Arthritis

Dr. Nadheer K M (AIIMS)MBBS

January 23, 2017

January 11, 2023

Arthritis
Arthritis

Summary

Arthritis is not a single disease, it is used to denote a group of about 100 joint diseases that are characterised by typical inflammation of the joints, knee, elbow, hip, and ankle causing redness and pain. There are several forms of arthritis but rheumatoid, juvenile and osteoarthritis are the most prevalent forms. Arthritis could be caused due to general wear and tear of joints with age or due to a number of conditions including uric acid accumulation in joints (gouty arthritis) and as an autoimmune condition (Rheumatoid arthritis and psoriatic arthritis) in which the body's immune system begins to destroy its own cells and cartilages. Affecting the joints and nearby area causing difficulty in movements. Arthritis has no permanent cure, however, managing it effectively can help in reducing pain and further prevent from risks associated with arthritis such cardiovascular and severe joint damages.

Types of Arthritis

Medical researchers believe that there exist at least 100 different forms of arthritis. Here, we are mainly highlighting the main kinds which affect people commonly. Arthritis can be mainly divided into the following categories

  • Rheumatoid Arthritis
    Rheumatoid Arthritis is an autoimmune condition in which the body's own cells attack healthy cells assuming it to be foreign invasions. It is typically characterised by the inflammation (swelling) of the joints in fingers, knee, elbow, and ankle. Researchers hints that this condition affects children and women more than men. It has a 0.7 %prevalence rate in India and about 1% of the world population is affected by this condition.
  • Osteoarthritis
    Osteoarthritis is a more commonly found type of arthritis found in people between 30- 50 years. Research hints that this type usually occurs due to excessive use and wear and tear of cartilage present in between the joints. Due to inflammation(swelling) and damaged cartilages, the movement in the joints become extremely painful and limited. However, osteoarthritis can also affect young individuals in the form of an occupational disorder or due to a joint injury. About 45 % woman over the age of 65 suffer from symptomatic osteoarthritis in India. It affects 18 % women and around 9.6 % men worldwide as per the World Health Organisations statistics. 
  • Juvenile Arthritis  
    Juvenile arthritis is characterised by pain and inflammation and it is a type of Rheumatic arthritis which is found in children below 16 years of age. Juvenile arthritis symptoms include redness, warmth, joint pain, difficulty in movements in small children.
  • Infectious arthritis
    Infectious arthritis is also known as septic arthritis, it is a painful condition in which infections are caused due to bacterial and viral invasions of the joints and the fluids surrounding the joints. The fluids surrounding the joints is known as the synovial fluid. It can occur at any age and the reasons responsible for infectious arthritis is still not clearly known. However it is found mostly to be an acquired condition, where the infection enters the body via open wounds, surgery or certain medications trigger arthritis.   
  • Gout
    Gout is a disease which occurs due accumulation of uric acid in the blood which further manifests into inflammation causing arthritis. It is characterised by pain, swelling, and redness in a located spot due to needle-like projections and chalks stone crystals formation in between the joints causing sudden severe pain. As per a report published by the Association of Physicians of India, gout affects about 2% of male population in the world and about 0.12% of the total population in India. It is the most common type of inflammatory joint conditions in men with more cases in the urban population below 30 years of age.
  • Psoriatic arthritis
    It is an autoimmune disease just like rheumatoid arthritis. However, unlike rheumatoid arthritis, psoriatic arthritis has one-sided symptoms which affect both men and women equally. It begins with psoriasis, a skin condition marked by rashes and itching an affects people in the age group of 30 to 55 years. Though only 45 % psoriasis cases develop into psoriatic arthritis.
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What is Arthritis?

Arthritis in layman term is usually referred to as a broad spectrum of joint diseases which can affect people of any age and gender. Previously researchers believed that arthritis was an age-related disorder only affecting people above 50 years. Recent studies claim that arthritis can strike anyone regardless of the age. In fact, this disease has become one of the major reasons of socio-economic concerns because this condition is famously known to disrupts locomotion (movement).

Arthritis Symptoms

Being a musculoskeletal condition (affecting joints and associated muscles), all types of Arthritis have four strikingly common symptoms. You may:

  • feel pain and swelling (inflammation)
  • experience stiffness & tenderness in the joints
  • get a regular fever
  • experience localised redness in the affected area.  

According to an article published in the Journal Bio-med, arthritis is a major cause of disabilities in the world, contributing to 19.2% of the global disability burden, 90% of which is borne by low and middle-income countries. Most people with arthritis-related disabilities cannot even do day to day work, plunging developing countries further into poverty.

