Arthritis Series Part I: Most Common Types Of Arthritis

Discussed

Osteoarthritis

There are about 200 types of arthritis, but the most common type is osteoarthritis.
Osteoarthritis came from three Greek words:" osteo" for bone;" arthro" for joint, and" itis"
for inflammation. It is a degenerative bone disease that is commonly manifested on old
people around age 50 and above. It prevails on 25 million Americans affecting their hands,
feet, and most commonly weight-bearing joints such as the knee. It mostly affects the
cartilage, the protective covering found around your joints. This tissue absorbs most of the
impact that your joints experience while walking, running, jumping and dancing. An injury
of the cartilage causes wear and tear of the joint heads, resulting to pain and inflammation
in the joints.

Types

There are two types of osteoarthritis depending on the onset and the cause.

Primary Osteoarthritis

This is the type of arthritis that is related to ageing. As you grow old the resilience
of your cartilage lessens due to decreasing water content. This would lead to the wear and
tear of the cartilage, resulting to exposed joint heads. Since there would be no cartilage to
reduce the friction between the two bones, "spurs" are produce. Spurs or osteophytes are
bone outgrowths produced by the body in attempt to re-align the joints. These spurs can
be very painful and greatly limits the range of motion of the affected joint.

Secondary Osteoarthritis

This is the type of arthritis that is caused by either trauma or medical condition.
Some of the most common causes of secondary osteoarthritis

¾ Obesity - the increased pressure on weight-bearing joints causes early wear and
tear of the cartilage.
¾ Diabetes - because there is damage to the peripheral nerves, particularly in the
lower limbs, the body does not perceive any trauma from the knees. A person
may go on with his usual activities without knowing there has been a change in
the joint structure.
¾ Injury - any trauma to the joints can cause breakage of the cartilage or
misalignment.
¾ Genetic disorders - any genetic disorder such as Ehlers-Danlos syndrome that
can produce a collagen disturbance or promote degeneration of the cartilage.
Signs and Symptoms

¾ Crepitus: this is the sensation or sound of two bones grating together. It is

most noted on weight bearing joints such as the knees and hips.
¾ Joint stiffness: a person with osteoarthritis may experience limited range of
motion that can cause limited or lack of mobility
¾ Inflammation: because of the damage to the cartilage, your joints may appear
swollen, and can be painful.
¾ Bouchard's Nodes: nodules or deformity present at the middle joints of the
hands.

Diagnosis

¾ X-Ray - a doctor may request for an x-ray to rule out trauma as the cause of
your joint immobility. The x-ray will also reveal the extent of damage or erosion
of the bone, presence of bone spurs, and a narrowing between the synovial
spaces between joints.
¾ Arthrocentesis - this is the aspiration of a fluid present between bones. This is
done to rule out other types of arthritis such as rheumatoid arthritis.
¾ Lab tests - these are done not to diagnose osteoarthritis, but to see if there is
presence of any infection or inflammatory condition that may be causing joint
stiffness.

When to Seek Medical Attention

Have an appointment with the doctor immediately when you show signs of infection
such as fever, swelling and redness of the joints. You may also need to visit the doctor
when you experience sudden or abrupt lack of mobility on your joints, difficulty with walking
or standing, or any significant change in function.

Treatment

There are three types of treatment for osteoarthritis: lifestyle modification,

medication, and surgery.

Lifestyle Modification

1) Lose weight - since the major problem lies on weight-bearing joints, weight
reduction will lessen the pressure on your joints and help ease the symptoms of
osteoarthritis and even limit its progression.
2) Exercise - non-impact sports such as swimming can help you strengthen your
muscles and encourage cartilage formation without causing undue injury to your
joints.
 3) Diet - anti-oxidants such as Vitamin C and E can help give some protection to your
bones. Make sure you have a daily intake of 1000-1200mg of calcium coupled with
400 IU of Vitamin D per day.
4) Heat therapy - paraffin or wax therapy has been proven to help alleviate the pain
of osteoarthritis.
5) Physical therapy - this will help you recover a certain degree of lost flexibility and
mobility, and help prevent further stiffness.

