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Arthritis

Definition

The word “Arthritis” is used to describe various painful conditions of the joints.

Osteoarthritis is the most common form of arthritis. It is a degenerative disease. With aging,, the cartilage at the bone ends gradually wear away and this leads to painful rubbing of bone on bone in the joints. It may also cause joints to fall out of their natural positions (become misaligned, deformed, bent etc.). The weight bearing joints of the body such as the knees, hip and spine are most commonly affected. Osteoarthritis mostly affects people beyond 50 years of age.

The second common type of the arthritis is Rheumatoid arthritis, which is the main type of inflammatory arthritis. It is a chronic condition identified by pain and swelling in the joints, leading to reduction of movement, and the breakdown of bone and cartilage. It affects about 3% to 5% of the population. It usually starts between the ages of 30 and 50, and women are affected three times more often than men.

Other forms of arthritis include Ankylosing spondylitis, Cervical Spondylitis, Fibromyalgia, Systemic Lupus Erythematosis (SLE or lupus), gout, psoriatic arthritis and Reiters syndrome.

Arthritis is often associated with older people, but it can also affect children. This is called Juvenile Idiopathic Arthritis (JIA), also known as juvenile chronic arthritis or juvenile rheumatic arthritis. The cause of JIA is unknown but theories include genetic factors, or viral infections.

Causes

The causes of arthritis are not fully known. One theory is that some people are genetically predisposed to developing the disease, but this is not yet proven.

Factors that may contribute to the development of osteoarthritis include:

Obesity (puts added strain on joints), Jobs that involve repetitive loading movements of a particular joint, or Previous trauma to joint, such as from a sports injury or fracture of bones forming the joint. Rheumatoid arthritis is an autoimmune disease and it is caused by a defect in the immune system that causes the body to attack its own tissues (particularly the synovial tissue that lines the membrane of the joints). This may be inherited genetically.

Symptoms

The main symptoms of all forms of arthritis are stiffness, pain and restricted movements of the joints. Swelling, warmth and redness of the skin over the joint may also occur.

Osteoarthritis begins slowly with pain and stiffness in joints, and restricted movement of the affected joints. Some people experience only slight stiffness while others may experience a crackling sound along with severe pain and limitation of movement in the joint. The pain and loss of movement tends to get worse as the day progresses, as the joints are used more. In very advanced stages, the joints go out of alignment.

Rheumatoid arthritis also begins gradually, with a swollen and painful joint, and may be accompanied by a general feeling of being unwell, such as tiredness. It can progress to pain, swelling and stiffness in the joints, and lack of mobility. It can also spread to other organs such as the eyes, lungs and skin. It is usually worse in the morning, but often improves during the day as the joints are flexed and used.

Diagnosis

Arthritis is diagnosed on the basis of symptoms (pain, crepitus, deformity, alteration in gait etc.) and a physical examination. Related factors such as occupation, other activities that may strain joints (such as regular sporting activities), medical history, and any history of arthritis in the family are also taken into account. To pinpoint the type and severity of the condition, X-rays are sometimes used. Computerised Tomography scan (CT scan) or MRI scan are very rarely required.

Treatment

Everyone experiences arthritis in a different way, so advice on management and treatment is also normally given on a case-by-case basis. It is important to start treatment early because any delay in treatment will cause further damage to joints and worsen the quality of life.

The treatment of arthritis is multidisciplinary which may include: Orthopaedician, Arthritis specialist (Rheumatologist), Physiotherapist, Occupational therapist, Nurse specialist, Dietician, Pharmacist and social worker.

Treatments for Osteoarthritis:

Initial treatment usually involves the prescription of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Some precautions and life style modifications (avoiding sitting on the floor, avoiding stairs, regular exercises etc.) are recommended at this stage to prevent or slow down the progression of disease.

To treat severe symptoms, corticosteroids are injected directly into the affected joint. This is not recommended on a long term basis because of serious side effects such as wasting away of tissue surrounding the joint. Specific methods and exercises can be used to restore movement in the affected joints. Weight reduction will also help by reducing the stress on the joints. Surgery (joint replacement) is usually the last option, although not all joints can be artificially replaced with synthetic joints. Other possible procedures might include surgical realignment of the joint (osteotomy).

Other treatments include bracing or taping of the affected joint to realign them and reduce pain when they are moved. This is usually not an effective method of treatment and is not recommended.

Treatments for Rheumatoid arthritis:

Treatments for Rheumatoid arthritis aim to control swelling and inflammation of the joints. Drugs are prescribed to limit damage to joints and to relieve pain. Medicines such as paracetamol or aspirin are used, but can have serious side effects such as stomach pain and bleeding when taken over long periods or in high doses.

Disease Modifying Anti-Rheumatic Drugs (DMARDs) are routinely used nowadays. They help in limiting the damage to the joint and are believed to have fewer side effects. They are also known as immune-modulator drugs.

Joint Replacement Surgery can be used to treat rheumatoid arthritis, provided that this is possible with the affected joint. Relaxation techniques and physiotherapy can be effective.

Low doses of oral corticosteroids are also used to tide over acute crisis.

Other therapies have also been used to treat arthritis, although not all have been clinically proven to be effective. They include:

Acupuncture, Hydrotherapy, Electrotherapy Nutritional supplements such as glucosamine, chondroitin and fish oil Herbal medicines.

Complications Of Disease

In the long term, arthritis can result in worsening pain, loss of mobility, and may sometimes make walking difficult or impossible. Depression often accompanies this condition.

General effects of Rheumatoid arthritis may include loss of appetite and weight loss, tiredness, muscle pain, nodules under the skin, inflammation of tendons, and problems affecting the vision. Blood disorders like anaemia and vasculitis (inflammation of the blood vessels) may also develop.

Some treatments have side-effects that cause additional problems. NSAIDs may damage the stomach and digestive system and may also be associated with kidney problems in some people. Corticosteroids can cause reduction in bone density (osteoporosis) leading to an increased risk of fractures.

Preventive

Weight reduction helps ease pressure on the joints, and avoiding stress or injury to your joints can also help to prevent or reduce the severity of Osteoarthritis.

It is not true that avoiding exercise will help reduce joint problems in later life. Weight-bearing exercise such as walking will help to prevent Osteoarthritis by increasing the strength of muscles that support joints.

Good posture can assist the strengthening of healthy joint structures, and physiotherapy and use of a walking stick or cane, can help prevent worsening of existing conditions.

There is no known way to prevent Rheumatoid arthritis

College Health

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Community Health

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E-health Record

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Wellness

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