Here are the symptoms of specific types of arthritis:

Symptoms of Juvenile arthritis 

If your child has juvenile arthritis, s/he may:

Symptoms of Rheumatoid Arthritis

Rheumatoid Arthritis commonly presents with these symptoms; you may:

  • experience limited range of motion in your (hands, fingers, joints, and feet)
  • suffer from anemia (low levels of iron in the body)
  • feel extreme tiredness (fatigue)   
  • suffer from depression (feeling low and unmotivated)
  • limp while walking (in advanced arthritis cases). Often you may not notice the limp but others can spot it.
  • experience joint deformity (advanced cases)
  • advances to more joints gradually and can involve major organs such as the heart, lungs, kidneys and eyes. 

Symptoms of Osteoarthritis 

  • pain in the joints and muscles immediately after getting up in the morning.
  • audible crackling or popping sound from your joints.  
  • swelling or bulges in and around the joints
  • pain in the muscles and the joints by the end of the day, or even while you are resting.

Symptoms of gout

  • swelling along with tenderness.
  • warmth in that specific region.
  • skin may appear red, yellow, pale, mostly red.
  • affected area will be severely painful when touched.

Symptoms of psoriatic arthritis

  • begins with skin rashes 
  • pain in distal joints that is phalanges and of hands and feet, metacarpals and metatarsals and the axial spine 
  • one-sided symptoms
  • swelling and pain in joints with stiffness

When to see a doctor

You are highly recommended to see a doctor when you are experiencing regular pain and stiffness in the joints limiting your activities. Please do not delay as it is a lifelong condition and earlier you seek medical help better it is. 

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Causes & Risk Factors of Arthritis

Medical researchers have still not yet been able to ascertain the exact causes of Arthritis. However, genetics and certain diseases are believed to increase your chances of having arthritis in many folds. This with reference to genetics arthritis, if it is running in your family then you are at greater likelihood of getting it from your parents. Top researchers suggest that people with arthritis genes pass it to their progenies and early prevention of this disease is the only way out to manage this condition. 

Certain injuries or impacts on joint hinges can increase your chances of getting arthritis. Researchers claim that inflammations (swellings) caused due to sudden injuries which are ignored and neglected may turn into arthritis. Certain Infections promote the onset of arthritis, for example, Rheumatoid arthritis is caused due to bacterial and viral invasions (attack) in the body.

Demanding occupations which require the body to undergo tremendous strain such as daily walking, long hours of standing or same position sitting for long durations aid to contracting arthritis. Doing exercises without the supervision of a professional guide may also lead to damaging of cartilages and joints. Researchers also believe that smoking also promotes joint stiffness and leads to arthritis. Hence quitting smoking is one of the safest and easiest options if arthritis is running in your family.

Risk Factors

The risk of developing arthritis may be higher if you

  • are overweight
  • are older
  • consume excessive amounts of alcohol and smoke
  • are suffering from malnutrition
  • have some sports injuries or have neglected some injuries
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Prevention of Arthritis

How to prevent arthritis?

As the saying goes "prevention is better than cure", and as you may already know that its difficult to prevent arthritis specially with reference to people having arthritis in their genes. But we must try. Here are the following points which when followed can help delay the onset of arthritis and may also prevent this condition. 

  • Wear proper footwear. It has been observed improper gears lead to wear and tear of joints and aid to arthritis.
  • Eat a balanced diet specially rich in omega 3 fatty acids.  Certain fishes such as salmon and freshwater fishes are rich in omega-3 fatty acids. Calcium-rich diet is also recommended.
  • Maintain a healthy weight. The more pressure the bones exert on the body the more are the chances for joint wear and tear. (Check More - Weight Loss Treatment)
  • Do not neglect any injury especially of the knee and elbow and other joints. Show a doctor. 
  • Include gymming, yoga, swimming or any kind of physical activity to ensure healthy weight and also proper joint function. 
  • Last but not the least limit alcohol and avoid smoking so that you have healthy bones and joints. 

Diagnosis of Arthritis

Diagnosing arthritis is not easy and you are highly recommended to take help of a medical practitioner in confirming the disease. Do not assume you have arthritis till your physician confirms. You may need to undergo tests and physical examinations. Depending on your symptoms your doctor will physically examine you first. They will examine the site of inflammation and pain. They might gently press that region and assess the intensity of pain, redness, swelling, fluid accumulation and range of mobility. Depending on the initial screening your doctor will recommend certain tests.

  • Blood test
    Certain blood tests such as ESR test is done (Erythrocyte sedimentation test) this determines swelling inflammations in the joints. More the inflammations it is more likely that you may have arthritis. CRP (C- reactive protein) test is one of the best tests which detects a specific kind of protein which is found high when there are inflammations in the body due to arthritis.
     