Medication

1) Acetaminophen is the first drug of choice to help you cope with athralgia. This is
used during acute pain attacks and not advisable for chronic pain.
2) NSAIDs will be prescribed by your doctor if you are experiencing chronic pain. These
includes naproxen, salicylate, aspirin, and ibuprofen.
3) Narcotics - when other medications cannot relieve joint pain, your doctor will
advise intake of morphine for moderate to severe chronic pain.
4) Hyaluronic acid - is a supplement injected between your joints, specifically your
knee, which is designed to cushion and lubricate your joints. It can be given in a
series of 3-5 injections and can relieve osteoarthritis for up to several months.

Surgery

This is the last resort to help cure osteoarthritis. This surgery is done for three
reasons:

o Smoothen the surface of worn-out bones for better articulation

o Repositioning bones that have been misaligned due to wear and tear
o Removal of any deposits such as bone fragments that cause severe
limitation in mobility.
o Application of prosthesis if the joint heads are severely damaged.
Depending on the type of prosthesis used, your artificial joints can last up
to 15 years or more. The surgeon will determine the type and design of
your prosthesis based on your age, weight, sex, and level of physical
activity.

Your doctor will decide if you are a candidate for surgery and will base his decision
on:

o Age
o Occupational status
o Level of physical impairment
o How much your condition is affecting your activities of daily living.
 Osteoarthritis can be painful and difficult to treat. Among all the treatments stated,
weight management is the best way to help prevent the rapid onset of osteoarthritis, and
prevent its progression. If your osteoarthritis is secondary in nature, you must first address
your medical condition before you treat your osteoarthritis.
Arthritis Series Part II: Most Common Types Of Arthritis
Discussed

Rheumatoid Arthritis

Rheumatoid arthritis is characterized by an inflammation of the joints with marked

swelling and redness. It is a perplexing condition to treat because it is an autoimmune
disorder. In RA, anti-bodies attack your own body cells; this includes your joints, lungs,
liver, and kidneys. As anti-bodies attack the synovial lining of your joints, this would elicit
an inflammatory response. This can irritate the cartilage, eventually breaking up its surface
and thinning it down. Once this starts, the space in between the bones will narrow and will
result to inflammation of the joint lining. The increased size of the joint lining will cause it
to invade the space of the other joint and erode the bone surface.

Cause

Rheumatoid arthritis occurs when your immune system starts to attack the lining of
your joints. It is still unknown how or why this process occurs. However, genetic
predisposition is seen as a major factor that predisposes a person to rheumatoid arthritis.
It is observed that an onset of a severe infection can trigger the immune system to attack
the linings of the joints and other body organs.

Classification of Rheumatoid Arthritis

The American College of Rheumatology created a system of classifying rheumatoid

arthritis basing on the x-ray of affected joints. This classification helps medical
professionals to categorize rheumatoid arthritis according to its severity, but it is not used
as a basis for treatment for rheumatoid arthritis. Most practitioners believe that early
management of rheumatoid arthritis before the onset of severe symptoms can prevent
further deterioration of the joints and increase the chance of rehabilitation.

I. Stage I: there may be signs of bone erosion, but with no damage to the joints.
II. Stage II:
a. evidence of bone thinning is present that may or may not be accompanied by
minimal bone damage.
b. Possible damage to cartilage, although minimal.
c. Limited joint mobility with absence of joint deformities.
d. Muscular atrophy of nearby muscles.
e. Possible presence of surrounding soft tissue abnormalities
III. Stage III
 a. Noted cartilage and bone damage, plus bone thinning around the joint on x-
ray
b. Presence of joint deformity with temporary stiffening of fixation on the joint.
c. Marked atrophy of surrounding muscle
d. Soft tissue abnormalities around the joint are probable
IV.Stage IV:
a. Cartilage and bone damage is seen around the join on x-ray as well as
osteoporosis
b. Presence of ankylosis (the joint is deformed and permanently fixated)
c. Marked atrophy of surrounding muscle
d. Possible adjacent soft tissue abnormalities

Signs and Symptoms

The signs and symptoms of rheumatoid arthritis can come and go. When the
symptoms disappear, this is called remission. The patient can feel quite well for several
weeks, months, and even years. This can happen either with the presence or absence of
treatment. But when rheumatoid arthritis goes back, termed as relapse, the symptoms will
start to appear again. Flare is considered present when all of the signs and symptoms of
rheumatoid arthritis is noted.

