Arthritis

What is Arthritis? What Causes Arthritis?

The word arthritis comes from the Greek arthron meaning “joint” and the Latin itis meaning “inflammation”. The plural of arthritis is arthritides. Arthritis affects the musculoskeletal system, specifically the joints. It is the main cause of disability among people over fifty-five years of age in industrialized countries.

Arthritis is not a single disease – it is a term that covers over 100 medical conditions. Osteoarthritis (OA) is the most common form of arthritis and generally affects elderly patients. Some forms of arthritis can affect people at a very early age.

What causes arthritis?

In order to better understand what is going on when a person suffers from some form of arthritis, let us look at how a joint works.

Diagram of a Joint

Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move.

Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly.

A capsule surrounds the joint. The space within the joint – the joint cavity – has synovial fluid. Synovial fluid nourishes the joint and the cartilage. The synovial fluid is produced by the synovium (synovial membrane) which lines the joint cavity.

If you have arthritis something goes wrong with the joint(s). What goes wrong depends on what type of arthritis you have. It could be that the cartilage is wearing away, a lack of fluid, autoimmunity (your body attacking itself), infection, or a combination of many factors.

Types of arthritis

There are over 100 types of arthritis. Here is a description of some common ones, together with the causes:

  • Osteoarthritis – cartilage loses its elasticity. If the cartilage is stiff it becomes damaged more easily. The cartilage, which acts as a shock absorber, will gradually wear away in some areas. As the cartilage becomes damaged tendons and ligaments become stretched, causing pain. Eventually the bones may rub against each other causing very severe pain.
  • Rheumatoid arthritis – this is an inflammatory form of arthritis. The synovial membrane (synovium) is attacked, resulting in swelling and pain. If left untreated the arthritis can lead to deformity. Rheumatoid arthritis is significantly more common in women than men and generally strikes when the patient is aged between 40 and 60. However, children and much older people may also be affected.
  • Infectious arthritis (septic arthritic) – an infection in the synovial fluid and tissues of a joint. It is usually caused by bacteria, but could also be caused by fungi or viruses. Bacteria, fungi or viruses may spread through the bloodstream from infected tissue nearby, and infect a joint. Most susceptible people are those who already have some form of arthritis and develop an infection that travels in the bloodstream.
  • Juvenile rheumatoid arthritis (JRA) – means arthritis that affects a person aged 16 or less. JRA can be various forms of arthritis; it basically means that a child has it. There are three main types:
    1. Pauciarticular JRA, the most common and mildest. The child experiences pain in up to 4 joints.
    2. Polyarticular JRA affects more joints and is more severe. As time goes by it tends to get worse.
    3. Systemic JRA is the least common. Pain is experienced in many joints. It can spread to organs. This can be the most serious JRA.

What are the signs and symptoms of arthritis?

The symptoms of arthritis depend on the type of arthritis, for example:

  • Osteoarthritis – The symptoms develop slowly and get worse as time goes by. There is pain in a joint, either during or after use, or after a period of inactivity. There will be tenderness when pressure is applied to the joint. The joint will be stiff, especially first thing in the morning. The patient may find it harder to use the joint – it loses its flexibility. Some patients experience a grating sensation when they use the joint. Hard lumps, or bone spurs may appear around the joint. In some cases the joint might swell. The most common affected joints are in the hips, hands, knees and spine.
  • Rheumatoid arthritis – The patient often finds the same joints in each side of the body are painfully swollen, inflamed, and stiff. The fingers, arms, legs and wrists are most commonly affected. Symptoms are usually worst on waking up in the morning and the stiffness can last for 30 minutes at this time. The joint is tender when touched. Hands may be red and puffy. There may be rheumatoid nodules (bumps of tissue under the skin of the patient’s arms). Many patients with rheumatoid arthritis feel tired most of the time. Weight loss is common.The smaller joints are usually noticeably affected first. Experts say patients with rheumatoid arthritis have problems with several joints at the same time. As the arthritis progresses it spreads from the smaller joints in your hands, wrists, ankles and feet to your elbows, knees, hips, neck, shoulders and jaw.
  • Infectious arthritis – The patient has a fever, joint inflammation and swelling. He will feel tenderness and/or a sharp pain. Often these symptoms are linked to an injury or another illness. Most commonly affected areas are the knee, shoulder, elbow, wrist and finger. In the majority of cases, just one joint is affected.
  • Juvenile rheumatoid arthritis – The patient is a child. He will experience intermittent fevers which tend to peak in the evening and then suddenly disappear. His appetite will be poor and he will lose weight. There may be blotchy rashes on his arms and legs. Anemia is also common. The child may limp or have a sore wrist, finger, or knee. A joint may suddenly swell and stay larger than it usually is. The child may experience a stiff neck, hips or some other joint.

