Arthritis

What is Arthritis?

The term arthritis literally means ‘inflammation of a joint’, but is generally used to describe any condition in which there is pain, swelling or stiffness leading to limitation in joint function. It is not a single condition and encompasses many different forms due to variable causes. Inflammation is the body's natural response to injury and pain is a defence mechanism whereby pain and limitation in the movement allows the joint to rest and heal inflammation. The warning signs that inflammation presents are redness, swelling, heat, and pain. However, if these symptoms persist beyond a few days or weeks, there is often an underlying pathology. If untreated, this might lead to damage to the joint.

There is a general increase in the incidence and prevalence of arthritis worldwide due to lifestyle factors such as sedentary lifestyle, processed food, lack of exercise, smoking and many other environmental factors. Depending on the type, arthritis can affect all age groups including children. The most common form of arthritis affecting older people is known as Osteoarthritis. This often results from long term wear and tear in the cartilage and weakness in surrounding muscles. Some forms of arthritis can be self limiting, but most of them have no permanent cure. However, over the years, there have been breakthrough advances in the therapeutics leading to improved outcomes provided the condition is diagnosed early with an early treatment. In addition to drug treatment, remaining physically active with weight management and a healthy diet is absolutely vital for any form of arthritis.

The cartilage is a padding that absorbs stress. The proportion of cartilage damage and inflammation in various structures of the joint varies with the type and stage of arthritis. Usually, the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

How does a normal joint look like?

There are over 100 different types of rheumatic diseases. The most common are:

• Osteoarthritis: Osteoarthritis is also called degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear out over time. In extreme cases, the cartilage can completely wear out, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur (osteophytes)
• Osteoarthritis causes joint pain and can limit a person's normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, Knees, and Hips. There is no permanent cure for this form of arthritis and quite often pain killers are used only to alleviate the symptoms of pain and discomfort. The key advise is to prevent the progression at a very early stage by weight management, strengthening and stretching muscles and joints and keeping active. In advanced cases, some people may need a joint replacement if there is severe pain or disability.
• Rheumatoid Arthritis: This is an auto-immune condition in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues, and organs for unknown reasons. Occurring most often in women of childbearing age (15-), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe and not treated earlyrheumatoid arthritis can deform, or change, a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.
• Rheumatoid Arthritis can affect any joint in limbs but most commonly involve small joints of the hands in a symmetrical pattern About two to three times as many women as men have this disease. Family history of RA, Cigarette smoking, Obesity and un-healthy lifestyle are some of the risk factors for developing RA.
• The key to effective treatment of RA is early diagnosis and early treatment. This commonly includes drugs that dampen the overactive immune responses to alleviate inflammation and are known as Disease Modifying Anti Rheumatic Drugs (DMARDs). There are long term treatment and vary according to the severity of RA. Early treatment is essential as a damaged joint is irreversible in RA. In the last two decades, improved treatment options enable doctors to offer a tailored treatment with newer forms of DMARDs known as Biological therapies. In addition, a healthy lifestyle including smoking cessation, healthy diet, regular exercise and stress management are absolutely essential in improving outcomes of RA.
• Post-traumatic Arthritis: Arthritis developing following an injury to any joint is called post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain, or ligament tears. Repetitive injuries such as sports injuries or high impact activities can lead to early osteoarthritis. This is a common form of arthritis in young people and may lead to chronic pain and disability. Rehabilitation and Physical therapy remain the main forms of treatment in addition to regular low impact exercises such as Yoga and Pilates.
• Spondyloarthritis (SpA): This form of arthritis include a group of conditions that not only affect joints of spine and limbs but also other structures of the body such as skin, gut, eyes and other organs. They share a common gene called HLA B27 in most people and may run in families. The common forms of SpA are Psoriatic arthritis and Ankylosing spondylitis (refer to the individual conditions for more details). The inflammation in these conditions often start in small areas of connective tissues called ‘Entheses’ that connect muscles, tendons and ligaments to the bone. Psoriasis of skin may co-exist or precede the onset of joint symptoms. Ankylosing spondylitis predominantly affects young men although women can be affected as well. Due to unclear symptoms often diagnosis is missed in early stages and can take several years before the condition is identified. Standard forms of treatment include symptomatic therapies such as physiotherapy, pain killers and anti-inflammatory medicines. However, like other auto immune conditions, DMARDs are the immunomodulatory medicines that are needed to prevent the progression and damage of joints and other structures involved.
• Psoriatic Arthritis: This form of Arthritis occurs in some persons with psoriasis, a scaling skin disorder, and affects the joints, spine and other structures such as tendons, ligaments and cartilage. Typically psoriasis can affect skin of extremities (knees, shins, elbows etc), scalp and nails. Inflammation leads to joint pains, stiffness at nights and mornings or any prolonged period of inactivity, and if untreated can progress to damage the structures affected leading to deformities. Diagnosis is entirely clinical and there are no specific blood tests to confirm it. Imaging such as Ultrasound scan and MRI are often used to understand the nature and extent of joint involvement. Treatments include topical creams for skin psoriasis but often need DMARDs to halt the disease progression.

What are the Causes of Arthritis?

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury, or deformity. Primary osteoarthritis is commonly associated with aging and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Rheumatoid arthritis is often caused when the genes responsible for the disease are triggered by infection or any environmental factors. With this trigger, the body produces antibodies, the defence mechanism of the body, against the joint and may cause rheumatoid arthritis.

Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. It is considered that your body secretes certain hormones following injury which may cause the death of the cartilage cells.

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.

What are the Symptoms of Arthritis?

There are more than 150 different forms of arthritis. Symptoms vary according to the form of Arthritis. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

Diagnosis of Arthritis

Doctors diagnose arthritis with a medical history, physical exam, and X-rays of the affected part. Ultrasound scan, Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.

What are the Treatments for Arthritis?

There is no permanent cure for arthritis. Initial treatment for arthritis is conservative, consisting of rest, avoidance of vigorous weight-bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms, a cane or braces may be helpful. For more severe inflammation in one to joints, an injection of cortisone into the joint is frequently advised and can be quite helpful. Depending on the type of arthritis, there are treatments available to help relieve pain, inflammation and in auto immune inflammatory arthritis, specific forms of therapies (DMARDs) have a major role to play in preventing progression and damage. If treatments are started early, patients can lead a normal life without pain or disability. You may be recommended occupational therapy or physiotherapy, which includes exercises and local treatment. Only in severe forms of arthritis with a severe damage to the joint, surgery may be suggested.Less invasive surgeries may be indicated to resect inflammaed synovium, repair tendon tears etc. . In the elderly with severe arthritis, joint replacement can give good results.

post-traumatic arthritis or avascular necrosis. The goal of the surgery is to relieve pain and restore the normal functioning of