We’ve all heard of arthritis. We dismiss it as that thing that old people have. But what is arthritis, really?
Arthritis is actually an inflammatory disorder involving one or more joints in patients. While bones aren’t directly affected in the early stages, with progression, they get involved too. Inside a joint, the two or more opposing surfaces of bones are lined by a form of cartilage called Articular cartilage, with a little lubricating fluid in between, called synovial fluid. Both these prevent the ends of bones from grating against each other, and evenly distribute the ‘load’ of both bones, so that the forces are balanced, which allows the joints to move without restriction or pain.
In most common forms of arthritis, inflammation and erosion cause first the cartilage to be affected, then the ends of bone. Especially in osteoarthritis, the articular cartilage has altered physical and biochemical properties, making it prone to erosion. This is why Osteoarthritis is characterized by breakdown of the articular cartilage.
The most common cause of Osteoarthritis is aging. After 45 years of age, years of use and gradual calcium and dietary deficiencies add up and precipitate arthritis. This is even more accelerated in patients who have suffered traumatic joint injuries, or undergone invasive surgeries, especially if they did not rest the joint enough in the healing period. In some cases osteoarthritis may appear in young people too, if they have some predisposing condition, such as a macrotraumatic or repeated microtraumatic injuries in a joint ,or some underlying systemic disease such as diabetes, Ochronosis, Hemochromatosis or marked obesity (secondary osteoarthritis).
The chances of getting Osteoarthritis are higher if your parents, grandparents, or siblings have had osteoarthritis. Women are more likely to develop Osteoarthritis, which has been linked to higher Estrogen levels. Those who are obese are much more likely to develop Osteoarthritis earlier, and more severely, as the increased weight puts extreme stress on the weight bearing joints of the body, like the hips and the knees.
Generally, most commonly affected joints are joints in your arms and legs, including your fingers, wrists, knees, ankles, and hips. The biggest feature is pain, with restricted movement. Early arthritis shows pain and tenderness differently. Tenderness is discomfort felt on pressing down on the joint, while pain is felt on moving or using the joint. There might even be a grating sensation or sickening scrape like sound in the joint. Stiffness of joints on waking up, or after sitting in the same position for a long time, is also a feature.
Management of arthritis requires good patient education, in addition to treatment. As counterproductive as it may seem, regular exercise strengthens muscles and helps in reducing the strain on joints. For example, quadricep strengthening exercises help relieve the knee joint of its load. In addition, this helps in reducing obesity, and as multiple positive beneficial effects on overall health, like reducing diabetes and hypertension. Wearing shock absorbing and cushioned footwear also helps.
Medicines like analegics are given to manage pain, like NSAIDs, topical NSAIDs, and simple pain relievers like Ibuprofen or Acetaminophen are useful for more mild to moderate pain. For more severe pain, opiates may need to be given, but they need to be given with caution, because of their addictive potential. Intra articular injections of corticosteroids are useful for some patients too. Local heat and cold application helps with temporary management of pain. Surgical options like osteotomies and joint replacement may be needed for very severe cases, sometimes involving joint reconstruction.
Rheumatoid arthritis is the other major cause of arthritis. More than mechanical wear and tear, this is an inflammation of the joints caused by an autoimmune reaction, where the body’s self defense, the immune system, begins attacking the joint’s lining, along with other tissues. The symptoms of Rheumatoid arthritis begin first in the smaller joints, like knuckles and wrists, spreading gradually to the next joints, like to the elbows from wrists, or to the ankles from toes. The joints are swollen, inflamed and tender to touch, and may even be warm to touch. Unlike in Osteoarthritis, the morning stiffness lasts for hours and is more painful too. Rheumatoid arthritis features have frequent ‘flare – ups’, and remissions.
The exact cause of what triggers the autoimmune attack is not known, but Rheumatoid arthritis has a marked tendency to recur in families. It is also more common in women, and after the age of forty. However, it is a more serious condition as it may cause heart problems, like valvular disease and lung problems, like shortness of breath and damage to lung tissue. Gradual weakening of bones due to osteoporosis may occur too.
Diagnosis of RA can be made on the basis of tests for Anti CCP Antibodies, RA factor and elevation of the ESR, which is the sedimentation rate of RBCs in blood.
Treatment of rheumatoid arthritis is more complicated, as there is no definitive cure. Pain can be managed with analgesics and corticosteroids to reduce inflammation, but drugs called Disease Modifying Anti Rheumatic Drugs (DMARDs) may be needed. DMARDs are drugs that slow the progression of the rheumatoid arthritis, at the cost of some side effects, for e.g. Methotrexate, Sulfasalazine, and HydorxyChloroquine. Newer DMARDs are biological agents that target the immune system, like Golimumab, Rituximab and Infliximab. Combinations of these drugs may be used. In addition, lifestyle modifications, physiotherapy, joint therapy and assistive devices improve the quality of life in people with all form of arthritis.
If you have any more concerns about arthritis, you can ask any medical question at www.askthedoctor.com where our team of certified physicians are ready to help!