ARTHRITIS
Arthritis is derived from Greek word, arthro – joint, itis – inflammation. It is a form of joint disorder that involves inflammation of one or more joints. There are over 200 types of arthritis – or musculoskeletal conditions – which can be grouped into three types
- Inflammatory arthritis – such as rheumatoid arthritis, ankylosing spondylitis, gout
- Non-inflammatory arthritis (degenerative) – such as osteoarthritis, scoliosis, torn ligaments
- Infectious arthritis – arthritis due to bacteria, virus or fungal infection.
The common symptoms for all arthritis disorders include varying degree of pain, swelling and stiffness of the joint. The major complaint by individuals is joint pain. The pain may be due to inflammation, damage to the joint, daily wear and tear of joint, muscle or ligament strains and weakness/fatigue of the muscles. Arthritis may affect any age group. Few disorders have gender preferences. As a whole arthritis disorders are more common in females, in third and fourth decades.
The most common form, osteoarthritis (degenerative joint disease), is a result of trauma, ligamental injury, fracture involving the joint, old infection to the joint, obesity or age. Other arthritis forms are Rheumatoid arthritis, Psoriatic arthritis and related autoimmune diseases. Septic arthritis is caused by joint infection.
Inflammatory arthritis disorders include Spondyloarthritis, Rheumatoid arthritis and connective tissue disorders. Connective tissue diseases include SLE, Scleroderma, Sjogren’s syndrome, myositis and mixed connective tissue disease (MCTD). Diseases like Rheumatoid arthritis, SLE are common in females with a ratio varying from 4:1 to 9:1 (F: M). RA is a crippling disease that causes pain, swelling and damages the joints predominantly affecting the upper limb small joints of the hands. On the other hand, Spondyloarthropathies are another type of arthritis that is common in males, predominantly affects the spine and large joints of the lower limb which includes disease like Ankylosing spondylitis, reactive arthritis, Psoriatic arthritis, IBD related arthritis and undifferentiated spondyloarthropathy. Inflammatory arthritic disorders can also affect other organs in the body with a variety of symptoms; fever, skin rash/thickening, nodules, raynaud’s phenomenon, red eye, oral ulcers, weight loss, malaise and generalized weakness, weakness of the muscle, muscle pain, dryness of mouth and eye with varying frequency.
Gout is another arthritis condition charecterised by recurrent attacks of red, tender, hot, swollen joint. Gout was historically known as “the disease of kings” or “rich man’s disease” but now it has become a part of metabolic syndrome. The base of the big toe is affected most often, accounting for half of cases. This condition is caused by excess of uric acid in the blood.
Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible joint damage
Diagnosis
Diagnosis is made by clinical evaluation/examination and supported by other tests such as radiology and blood tests depending on the type of suspected arthritis. The physician/Rheumatologist assess whether it is arthritis (arising from the joint) or some other pain (eg neuropathy). Physician/Rheumatologist goes through the details of the history like;
- Age of onset (juvenile, adult or elderly)
- Gender
- onset of the disease (acute or chronic),
- number of joints involved (single or multiple)
- pattern of arthritis (migratory, additive or episodic arthritis),
- location (upper or lower limbs, small or large joints, with or without back pain) and
- Associated symptoms
Treatment
Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), medications and surgeries. 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 may be slowed.
Physical and occupational therapy
Individuals with arthritis can 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. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities as well as equipment.
Medications
Two to three decade back there were only pain relievers as the treatment to these arthritic disorders. But today with the improvement in understanding the basic mechanisms of the diseases we have different drugs for the control of the disease activity. These have been grouped under NSAIDs (non steroidal anti inflammatory drugs), glucocorticoids, DMARDs (disease modifying anti rheumatic drugs), biological agents and Immunosuppressive drugs. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.
Long term effects and disability
Today we are worried about the long term effects of the diseases. Arthritis disorders if not controlled properly may cause damage of the joint involved leading to deformities and movement restriction. It is common in advanced arthritis for significant secondary changes to occur. This may have an impact on the personal, professional, social lifestyle of the patient. Absenteeism from the job and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and some become home bound. Arthritis can make it very difficult for an individual to remain physically active, contributing to an increased risk of obesity and vulnerability to heart diseases. Individuals with arthritis are also at increased risk of depression. This may lead to economic burden to the individual and to the country with loss of production and expenses of the patient.
Complications of arthritis include:
- Long-term (chronic) pain
- Disability
- Difficulty performing daily activities
- Deformities
Few websites of rheumatology organizations both national and international for further references
www.indianrheumatology.org
www.aplar.org
www.rheumatology.org
www.eular.org
www.rheumatology.org.uk