Localized signs and symptoms

When rheumatoid arthritis attacks, the patient will notice the following in reference
to the affected joint:

¾ Morning stiffness that can last for up to 3 hours accompanied by swelling, pain,
and redness.
¾ Stiffness that occur during prolonged periods of inactivity.
¾ Heberden's Nodes: these are subcutaneous nodules that cause the deformity of
small joints at the ends of the fingers.
¾ On rare occasions, when the cricoarytenoid joint is affected or inflamed, voice
becomes hoarse. Reason is the cricoarytenoid joint helps to modulate voice tone.

Systemic Signs and Symptoms

Because rheumatoid arthritis is an autoimmune disorder, it can also represent

generalized or systemic signs and symptoms. These symptoms can be of:

¾ Sjorgren's syndrome: this is the dryness of the eyes and mouth due to
inflammation of glands that lubricate the oral and ocular mucosa.
¾ Pleuritis: the antibodies also attack the lining of the lungs, causing
o Sharp chest pain during inhalation
o Shortness of breath or difficulty f breathing
o Coughing
 ¾ Pneumonitis: the lungs can also become inflamed, with presence of rheumatoid
nodules and even scarring.
¾ Pericarditis: the lining that surrounds the heart can also be affected, leading to
chest pain while leaning forward or lying down.
¾ Anemia: the inflamed tissues secrete cytokines and several other protein
compounds that affect the production of erythropoietin in the kidneys.
Erythropoietin is responsible for stimulating the bone marrow to produce new red
blood cells that die after 120 days. Because of this, anemia in rheumatoid
arthritis is the most prevalent of all systemic symptoms of rheumatoid arthritis,
which can lead to:
o Loss of appetite
o Fatigue
o Malaise
¾ Vasculitis: this is a rare, but very serious complication due to prolonged
rheumatoid disease. The blood vessel lining becomes inflamed, causing
impairment of blood supply to the peripheral tissues that can lead to tissue
necrosis (death). This is manifested by small black areas around the nail beds or
as leg ulcers that can lead to gangrene and ultimately amputation of a limb.

Diagnosis

X-ray is done to see the extent of bone damage on the affected joints. Blood tests
such as ANA and anti-CCP will be done to detect the presence of antibodies that cause
rheumatoid arthritis. The erythrocyte sedimentation rate is a test to roughly determine the
extensiveness of joint inflammation. The C-reactive protein, on the other hand, measures
the degree of inflammation in the body when systemic signs and symptoms of rheumatoid
disease is present. BUN and Creatinine clearance will also be done to determine if there is
kidney affectation, and to see if the kidneys can handle any aggressive medical treatment
that will be prescribed to treat rheumatoid arthritis.

Treatment

There are no conclusive treatments yet for rheumatoid arthritis. Most treatment is
aimed to limit the progression of bone destruction as well as to address the signs and
symptoms of rheumatoid arthritis such as pain, redness, and swelling.

Home Therapy

Non-vigorous exercise can help you lessen the progression of stiffness and weakness
of muscles around your joints. This can include walking around the park for a short period
of time, interspersed with rest. Swimming and water aerobics can also help you maintain
muscle tone without needlessly tiring you or putting pressure on your joints. If your joints
are tender and inflamed, hold of exercising for a while.
 To ease the pain and promote mobility, take a hot shower or a hot bath for 15
minutes. To help lessen the pain, place an ice compress on a tender and inflamed joint.
However, this is not advisable when you have signs of poor circulation such as paleness,
tingling sensation, a difference in temperature as in the affected extremity is colder than the
other.

Stress can also worsen your symptoms, so make it a point to rest every now and
then. Lessen your workload, and as much as possible delegate tasks to other people you
can trust so you won't have to worry about not accomplishing a project.

Learn as much as you can about the disease by subscribing to journals and reading
related literature about your condition. Always maintain your scheduled appointment, and
actively search for ways help you cope with rheumatoid arthritis.

Medication

NSAIDs can help lessen the pain and inflammation. These can be bought over-the-
counter, but must be used with caution. Prolonged use can cause tinnitus (ringing in the
ears), bruising due to decreased clotting ability of the blood, gastric ulcers, liver, and kidney
problems.