How will arthritis affect me?

Arthritis affects people in many different ways. How long the patient is affected and how severely it is depends on the type of arthritis. Arthritis sufferers will find there are good and bad days. Most patients with arthritis will suffer from discomfort, pain, stiffness and/or fatigue.

You may also feel frustrated that you are no longer able to grip things so well or get around like you used to. It is important to remember that if you suffer from arthritis this does not mean you have to give up having an active lifestyle. With some changes to your way of life there is no reason why you cannot continue being active.

Physical therapy and occupational therapy for arthritis

Physical therapy and occupational therapy help maintain joint mobility and range of motion. How much therapy you need, and what kind of therapy will depend on many factors, such as the severity and type of arthritis you have, your age, and your general state of health. This has to be decided by you with your physician and physical or occupational therapist.

People with arthritis will often avoid moving the affected joint because of the pain. A physical therapist can help the patient work out the joint stiffness without damaging it. In order to perform your daily activity the physical therapist will help you achieve a good range of motion. This may involve building strength in the muscles that surround the affected joint – stronger muscles help stabilize a weakened joint. You will also be taught the best way to move from one position to another, as well as learning how to use such walking aids as crutches, a cane or a walker, if you need one.

Occupational therapy can teach you how to reduce the strain on your joints as you go about your daily activities. The occupational therapist can help you modify your home and workplace so that your movements do not aggravate your arthritis. You may need a splint for your hands or wrists, as well as aids for dressing, housekeeping, work activities, driving and washing/bathing yourself.

An occupational and/or physical therapist can make an enormous difference to your quality of life if you suffer from arthritis. He/she will help you learn more about your arthritis, devise a dietary plan if you are overweight and overstressing the joints as a result, help you make better decisions about what shoes to buy if that part of the body is affected. You will learn how and when to rest – rest is crucial for treating inflammation and pain, especially when many joints are affected and you feel tired. Resting individual joints is very helpful too – custom splints can be made to rest and support affected joints.

Local pain can be relieved with ice packs or heating pads. Ultrasound and hot packs provide deep heat which relieves localized pain and relaxes muscle spasm around the affected joint. You may find that a warm bath/shower makes it easier for you to exercise afterwards.

Your therapist will most likely devise an exercise program for you. Exercise is a crucial part of effective arthritis therapy.

Medications for arthritis

  • NSAIDs NSAIDs (nonsteroidal anti-inflammatory drugs) are the most commonly prescribed drugs for arthritis patients. These may be either prescription or over-the-counter (OTC). At low doses NSAIDs help a vast range of ailments, from headaches, muscle aches, to fever and minor pain. At a higher dose – prescription dose – NSAIDs also help reduce joint inflammation. There are three main types of NSAIDs and they all work by blocking prostaglandins – hormone-like substances that trigger pain, inflammation, muscle cramps and fever:Traditional NSAIDs – these are the largest subset of NSAIDs. As is the case with most drugs, they do carry a risk of side-effects, such as stomach upset and gastrointestinal bleeding. The risk of side effects is significantly higher if the patient is over 60. A patient should take this type of drug at high doses under the supervision of a doctor.COX-2 inhibitors – these also reduce pain and inflammation. However, they are designed to have fewer stomach and gastrointestinal side-effects. In 22004/2005 Vioxx and Bextra were taken off the market after some major studies showed Vioxx carried increased cardiovascular risks, while Bextra triggered serious skin reactions. Some other COX-2 inhibitors are also being investigated for side-effects. The FDA asked makers of NSAIDs to highlight warnings on their labels in a black box.

