Arthritis

What is Arthritis? What causes Arthritis?

Arthritis is a form of joint disorder that involves inflammation of one or more joints. There are over 100 different forms of arthritis. The most common form of arthritis is: osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and related autoimmune diseases. Septic arthritis is caused by joint infection. The major complaint by individuals who have arthritis is joint pain. Pain is often a constant and may be localized to the joint affected. The pain from arthritis is due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff painful joints and fatigue.

History of Arthritis

While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples. It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC.

Signs and Symptoms of Arthritis

• Extra-articular features of joint disease
• Cutaneous nodules
• Cutaneous vasculitis lesions
• Lymphadenopathy
• Oedema
• Ocular inflammation
• Urethritis
• Tenosynovitis (tendon sheath effusions)
• Bursitis (swollen bursa)
• Diarrhea
• Orogenital ulceration

Pain, which can vary in severity, is a common symptom in virtually all types of arthritis.,Other symptoms include swelling, joint stiffness and aching around the joint(s). Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. 

Symptoms may include:

• Inability to use the hand or walk
• Stiffness, which may be worse in the morning, or after use
• Malaise and fatigue
• Weight loss
• Poor sleep
• Muscle aches and pains
• Tenderness
• Difficulty moving the joint
• It is common in advanced arthritis for significant secondary changes to occur. For example, arthritic symptoms might make it difficult for a person to move around and/or exercise, which can lead to secondary effects, such as:
• Muscle weakness
• Loss of flexibility
• Decreased aerobic fitness

What is Arthritis Video?-

Comparison of some major forms of arthritis
	Osteoarthritis	Rheumatoid arthritis	Gouty arthritis
Speed of onset	Months	Weeks-months	Hours for an attack
Main locations	Weight-bearing joints (such as knees, hips, vertebral column) and hands	Hands (proximal interphalangeal and metacarpophalangeal joint) wrists, ankles, kneesand hips	Great toe, ankles,knees and elbows
Inflammation	May occur, though often mild compared to inflammation in rheumatoid arthritis	Yes	Yes
Radiologicchanges	·         Narrowed joint space ·         Osteophytes ·         Local osteosclerosis ·         Subchondral cysts	·         Narrowed joint space ·         Bone erosions	·         "Punched out" bone erosions
Laboratory findings	None	Anemia, elevated ESR and C-reactive protein(CRP), rheumatoid factor, anti-citrullinated protein antibody	Crystal in joints
Other features	·         No systemic signs ·         Bouchard's and Heberden's nodes	·         Extra-articular features are common ·         Ulnar deviation, swan neck- and Boutonniere deformity of the hand	·         Tophi ·         Nephrolithias

Types of arthritis

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is the most common type of arthritis in the UK, affecting around 8 million people.

It often develops in people who are over 50 years of age. However, it can occur at any age as a result of an injury or another joint-related condition.

Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness.

The cartilage lining of the joint can then thin and tissues within the joint can become more active. This can then lead to swelling and the formation of bony spurs, called osteophytes.

In osteoarthritis, the cartilage (connective tissue) between the bones gradually erodes, causing bone in the joints to rub together. The joints that are most commonly affected are those in the hands, spine, knees and hips. Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, wrists, feet, back, hip, and knee. The disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. In recent years, some joint or limb deformities such as knock-knee or acetabular over coverage or dysplasia have also been considered as a predisposing factor for knee or hip osteoarthritis. Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other. Initially, the condition starts with minor pain during activities, but soon the pain can be continuous and even occur while in a state of rest. The pain can be debilitating and prevent one from doing some activities. Osteoarthritis typically affects the weight-bearing joints, such as the back, spine, and pelvis. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. More than 30 percent of women have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include prior joint trauma, obesity, and a sedentary lifestyle.

Rheumatoid arthritis

In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and 50 years old. Women are three times more likely to be affected than men.

Rheumatoid and osteoarthritis are two different conditions. Rheumatoid osteoarthritis occurs when the body's immune system targets affected joints, which leads to pain and swelling.

The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joint's shape. This can cause the bone and cartilage to break down.

People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.Rheumatoid arthritis is a disorder in which the bodies own immune system starts to attack body tissues. The attack is not only directed at the joint but too many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis often affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical (appears on both sides of the body) and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. Often, it is not clear why the rheumatoid arthritis occurred. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. The latest drugs like Remicade can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.

Other types of arthritis and related conditions

Ankylosing spondylitis – a long-term inflammatory condition that mainly affects the bones, muscles and ligaments of the spine, leading to stiffness. Other problems can include the swelling of tendons, eyes and large joints.

Cervical spondylosis – also known as degenerative osteoarthritis, cervical spondylitis affects the joints and bones in the neck, which can lead to pain and stiffness.

Fibromyalgia – causes pain in the body's muscles, ligaments and tendons.

Lupus – an autoimmune condition that can affect many different organs and the body's tissues.

Gout – a type of arthritis caused by too much uric acid in the body. This can be left in joints (usually affecting the big toe) but can develop in any joint. It causes intense pain and swelling.

Psoriatic arthritis – an inflammatory joint condition that can affect people with psoriasis.

Enteropathic arthritis – a form of chronic, inflammatory arthritis associated with inflammatory bowel disease (IBD), the two best-known types being ulcerative colitis and Crohn's disease. About 1 in 5 people with Crohn's or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by inflammation are the peripheral (limb) joints and the spine.

Reactive arthritis – this can cause inflammation of the joints, eyes and urethra (the tube that urine passes through). It develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat infection.

Secondary arthritis – a type of arthritis that can develop after a joint injury and sometimes occurs many years afterwards.

Polymyalgia rheumatica – a condition that affects people over 50 years of age, where the immune system causes muscle pain, stiffness and joint inflammation.

These changes, in addition to the primary symptoms, can have a huge impact on quality of life.

Disability

Arthritis is the most common cause of disability in the USA. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis can be very difficult for individuals to be physically active and some become home bound.

It is estimated that the total cost of arthritis cases is close to $100 billion of which almost 50% is from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers.

Decreased mobility, in combination with the above symptoms, can make it difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease. People with arthritis are also at increased risk of depression, which may be a response to numerous factors, including fear of worsening symptoms.

Diagnosis

Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.

Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, and tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity. Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.

Medications

There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.

Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Opioids and NSAIDs are less well tolerated.

Rheumatoid arthritis (RA) is autoimmune so in addition to using pain medications and anti-inflammatory drugs, this type uses another category of drug called disease modifying anti-rheumatic drugs (DMARDS). An example of this type of drug is Methotrexate. These types of drugs act on the immune system and slow down the progression of RA.

Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, and tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.