Joint inflammation in Arthritis restricts activity in young and old people. Orthopedic doctors recommend immediate arthritis treatment and management.

Arthritis

Online Consultation

Iqra Mazhar

Overview

Arthritis causes tenderness and swelling in either one or more joints. One of the main symptoms is joint stiffness and pain, which worsens with age. The two common types of arthritis are rheumatoid arthritis and osteoarthritis.

<a href="https://merisehat.pk/disease/osteoarthritis-64627">Osteoarthritis</a> is characterised by cartilage break down. Cartilages cover the ends of bones, creating a cushion and low-friction environment on the surface of the joints. However, in rheumatoid arthritis, the joints are attacked by the immune system, starting from the lining of the joints.

Underlying diseases and infections such as lupus and <a href="https://merisehat.pk/disease/psoriasis">psoriasis</a> can lead to other types of arthritis. Another example could be gout, wherein excess uric acid in your blood can form uric acid crystals. Repeated bouts of gout can lead to gouty arthritis.

The treatment of arthritis is based on the type. However, the main aim is to reduce the symptoms and improve the patient&rsquo;s quality of life. 
&nbsp;

<h5> 
Ankylosing Spondylitis</h5>

Ankylosing spondylitis causes some of the bones in the spine to fuse because of inflammation. It makes the spine less flexible and results in hunching. Moreover, if the ribs are affected, it can lead to breathing difficulties.

This type of arthritis is more common in men compared to women. The symptoms usually start from early adulthood, and it can lead to inflammation in other parts of the body as well, for example, the eyes.

Ankylosing spondylitis has no cure. However, treatment provides symptomatic relief and reduces the progression of the disease.&nbsp; 
&nbsp;

<h5>Gout</h5>

<a href="https://merisehat.pk/disease/gout">Gout</a> is one of the most common and complex forms of arthritis, which can affect anyone. The symptoms include sudden and severe attacks of pain, redness, and swelling, in addition to tenderness in one or more joints, usually the big toe.

A gout attack has an abrupt onset and can keep the sufferer awake at night. It usually feels like the big toe is on fire. The joint that is affected feels hot, tender, and swollen. For some people, even the weight of their blanket may be intolerable.

The symptoms of gout fluctuate; however, it can be managed in various ways.&nbsp; 
&nbsp;

<h5>Juvenile Idiopathic Arthritis</h5>

Formerly called juvenile rheumatoid arthritis, juvenile idiopathic arthritis is very common in children under sixteen. It is characterized by persistent joint pain, stiffness, and swelling. Furthermore, some children have symptoms only for a few months, whereas other children have them for several years.

Certain types of juvenile arthritis can lead to serious complications. For example, joint damage, growth problems, and inflammation of the eye. The main aim of the treatment is to control pain and inflammation, improve function, and prevent damage. 
&nbsp;

<h5>Osteoarthritis&nbsp;</h5>

It is the most common type of arthritis and affects millions across the globe. In it, the cartilage wears off with time. Although it can damage any joint, it often affects the joints of the hands, spine, hips, and knees.

The symptoms of osteoarthritis can be managed, but unfortunately, the damage to the joints is often irreversible. An active lifestyle, exercise, maintenance of a healthy weight, and getting the right treatment can slow down the progression of the disease. These measures can also improve joint function and reduce pain.&nbsp;&nbsp; 
&nbsp;

<h5>Psoriatic Arthritis&nbsp;</h5>

People who have psoriasis usually have psoriatic arthritis, which causes red patches topped with silver scales to appear on the skin. Most people develop psoriasis years before the development of psoriatic arthritis. However, for some people, psoriatic arthritis starts years before psoriasis patches start showing. Sometimes both start at the same time.

The signs and symptoms of psoriatic arthritis are joint pain, swelling, and stiffness. Moreover, any part of the body can be affected, including the spine, and fingertips. The pain ranges from mild to severe. In cases of both skin and joint involvement, the disease can flare up followed by periods of remission.&nbsp;&nbsp;

Psoriatic arthritis has no cure, and treatment involves controlling the symptoms and preventing damage to the joints. If not treated promptly, it can lead to disability.

&nbsp;

<h5>Reactive Arthritis&nbsp;</h5>

Formerly called Reiter&rsquo;s syndrome, reactive arthritis is an infection affecting the genitals, intestines, and urinary tract, etc. It mostly targets the feet, ankles, and knees. Furthermore, the inflammation can affect the eyes, skin, and urethra.&nbsp;

Reactive arthritis is uncommon and for most people, the symptoms fluctuate and disappear within a year.

