Arthritis
Introduction
Arthritis is a general term for a number of painful conditions of the joints and bones. Two of the main types of arthritis are osteoarthritis and rheumatoid arthritis
Osteoarthritis is the most common form of arthritis. Cartilage between the bones gradually wastes away and this can lead to painful rubbing of bone on bone in the joints. It may also cause joints to fall out of their natural positions (misalignment). The most frequently affected joints are in the hands, spine, knees and hips.
Rheumatoid arthritis is the main type of inflammatory arthritis. Also known as inflammatory arthritis, rheumatoid arthritis is a more severe, but less common condition. The body's immune system attacks and destroys the joint, causing pain and swelling. It can lead to reduction of movement, and the breakdown of bone and cartilage.
There are over 200 forms of arthritis. More common forms include:
- ankylosing spondylitis,
- cervical spondylitis,
- fibromyalgia,
- systemic lupus erythematosis (lupus),
gout,
- psoriatic arthritis, and
- Reiter's syndrome.
Arthritis is often associated with older people, but it can also affect children. About one in 1,000 children develop arthritis. Arthritis in children is often called juvenile idiopathic arthritis (JIA). The three main types of JIA are:
- Oligo-articular JIA - is the most common form of JIA. It affects four or fewer joints in the body, most commonly the knees, ankles and wrists. This type has good recovery rates and the effects are rarely long term. However, there is a risk of developing eye problems, so children should have regular checks with an eye specialist (ophthalmologist).
- Polyarticular JIA (or polyarthritis)- affects five or more joints, and the symptoms are very similar to adult rheumatoid arthritis. It can quickly spread from one joint to another and can develop at any age. It is often accompanied by a rash or fever.
- Systemic onset JIA - begins with symptoms such as fever, rashes, lethargy and enlarged glands, and later develops into swollen and inflamed joints. It can also affect children of any age.
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Symptoms
The main symptoms of all forms of arthritis include:
- stiffness,
- pain,
- restricted movements of the joints
- swelling, and
- warmth and redness of the skin over the joint.
Osteoarthritis
Osteoarthritis often develops in people who are between 40-60 years of age. Osteoarthritis becomes more common with age with around 12% of people over 65 affected by the condition.
Osteoarthritis begins slowly with pain and stiffness in joints when they are moved, and restricted movement of the joints affected. For some, slight stiffness is all they will experience, but others go on to have grating joints, knobbly bone growths (especially on the hands), and joints that go out of alignment. The pain and loss of movement tends to get worse as the day goes on, as the joints are used more.
Rheumatoid arthritis
Rheumatoid arthritis affects between 1-3% of the population, and often starts between 30-50 years of age. Women are three times more likely to be affected by rheumatoid arthritis than men.
Like osteoarthritis, rheumatoid arthritis begins gradually, with the first symptoms often being felt in small joints, such as fingers or toes. The condition can then progress to cause pain, swelling and stiffness of other joints, causing a lack of mobility. Cold and damp weather may aggravate the symptoms which are often worse in the morning. However, your symptoms may improve during the day as you start using and flexing your joints. Rheumatoid arthritis can also sometimes leave people feeling generally unwell and tired.
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Causes
The cause of arthritis is not fully known. One theory is that some people are genetically predisposed to developing the disease, but this is not yet proven.
Factors that may contribute to the development of osteoarthritis include:
- obesity (puts added strain on joints),
- jobs that involve repetitive movements of a particular joint, or
- previous damage to joint, such as from a sports injury.
Rheumatoid arthritis is thought to be caused by a fault in the immune system that causes the body to attack its own tissues. This may be inherited genetically.
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Diagnosis
Arthritis is diagnosed by symptoms and a physical examination. Related factors such as occupation, other activities that may strain joints (such as regular sporting activities), medical history, and any history of arthritis in the family will be taken into account. An X-Ray is particularly useful for identifying osteoarthritis, as it can highlight the narrowed space between the bones in a joint. It can also show whether there is any calcification, which is where calcium builds up in the body tissue, causing it to harden.
Occasionally, a computerised tomography scan (CT scan) or magnetic resonance imaging scan (MRI scan) is used to identify arthritis.
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Treatment
Everyone experiences arthritis in a different way, so individual advice on management and treatment is normally given. It is also important to start treatment as early as possible after symptoms begin in order to reduce further damage to joints and improve quality of life.
