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Arthritis

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What is Arthritis?

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body's natural response to injury. The warning signs that inflammation is present are redness, swelling, heat and pain.

The cartilage coats the joint surfaces to absorb stress, and allow smooth joint movement. The proportion of cartilage damage and synovial inflammation (the lining and fluid in the joint capsule) varies with the type and stage of arthritis. Usually the early pain is due to inflammation. Later in the disease, pain is from the irritation of the worn joint structures and inability of the joint to move properly.

What are the different types of Arthritis?

There are over 150 different types of rheumatic diseases. e.g., Osteoarthritis, Rheumatoid Arthritis

Osteoarthritis is the most common form of arthritis. It is often referred to as wear and tear arthritis as it involves the thinning and breakdown of the cartilage lining, which cushions and protects the joints, where two bones meet. The bone may lose shape and thicken at the ends or produce bony spurs. It causes pain in the joints and surrounding soft tissues and limits the range of movement of a joint. Osteoarthritis affects many joints including the large, weight bearing joints of the hips and knees and also the spine, hands, feet and shoulders. There are several reasons for the development of osteoarthritis including age, being overweight, heredity factors, and joint damage from a previous injury or during early development of a joint. The severe pain of osteoarthritis can be very fatiguing and disabling.

Rheumatoid arthritis. This is an auto-immune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint.

Rheumatoid arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (like both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Fibromyalgia. Fibromyalgia is a condition associated with generalised muscle pain and fatigue. It is often described as a form of "soft tissue rheumatism", which means it is a condition that causes pain and stiffness around the joints and in muscles and bones. It does not cause inflammation.

Gout is a form of arthritis. The joints appear painful, tight and swollen. The pain is caused by needle shaped microcrystals which can destroy the joint cartilage. When a person has gout, they have higher than normal levels of uric acid in the blood. The body makes uric acid from the foods we eat. Too much uric acid causes deposits, called uric acid crystals, which form in the fluid and lining of the joints. If the kidneys don't work properly then you can't get rid of the uric acid in the urine as you should. The result is an extremely painful attack of arthritis. People often inherit gout and although we don't know why, Maori and Pacific island peoples are more likely to get gout. The joint most commonly affected is the big toe.

Infectious arthritis. Arthritis can be caused by an infection, either bacterial or viral. When this disease is causedby bacteria, early treatment with antibiotics can ease symptoms and cure the disease.

Reactive arthritis. This is arthritis that develops after a person has an infection in the urinary tract, bowel, or other organs. People who have this disease often have eye problems, skin rashes, and mouth sores.

Systemic lupus erythematosus. Also called lupus or SLE is a form of arthritis which affects joints, muscles and other parts of the body. It is one of the autoimmune rheumatic diseases. In people with autoimmune diseases, antibodies are produced which act against certain body tissues and cause inflammation. There are two main form of Lupus: Discoid Lupus which affects only skin, and Systemic Lupus which involves the joints and sometimes the internal organs as well. Lupus (Latin for wolf) takes its name from the fact that it can cause serious rashes across the cheeks and nose (rather fancifully resembling the face of the wolf) (Arthritis NZ)

Ankylosing spondylitis is a term used to describe a form of arthritis that mainly affects the joints of the spine. However it may affect other parts of the body, e.g. hips, shoulders, knees or ankles. It causes inflammation outside the joint where the ligaments and tendons are attached to the bone, whereas in most forms of arthritis the inside of the joint is inflamed. It usually affects the little joints between the vertebrae of the spine and tends to diminish the movement which takes place at these joints. It affects younger people, teenagers to mid thirties and more men then women.

Juvenile rheumatoid arthritis. The most common type of arthritis in children, this disease causes pain, stiffness, swelling, and loss of function in the joints. A young person can also have rashes and fevers with this disease.

Polymyalgia rheumatica which means rheumatic pain in many muscles, results in severe stiffness and pain in the muscles of the neck, shoulders, lower back, buttocks and thighs. Other symptoms may be fatigue, loss of weight, night sweats and fever. Visual disturbance may indicate temporal arteritis or Giant cell Arteritis.

Polymyositis. Causing inflammation and weakness in the muscles, this disease can affect the whole body and cause disability.

Psoriatic arthritis. Is an inflammatory arthritis associated with psoriasis, a chronic skin and nail disease. Psoriatic arthritis affects about 10% of people with psoriasis. It can affect single joints, usually of the fingers or toes, as well as wrists, knees, ankles and sacro iliac joints of the spine.

Bursitis. This condition involves inflammation of the bursa, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursa. Bursitis produces pain and tenderness and may limit the movement of nearby joints.

Tendinitis. Also called tendonitis, this condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.

What causes Osteoarthritis?

