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 bodyās 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:Ā 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 personās 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:Ā This is an auto-immune disease in which the bodyās immune system (the bodyās 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 personās 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:Ā 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:Ā 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:Ā 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:Ā 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:Ā 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.
Do you have more questions?Ā
What is arthritis?
Arthritis literally means inflammation inside the joint. It is a term usually used for degenerative or aging process of the joint which lead to loss of the cartilage lining of the joints. There are other rare forms of arthritis, which are associated with certain systemic diseases like rheumatoid arthritis, SLE or lupus, psoriasis, and many other inflammatory arthritis. The infective infection of the joint is also known as infective arthritis or septic arthritis. Occasionally age-related arthritis can be accelerated due to trauma or accident.
What are the symptoms of arthritis?
Arthritis usually presents with pain, swelling, grinding sensation on movement, hearing of crepitus, diminishing of range of movement, and stiffness. It may be associated with fluid in the joint also. This my lead to worsening quality of life. Use of stairs getting in and out of chair or bed are especially difficult. Pain and swelling are also worsened with prolonged activity like walking or standing.
What is the most common type of arthritis?
The most common type of arthritis is the one caused by aging. It is called degenerative arthritis or Primary Osteoarthritis. It causes slow and gradual roughening or damage to the cartilage. Other forms of arthritis are called secondary arthritis and are related to trauma, systemic diseases like rheumatoid arthritis, SLE or lupus, psoriasis, and other forms of inflammatory arthritis etc. Secondary arthritis causes rapid deterioration of cartilage and progressively worsening symptoms.
What are the risk factors for arthritis?
The risk factor for arthritis includes gender, weight, age, family history, systemic diseases like SLE or lupus, rheumatoid arthritis, psoriasis, and other autoimmune disorders, smoking, comorbidities like diabetes mellitus.
How is arthritis diagnosed?
The diagnosis of arthritis is made clinically by history and examination of the patient. Radiological examination in the form of x-rays can be helpful, especially in advanced cases of arthritis. In certain cases of arthritis with suspicion to other diseases, further investigations can be done to rule out other form of arthritis. Occasionally, advanced radiological imaging like MRI may be needed to confirm the diagnosis and rule out other pathologies.
Why do my joints make popping and clicking sounds? Does that mean I have arthritis?
Popping and cracking sounds from the joint may be a normal phenomenon, especially in younger age group. If they are associated with pain, with or without swelling, then there may be a pathological reason inside the joint that cause these sounds. They can be caused by soft tissue inside the joint called plica, rubbing of the cartilages against each other called the meniscus or due to a meniscal tear. Imaging techniques like x-rays and MRI can help rule out such diseases.
Does the weather have impact on joint pain severity?
Multiple studies have been done in the past but have not conclude that weather does affect joint pain severity. Though, recently a study did find that the change in pressure levels do affect the joint pain, but a change in pressure effects are not easily measurable to common population. It is a change in weather, that is associated with the pressure change that causes difference in joint pain severity.
Why does my knee hurts when it rains?
Though it feels that the joint pains are usually related to change in whether, especially rain. But recent findings have found that they are more due to change in pressure, rather than humidity or temperature. But, it is difficult to measure pressure and the change in pressure is more related to the rain.
How does weight affect arthritis?
Increased weight means increased stresses on the joints, especially the lower extremities: the hip, the knee and the ankle joint. Loss of few pounds of weight can have tremendous effects in reducing the symptoms of arthritis and improving the quality of life.
How much weight should I lose to reduce arthritis pain?
A desirable body mass index (BMI) of a patient should be around 25. Any weight over 25-30 BMI should be lost to help good relief in arthritis symptoms. Even a loss of 10-20 pounds can cause improvement in symptoms of arthritis.
What are the best ways to get in and out of the car?
We should try to minimize the twisting forces on the knee joint while getting in and outside the car. Person can first sit on the seat and then get their legs inside by turning the whole torso. The same should be getting done when getting out of the car.
When should a person with arthritis ask for help?
If the patient has pain in their joint which persist for a few days at a time or is recurrent, it may be arthritis. They should initially treat it with short period of rest and anti-inflammatory medications, ice or heat, whichever is preferable, and a possible use of compression sleeves. If the pain is not improved or associated with other symptoms like swelling, locking or giving way then they should seek medical attention to know more about it. If they are associated with fever, or redness than urgent medical attention is warranted.
