Arthritis

What is Arthritis?

There are over 100 disorders that typically affect joints, tendons, ligaments, bones, and muscles and are termed arthritis and rheumatic diseases. Some of these may also involve internal organs.

Forms of arthritis

Examples of arthritis include:

  • Rheumatoid arthritis
  • Osteoarthritis
  • Juvenile idiopathic arthritis
  • Fibromyalgia
  • Gout
  • Systemic lupus erythematosus (lupus)
  • Scleroderma
  • Spondyloarthropathies or ankylosing Spondylosis
  • Infectious arthritis
  • Polymyalgia rheumatic
  • Polymyositis
  • Psoriasis and Psoriatic arthritis
  • Inflammatory arthritis
  • Tendinitis
  • Bursitis

Causes of arthritis

Rheumatic diseases are myriad in their manifestations and causes. While some of these are genetic and a person may be predisposed to getting them or the arthritis may develop a trigger that causes arthritis. This could be an injury or an infection. A cold, flu, or other type of virus could trigger a rheumatic disease in some people. Osteoarthritis may be caused by wear and tear on the joints or by an injury to a joint.

Age and sex play a role in risk of getting arthritis. Some of the conditions are more common among elderly while some including osteoarthritis are more common in women after menopause.

Lupus, rheumatoid arthritis, scleroderma, and fibromyalgia are more common among women. Rheumatoid arthritis occurs two to three times more often in women than in men.

Gout is more common in men than in women. After menopause, the incidence of gout in women begins to rise. This could be due to the hormonal differences or due to genetic differences.

In addition, some races and ethnicities are more at risk. Lupus for example is more common in African Americans and Hispanics than in Caucasians.

Diagnosis of arthritis

Rheumatic diseases are diagnosed by regular physicians, orthopedicians as well as specialists in rheumatic diseases or a rheumatologist. Common signs and symptoms include:

  • Pain in one or more joints
  • Swelling in one or more joints. There may be warmth and redness in and around the joint.
  • Stiffness around the joints that lasts for at least 1 hour in the early morning after waking up. This is termed morning stiffness.
  • Constant or recurring pain
  • Difficulty using or moving a joint

Tests for arthritis

Tests commonly include:

  • routine blood tests
  • medical history
  • physical exam
  • X rays
  • imaging studies like CT scans and MRI of joints

Possible treatment

The common treatments that are applicable for most arthritis include rest, relaxation, physical therapy, monitored exercises and joint mobilization, healthy diet, weight loss.

Other therapies include water therapy, health and cold therapy, care for joints, devices such as splints, braces, crutches etc.

Patients may undergo surgery to restore function or to relieve pain and sometimes to introduce prosthetic joint replacements for better mobility. A plan of therapy is developed in conjunction with the patient and a multidisciplinary team.

Drugs are used in many forms of arthritis. The type of drug depends on the condition and on the individual patient. Most of these drugs do not provide a cure but rather limit the symptoms. One of the exceptions is arthritis that is caused by an infection, in which antibiotics can cure the condition.

Commonly used drugs in arthritis include pain relievers that may be applied locally over the skin or taken as pills.  In rheumatoid arthritis, Disease-modifying antirheumatic drugs (DMARDs) and Biologic response modifiers may be tried. Corticosteroids are also used in many rheumatic conditions because they reduce swelling and block or slow down the immune system.

Other drugs used include Hyaluronic acid substitutes, nutritional supplements, enzyme inhibitors like Allopurinol (used in gout) etc.

Types of Arthritis

There are over 100 different types of diseases that affect the joints and are loosely termed arthritis. Some signs of arthritis include pain, aching, stiffness, and swelling.

Typically arthritis is characterized by inflammation and loss of function of one or more joints of the body. Some of these are known as autoimmune diseases because they occur when the immune system, which normally protects the body from infection and disease, attacks the body’s own tissues.