The treatment of arthritis usually involves a range of healthcare professionals which may include:
- your GP,
- arthritis specialist (rheumatologist),
- physiotherapist,
- occupational therapist,
- nurse specialist,
- dietitian,
- podiatrist,
- pharmacist and
- social worker.
Treatments for osteoarthritis:
The medicines prescribed for osteoarthritis tend to fall into three groups:
- analgesics - such as paracetamol. They help to relieve pain.
- non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen and aspirin. However, when taken over long periods, or in high doses, these medicines can lead to digestive problems and bleeding in the stomach. Aspirin should not be given to children under 16 years of age. Cox-2 selective inhibitors are a type of NSAID which are designed to be less harmful to the stomach. However, research has linked the use of Cox-2 inhibitors to an increased risk of strokes, raised blood pressure, heart disease and heart attacks, so it is important to make your GP aware if you have a history of high blood pressure or high cholesterol, or if you smoke.
- corticosteroids - these are injected directly into the affected joint. However, this is not recommended on a long term basis because of serious side effects, such as wasting away of tissue surrounding the joint.
Sometimes, surgery (arthroplasty) may be used to treat severe cases of osteoarthritis. Arthroplasty involves either reconstructing, or replacing, a diseased joint. For arthritis patients it can help restore movement and function to the joint. However, not all joints can be artificially replaced. Other possible procedures might include realignment of the joint (osteotomy).
Treatments for rheumatoid arthritis:
The main objective for the treatment of rheumatoid arthritis is to reduce the damaging inflammation. Some of the main treatments are outlined below.
- Disease modifying anti-rheumatic drugs (DMARDs) can help stop the progress of rheumatoid arthritis. Therefore, the earlier these are prescribed, the more effective they are. DMARDs are thought to have fewer side effects than long-term use of drugs, such as paracetamol. However, there are some associated risks including diarrhoea, nausea, skin rash and hair-loss. DMARDs are often used in conjunction with NSAIDs
- Relaxation techniques and physiotherapy can be effective in treating types of arthritis that involves swelling of the joints.
- Alternative techniques are being developed, including low-level laser therapy (LLLT), and low doses of orally administered corticosteroids, although the evidence of these treatments being beneficial is limited
- New medicines, such as tumour necrosis factor (TNF ) blockers, are in development and are showing very promising results. However, this type of medicine is not appropriate for everyone with arthritis.
There are a number of other therapies that have been used to treat arthritis. However, not all of them have been clinically proven to be effective. These therapies include:
- massage,
- acupuncture - the insertion of fine needles at chosen points on the skin,
- osteopathy - a mixture of gentle and forceful massage techniques aimed to reduce pain and swelling,
- chiropractics - involves careful manipulation of the joints, muscles and tendons to provide pain relief,
- hydrotherapy - exercise programmes in either a warm shallow swimming pool or a special hydrotherapy bath,
- electrotherapy - uses electrical impulses (tiny electrical shocks) to stimulate the nervous system, and
- nutritional supplements - such as glucosamine sulphate, chondroitin and fish oil.
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Complications
In the long term, arthritis can produce worsening pain, loss of mobility, and sometimes may make walking difficult or impossible. Depression often accompanies this condition.
General effects of rheumatoid arthritis may include:
- loss of appetite and weight,
- tiredness,
- muscle pain,
- nodules under the skin,
- inflammation of tendons,
- problems affecting the sight,
- anaemia and
- vasculitis (inflammationof the blood vessels).
Some treatments have side-effects that cause additional problems. NSAIDs may damage the stomach and digestive system and may also be associated with kidney problems in some people. Corticosteroids can cause reduction in bone density (osteoporosis – leading to increased risk of fractures) and may also lead to the development of shingles, cataracts, diabetes.
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Prevention
Weight control helps ease pressure on joints, and avoiding stress or injury to your joints can also help to prevent or reduce the severity of osteoarthritis.
It is not true that avoiding exercise will help reduce joint problems in later life. Weight-bearing exercise such as walking will help to prevent osteoarthritis by increasing the strength of muscles that support joints.
Good posture can assist the strengthening of healthy joint structures, and physiotherapy and use of a walking stick or cane, can help prevent worsening of existing conditions.
There is no known way to prevent rheumatoid arthritis.
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