Steroids will be prescribed to decrease the inflammation brought about by

rheumatoid disease. This is given to relieve acute symptoms and should not be used for a
long time. Do not abruptly discontinue your medication. Inform your doctor if you are not
compatible with the regimen so he can help you taper your dose until your body is used to
the absence of the medication.

Disease modifying antirheumatic drugs (DMARDs) will lessen the rate of

progression of rheumatoid arthritis. Methotrexate is the first drug of choice among DMARDs
for you don't need to wait long to experience its effect. It is effective in lessening the signs
and symptoms of rheumatoid arthritis, and can slow down or halt the progression of
radiographic damage. Most patients continue to use it for years because of its better
efficacy and low cost compared to leflunomide and sulfasalazine.

Surgery

If conventional and pharmaceutical treatments fail to lessen the symptoms and halt
the progression of rheumatoid arthritis, surgery may be considered by your doctor. Surgery
is done to lessen pain, fix joint deformities, and restore function to your joints.

One type of surgical treatment is arthroplasy. The surgeon removes the damaged
areas on your joints, and replaces is totally with a prosthesis that is either made up of metal
or plastic. If the inflammation has also affected the tendons around your joints, your
surgeon may have to perform tendon repair to bring back mobility to our joints.
Synovectomy is a procedure where the lining of the affected joint is removed due to
severe inflammation and pain.
 Remember that when you enter a treatment regimen for rheumatoid arthritis, your
aim is to control the signs and symptoms, diminish damage to your joints, and prevent
onset of disability. If your current choice of regimen is not working for you, contact your
physician so you can discuss other forms of alternative to help you deal with rheumatoid
arthritis.
Arthritis Series Part III: Most Common Types Of Arthritis
Discussed

Acute Gouty Arthritis

Gout is described as a metabolic disorder characterized by the body's

inability to properly metabolize uric acid. Uric acid tends to accumulate in a
person's blood stream due to the body's tendency to produce too much uric
acid during purine metabolism, or the body's inability to excrete uric acid.
To some, this accumulation of uric acid will only lead to hyperuricemia and
not produce any gouty symptoms. On others, it leads to the formation of
urate crystals that deposit themselves in several tissues of the body. The
deposit may occur in the kidneys, or between joints particularly in the big
toe.

Gouty arthritis occurs when a large amount of urate crystals deposit

themselves in the synovial fluid and synovial linings (fluid and lining of
joints). This in turn will cause an autoimmune response where antibodies
will attack the crystals, initiating the body's inflammatory response. Once
this happens, chemical mediators such as prostaglandin will be activated,
producing redness, pain, and swelling. The pain is characterized as being so
painful, the mere touch of a bed sheet can cause the most excruciating pain.

Causes of Acute Gouty Arthritis

The exact cause of gout is unknown. Men suffer from gout more in
comparison to women, and it commonly happens after they reach the age of
puberty, and peaks around the age of 75. Women who are predisposed to
gout suffer from its signs and symptoms once they reach menopause. Other
risk factors for gout are:

• Obesity
• Alcohol intake
• High blood pressure
 • Kidney problems
• Medication such as thiazide diuretics
• Medical conditions such as sickle-cell anemia, leukemia, or
lymphoma among others.

Signs And Symptoms

The signs of and symptoms of gouty arthritis occurs after several years
of uric acid and urate crystal accumulation on the joints and other body
organs. These signs and symptoms typically include:

¾ Tophi: this is the collection of urate crystals between joints of the

big toe and elbow, in the earlobe and Achilles tendon. This lump is
characterized with
¾ Joint pain: unlike the joint pain of osteoarthritis and rheumatoid
arthritis, joint pain in gouty arthritis begins suddenly. It can
involve one or several joints at the same time, with the great toe,
knee, or ankle joints being mostly affected. The pain is often
characterized as severe, stabbing, and excruciating. The pain is so
severe, that a touch of a bed blanket can cause the person to either
lose sleep or wake up in the middle f the night.
¾ Stiff, swollen joints that may be warm to the touch and ruddy red in
appearance
¾ Fever can occur during acute gout attacks due to activation of the
inflammatory response.

