Arthritis

Arthritis
Classification and external resources
325px Hands affected by rheumatoid arthritis, an autoimmune form of arthritis
ICD-10	M00.-M25.
ICD-9	710-719
DiseasesDB	15237
MedlinePlus	001243
eMedicine	topic list
MeSH	D001168

Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions involving damage to the joints of the body.

There are over 100 different forms of arthritis. The most common form, 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 in which the body attacks itself. Septic arthritis is caused by joint infection.

The major complaint by individuals who have arthritis is pain. Pain is often a constant and daily feature of the disease. The pain may be localized to the back, neck, hip, knee or feet. The pain from arthritis occurs due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscles strains caused by forceful movements against stiff, painful joints and fatigue. The most important factor in treatment is to understand the disorder and find ways to overcome the obstacles which prevent physical exercise.

Classification

Primary forms of arthritis:

• Osteoarthritis
• Rheumatoid arthritis
• Septic arthritis
• Gout and pseudo-gout
• Juvenile idiopathic arthritis
• Still's disease
• Ankylosing spondylitis

Secondary to other diseases:

• Ehlers-Danlos Syndrome
• Sarcoidosis
• Henoch-Schönlein purpura
• Psoriatic arthritis
• Reactive arthritis
• Haemochromatosis
• Hepatitis
• Wegener's granulomatosis (and many other vasculitis syndromes)
• Lyme disease
• Familial Mediterranean fever
• Hyperimmunoglobulinemia D with recurrent fever
• TNF receptor associated periodic syndrome
• Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis)

Diseases that can mimic arthritis include:

• Hypertrophic osteoarthropathy (nail clubbing)
• Multiple myeloma
• Osteoporosis
• Fifth disease (parvovirus infection)

Rheumatoid Arthritis

Rheumatoid arthritis is a disorder where, for some unknown reason, the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to 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 affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical 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. No one knows why rheumatoid arthritis occurs and all treatments are focused on easing the symptoms. 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.

Rheumatic fever has now seen resurgence in America primarily because of mass immigration of people from developing countries. The disorder can present with a migratory nature of arthritis with many other features like heart problems, skin rash, gait abnormality and skin nodules.

Osteoarthritis

Unlike rheumatoid arthritis, osteoarthritis can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially one acquired from daily wear and tear of the joint. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night. The pain can be debilitating and prevent one from doing any type of activity. Osteoarthritis typically affects the weight bearing joints like the back, spine and pelvis. Unlike rheumatoid arthritis, osteoarthritis is a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65.

Risk factors for osteoarthritis:

• Prior joint trauma
• Obesity
• Repetitive joint use
• Sedentary lifestyle

Osteoarthritis, like rheumatoid arthritis, cannot be cured but one can prevent the condition from worsening. Weight loss is the key to improving symptoms and preventing progression. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.

Lupus

This is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, emotional lability, lung fibrosis and constant joint pain.

Gout

Gout is caused by deposition of uric acid crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate. This gout is known as pseudogout. In the early stages, the gouty arthritis usually occur in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function.

Other

Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible and permanent joint damage.

Psoriasis is another type of arthritis. With psoriasis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joint in the hands and can lead to permanent disability and loss of hand function

Signs and symptoms

Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.

• Inability to use the hand or walk
• Malaise and a feeling of tiredness
• Fever
• 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, in someone who has limited their physical activity:

• Muscle weakness
• Loss of flexibility
• Decreased aerobic fitness

These changes can also impact on life and social roles, such as community involvement.

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 makes it very difficult for individuals to be physically active and soon become home bound.

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

Arthritis makes it very difficult for the individual to remain physically active. Many individuals who have arthritis also suffer from obesity, high cholesterol or have heart disease. Individuals with arthritis also become depressed and have 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, 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.

Prevention

While neither Rheumatoid arthritis nor osteoarthritis can be completely prevented, one can reduce the risks by becoming physically active, participating in physical therapy, losing weight and eating healthily. All individuals who have pain in the joints should seek early diagnosis because the earlier the treatment is started, the better is the prognosis.

Treatment

Once the diagnosis of arthritis is made, treatments are available for a variety of symptoms. There is no cure for either rheumatoid or osteoarthritis.

Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, medications, and dietary supplements (symptomatic or targeted at the disease process causing the arthritis). Arthroplasty (joint replacement surgery) may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage is slowed.

In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.

Physical Therapy

Individuals with arthritis can definitely benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases . Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focusses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can teach you how to reduce stress on your joint from daily living activities. Occupation therapy can also teach you how to modify your home and work environment so that you do reduce movements that may worsen your arthritis. There are also assist devices available that can help you drive, getting a bath, dressing and also in housekeeping labors.

As well as exercise, physical therapy may include education about modifying activities, and other self-management skills such as using ice or heat, and ultrasound. Physical therapists will routinely educate patients to manage their problems related to arthritis themselves. Other aspects of physical therapy means learning how to maintain good posture, conserving energy by allowing rest before and after activity.

Occupational therapy can help you do everyday activities without worsening pain or causing joint damage. The techniques can help you distribute pressures to minimize stress on any one joint. Ways to accomplish daily living tasks are made easier.

Medications

Physicians usually start with drugs which have the fewest side effects and shift to stronger medications as the disease progresses.

Non-steroidal anti-inflammatory drugs (NSAIDs) are usually the drugs of first choice. These drugs help decrease inflammation and reduce pain. Over the counter medications like Ibuprofen or Aleve do help but most people require stronger prescription painkillers like Celebrex or tramadol. While these drugs are effective, they are also associated with a variety of side effects like abdominal pain, bleeding, ulcers, liver and kidney damage. Non steroidal anti inflammatory drugs should not be used for prolonged periods without proper physician supervision.

Corticosteroids are frequently prescribed for individuals with arthritis. These potent drugs can help reduce inflammation and slow down joint damage. However, corticosteroids have potent side effects which range from ulcer, skin bruising, weight gain, cataracts, bone thinning, diabetes and hypertension. Corticosteroids are usually given for a short time to help reduce acute symptoms.

Disease-modifying antirheumatic drugs (DMARDs) can help slow down progression of rheumatoid arthritis and joint damage. The most common DMARDs include methotrexate (Rheumatrex, Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and minocycline (Dynacin, Minocin). All these drugs have side effects which include liver damage, bone marrow suppression and possibility of opportunistic infections.

Immunosuppressants like cyclosporine and cyclophosphamide suppress potent cells of the body and help decrease the inflammation. These medications do help treat severe arthritis but also make one prone to infections.

Tumor necrosis factor inhibitors have been shown to reduce inflammation, pain, morning stiffness and swelling of joints. Drugs like etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira) can significantly improve quality of life. The most common side effects from these drugs include pain at site of injection, heart failure and increased risk of infection.

Epidemiology

Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. An estimated 46 million individuals in USA have arthritis and the numbers continue to increase each year. Close to one million individuals are admitted to hospitals each year because of their arthritis.

History

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

In 1715 William Musgrave published the second edition of his most important medical work De arthritide symptomatica which concerned arthritis and its effects.

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

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.

See also

• Arthritis Care (charity in the UK)
• Osteoimmunology
• Arthritis Foundation (US not-for-profit)

External links

• Arthritis at the Open Directory Project
• American College of Rheumatology - US professional society of rheumatologists
• Arthritis Foundation - US national not-for-profit organization for arthritis

ar:التهاب المفاصل zh:关节炎