRI) combined radio waves along with strong magnetic field to produce cross-sectional images to view details of soft tissues of tendons, cartilage and ligaments.

Ultrasound is used to produce images of cartilage, soft tissues, and fluid-filled structures like bursae. Needle placement for joint aspirations and injections can also be guided by ultrasound.

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Treatment for Arthritis

Arthritis treatment focuses on relieving the symptoms and also improvement of the joint function. Arthritis can be treated with several different methods, or can be treated by combinations of different treatment modalities.

Medications

The medications vary depending on type of arthritis. Common medications used for arthritis include:

  • Analgesics: These medications relieve pain, but have no effect on inflammation. Examples of analgesic are paracetamol, narcotics like oxycodone, tramadol or hydrocodone.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs not only reduce pain but even decrease inflammation. NSAIDs like ibuprofen and naproxen sodium are used to treat arthritis. Oral NSAIDs are known to cause stomach irritation. Some can also increase the risk of heart attack or stroke. Some NSAIDs in the form of creams or gels can be rubbed on joints.
  • Counterirritants: The creams and ointments containing capsaicin or menthol are used as a rub on the skin over the aching joint. These counterirritants are known to interfere with the pain signals transmitted from the joint and thus relieving the pain.
  • Disease-modifying antirheumatic drugs (DMARDs): DMARDs slow or stop the immune system and prevent attacks on the joints. Examples include hydroxychloroquine and methotrexate.
  • Biologic response modifiers: These are typically used in combination with DMARDs. They are genetically engineered drugs which target various protein molecules involved in the immune response. Examples include infliximab and etanercept.
  • Corticosteroids:  Prednisone and Cortisone are the steroids which are used to reduce inflammation and suppress immune system. Corticosteroids are taken orally and can be injected into the painful joint directly.

Therapy

Physical therapy is useful for many types of arthritis. Exercises are used to improve the range of motion and strengthen the muscles that surround the joints. In some cases, splints or braces may be necessary.

Surgery for Arthritis

If conservative measures don’t show any improvement the doctor would suggest surgery.

  • Joint repair: In this surgery, joint surfaces are smoothened and realigned to decrease pain and improve function. These procedures are done arthroscopically, with the help of small incisions over the joint.
  • Joint replacement: This procedure replaces the damaged joint with an artificial one. Examples are hips and knees.
  • Joint fusion: Smaller joints, like fingers, wrist, and ankle are treated by joint fusion. The ends of the two bones are removed in the joint and locked together until they heal into one unit.

Prevention of Arthritis

  • Arthritis is not always preventable. Healthy habits can reduce the risk of developing painful joints as a person gets older.
  • Healthy polyunsaturated fats like omega-3 fatty acids are found in certain fish and are known to reduce inflammation in the body. Rheumatoid arthritis is lower in individuals who eat fish rich in omega-3 fatty acids like mackerel, trout, salmon, and sardines twice a week.
  • Overweight women are four times more prone to knee osteoarthritis than healthy weight women. Diet and exercise can play an important role in bringing the weight into a healthier range.
  • Exercise reduces excess weight and strengthens the muscles around the joints. This protects them from wear and tear. Aerobic activities like swimming or walking are strengthening exercises. Stretching exercises maintain flexibility and range of movements.
  • Over time, joints begin to wear out. When an injury occurs to the joints, like during an accident or sports, they damage the cartilage and cause them to wear more quickly. Use proper safety equipment during playing sports, and learn the correct exercise techniques to avoid injury.
  • Correct techniques during working, sitting and lifting will protect the joints. For example, carrying items close to the body will not put too much strain on the person’s wrists. If the person has to sit for long periods at work, the legs, back, and arms have to be well supported.
  • Women, who drink moderate amounts of alcohol, may have a lower risk of rheumatoid arthritis.

FAQs for Arthritis

  1. What is Arthritis?

Arthritis by is inflammation of one, two or more joints and cause pain and swelling.

  1. What are the most common types of arthritis?

Types of arthritis are osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and reactive arthritis.

  1. What is the risk for arthritis?

Age, Sex, Genetic factors, Obesity, Joint injuries, Infection, Occupation

Apollo Hospitals has the best arthritis treatment doctors in India. To find the best arthritis doctors in your nearby cities visit the links below:

Arthritis doctors in Bangalore

Arthritis doctors in Chennai

Arthritis doctors in Hyderabad

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