These signs and symptoms can disappear for a long period of time,
and can occur several times in a year. Some succeeding attacks can last
longer compared to other episodes.

Diagnostic Tests

Doctors may prescribe several diagnostic tests to confirm gouty

arthritis and rule out any other systemic conditions.

• X-Ray - this is not a conclusive test to diagnose the presence of

gout. Most patients seek medical attention because of severe joint
pain in the absence of tophi or bone erosion. X-ray done during the

2
 late stages can reveal the size and location of the tophi and the
extent of bone erosion if there is any.
• Uric acid blood test - this test is done to detect the level of uric
acid in your blood, but also not a conclusive test to diagnose gout.
People with high levels of uric acid in their blood do not necessarily
manifest gout symptoms. This test, however, can determine if the
current medication you're taking is lessening the level of uric acid
levels in your body.
• Joint aspiration (arthrocentesis) - will determine if the joint
inflammation is caused by presence of urate crystals in the joint
fluid or a bacterial infection or autoimmune disorder. Sometimes
calcium pyrophosphate can be found in the synovial fluid causing a
condition called "pseudogout."
• Synovial biopsy - this can help rule out any other joint condition
such as fungal arthritis, rheumatoid arthritis, or coccidioidomycosis.

Treatment

There are two types of treatment for gouty arthritis:

Home Therapy

There are two levels of home therapy: prevention of attacks, and

alleviation of onset of signs and symptoms.

Prevention
¾ Dietary modification: lessen the intake of food high in purine
such as meat, seafood, and legumes. You may also need to limit
your fat intake by reducing your consumption of salad dressings
and fried food.
¾ Limit the intake of alcohol: some alcoholic beverages like beer
and wine contain high levels of purine. Aside from that, alcohol can
greatly reduce your body's ability to flush out uric acid from your
body, causing it to accumulate in your blood stream.
¾ Lose weight: maintain a weight that is ideal for your height.
¾ Exercise: moderate exercise can help you promote blood
circulation, preventing blood stasis that can predispose you to urate
crystal accumulation on joints and body organs.

3
 Attack Relief
¾ Never put pressure on your affected extremity and rest it for as
long as the attack is in progress, plus an additional 1-2 days from
the remission of symptoms.
¾ Elevate the affected joint in a level higher above your chest if
possible.
¾ Use ice packs to lessen the inflammation and dull the pain. Place
the icepack on the affected joint for 15-20 minutes.
¾ Consume as much as 3 liters of water to help your body flush out
uric acid.

Medication

There are several medications that a doctor would prescribe to help

lessen the symptoms of gouty arthritis and prolong the interval between
attacks.

¾ Allopurinol - this is the best medication that can help slow down
the formation of uric acid in the body, making it very effective in
lowering your uric acid level. Inform your physician if you're taking
azathioprine, 6-mercaptopurin, or cyclophosphamide. Your dose
must be adjusted accordingly to prevent any adverse drug-to-drug
interaction. Avoid the use of ampicillin during your medication for it
can cause the development of rash. Discontinue your medication if
you are experiencing hypersensitivity to the drug that is manifested
by fever, rash, kidney, and liver failure, as well as bone marrow
failure.
¾ Probenecid - this medication helps you in eliminating excess uric
acid via the kidneys. It is important that you drink at least 2 liters
of water, though 3 liters would be most advisable in order to
prevent uric acid stones from forming in your kidneys.
¾ NSAIDs - these can be used to help to lessen and control the
inflammation.
¾ Colchicine - helps treat acute attacks as well as prevent
recurrences. It is given a treatment of 10 doses, once every hour.
Treatment is stopped when the therapeutic goal is reached, the
number of prescribed doses have been consumed, or side effects

4
 such as nausea, vomiting, or diarrhea. This is the reason why this
is not commonly used for treating the symptoms of gouty arthritis.

Once your doctor has confirmed the presence of gouty arthritis, you
must always maintain your regular follow-up check up with your doctor.
Gouty arthritis is addressed in two different ways: treating the signs and
symptoms and preventing the recurrence of attacks. Maintain your
medication to help you live with your gouty arthritis and limit the level of
deformity that may occur due to recurrent attacks.

For more information, please visit:

http://doityourselfdoctor.com/