Common types of arthritis

Some of the common types of arthritis include:

Osteoarthritis

This is the most common type of arthritis. It primarily affects cartilage, which is the tissue that cushions the ends of bones within the joint. Once affected the cartilage begins to erode away and may entirely wear off. This leads to joint pain and stiffness.

Rheumatoid arthritis

This is an inflammatory disease of the lining of the joint. There is pain, stiffness, swelling and eventually joint damage, and loss of function of the joints. It may affect hands and feet of both sides of the body.

Juvenile rheumatoid arthritis

This is the most common form of arthritis in childhood. It leads to pain, stiffness, swelling, and loss of function of the joints. In addition, there may be rashes or fevers, and may affect various parts of the body.

Fibromyalgia

This is a pain syndrome that affects the body widely. Pain, stiffness, and localized tender points are found on various muscles and tendons, particularly those of the neck, spine, shoulders, and hips. In addition, there are tiredness and sleep difficulties.

Systemic lupus erythematosus or SLE

This is an autoimmune disease. There is inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain

Spondyloarthropathies

These affect the spine commonly. One of the common forms is ankylosing spondylitis that affects the spine, neck and sometimes the hips, shoulders, and knees.

Other types of arthritis

Other types of arthritis include (1) :

  • Achilles tendinitis
  • Achondroplasia
  • Acromegalic arthropathy
  • Adhesive capsulitis
  • Adult onset Still's disease
  • Ankylosing spondylitis
  • Anserine bursitis
  • Avascular necrosis
  • Behcet's syndrome
  • Bicipital tendinitis
  • Blount's disease
  • Brucellar spondylitis
  • Bursitis
  • Calcaneal bursitis
  • Calcium pyrophosphate dihydrate (CPPD) Crystal deposition disease
  • Caplan's syndrome
  • Carpal tunnel syndrome
  • Chondrocalcinosis
  • Chondromalacia patellae
  • Chronic synovitis
  • Chronic recurrent multifocal osteomyelitis
  • Churg-Strauss syndrome
  • Cogan's syndrome
  • Corticosteroid-induced osteoporosis
  • Costosternal syndrome
  • CREST syndrome
  • Cryoglobulinemia
  • Degenerative joint disease
  • Dermatomyositis
  • Diabetic finger sclerosis
  • Diffuse idiopathic skeletal hyperostosis (DISH)
  • Discitis
  • Discoid lupus erythematosus
  • Drug-induced lupus
  • Duchenne's muscular dystrophy
  • Dupuytren's contracture
  • Ehlers-Danlos syndrome
  • Enteropathic arthritis
  • Epicondylitis
  • Erosive inflammatory osteoarthritis
  • Exercise-induced compartment syndrome
  • Fabry's disease
  • Familial Mediterranean fever
  • Farber's lipogranulomatosis
  • Felty's syndrome
  • Fibromyalgia
  • Fifth's disease
  • Flat feet
  • Foreign body synovitis
  • Freiberg's disease
  • Fungal arthritis
  • Gaucher's disease
  • Giant cell arteritis
  • Gonococcal arthritis
  • Goodpasture's syndrome
  • Gout
  • Granulomatous arteritis
  • Hemarthrosis
  • Hemochromatosis
  • Henoch-Schonlein purpura
  • Hepatitis B surface antigen disease
  • Hip dysplasia
  • Hurler syndrome
  • Hypermobility syndrome
  • Hypersensitivity vasculitis
  • Hypertrophic osteoarthropathy
  • Immune complex disease
  • Impingement syndrome
  • Jaccoud's arthropathy
  • Juvenile ankylosing spondylitis
  • Juvenile dermatomyositis
  • Juvenile rheumatoid arthritis
  • Kawasaki disease
