ARTHRITIS

DEFINITION:
*acute or chronic inflammation of a joint, often accompanied by pain and structural
changes and having diverse causes, as infection, crystal deposition, or injury

*Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and

resulting from infection, trauma, degenerative changes, metabolic disturbances, or other
causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or
rheumatoid arthritis

*painful inflammation of a joint or joints of the body, usually producing heat and redness.

TYPES:
*Rheumatoid arthritis Rheumatoid arthritis is the most common serious inflammatory
form of arthritis. It affects roughly 1 per cent of the population and is the prototypical
autoimmune form of arthritis. Because it may do most of its damage in the first year,
early diagnosis and aggressive therapy is critical. Left untreated RA may shorten life
expectancy by as much as 18 years!

*Psoriatic arthritis Psoriatic arthritis is a potentially serious inflammatory form of arthritis

that is often found in association with psoriasis. Because it may begin and progress
insidiously, it can cause serious problems. Early diagnosis and aggressive intervention
are recommended.

*Osteoarthritis This type of arthritis is the one people think of as being associated with
aging. osteoarthritis affects weight-bearing areas such as the spine, hips, knees, base
of the thumbs, and feet. Genetics and mechanical factors also play a big role. Research
is being done on medications that will slow down the progression of this disease.

*Polymyalgia rheumatica Polymyalgia rheumatica occurs in people after the age of 50

and presents with severe stiffness and aching in the neck, shoulders, and hips.
Because it is very treatable, accurate diagnosis is needed. Because so many other
conditions look like it, an accurate diagnosis is not always easy.

*Ankylosing spondylitis This inflammatory form of arthritis affects the spine and the
sacroiliac joints. Since it often presents with low back pain, it is often misdiagnosed. AS
is very treatable; accurate diagnosis and aggressive therapy are advisable
*Reactive arthritis Reactive arthritis is a form of arthritis that comes on after infections...
the most common being types of infections being intestinal or genitourinary. Young
adults are often affected. Appropriate medical treatment is very effective.

*Gout This common form of arthritis is due to deposition of monosodium urate (MSU)
crystals. In addition to joints, the kidneys are a big target of this disease. Dietary
changes and medicines are very effective in treating this disorder.

*Pseudogout This form of arthritis is also due to crystals- deposits of calcium

pyrophosphate or hydroxyapatite in most instances. Pseudogout may mimic other types
of arthritis such as gout and rheumatoid arthritis. Further, it may coexist with other types
of arthritis making it very difficult to diagnose.

*Systemic lupus erythematosus this relatively common autoimmune disease is systemic

in nature and capable of affecting many internal organ systems. SLE most often affects
women in the child-bearing years. Early diagnosis and management are necessary
since this disorder is potentially life-threatening.

*Polymyositis This inflammatory form of muscle disease is often associated with

arthritis. Because it is a systemic condition that affects all muscles- including those that
are responsible for the functioning of the heart, lungs, etc., careful examination and
appropriate aggressive medical therapy are necessary.

*Fibromyalgia Fibromyalgia is a soft tissue form of arthritis that is due to defective

neurotransmitter function in the brain. Because these neurotransmitters are responsible
for many sensory functions, patients with fibromyalgia present with bizarre symptoms. It
is imperative that other forms of arthritis be ruled out first.

*Lyme disease Lyme disease occurs as a result of infection with Borrelia burgdorferi.
The organism is transmitted by a deer tick bite. Early recognition and antibiotic therapy
is effective in most cases.

RISK FACTORS:
*Genetics
Exactly how much heredity or genetics contributes to the cause of arthritis is not well
understood. However, there are likely genetic variations that can contribute to the cause
of arthritis.
*Age
Cartilage becomes more brittle with age and has less of a capacity to repair itself. As
people grow older they are more likely to develop arthritis.

*Weight
Because joint damage is partly dependent on the load the joint has to support, excess
body weight can lead to arthritis. This is especially true of the hips and knees that can be
worn quickly in heavier patients.

*Previous Injury
Joint damage can cause irregularities in the normal smooth joint surface. Previous major
injuries can be part of the cause of arthritis. An example of an injury leading to arthritis is
a tibial plateau fracture, where the broken area of bone enters the cartilage of the knee
joint.

*Occupational Hazards
Workers in some specific occupations seem to have a higher risk of developing arthritis
than other jobs. These are primarily high demand jobs such as assembly line workers
and heavy construction.

*Some High-Level Sports

It is difficult to determine how much sports participation contributes to development of
arthritis. Certainly, sports participation can lead to joint injury and subsequent arthritis.
However, the benefits of activity likely outweigh any risk of arthritis.

*Illness or Infection
People who experience a joint infection (septic joint), multiple episodes of gout, or other
medical conditions, can develop arthritis of the joint

*The condition can be brought about by nerve impairment, increased or decreased

function of the endocrine glands, or degeneration due to age. Less frequently, it is
caused by infection

SIGNS AND SYMPTOMS:

*pain

* limited function of joints

*joint stiffness

* swelling

* redness

*. loss of range of motion

* fever

* gland swelling

* weight loss,

*fatigue

Diagnosis

X-ray of the hand in rheumatoid arthritis.

Appearance of synovial fluid from a joint with inflammatory arthritis.

*ultrasonography

*magnetic resonance imaging

*X-rays

*blood
TREATMENT
A cornerstone of therapy of any form of arthritis is physical therapy and occupational
therapy to maintain joint mobility and range of motion. The proper kind and amount of this
therapy will vary depending upon the underlying cause and upon individual factors that your
physician will discuss with you.

