Arthritis

Overview

The debilitating condition actually includes more than 100 different types of joint disease, with the most common types being osteoarthritis, rheumatoid arthritis, and gout. These conditions are collectively described as arthritis. Unfortunately, arthritis affects around 15% of our population - over 180 million Indians. These conditions can severely restrict mobility, which means that they take a toll on one’s ability to function effectively at home or at work.

This is why it is so important for us to develop a better understanding of arthritis, how it affects quality of life, and how to help cope with it.

Symptoms

The most common symptoms of arthritis generally affect the joints. Depending on the type of arthritis you have, you’ll notice symptoms such as:

• Pain
• Stiffness
• Swelling
• Redness
• Decreased range of motion

Types

There are several different types of arthritis, but the two most common types include osteoarthritis and rheumatoid arthritis. Both these types of arthritis damage joints in different ways.

Osteoarthritis

Osteoarthritis is said to be the most common type of arthritis. It often damages the joint’s cartilage, the hard coating at the ends of the bones where they form a joint. The main function of the cartilage is to cushion the ends of the bones and allows nearly frictionless joint motion. When the cartilage is damaged, it results in bone grinding directly to each other, which causes pain, inflammation and restricted movement. Such damage can occur over many years, or it can be a result of a joint injury or infection.

Osteoarthritis also affects the entire joint. It typically leads to changes in the bones and deteriorates the connective tissues that attach muscles to the bones and hold the joint in place. It often causes inflammation of the joint lining.

Rheumatoid arthritis

The body’s immune system attacks the lining of the joint capsule in rheumatoid arthritis. This lining, medically referred to as synovial membrane, becomes inflamed and swells when it is attacked by the immune system. The progression of the diseases can eventually lead to the destruction of the cartilage and bone within the joint.

Risk factors

Mentioned below are the factors that contribute to the risk of developing the condition.

• Family History - Some types of arthritis are genetic, i.e they run in families. In such cases, you may be more likely to develop arthritis if your parents or siblings have the disorder. With a family history of arthritis, your genes are more susceptible to environmental factors that may trigger arthritis.
• Age - The risks of developing arthritis, especially osteoarthritis, rheumatoid arthritis and gout, increases with age.
• Your sex - Sex: As compared to men, women are more likely to develop rheumatoid arthritis, while the numbers of gout (another type of arthritis) are higher in men.
• Previous joint injury - Those who have had a joint injury, perhaps by playing sports or had an accident, are more likely to develop arthritis in that joint, later in life.
• Obesity - Being obese or overweight can put stress on your joints, particularly the knees, hips and spine. People with excess weight are more likely to develop arthritis.

Complications

Severe, chronic arthritis can interrupt your daily routine and make everyday tasks difficult, especially if it’s affected your hands and arms. Arthritis of weight-bearing joints (ankles, knees and hips) can make walking and sitting up straight uncomfortable and painful tasks. In some cases of arthritis, joints may even deform or twist.

Diagnosis

Physical examination for diagnosing the presence of arthritis involves checking for joint swelling, redness and warmth. Your doctor may also tell you to move your joints to examine how well they function.

Basis the type of arthritis suspected, your doctor will suggest you a few of the following tests:

Laboratory tests

These tests involve the analysis of different types of body fluids that help pinpoint the type of arthritis a patient may have. Fluids that are commonly analysed include blood, urine and joint fluid.

Imaging

These types of tests can detect problems within your joint that may be causing the symptoms. Examples include:

• X-rays - X-Rays can show cartilage loss, bone damage and bone spurs precisely. It may not reveal early damages caused by the condition, but it is usually used to track the progression of the disease.
• Computerized Tomography (CT) Scans: CT scanners take X-rays, but from multiple different angles and combine the information gathered to create cross-sectional images of the internal structures. CT scans can not only visualize the bone, but also the surrounding soft tissues.
• Magnetic Resonance Imaging (MRI): MRIs can produce more-detailed cross-sectional images of the soft tissues (cartilage, tendons and ligaments).
• Ultrasound: This imaging technology uses high-frequency sound waves to image soft tissues and different fluid-containing structures near the joins. It is also used to guide the placement of needles in joint aspirations and injections.

Treatment

The main focus of arthritis treatment is to relieve the pain and symptoms and to improve the joint functions. You may need to try several different treatments, or combinations of treatments, before you can determine what works best for you.