&nbsp;

<h5>Rheumatoid Arthritis&nbsp;</h5>

RA is a chronic inflammatory disorder. It affects more than one joint, and, in some people, it can damage the eyes, lungs, skin, blood vessels, and heart. It is an autoimmune disorder that occurs when the immune system accidentally attacks the body&rsquo;s tissues.

<a href="https://merisehat.pk/disease/rheumatoid-arthritis">Rheumatoid arthritis</a> affects the lining of the joints, unlike other forms that cause wear-and-tear damage. The swelling caused by it leads to erosion and deformity of the joint. Moreover, the associated inflammation can damage other parts of the body. While advancements in medicine have improved treatment, severe RA can cause physical disabilities. 
&nbsp;

<h5>Septic Arthritis</h5>

Germs travel through the bloodstream and cause a painful infection, which is called septic arthritis. It can occur after a penetrating injury, for example, an animal bite and trauma.

Infants and the elderly are more prone to it and people with artificial joints are also at risk. The part that is often affected is the knee. However, shoulders, hips, and other joints can also be affected. The infection damages the cartilage and bones, affecting the whole joint; hence, rapid treatment is crucial.&nbsp; 
The treatment involved draining the joint, and antibiotics are also prescribed in most cases. 
&nbsp;

<h5>Thumb Arthritis</h5>

Thumb arthritis is common in elderly people, and it wears the cartilage away from the bones of the carpometacarpal joint. It can cause severe pain, decreased strength, swelling, and movement difficulties. People are unable to do simple chores, for example, opening a lid or turning doorknobs. Healthcare providers treat it with splints and medications. However, if it is severe, surgery may be required. 
&nbsp;

Signs And Symptoms

Joint pain, swelling, and stiffness are the most common symptoms of arthritis. Furthermore, the symptoms also feel worse in the morning and when people stand after resting.

&nbsp;

Symptoms of osteoarthritis include:

<ul>
	<li>People with arthritis often have a limited range of motion.&nbsp;</li>
	<li>Clicking sounds and popping sounds with bending is common. These sounds are also common while praying namaz.</li>
	<li>Weakness of muscles around the joints.</li>
	<li>Buckling and instability of the joint.</li>
	<li>Weakness in the muscles around the joint.</li>
	<li>The fingers have bony growths.</li>
	<li>The knees feel like they are scraping and grating.</li>
</ul>

&nbsp;

The other symptoms of arthritis include:

<ul>
	<li>Morning stiffness longer than thirty minutes.</li>
	<li>More than one joint is affected.</li>
	<li>The onset is in smaller joints, for example, the hands and feet.</li>
	<li>The same joints on both sides of the body have symptoms and pain.</li>
	<li>Low-grade fever.</li>
	<li>Fatigue.</li>
	<li>The eyes and mouth become inflamed.</li>
	<li>The blood vessels and heart muscles become inflamed.</li>
	<li>The RBC count becomes low. 
	&nbsp;</li>
</ul>

Causes

The two main types of arthritis are osteoarthritis and rheumatoid arthritis. Both damage the joints differently.

&nbsp;

<h4>Osteoarthritis</h4>

It is the most common type. It damages the cartilage of the joints. Cartilage is the hard slick coating at the bone ends, where the joints are formed. The cartilage cushions the ends of the bones and reduces friction on movement. Damage to the cartilage can lead to bone grinding, causing pain and restricted movement. Moreover, this wear and tear occurs over several years and can be hastened by infection or joint injury.

Osteoarthritis can cause the deterioration of the connective tissues that hold the joint and attach the muscles to bones. The joint lining can also swell and become inflamed if the cartilage is severely damaged.

&nbsp;

<h4>Rheumatoid Arthritis (RA)</h4>

The immune system of the body attacks the lining of the joint capsule in <a href="https://merisehat.pk/disease/rheumatoid-arthritis">rheumatoid arthritis</a>. The joint capsule is a tough membrane that encloses all the parts of the joint. Furthermore, the synovial membrane becomes inflamed and swollen. Eventually, RA can destroy the bone and cartilage within the joint.&nbsp; 
&nbsp;

<h4> 
Rheumatoid Factor And Anti-Cyclic Citrullinated Peptide (Anti-CCP) Antibodies</h4>

Rheumatoid factor: It measures the levels of RA in the blood. Rheumatoid factors are produced by the immune system when antibodies attack healthy tissues<a href="#accordion">[1]</a>.&nbsp;

Anti-CCP Antibodies: Anti-CCPs are antibodies produced by the immune system and their levels are determined through a blood test. People who test positive have a chance of developing RA; however, everyone with the disease doesn&rsquo;t have the antibodies.

