Arthritis

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body’s natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

The cartilage lining of the joint that acts as a padding that absorbs stress and along with the joint fluid allows smooth movement with the least friction. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

There are over 100 different types of arthritis. The most common are:

Osteoarthritis: Osteoarthritis is also called as degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Extra bone tends to form on the sides of the joints to stabilize the joint as a protective mechanism of the body and can be seen as a bulge stick out at the end of a joint on examination or x rays. This is called a bone spur.

Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees, and hips but can affect almost any joint in the body.

Occasionally patients with osteoarthritis may have sudden deterioration of function along with pain and swelling. This is usually due to tear of the meniscus or the cartilage with resultant flap formation contributing the to sudden onset pain. In patients with mild/moderate arthritis, taking care of the secondary pathology may help improve function, alleviate pain as well as slow down the process of arthritis.

Rheumatoid Arthritis: This is an auto-immune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint. For example, the joints in a person’s finger can become deformed, causing the finger to bend or curve.

Rheumatoid Arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both the hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Post-traumatic arthritis: Arthritis developing following an injury to bones near or involving the joint surface is called as post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain, or ligament tears. It can also be caused due to overuse activities or multiple microtrauma like with sports or occupational activity.

Psoriatic arthritis: This form of Arthritis occurs in some patients with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.

Infective or Septic Arthritis: This form of arthritis is rare and is caused due to infection of the joint due to microorganism like bacteria or rarely fungus or tuberculosis among others. It is usually associated with swelling, redness and fever. These patients may need urgent treatment which may include drainage and shall need prolonged antibiotic treatment.

Causes of arthritis

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Rheumatoid arthritis is often caused when the genes responsible for the disease is triggered by infection or any environmental factors. With this trigger body produce antibodies, the defense mechanism of body, against the joint and may cause rheumatoid arthritis.

Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. It is considered that your body secretes certain hormones following injury which may cause death of the cartilage cells.

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.

Symptoms of arthritis

There are more than 150 different forms of arthritis. Symptoms vary according to the form of Arthritis. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

Diagnosis

Doctors diagnose arthritis with a medical history, physical exam and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis as well as secondary pathology what may be contributory to the disfunction and pain.

Treatment Options

There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results.

Initial treatment for arthritis is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms a cane or braces may be helpful. For more severe symptoms, an injection of cortisone or viscosupplement into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted, offer no relief, and has become disabling, the surgery may be recommended. Surgery is usually considered if nonsurgical treatment fails to give relief. There are different surgical procedures that can be used and may include:

Arthroscopy: Arthroscopic surgery for arthritis especially that of knee, has not shown long term benefits but it is a useful tool for patients who have had sudden deterioration in their pain and function which is due to secondary process like meniscus tear or a cartilage flap overlying a stable low/moderate grade arthritis. These patients are usually not candidate for joint replacement surgery due to milder form of arthritis. Arthroscopic surgery in such patients not only can help them alleviate pain and regain function but also can prevent accelerated deterioration of arthritis by taking care of the secondary pathology.

Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis (like Rheumatoid Arthritis) where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.

Arthroplasty: In this procedure, your surgeon removes the affected joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis. The goal of the surgery is to relieve pain and restore the normal functioning of the joint. Total joint replacement can be performed through an open or minimally invasive approach.

Arthrodesis: A fusion, also called an arthrodesis involves removal of the joints and fusing the bones of the joint together using metal wires or screws. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and when heavy manual use is expected.

Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.