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 ageing 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.

Some people may have developmental or congenital abnormalities of the joints that may cause early degeneration and subsequently cause arthritis.

Predisposing factors to Osteoarthritis

Unalterable

  • Age
  • Gender
  • Race
  • Genetics

Potentially Preventable

  • Obesity
  • Injury and joint trauma- in the knee from fractures and torn ligaments and cartilage (menisci)
  • Mechanical stress
  • Deformity and malalignment in the hip, growth abnormalities or childhood hip problems
  • Prior inflammatory disorders
  • Endocrine and metabolic disorders

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 a joint, early morning stiffness, and skin changes, including rashes.

How can a doctor diagnose Arthritis?

Doctors diagnose arthritis with a medical history, physical exam, x-rays and blood tests. There is no blood test for osteoarthritis.

What you can do?

  • Consult a doctor to determine the type of arthritis you have. Treatment will depend
    on a correct diagnosis
  • Take medication as recommended by your doctor
  • Rest/ and or exercise. A balance as advised by your doctor or health professional
  • Protect your joint/s from further damage
  • Pain relief such as heat or cold therapy
  • Weight control to prevent extra stress on weight bearing joints
  • Maintain your general health and well being

What your doctor can do for you?

There is no cure for arthritis, so beware of 'miracle cures'. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested, such as a hip or knee replacement. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results.

Treatment Options

Initial treatment for osteoarthritis is conservative with a balance of rest and exercise, avoiding vigorous weight bearing activities, education in arthritis management, support, and joint protection such as walking aids or braces, and non invasive pain relief techniques. Pharmacy measures include analgesic and anti- inflammatory medication, complementary medication, possibly injections into the joint of cortisone/ corticosteroids. OA should be managed with combined non pharmacological and pharmacological approaches.

Treatment of osteoarthritis focuses on decreasing pain and improving joint movement, and may include:

  • Education and understanding
  • Exercises to keep joints flexible and improve muscle strength
  • Support, from health professionals and family
  • Joint protection, to prevent stress or strain on painful joints e.g. suitable foot wear
  • Weight control to prevent extra stress on weight bearing joints
  • Physiotherapy and/ or heat or cold treatments
  • Medication approaches i.e. anti inflammatory gels/rub ons, the use of non steroidal anti inflammatory medication, non narcotic analgesics such as paracetamol and complementary and alternative medications such as glucosamine with or without chondroitin and injections of glucocorticoids into the joint if needed
  • Surgery to relieve chronic pain in damaged joints

Does exercise really help those who have Arthritis?

Exercise is very important because it increases lubrication of the joints and strengthens the surrounding muscles, putting less stress on joints. Exercise in heated swimming pools-hydrotherapy-can bring enormous relief from pain and stiffness. Also studies have shown that exercise helps people with arthritis by reducing joint pain and stiffness and increasing flexibility, muscle strength and energy. It also helps with weight reduction and offers an improved sense of well-being.

Can special diets treat Arthritis?

But what if you have arthritis - are diet and nutrition still such a simple matter? Can what you eat cure your arthritis? Can food prevent it from occurring? Are there foods that can cause your arthritis to 'flare' or go into remission? What role do vitamins and nutritional supplements play in the treatment of arthritis? Will losing (or gaining) weight help ease your symptoms? Will taking powerful anti-arthritic medications affect your appetite or your ability to eat certain foods?

These are the sorts of questions that people with arthritis often ask, and they're valid questions. Some questions "Can what you eat cure your arthritis?" have simple answers "No". Some questions "Are there foods that can cause your arthritis to 'flare' or go into remission?" aren't so straightforward. "Perhaps..."

Most of what you need to know about diet and nutrition is common sense; healthy eating is pretty much the same for anyone, whether you have arthritis or not. But there are exceptions.

Summary

From learning about the importance of exercising regularly to fully understanding your arthritis medications, the information contained in this section is meant to provide you with insights, information and tips that can be used by you to help make living with arthritis a little bit more manageable.

For people with arthritis, learning to make it part of your life can be difficult. But learning as much as you can about your particular type of arthritis and actively working with your arthritis treatment team are two very effective ways of regaining control over your life. There is plenty of information, some specific to arthritis and some not, that can be very helpful to someone facing the challenges associated with having a chronic or lifelong disease.

Our suggestion is - don't let arthritis beat you. Take control. How? Arm yourself with as much information as possible. Learn from the experiences of others in similar circumstances. What we're presenting here is a virtual toolbox of tips for living well with arthritis. Some may work for you one day and not the other. Some may work for you but not others. That's why we've tried to cover several topics. There are plenty of tools or tips here. Use them or refer to them when you need them. Call upon them when you require help.

Injury Information at Orthoillustrated