How can I make my knee pain go away?
A knee pain can be usually treated with over the counter anti-inflammatory medication, usually. If the pain is not improved with these medications, rest, elevation, and use of ice or heat, then they should seek medical attention to rule out other pathologies. Sometimes, a cortisone injection in the knee may help decreasing the pain. The patient may also be sent for physical therapy to strengthen the muscles. If all the conservative treatment are not able to provide pain relief, then advanced imaging may be needed to find out the cause of pain that can be treated with minimal intervention.
Is walking good for arthritis in the knee?
Walking is a good exercise for arthritis of the knee, as it helps strengthen the muscles, as well improve the overall health. Walking should be practiced with good cushioned shoes and on a firm surface. Fast walking if tolerable is also a good exercise.
What is the best drug for arthritis?
There are multiple drugs used to treat arthritis including anti-inflammatory medications which may range from over the counter medications like Advil or Aleve to prescription medications, cortisone shots, oral corticosteroids, some disease modifying drugs especially in the case of inflammatory and autoimmune arthritis. There are medications in the market like glucosamine and chondroitin sulfate, which are found to be equivocal in the treatment of arthritis and can be tried as over the counter drugs. Patient can also get gel (viscosupplementation) injections in the knee joint to help relief the pain.
What are the early signs of arthritis?
Early signs of arthritis include pain, feel of grinding sensation, crepitus, and stiffness, especially at the extremes of range of motion. Patient may have recurrent episodes of acute pain which may remit to complete normalcy. Overtime these episodes start occurring more frequently and in worsening severity. Use of stairs getting in and out of chair or bed are especially difficult during an acute episode. Pain and swelling are also worsened with prolonged activity like walking or standing.
What is the best exercise, especially for bad knees?
Patients with bad knees are advised to strengthen their muscles of thigh especially the quadriceps and the hamstrings but avoid high impact exercises as there is risk it poses to the knee. The good exercises include walking, biking, ellipticals, rowing, swimming, and various forms of stretching and strengthening exercises like yoga and pilates.
How do you get rid of water in the knee?
Water in the knee is formed as a reaction to the inflammation inside the knee. It can be resolved by reducing the inflammation using anti-inflammatory medications or disease modifying medications, especially in the case of inflammatory or autoimmune arthritis. The water can also be removed by putting a needle into the knee joint under sterile conditions and aspirating it.
Usually cortisone shot is given at the same time, which may help in decreasing the inflammation and preventing the recurrence of formation of more fluid inside the knee joint. Compression of the knee by use of sleeves can also be helpful in reducing the fluid in the knee as well as preventing the reformation of the extra joint fluid. Ice and elevation also help in decreasing the swelling in and around the knee.
How do you prevent arthritis in your knee?
An arthritis in the knee can be prevented by keeping fit, weight control, avoiding smoking, and keeping yourself active. Regular exercises of the body, in the form of stretching and strengthening have been found to prevent as well as delay worsening of arthritis in the knee joint.
Can arthritis ever go away?
Arthritis causing damage to the articular cartilage, is irreversible process because the body cannot regenerate the original cartilage. The cartilage that is formed in the repair process is not of the same quality as the native cartilage. But taking steps for prevention or treatment of the arthritis help to decrease the speed of breakdown of the cartilage.
Why do my knee burn?
Injury to the cartilage or the meniscus can ocassionally present with burning sensation around the knee. It can occasionally be a symptom of nerve pain, and not from the arthritis. The patient may be having spine problem or systemic diseases like diabetes, which may cause nerve pain.
What is better for the knee pain, heat or cold?
Though acute onset knee pain should be treated with cold or ice, and longstanding pain usually treated with heat, it is more of patientās preference as to what makes them feel better and should be used accordingly.
Can you damage your knees by kneeling?
Kneeling causes an extreme of range of motion of the knee and causes increased joint pressures, especially on the knee cap. Excessive kneeling can be damaging to the cartilage as well as irritating to the knee joint and cause damage and causing pain and swelling of the knee joint.
Is it bad to sit cross-legged?
Sitting in cross-legged position for long period may cause stretching of ligaments and muscles, especially on the outer side and compression on the inner side of the knee along with twisting forces which may be detrimental to the knee joint.
What exercise does relieve arthritis symptoms?
Exercises of the muscles around the knee and the hip joint, especially strengthening and stretching exercises of quadriceps and hamstrings help in relieving of knee symptoms like pain and swelling as well as increases circulation.