    Salicylates – includes aspirin which continues to be the preferred medication of many doctors and patients. Patients need to consult their doctor if they plan to take aspirin more than just occasionally. Long term high dosage usage of aspirin carries with it a significant risk of serious undesirable side effects, such as kidney problems and gastrointestinal bleeding. For effective control of arthritis pain and inflammation frequent large doses are needed. Nonacetylated salicylate is especially designed to have fewer side effects than aspirin. Some doctors may prescribe nonacetylated salicylate if they feel aspirin is too risky for their patient. However, nonacetylated salicylate does not have the chemical aspirin has which protects against cardiovascular disease. Some doctors prescribe low dose aspirin along with nonacetylated salicylate for patients who they feel need cardiovascular protection.

  • Glucocorticoids are anti-inflammatory steroids and are very effective at combating inflammation and can be extremely helpful when used properly. The patient needs to consider the potential for undesirable side-effects with this type of drug.
  • Anti-malarials, such as hydroxychloroquine and chloroquine are commonly used for treating mild inflammatory arthritis.
  • Minocycline – an antibiotic that is sometimes used as antibiotic therapy for rheumatoid arthritis. Its use is controversial.
  • Sulfasalazine – commonly used for many types of inflammatory arthritis. Sulfasalazine is a sulfa derivative.
  • Methotrexate – works by blocking the metabolism of rapidly dividing cells. It is commonly used for treating more serious types of inflammatory arthritis.
  • Azathioprine – used for severe forms of inflammatory arthritis. Azathioprine also blocks the metabolism of rapidly dividing cells.
  • Gout medications – some physicians may use gout medications to treat some forms of arthritis.
  • Leflunomide – used to treat rheumatoid arthritis and psoriatic arthritis. It also blocks cell metabolism. However, biologic therapy is gradually taking over.
  • Cyclosporine – an immunosuppressant drug – it makes your immune system less aggressive. Cyclosporine is commonly used by transplant patients so that their bodies do not reject their transplanted organs. Cyclosporine is usually used in combination with methotrexate for arthritis patients. Although effective, this may be limited by its toxicity.

Diet and bodyweight impact on arthritis

Experts say that eating a well-balanced diet is vital when you have arthritis. Not only will you be receiving critical nutrients, you will also be either maintaining or arriving more quickly at a healthy bodyweight. If you are overweight you will be adding extra pressure on weight-bearing joints. Many patients have found that losing just a few pounds made a significant difference to their quality of life.

Doctors and nutritionists are more frequently advising arthritis patients to keep sugary and/or fatty foods to a minimum – such as red meat, cream and cheese. You should make sure you are eating plenty of fruit and vegetables, as well as whole grains. Omega-3 essential fatty acids are thought to relieve to some extent the symptoms of arthritis. A common source of Omega-3 fatty acids is oily fish, such as sardines, herring, trout, and salmon.

Many of us tend to place large portions on our plate. If you reduce the size of the portions you may lose weight more effectively. Make sure that vegetables and fruit make up a large part of your portion.

Living with arthritis

Although arthritis can make daily tasks more difficult and exhausting, there are many techniques and therapies, which added together, can give you a much better quality life, compared to no therapy at all.

It is important that people with arthritis seek medical health and treatment. Although there is no cure for arthritis, there is a lot you can do to minimize its overall effects on your everyday life.

You may wish or have to continue working, and with the right techniques and help from an occupational therapist you may find it is not as daunting as you first thought.

There is a lot you can do to minimize the impact your arthritis might have on family life and raising your children. A person with arthritis will need to remember that being there for the child is much more important than being a super active parent. If you pace yourself and prioritize you will be surprised at how much you can achieve successfully. Be open with your family members about your arthritis – explain how it affects you so that they recognize when you may need extra understanding and support.

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