Arthritis: The basics

INTRODUCTION TO ARTHRITIS

Arthritis is an inflammation that can affect one or more joints. There are many different kinds of arthritis with varying causes and treatment modalities. The two very common ones are osteoarthritis (OA) and rheumatoid arthritis (RA). The symptoms of arthritis appear gradually though they may also be quick to disappear. Arthritis is majorly seen in the Elderly population especially in those above 65 years though it is not unusual to find it in children, teenagers, and young adults. It has a gender predilection for women than men and it also occurs more in people who are overweight or obese.

SYMPTOMS OF ARTHRITIS

The consistent features in arthritis are joint pain, stiffness, and swelling. Other symptoms include a decrease in the range of movement, reddening of the skin around the joint. Those with arthritis experience worsening symptoms early in the morning.

 Rheumatoid arthritis may cause weakness and an appetite loss because of the ongoing inflammation in the body’s immune system. The red blood cell count may also be reduced to cause anemia and a mild fever may be present. If left untreated, rheumatoid arthritis can cause joint deformity when severe.

CAUSES OF ARTHRITIS

When there is a decrease in the amount of cartilage in the joint, arthritis can develop. Cartilage is a connective tissue that is strong, elastic and situated in the joints. It serves to protect the joints by acting as a pressure and shock absorber during movement and when pressure is being applied to the joints.

Osteoarthritis is caused by frequent use of a joint which makes it undergo wear and tear. An infection or an injury to the joint worsens the natural breakdown of the tissues of the cartilage. You have a higher risk of developing OA if you have a family history of the condition.

RA, the other common form of arthritis is autoimmune in origin. It is a result of a direct attack of the immune system on the tissues of the body. This attack has an effect on the synovium. The synovium of the joint is a soft tissue that produces synovial fluid which serves to nourish the cartilage and lubricate the joint spaces.

RA is a synovial disease that penetrates and damages a joint. It causes complete damage to the bones and cartilage that are present in a joint.

The cause of this immune system disorder is unknown but there are some genetic markers that have been known to increase the likelihood of developing RA by fivefold.

DIAGNOSIS OF ARTHRITIS

Speak to a primary care physician about your symptoms. They will conduct a physical examination to check for any fluid collection around the joints, reddening of joint, warmness of the joint and the range of movement in that joint. If there is any need to, the doctor will make a referral to a specialist.

If the symptoms you experience are severe, try to schedule an appointment with a rheumatologist as this will make the diagnosis and treatment much faster.

The level of inflammation in the blood and synovial fluid can be determined by sending samples to the lab, this will also specify the kind of arthritis that is present. The major diagnostic tests are anti-CCP (anti-cyclic citrullinated peptide), Rheumatoid factor (RF), and Antinuclear antibody (ANA).

Imaging studies such as CT scan, MRI or X-ray can also be used to reinforce the diagnosis. They produce an image of the bones and cartilage thus excluding other possible causes of the symptoms you experience, such as bone spurs.

TREATMENT OF ARTHRITIS

The aim of treatment is to alleviate pain and prevent permanent joint damage. People have varying pain thresholds and the thing that works for one person may not work for another. You will get to learn what is very potent for your pain control. Heating pads and ice packs have been beneficial for some patients. Other people make use of mobility devices like canes or staff to assist in relieving pressure off tender joints.

The doctor may additionally prescribe medications or a combination of treatment modalities which help to improve the functionality of the joints.

MEDICATION

Various medicines can be used to treat arthritis. They include:

• Analgesics: these are pain relievers and they are used for pain control. Examples include acetaminophen (Tylenol) or hydrocodone (Vicodin)
• Non-steroidal anti-inflammatory drugs (NSAIDs): these are used to control both pain and inflammation. Examples include ibuprofen and salicylates. Salicylates make the blood thin and when they are used alongside other blood thinners, great precautions should be taken.
• Menthol or capsaicin: available as creams for topical use, they prevent pain conduction signals from getting to the joint.
• Immuno-suppressants: such as prednisolone or cortisone are also good for controlling inflammation

Disease modifying anti-rheumatic drugs (DMARDs) are also immunosuppressive drugs that are administered to those with rheumatoid arthritis. Many other medications are available over-the-counter for the treatment of osteoarthritis.

SURGERY

Joint replacement surgery is an option in surgery. Here, the joint is replaced by an artificial one. The hip joint and knee joints are the two common joints that are replaced.  

For those who have symptoms that are severe in the fingers or wrist, joint fusion surgery can be done where the distal parts of the bones are interposed together until they heal and fuse to become one.

PHYSICAL THERAPY

Carrying out exercises that assist in strengthening the muscles surrounding a diseased joint will help in the treatment of arthritis.

LIFE STYLE MODIFICATION FOR PEOPLE WITH ARTHRITIS

• Weight loss
• Dietary adjustment
• Exercising

The above three modalities of treatment can help in managing arthritis.

WEIGHT LOSS

Those who maintain a healthy weight have lesser chances of coming down with osteoarthritis. If you already have osteoarthritis, weight loss can help to reduce the symptoms noticed. Certain foods can assist in weight loss.

DIETARY ADJUSTMENT

 A diet that is rich in antioxidants such as vegetables, fresh fruits and herbs can help to reduce inflammation. Fish and nuts also decrease inflammation. Do away with processed foods, fried foods, dairy products and also decrease your meat intake.

For RA patients, a diet devoid of gluten may reduce the symptoms experienced, this is because gluten antibodies have been found by some researchers to be present in those who suffer from rheumatoid arthritis. Also, a study done in 2015 recommends cessation of gluten in the diet of those with an undifferentiated form of connective tissue disease.

EXERCISE

Exercising regularly will help to maintain joint flexibility. Walking and running as a form of exercise may not be too good as they mount pressure on the joints but swimming does not thus it is a good form of exercise. Remain active but do not over-exert yourself and rest when there is a need to.

Exercises that can be done at home include:

• Exercises to alleviate neck pain such as head tilting, neck rotation
• Exercises that reduce pain in the hands such as thumb and finger bends
• Exercises good for knee arthritis such as leg raises, hamstring stretches

LONG TERM OUTLOOK

There is no known cure for arthritis, the symptoms can only be managed. The different treatment modalities help to reduce symptoms.

In addition to symptom control, some lifestyle changes can help in the management of arthritis.