  • Kienbock's disease
  • Legg-Calve-Perthes disease
  • Lesch-Nyhan syndrome
  • Linear scleroderma
  • Lipoid dermatoarthritis
  • Lofgren's syndrome
  • Lyme disease
  • Malignant synovioma
  • Marfan's syndrome
  • Medial plica syndrome
  • Metastatic carcinomatous arthritis
  • Mixed connective tissue disease (MCTD)
  • Mixed cryoglobulinemia
  • Mucopolysaccharidosis
  • Multicentric reticulohistiocytosis
  • Multiple epiphyseal dysplasia
  • Mycoplasmal arthritis
  • Myofascial pain syndrome
  • Neonatal lupus
  • Neuropathic arthropathy
  • Nodular panniculitis
  • Ochronosis
  • Olecranon bursitis
  • Osgood-Schlatter's disease
  • Osteoarthritis
  • Osteochondromatosis
  • Osteogenesis imperfect
  • Osteomalacia
  • Osteomyelitis
  • Osteonecrosis
  • Osteoporosis
  • Overlap syndrome
  • Pachydermoperiostosis Paget's disease of bone
  • Palindromic rheumatism
  • Patellofemoral pain syndrome
  • Pellegrini-Stieda syndrome
  • Pigmented villonodular synovitis
  • Piriformis syndrome
  • Plantar fasciitis
  • Polyarteritis nodosa
  • Polymyalgia rheumatic
  • Polymyositis
  • Popliteal cysts
  • Posterior tibial tendinitis
  • Pott's disease
  • Prepatellar bursitis
  • Prosthetic joint infection
  • Pseudoxanthoma elasticum
  • Psoriatic arthritis
  • Raynaud's phenomenon
  • Reactive arthritis/Reiter's syndrome
  • Reflex sympathetic dystrophy syndrome
  • Relapsing polychondritis
  • Retrocalcaneal bursitis
  • Rheumatic fever
  • Rheumatoid arthritis
  • Rheumatoid vasculitis
  • Rotator cuff tendinitis
  • Sacroiliitis
  • Salmonella osteomyelitis
  • Sarcoidosis
  • Saturnine gout
  • Scheuermann's osteochondritis
  • Scleroderma
  • Septic arthritis
  • Seronegative arthritis
  • Shigella arthritis
  • Shoulder-hand syndrome
  • Sickle cell arthropathy
  • Sjogren's syndrome
  • Slipped capital femoral epiphysis
  • Spinal stenosis
  • Spondylolysis
  • Staphylococcus arthritis
  • Stickler syndrome
  • Subacute cutaneous lupus
  • Sweet's syndrome
  • Sydenham's chorea
  • Syphilitic arthritis
  • Systemic lupus erythematosus (SLE)
  • Takayasu's arteritis
  • Tarsal tunnel syndrome
  • Tennis elbow
  • Tietse's syndrome
  • Transient osteoporosis
  • Traumatic arthritis
  • Trochanteric bursitis
  • Tuberculosis arthritis
  • Arthritis of Ulcerative colitis
  • Undifferentiated connective tissue syndrome (UCTS)
  • Urticarial vasculitis
  • Viral arthritis
  • Wegener's granulomatosis
  • Whipple's disease
  • Wilson's disease
  • Yersinial arthritis

Arthritis Treatment

Treatment and management of arthritis depends on the type and severity of the condition.

Aims of arthritis treatment

Goals of treatment of arthritis include:

  • Every individual should be treated for his or her particular type and severity of arthritis
  • There is not best treatment for any type of arthritis. Every individual with a particular type of arthritis may respond differently to different treatments and more than one therapy may be tried before symptom relief is achieved
  • Treatment should be guided by regular follow up and feedback on treatment from the patient. This is considered as valuable in diagnosis and management as information from X rays and laboratory test results.
  • The aim of therapy should be to improve joint function and relieve pain
  • Arthritis cure is not always possible and aim to be to provide maximum symptom relief so as to improve the quality of life.