People who test positive for both rheumatoid factor and anti-CCP may have extreme RA and would require high-level treatment.&nbsp;

Although, it needs to be kept in mind that these tests are only used for the detection of RA and not any other type of arthritis. 
&nbsp;

Diagnosis

Arthritis diagnosis is difficult as there are more than a hundred types of arthritis, for example, inflammatory arthritis, degenerative arthritis, infectious arthritis, metabolic arthritis, etc.&nbsp;

&nbsp;

Healthcare providers do the following to diagnose arthritis:

<ul>
	<li>They review the patient&rsquo;s medical history and current symptoms.</li>
	<li>A thorough examination of the joints.</li>
	<li>Lab tests, X-rays, ultrasounds, and MRIs.</li>
	<li>Arthrocentesis: They remove the fluid from the joint.</li>
</ul>

<h3 dir="ltr">&nbsp;</h3>

<h5>Lab Tests</h5>

Other than a complete medical history and physical exam, the following lab tests can be additionally performed for the diagnosis of arthritis:&nbsp;

<ul>
	<li>The antinuclear antibody test measures the level of multiple antibodies in the blood, which are present in people with certain arthritis types.</li>
	<li>Arthrocentesis, also called joint aspiration is an examination of the joint fluid, where a needle is inserted in the joint and the synovial fluid is removed. The cell count is examined, in addition to crystal analysis, culture, and other tests.</li>
	<li>A complement test measures the level of proteins in the blood. It helps in the diagnosis of systemic lupus erythematosus (SLE) and RA.</li>
	<li>Complete blood count measures the WBCs, RBCs, and platelets in the blood. Leukopenia (low WBC blood count), <a href="https://merisehat.pk/disease/anemia">anemia</a> (low RBC count), and thrombocytopenia (low platelet count) are associated with arthritis. Medications are needed to treat them.&nbsp;</li>
	<li>Creatinine blood test monitors the patient for any underlying kidney disease.</li>
	<li>C-reactive protein is elevated when the body is inflamed due to arthritis. The protein levels can be tested for the diagnosis of arthritis.</li>
	<li>ESR (erythrocyte sedimentation rate) measures the speed at which the RBCs fall to the bottom of the tube. Moreover, ESR is elevated when the body is inflamed. This happens in some types of arthritis.</li>
	<li>Hematocrit measures the red blood cells in the blood. People with low RBCs may have arthritis.</li>
	<li>Rheumatoid factor checks the antibodies that are present in people with RA.</li>
	<li>Urinalysis examines the urine for kidney diseases, which are associated with several types of arthritis.</li>
	<li>Uric acid is elevated in case of gouty arthritis.</li>
</ul>

<h4>&nbsp;</h4>

<h5>Imaging Tests</h5>

Imaging techniques give a clear picture of the joints. They include the following:

<h5 dir="ltr"> 
X-Rays</h5>

The changes in the joints and damage in the bones can be seen through an X-ray. However, other imaging tests should also be done.

<h5 dir="ltr"> 
Ultrasound</h5>

An ultrasound uses sound waves to see the quality of the synovial tissues, tendons, bones, and ligaments.

<h5 dir="ltr"> 
MRI</h5>

MRI (magnetic resonance imaging) shows joint damage, muscle damage, ligament, and cartilage damage.

<h5 dir="ltr"> 
Arthroscopy</h5>

An arthroscope is used in arthroscopy to look into the joint tissues. The arthroscope is inserted and the inside of the joint is shown on a screen and evaluated for degenerative or arthritic joint changes. It detects bone disease and tumors. Also determines the reason behind the pain or inflammation, which helps in the formulation of treatment plans. 
&nbsp;

Treatment

Arthritis treatment aims to reduce the pain and prevent further damage. Patients and their healthcare providers can work together to create individualized treatment plans.&nbsp; 
&nbsp;

The treatment is a combination of:

<ul>
	<li>Medications</li>
	<li>Supplements</li>
	<li>Occupational therapy</li>
	<li>Diet rich in nutrients</li>
	<li>Exercising</li>
	<li><a href="https://merisehat.pk/disease/bulimia-nervosa">Weight loss</a></li>
	<li>Hot and cold compresses</li>
	<li>Walkers and canes (mobility devices)</li>
</ul>

&nbsp;

Joint function improvement is important and healthcare providers prescribe a combination of treatments for better results. 
&nbsp;

<h5>Medications&nbsp;</h5>

Medications that are used in the treatment are:

&nbsp;

<ul dir="ltr">
	<li>Analgesics</li>
</ul>

Hydrocodone and acetaminophen relieve the pain; however, they do not relieve the inflammation.

