ARTHRITIS

What is Arthritis?

Arthritis is an inflammatory joint disease.  It is one of the most common causes of chronic pain and the leading cause of disability for Americans over the age of 15.  It limits the activities of more than 19 million adults, and the Center for Disease Control estimates that by 2030, nearly 67 million adults will be diagnosed with arthritis in the United States.

What are the signs of Arthritis in my joints?

• Swelling
• Redness
• Warmth
• Deformity
• Loss of motion

What are the different types of Arthritis?

There are about 200 different types of arthritis, but they are generally classified in three general categories:

• Non-inflammatory
• Osteoarthritis
• Scoliosis
• Torn ligaments
• Inflammatory
• Rheumatoid arthritis
• Ankylosing spondylitis (the spine fuses resulting in very limited mobility)
• Gout/pseudogout
• Connective Tissue disease
• Lupus

What is Osteoarthritis?

It is a degenerative joint disease, and the most common form of arthritis.  According to the Centers for Disease Control, an estimated 27 million Americans over the age of 25 suffer from osteoarthritis, and it is the most common cause of disability.  It usually develops slowly in the weight-bearing joints. Early in the disease, your joints may ache after physical work or exercise/sports.  The hips, knees, fingers and spine are the most common areas that are affected by osteoarthritis.  Less affected are the shoulders, wrists, elbows and ankles.

What are the symptoms of osteoarthritis?

The symptoms of osteoarthritis are caused by the gradual degeneration of joint cartilage.  Cartilage or synovium covers the joint surfaces and protects the ends of the bones. It forms a synovial lining of the joints that keep the joint moving easily.  When cartilage starts to break down, inflammation arises from the debris, causing pain and swelling in the joint. As the cartilage continues to wear off, the ends of the bone rub against each other causing more pain and loss of flexibility.  Osteoarthritis is also known as degenerative joint disease.  It is characterized by the following symptoms:

• Joint pain during or after use, or after periods of inactivity
• Discomfort in a joint before or during a change in the weather
• Joint swelling and/or stiffness, particularly after activity
• Loss of joint flexibility

Those who are most at risk are:

• Age 50 or older
• Obese (affecting the weight-bearing joints)
• Have a history of joint injury
• Have joint instability
• Experienced prolonged occupational or sports stress

Diagnosis

Based upon certain criteria specific to the joint involved, your physician will make a diagnosis of osteoarthritis. A full evaluation will include:

• Medical history
• Physical exam that includes:
  • Gait analysis
  • Range of motion in the joint
  • Joint swelling/stiffness
• Characteristics of the pain, such as:
  • Is pain relieved by rest
  • Is the joint enlarged
  • Is there a crackling/grating sensation (crepitus) in the joint
• X-rays
• Laboratory exams to rule out other arthritic disorders

What treatment options are available?

Non-surgical treatment options:

• Analgesics – Acetaminophen
• NSAIDs – aspirin, ibuprofen, naproxen sodium
• Topical analgesics – capsaicin, lidocaine
• Steroid injections into the joints
• Viscosupplementation – series of hyaluronic acid injections into the joint over a period of weeks
• Glucosamine sulfate
• Chondroitin sulfate
• Proliferative therapy
• Platelet rich plasma (PRP) injections
• Surgical treatment options:
  • Arthoplasty - joint replacement with a prosthetic joint

How can I protect my joints?

• Maintain your ideal body weight.
  • This will decrease the stress on your joints
• Exercise and move your body and joints.
  • This protects and stabilizes the joints by strengthening the muscles around them. The muscles will also keep the joints from rubbing against each other, preventing them from wearing down the cartilage.
• Maintain good posture.
  • Good posture helps to protect the joints in your neck, back, hips and knees
• Use good body mechanics.
  • When lifting or carrying, use the largest and strongest joints and muscles to avoid injury to the smaller joints and muscles.
• Pace yourself and alternate activities.
  • Alternate periods of heavy activity with periods of rest. Repetitive activities on the joints will accelerate wear and tear and cause joint deterioration.
• Listen to your body.
  • If you have pain after activities or exercise, it can be an indication that you have overstressed your joints.
• Move frequently.
  • Staying in one position for prolonged periods of time will cause stiffness. Moving frequently will decrease the muscle and joint stiffness.
• Do not be a “weekend warrior.”
  • Over-exertion on the weekend with activities that you do not normally participate in will cause undue stress on your joints and muscles. If you are starting new activities, progress slowly allowing your body to adjust and avoiding injury.
• Wear protective equipment.
• Use helmets and wrist/knee pads, and make sure that they fit properly.
• Ask for help.
  • If a job is too big for you to accomplish, ask for help to avoid potential injury.

What is Rheumatoid Arthritis?

It is a degenerative joint disease that involves inflammation of the synovial lining of the joints. It triggers the release of proteins that will cause the gradual thickening of the synovial lining, which will result in destruction of the joint.  Chronic pain, loss of function and disability are a result of this joint destruction.  Rheumatoid arthritis affects approximate 2.1 million individuals each year and is 2 to 3 times more common in women than in men.  Unlike osteoarthritis, which affects the joints, rheumatoid arthritis is systemic and can affect other organs such as the lungs, heart, and even blood vessels.

What are the signs and symptoms?

Symptoms will vary among people with the disease, and may include:

• Tender, warm and swollen joints
• Symmetrical pattern of affected joints
• Joint inflammation often affecting the wrist and finger joints
• Joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles and feet
• Fatigue, occasional low-grade fever, a general sense of discomfort
• Pain and stiffness lasting for more than one hour in the morning or after a long rest
• Symptoms that last for many years, leading to joint deformity

How is rheumatoid arthritis diagnosed?

Based upon certain criteria specific to the joint involved, your physician will make a diagnosis of rheumatoid arthritis. A full evaluation will include:

• Medical history
• Physical exam
• Laboratory exams:
  • Rheumatoid factor
  • Antinuclear antibodies (ANA)
  • Erythrocyte sedimentation rate
  • Immunoglobulins (IgM, IgG)
  • Joint fluid examination
  • X-rays of the affected joints

What treatments are available?

Treatments will vary depending upon the level of your disease. Your COVA physician or rheumatologist will help you decide the best course of treatment. The most common treatments include:

• NSAIDS – ibuprofen, naproxen sodium
• Corticosteroids (oral/injected)
• Disease-modifying anti-rheumatic drugs (DMARDs)
• Biologic response modifiers

Links
Arthritis Foundation
National Institute of Health - Arthritis
AAOS - Arthritis
CDC - Arthritis