Common treatments for arthritis

Common treatments that are applicable for most forms of arthritis include:

  • rest, relaxation
  • physical therapy
  • monitored exercises
  • joint mobilization
  • healthy diet
  • weight loss
  • water therapy
  • health and cold fomentation therapy
  • joint care advice
  • devices such as splints, braces, crutches, wheelchairs etc. for improved mobility
  • physical and occupational therapy can help impairments and activity limitations

Patients may undergo surgery to restore function or to relieve pain and sometimes to introduce prosthetic joint replacements for better mobility. The therapy plan is developed in conjunction with the patient and a multidisciplinary team.

Arthritis drugs

Drugs are used in many forms of arthritis. The type of drug depends on the condition and on the individual patient. Most of these drugs do not provide a cure but rather limit the symptoms. One of the exceptions is arthritis that is caused by an infection, in which antibiotics can cure the condition.

Medications that may be used in various types of arthritis include:

  • Analgesics or pain relievers – These are drugs like Acetaminophen (Paracetamol), Ibuprofen, Diclofenac etc. They belong to the class Non steroidal anti-inflammatory drugs or NSAIDs. Pain relievers may be applied locally over the joint as creams, ointments and sprays or may be taken as pills
  • Antibiotics – these are useful in infection joint arthritis
  • Corticosteroids are also used in many rheumatic and auto-iimmune conditions because they reduce swelling and block or slow down the immune system.
  • In rheumatoid arthritis Disease-modifying antirheumatic drugs (DMARDs) and Biologic response modifiers may be tried. These often serve to stop the progress of the disease
  • Hyaluronic acid substitutes and nutritional supplements like Calcium and Vitamin D supplements are used to prevent bone loss
  • Allopurinol is an enzyme inhibitor that is used in gout.

 

Arthritis History

Arthritis has a severe impact on people of all ages and has been known to mankind since ancient times. Little was known of the diseases, except its symptoms and signs. Rheumatoid arthritis for example can be traced back to dinosaurs and prehistoric man.

Arthritis in dinosaurs

The first published research reports are a few centuries old. According to a book by Bruce M. Rothschild, “The Complete Dinosaur”, only a small portion of dinosaurs actually suffered anything resembling human arthritis.

On the other hand fossil records show evidence that other forms of arthritis did affect dinosaurs, specifically gout. A detailed examination by Rothschild of the bones of a Tyrannosaurus Rex showed the distinctive holes found in the bones of gout patients.

Early references to arthritis

Reference to arthritis is found in texts at least as far as 4500 BC. A text dated 123 AD first describes symptoms that appear similar to rheumatoid arthritis.

The details were noted among skeletal remains of Native Americans found in Tennessee. Bruce Rothschild showed that Tennessee bones belonged to some of the earliest sufferers of RA, and even today Native Americans tend to acquire the disease more often than people in other ethnic groups.

While examining the bones from the Tennessee site researchers found signs of arthritis with no evidence of tuberculosis. Jim Mobley, much later found spikes of rheumatoid arthritis along with tuberculosis. He suggested that the hypervigilant immune system is protective against tuberculosis at the cost of an increased risk of autoimmune disease.

Coining of the term “arthritis”

Before the 1600’s the disease was rare. It then spread across the Atlantic during the Age of Exploration. In 1859 the disease acquired its current name. The first recognized description of rheumatoid arthritis was in 1800 by the French physician Dr Augustin Jacob Landré-Beauvais (1772-1840) who was based in the famed Salpêtrière Hospital in Paris. The name "rheumatoid arthritis" itself was coined in 1859 by British rheumatologist Dr Alfred Baring Garrod.

One of the most important publications on arthritis was by William Musgrave called the De Arthritide Symptomatica in 1715. It is the earliest known text describing in detail the symptoms of RA.

Rheumatoid arthritis in 16th century

Rheumatoid arthritis appears to some to have been depicted in 16th century paintings. This was seen mostly in paintings of hands deformed with the disease. The art of Peter Paul Rubens may possibly depict the effects of rheumatoid arthritis.

Well known arthritis patients

Some of the well known rheumatoid arthritis and arthritis patients include Lucille Ball (comedienne), Auguste Renoir (artist), James Coburn (actor) and Camryn Manheim (actress).