Pain inflammation and stiffness in one or more joints.
The term arthritis covers a group of inflammatory and degenerative conditions that cause stiffness, swelling, and pain in the joints. Arthritis may also be linked to disorders such as psoriasis and Crohn’s disease.
What are the types
There are several different types of arthritis, each having different characteristics.
The most common form is osteoarthritis, which most often involves the knee, hips, and hands and usually affects middle aged women and older people. Cervical spondylitis is a form of osteoarthritis that affects the joints in the neck.
In a joint affected by osteoarthritis, the protective cartilage found at the ends of the bones is worn away. As the condition develops, the bone around the affected joint thickens, and bony growths called steophytes form. If the synovial tissue that lines the joint capsule becomes inflamed, the fluid may accumulate within the joint. These changes cause pain, swelling, and stiffness of the joints, reducing their mobility.
Osteoarthritis is most common in weight-bearing joints, such as the knees and hips. However, the hands, feet, and shoulders may also be affected, as may the bones of the neck. Nearly everyone has developed a degree of osteoarthritis by the age of 70, but only some people have symptoms. Women are more commonly affected by osteoarthritis than men, and their symptoms are more severe. This form of arthritis sometimes develops in younger people, particularly in those who have had joint injuries.
What are the causes?
There is often no obvious cause for the onset of osteoarthritis, but there are known factors that may increase the risk of developing the disorder. Wear occurs most often in joints that have been damaged by repeated strenuous activity or by repeated minor injuries. For example, the pressure that ballet dancers exert on their feet makes them susceptible to developing osteoarthritis of the ankle. Osteoarthritis is also common in former athletes.
Damage to a joint early in life may lead to osteoarthritis later on. Excessive weight can also increase a person’s risk of developing the condition because of the extra stress it places on the joints. Another risk factor is damage to cartilage caused by another joint disorder such as septic arthritis. Finally, if a close member of your family has osteoarthritis; you are more likely to develop the condition yourself.
What are the symptoms?
Initially, the symptoms are mild, but they may slowly get worse. Often only one or two joints are badly affected, but sometimes osteoarthritis is more widespread. The symptoms include:
- Pain and tenderness that worsen with activity and are relieved with rest
- Swelling around the joint
- Stiffness lasting a short time after a period of inactivity restricted joint movement
- Enlarged, distorted finger joints if the hands are affected
- Crackling noise on moving the affected joint
Referred pain, which is felt in areas remote from the site of damage but on the same nerve pathway as the affected joint, may develop. For example, an arthritic hip may cause referred pain in the knee. The pain may become worse towards the end of the day.
If movement is severely restricted, an affected person may be confined to the home. Lack of mobility may lead to weakness and wasting of muscles and sometimes to weight gain.
What is the medical treatment?
Your doctor may suspect that you have osteoarthritis from your symptoms, a history of joint problems, and a physical examination. It is often possible to confirm a diagnosis of osteoarthritis while at the same time ruling out other types of arthritis, by means of blood tests and X-rays.
Osteoarthritis cannot be cured, but with treatment most symptoms can be relieved. Your doctor may recommend that you take paracetamol or a nonsteroidal anti-inflammatory drug. If you experience a severe flare-up of pain and inflammation in a single joint, your doctor may inject a corticosteroid drug directly into the affected joint to reduce swelling and relieve pain.
To improve muscle function around joints affected by osteoarthritis, your doctor may refer you for physiotherapy. If osteoarthritis is very severe, surgery may be necessary to repair or replace an affected joint.
Rheumatoid arthritis is a damaging condition that causes inflammation in the joints and in other body tissues, such as the membranous heart coverings, lungs, and eyes. The disorder has different effects in children. In rheumatoid arthritis, the affected joints become stiff and swollen as a result of inflammation of the synovial membrane, which encloses each joint. If the inflammation persists, it may damage both ends of the bone and the cartilage that covers them. Tendons and ligaments, which support the joints, may also become worn and slack, and deformity of the joints occurs.
In most cases, rheumatoid arthritis affects several joints. The disorder usually appears first in the small joints of the hands and feet but may develop in any joint. Rheumatoid arthritis is a long-term disease and usually recurs in episodes lasting for several weeks or months. Some people remain free of symptoms between episodes. The disorder affects about 1 in 100 people and is three times more common in women than in men.
Rheumatoid arthritis is an autoimmune disorder in which the body produces antibodies that attack the synovial membrane and, in some cases, other body tissues. A genetic factor may be involved since the condition is common in some families.
What are the symptoms?
Rheumatoid arthritis usually develops slowly, although sometimes the onset of the inflammation can be abrupt. General symptoms associated with the condition include tiredness, poor appetite, and loss of weight. Specific symptoms may include:
- Painful, swollen joints that are stiff on waking in the morning
- Painless, small bumps (nodules) on areas of pressure, such as elbows
Since the condition can be both painful and debilitating, depression is common in people with rheumatoid arthritis. In women, the symptoms of rheumatoid arthritis may improve during pregnancy but may then flare up again after the baby is born.
What are the complications?
Over time thinning of the bones and a greater susceptibility to fractures may develop in people with rheumatoid arthritis. This results partly from the disease itself and partly from reduced mobility.
The general symptoms of rheumatoid arthritis are partly due to anaemia, caused by a failure of the bone marrow to manufacture enough new red blood cells. Bursitis may develop, in which one or more of the fluid-filled sacs around a joint become inflamed. Swelling that compresses the median nerve in the wrist may lead to a tingling feeling and pain in the fingers. Spasm or narrowing of the walls of the arteries that supply the fingers and toes results in Reynaud’s phenomenon, in which the digits become pale and painful on exposure to cold.
A less common complication is when the spleen and the lymph nodes enlarge. Inflammation may affect the membranous sac that surrounds the heart and also the lungs. In some cases, there may be inflammation of the white of the eye, or the eyes may become very dry
How is it diagnosed?
The diagnosis is usually based on your medical history and a physical examination. Your doctor may arrange for blood tests to check for the presence of an antibody known as rheumatoid factor, which is usually associated with rheumatoid arthritis. You may also have blood tests to measure the severity of the inflammation. X-rays of the affected joints may be taken to assess the degree of damage
What is the medical treatment?
There is no cure for rheumatoid arthritis. The aim of treatment is to control symptoms and reduce further joint damage by slowing the progression of the disease. Various types of drug are available, and your doctor’s recommendation will depend on the severity and progression of the disease, your age, and your general health.
If your symptoms are usually mild, your doctor may simply prescribe a nonsteroidal anti-inflammatory drug. However, if your symptoms are severe, he or she may prescribe drugs to slow the progression of the disease, which should limit permanent joint damage. These drugs may have to be taken for several months before the full benefits can be felt. An antirheumatic such as sulfasalazine or hydroxychloroquine may be given first. If your symptoms persist, the doctor may prescribe a drug such as gold, penicillamine, methotrexate, or cyclosporine. Since these drugs can sometimes cause serious side effects, which include kidney damage and blood disorders; the doctor will closely monitor your condition.
Your doctor may recommend that you use a splint or brace to support a particularly painful joint and to slow down the development of deformities. Taking gentle, regular exercise may help to keep your joints flexible and prevent supporting muscles from weakening. Physiotherapy may be given to improve your joint mobility and help to increase muscle strength. Hydrotherapy and heat or ice treatments may provide pain relief.
An intensely painful joint may be eased if your doctor injects with a corticosteroid drug. If a joint is severely damaged, your doctor may suggest that you have surgery to replace the damaged joint with an artificial one.