  • Urine test
    Urine tests are especially useful when arthritis cannot be detected in blood samples. Hence Urine sample is analyzed and is checked for the presence of red blood cells, pus cells (infections), and proteins to confirm arthritis.
     
  • X-ray scan
    A standard X-ray is usually recommended by doctors.  X-ray is a simple test (rays are used) by which the doctor can clearly view bone deformities or calcium deposits. By doing an X-ray the doctor can understand the severity of the disease.
     
  • MRI scan
    Your doctor may recommend you an MRI also because in certain cases X-ray is not good enough to detect arthritis. MRI is found to be extremely helpful in detecting joint damages, particularly damage to the ankle, spine, knee, or shoulder. To evaluate the disease completely your doctor may recommend full body or affected part MRI and also ask for repeat scans in six months to check on disease progression.
     
  • Ultrasound
    Your doctor may also recommend an ultrasound ( viewing organs with help of ultrasonic waves) and also for applying heat to joints ( an important way to treat people with rheumatoid arthritis) Read further in detail treatment section (Consult a doctor with Doctor app)

Treatment of Arthritis

There is no definite single cure for arthritis as of now. But having said that it does not mean that treatment is not required. You may be surprised to know that many patients self-treat themselves with topical painkillers etc and refrain from going to a doctor aiding to the progression of this disease. One must consult an Orthopedic and a rheumatologist in case of rheumatoid arthritis. 

For the treatment of various types of arthritis especially Osteoarthritis, Rheumatoid arthritis medicines are recommended by doctors to treat inflammations and swellings. Hot and cold compresses are used to treat symptoms such as redness, soreness in the affected region. Few patients who are in a progressive stage in the disease, find it very difficult to carry on daily activities which require walking, cycling, jogging and standing for long hours the doctors encourage them to take up 1 physical activity at least such as yoga, swimming, aerobics, which put less strain on joints and also ensure range of motion.

Physiotherapy is an important treatment aspect in patients with arthritis. Progressive disease condition may lead to various deformities and extra growth in the bone which may make mobility and locomotion difficult hence with the help of physiotherapy exercises you can not only restore range of motion but also achieve flexibility. Your doctor may also recommend ultrasonic waves to relieve you from pain and ligament tension. By applying heat to the joints people with rheumatoid arthritis (RA) relieve their muscle tensions and pain. So deep heat is applied to relax the affected joint areas.

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Complications of Arthritis

Advanced cases of arthritis may lead to certain complications. Please note that this may not always be the case though. Here are some possible complications:

  • Heart diseases
    Cardiovascular diseases such as strokes and heart attacks have been often linked in people with Rheumatoid arthritis (RA). Chest pain, pain near the lungs and pressure in the blood vessels (vasculitis) have also been linked with arthritis. Hence there is a high-risk factor to contract cardiovascular diseases when having arthritis. You are highly recommended not to smoke, limit alcohol intake, and to adopt some form of physical activity to avoid heart-related complications. (Check More - Heart Disease Treatment)
     
  • Diabetes
    Due to less physical activity and forced sedentary lifestyle, there may be hormonal imbalances in the body of patients living with arthritis. This may lead to faulty insulin secretion which can further lead to diabetes (a lifelong condition). (Check More - Diabetes Treatment)
     
  • Carpal tunnel
    Due to arthritis, there may be certain nerve compressions and damages which leads to tingling sensations and feeling of numbness. Carpal tunnel affects areas like wrists, fingers, and thumbs. When it gets severe, it may require surgical intervention.
     
  • Joint damage
    Arthritis is one of the world's leading reasons for joint damages. Doctors hint that if arthritis is not treated and arrested at an early stage then it leads to permanent joint damage causing damage to the tendons, nerves, and cartilages causing great discomfort and most of the times irreversible damages. It may cause permanent disabilities also.

Living with arthritis

Though arthritis can not be cured completely, it can be easily managed by following some simple dietary and lifestyle habits. Here are some lifestyle habits published in the National Health Service Uk and Harvard Medical School that can help you manage your arthritis better:

  • The first and most important step is to find out what kind of arthritis you are suffering from. This will help you in finding the best ways to deal with the symptoms
  • Include equal proportions of fresh fruits, vegetables, whole grains and dairy products in your diet. You can also hire a dietician to make a diet plan specific for your condition.
  • Exercise regularly to maintain optimal joint movement. If you are too scared to work out by yourself, hire a trainer.
  • Reduce stress on your affected joints. Find your strengths and use your healthier joints for repeated tasks
  • Buy automatic equipment to reduce your workload such as electronic can opener, automatic lint cleaners for your windowsills and curtains etc.


Medicines for Arthritis

Medicines listed below are available for Arthritis. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

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