1. 1. Medications

      The medications used to treat arthritis will vary depending on the type of arthritis. Commonly used arthritis medications include:

      • Pain Medication - An over-the-counter option includes acetaminophen (Tylenol, others).
      • Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - NSAIDs are most commonly used to reduce pain and inflammation.
      • Counterirritants - Some creams and ointments containing menthol or capsaicin (the compound that makes pepper spicy) may be used. Applying these medications on the skin over the aching joint may relieve pain.
      • Disease-modifying Antirheumatic dDrugs (DMARDs) - DMARDs slow or completely restrict the immune system from attacking the joints of your own body. They are usually used to treat rheumatoid arthritis. The most commonly used DMARDs include methotrexate and hydroxychloroquine.
      • Biologic Response Modifiers - They are usually used in conjunction with DMARDs. Examples include etanercept and infliximab.
      • Corticosteroids -These drugs reduce inflammation and suppress the immune system. They can be consumed orally or be injected directly into the painful joint. The most common types include prednisone and cortisone.
      • Hyaluronic Acid or Hyaluronate Injections - Also called viscosupplements, this treatment tries to restore synovial fluid, which is a viscous substance that helps lubricate the joints.
      • Platelet-rich Plasma (PRP) Injections - Commonly described as PRP therapy, this treatment exploits natural healing properties of blood plasma to repair damage to the joint cartilage, ligaments, or bones.
      • Mesenchymal Stem Cell Therapy - This is still an experimental treatment, but it has shown promise in pre-clinical models and can help resurface degenerated cartilage, reducing pain and facilitating healing.
   2. Physical Therapy: Physical therapy or Physiotherapy can be helpful for some types of arthritis. Exercises can help you improve your range of motion and strengthen the muscles around the affected joints. In a few cases, splints or braces may also be used to ease the efforts.
   3. Surgery : When conservative measures fail to help, doctors may suggest surgery. Some of the most common surgeries for treating arthritis include:
      • Joint Repair - Joint surfaces can be smoothed or realigned to reduce pain and improve mobility. These procedures can often be performed through small incisions over the joint (arthroscopically).
      • Joint Replacement - Joint Replacement is a procedure in which the damaged joint is replaced with an artificial one.
      • Joint Fusion - Most commonly used for smaller joints like the ones in the wrists, ankles and fingers. In this surgery, the ends of the two affected joints are removed and then the ends are locked together until they fuse into one rigid unit. 

Preventive Measures

Some of the preventive measures used to reduce the risks of developing the condition include:

• Weight Loss - If you're obese or overweight, losing those extra kilos will reduce the stress exerted on your joints. This may help you increase your mobility and decrease the risks of future joint injury.
• Exercise - You must exercise regularly to keep your joints flexible. Ideal exercises are considered to be swimming and water aerobics.
• Heat And Cold - Massaging the affected joints with heating pads or ice packs may help relieve arthritis pain.
• Assistive Devices - Using assistive devices such as canes, shoe inserts, walkers, raised toilet seats, etc can help improve your joint functions and the ability to perform daily tasks.

Alternative Medicine

A lot of people use various alternative remedies to relieve arthritis pain. However, there is little reliable evidence to support the use of most products. The most promising alternative remedies of the condition are as follows:

• Acupuncture - This therapy uses fine needles inserted at specific points on the skin to reduce various types of pain, including those caused by arthritis.
• Glucosamine - Although there have been contradicting results from many studies, people still tend to use this supplement.
• Chondroitin - Chondroitin may provide some pain relief from osteoarthritis. People tend to go for it even when the results from various studies are contradictory.
• Yoga and Tai Chi - The stretching movements involved in yoga and tai chi may help improve flexibility and range of motion.
• Massage - Light stroking and kneading of muscles may help relieve arthritis pain temporarily as it increases blood flow and warms the affected joints.

Find out more about our Department of Orthopaedics & Joint Replacements here at Aware Gleneagles Global Hospital.

Dr V V Satyanarayana E

MS Ortho, MCh Trauma (UK), AO Fellow Trauma & Arthroplasty (Greece)

Consultant – Orthopaedic & Arthroplasty Surgeon

Aware Gleneagles Global Hospital, LB Nagar

Disclaimer:The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.