Which muscles are found in the front of the thigh?
Quadriceps which is the largest muscle found in the body is found in the front of the thigh. It is made of four parts, Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius.
How is arthritis treated?
Arthritis usually caused by aging or degeneration of the joint cartilage is initially treated with anti-inflammatory medications along with physical therapy to help strengthen the muscles as well as maintain the mobility of the joint. Other supplements for arthritis like over the counter glucosamine and chondroitin sulfate can also be tried at the same time.
If the patient is not better with over-the-counter anti-inflammatory medications, then the physician may use cortisone injection to give pain relief as well as decrease the swelling. There are certain minimal invasive surgical procedures that can be done in cases the arthritis to treat and prevent complications of arthritis. If the arthritis is advanced and is bone-on-bone, then joint replacement may be the only treatment for arthritis.
Is exercise good for people who have arthritis?
Exercise is good for everyone, especially those with arthritis, because it keeps muscles strong as well as maintain the mobility of the joint. It also helps controlling the weight as well as controlling systemic diseases like diabetes and hypertension, which are all contributory to the comorbidity of arthritis.
What should I do if I have pain when I exercise?
If the exercise causes unbearable pain, then that specific exercise should not be done, but if the exercise is followed by a soreness, that may be due to the use and strengthening of the muscle. The soreness can be relieved with use of ice and elevation and occasional anti-inflammatory medications. This soreness usually goes off on regular exercises as the muscles get acclimatized to the strengthening process.
How does being overweight affect arthritis?
Being overweight means increased stresses to the bones and the joints and therefore accelerated degeneration of the cartilage. At the same time, being overweight also induces the risk of having systemic diseases like diabetes, which have detrimental effects on arthritis also. Loss of weight, maybe even 10 to 20 pounds, can have significant effect in decreasing the pain from hip/knee arthritis.
How does it feel like to have arthritis in the hip?
Hip arthritis usually presents with pain in the hip along with stiffness and restriction of range of motion, especially deep flexions, like doing squatting or doing childās pose in yoga. Patients usually have stiffness in the morning. Some patients in advanced cases may start to limp or waddle.
What are the symptoms of bursitis in the hip?
Bursitis of the hip usually involves the greater trochanteric bursa or the trochanteric bursa in which the pain is on the outer side of the hip. Patient is not able to lie on that side of the hip and thereās pain with movement. The patient can also feel pain on pressing on the outer side of the hip.
Where is the hip bursitis pain located?
Hip bursitis pain is located on the outer side of the hip. This is in comparison to the pain of hip arthritis, which is present along the front mostly on the front or on the back of the hip.
Where is the pain for hip arthritis?
Pain for hip arthritis is usually present along the front of the hip or uncommonly along the back of the hip. It can rarely be present on the outer aspect of the hip.
Is walking good for arthritis of the hip?
Walking is a good exercise for patients with arthritis of the hip as it helps maintain the range of motion as well as maintain the muscles of the hip and the knee. It also helps control weight as well as control systemic disease like diabetes and hypertension, which can be contributory to the pathology of arthritis of the hip.
How do they test for hip bursitis?
The physicians usually do a physical examination with a special test to find out if the patient has hip arthritis or bursitis. Then they also do x-rays of the hip to rule out hip arthritis. In rare cases, an MRI may be needed to confirm the diagnosis of hip arthritis or bursitis.
What medicine is good for hip pain?
If the patient has hip pain, initially they should try over-the-counter medications like Tylenol, Aleve and Advil. If the patient is not improved with the over-the-counter medications, then they should see a physician for a proper diagnosis and management of hip pain. They may need to use prescription medications as well as cortisone injection or oral cortisone for pain relief.
Can arthritis of the hip cause low back pain?
Arthritis of hip can be an uncommon cause of low back pain, especially on the same side of the back. Vice versa, low back arthritis can also be a cause of hip pain, and therefore a proper examination along with radiological findings of the patient is helpful to reveal the exact cause of the pain.
Why does my knee hurt with hip arthritis?
The nerve supply to the hip and knee are similar in some aspect, and therefore patients with hip arthritis can occasionally have pain referred to the knee joint and vice versa.
Is heat good for hip pain?
Ice is usually used for acute onset pain, especially associated with injury. In most of the other cases, heat is a good modality for pain relief. Occasionally, patients may have preference towards heat or ice, and they should use the modality which helps them best.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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