Many drugs are now used to treat the inflammation and pain associated with arthritis.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
(Motrin, and others), naproxen (Naprosyn, and others) and dicolfenac (Voltaren), have
immediate analgesic and anti-inflammatory effects and are relatively safe.

Second-line drugs used for treatment of rheumatoid arthritis include hydroxychloroquine,

gold, penicillamine, azathioprine, sulfasalazine and methotrexate. These agents (which have
no immediate analgesic effect) can control symptoms and may possibly delay progression of
the disease, but many of them can also cause severe adverse effects and diminish in
effectiveness over time. NSAIDs are usually taken concurrently with the slower acting
second-line drugs, which may take months to produce a therapeutic response.

Aspirin in high doses is as effective as any other NSAID and much less expensive, but some
patients cannot tolerate the gastrointestinal toxicity. Aspirin interferes with platelet function
and can rarely cause serious bleeding; this effect can persist for four to seven days after the
drug has been discontinued.

Tinnitus (ringing in the ears) and rarely, hepatitis (liver inflammation) or renal (kidney)
damage can also occur with high-dosage aspirin therapy. Enteric-coated aspirin is safer but
may not be fully absorbed. Nonacetylated salicylates, such as sodium salicylate, salsalate
(Disalcid, and others), and choline magnesium salicylate (Trilisate, and others), do not
interfere with platelet function and may be safer than acetylated salicylates for aspirin-
sensitive patients, but some clinicians have questioned their effectiveness.

Treatment
Once the diagnosis of arthritis is made, treatments are available for a variety of symptoms. There
is no cure for either rheumatoid or osteoarthritis.

Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle
changes (including exercise and weight control), orthopedic bracing, medications, and dietary
supplements (symptomatic or targeted at the disease process causing the arthritis). Arthroplasty
(joint replacement surgery) may be required in eroding forms of arthritis. Medications can help
reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation,
the joint damage is slowed.[12]

In general, studies have shown that physical exercise of the affected joint can have noticeable
improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is
encouraged to maintain the health of the particular joint and the overall body of the person.[13]

[edit] Physical Therapy

Individuals with arthritis can definitely benefit from both physical and occupational therapy. In
arthritis the joints become stiff and the range of movement can be limited. Physical therapy has
been shown to significantly improve function, decrease pain, and delay need for surgical
intervention in advanced cases [14]. Exercise prescribed by a physical therapist has been shown to
be more effective than medications in treating osteoarthritis of the knee. Exercise often focusses
on improving muscle strength, endurance and flexibility. In some cases, exercises may be
designed to train balance. Occupational therapy can teach you how to reduce stress on your joint
from daily living activities. Occupation therapy can also teach you how to modify your home and
work environment so that you do reduce movements that may worsen your arthritis. There are
also assist devices available that can help you drive, getting a bath, dressing and also in
housekeeping labors.

As well as exercise, physical therapy may include education about modifying activities, and
other self-management skills such as using ice or heat, and ultrasound. Physical therapists will
routinely educate patients to manage their problems related to arthritis themselves. Other aspects
of physical therapy means learning how to maintain good posture, conserving energy by
allowing rest before and after activity.

Occupational therapy can help you do everyday activities without worsening pain or causing
joint damage. The techniques can help you distribute pressures to minimize stress on any one
joint. Ways to accomplish daily living tasks are made easier.[15]

[edit] Medications

Physicians usually start with drugs which have the fewest side effects and shift to stronger
medications as the disease progresses.[16]

Non-steroidal anti-inflammatory drugs (NSAIDs) are usually the drugs of first choice. These
drugs help decrease inflammation and reduce pain. Over the counter medications like Ibuprofen
or Aleve do help but most people require stronger prescription painkillers like Celebrex or
tramadol. While these drugs are effective, they are also associated with a variety of side effects
like abdominal pain, bleeding, ulcers, liver and kidney damage. Non steroidal anti inflammatory
drugs should not be used for prolonged periods without proper physician supervision.[17]

Corticosteroids are frequently prescribed for individuals with arthritis. These potent drugs can
help reduce inflammation and slow down joint damage. However, corticosteroids have potent
side effects which range from ulcer, skin bruising, weight gain, cataracts, bone thinning, diabetes
and hypertension. Corticosteroids are usually given for a short time to help reduce acute
symptoms.

Disease-modifying antirheumatic drugs (DMARDs) can help slow down progression of

rheumatoid arthritis and joint damage. The most common DMARDs include methotrexate
(Rheumatrex, Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine
(Azulfidine) and minocycline (Dynacin, Minocin). All these drugs have side effects which
include liver damage, bone marrow suppression and possibility of opportunistic infections.
Immunosuppressants like cyclosporine and cyclophosphamide suppress potent cells of the body
and help decrease the inflammation. These medications do help treat severe arthritis but also
make one prone to infections.

Tumor necrosis factor inhibitors have been shown to reduce inflammation, pain, morning
stiffness and swelling of joints. Drugs like etanercept (Enbrel), infliximab (Remicade) and
adalimumab (Humira) can significantly improve quality of life. The most common side effects
from these drugs include pain at site of injection, heart failure and increased risk of infection.[18]

[edit] Alternative Medicine

Aloe Vera has been used orally and topically[19] by some sufferers as an alternative medicine and
many have claimed it is successful in reducing the inflammation around affected joints, and
hence the pain, while avoiding the side effects that can be found in certain prescription drugs
(see above) [20] [21]