<ul dir="ltr">
	<li>NSAIDs</li>
</ul>

Ibuprofen and salicylates help in managing pain and inflammation. Salicylates are blood thinners, so people who are already on blood thinners should not use them.

<ul dir="ltr">
	<li>Menthol Or Capsaicin Creams</li>
</ul>

When patients use these creams, it blocks the transmission of pain signals in the joints.

<ul dir="ltr">
	<li>Steroids</li>
</ul>

Steroids help in reducing inflammation. However, they should be used briefly and cautiously.

<ul dir="ltr">
	<li>Immunosuppressants</li>
</ul>

Patients with moderate to severe inflammatory arthritis, for example, RA, are prescribed immunosuppressants.

Healthcare workers recommend corticosteroids or DMARDs to patients with RA; it suppresses the immune system. Moreover, methotrexate is the first-line drug for treatment.

&nbsp;

<h4>Supplements&nbsp;</h4>

Although there isn&rsquo;t much data on supplements and their benefit for arthritis, a few of them are beneficial<a href="#accordion">[2]</a>. For example, avocado and soybean. Turmeric and fish oil supplements also reduce inflammation in people with rheumatoid arthritis.

But it is recommended that people talk to their healthcare provider before taking any supplements. This is necessary to prevent any drug interactions.&nbsp;&nbsp; 
&nbsp;

<h4>Surgery</h4>

Replacing the joint with a prosthetic implant is also an option. It is most common in the hips and knees.

If the arthritis is severe in the wrists and fingers, healthcare providers perform a joint fusion. The joint is eliminated in this procedure and the bones are fused. 
&nbsp;

<h4>Physical Therapy&nbsp;</h4>

Physical therapy strengthens the affected muscles through exercise. It is a core component in treating arthritis.

Physical therapists recommend a daily movement plan, in addition to exercises that can be done at home. They help in building strength and improving balance, and mobility.&nbsp;

&nbsp;

The symptoms of arthritis become worse if they are left untreated:

 
Reduction In Mobility

With the progression of arthritis, patients experience uncomfortable movements. It can interfere with daily activities as well.

 
Weight Gain

When there is a lack of movement, the chances of weight gain are higher, and the discomfort can prevent people from exercising.

 
Metabolic Disorders

The risk of metabolic disorders is higher in people who are overweight and have inflammatory conditions, for example, arthritis. It can increase the chances of developing diabetes type 2, high cholesterol, and cardiovascular diseases<a href="#accorion">[3]</a>.

 
Inflammation

If arthritis is attributed to <a href="https://www.merisehat.pk/article/how-an-over-prescription-of-antibiotics-affects-your-immune-system">autoimmune</a> diseases, it can cause inflammation in the eyes, skin, lungs, and blood vessels.

 
Falls

People with osteoarthritis are more likely to experience falls and fractures<a href="#accordion">[4]</a>. This is because of weak muscles and dizziness from pain medications.

 
Hinders The Ability To Work

Most people with arthritis are of working age and it may affect their ability to move<a href="#accordion">[5]</a>.

 
Mental Health

Since people are in constant pain, it can harm their mental health, increasing <a href="https://merisehat.pk/disease/anxiety">anxiety</a> and <a href="https://merisehat.pk/disease/depression">depression</a><a href="#accord">[6]</a>. 
&nbsp;

The risk factors of arthritis are:&nbsp;

 
Obesity

<a href="https://merisehat.pk/disease/obesity">Obesity</a> stresses the joints, for example, hips and knees. Weight loss can help in reducing the risks and may also help in improving the condition.

 
Gender And Age

The risk of arthritis increases as people age, and it is more common in women compared to men. However, <a href="https://merisehat.pk/disease/gout">gout</a> is more common in men<a href="#accordion">[7]</a>.&nbsp;

 
Injuries And Overuse

Continuous stress and injuries during daily tasks and exercise can increase the risk of osteoarthritis.&nbsp;

 
Genetic Predisposition

People with a family history of autoimmune diseases and inherited genes are at a higher risk of rheumatoid arthritis<a href="http://#accordion">[8]</a>.

 
Smoking

The risk of RA is higher in people who smoke.&nbsp;&nbsp; 
&nbsp;

Some preventive measure include:

<ul>
	<li>Avoid tobacco-based products, for example, cigarettes.</li>
	<li>Perform low impact exercises.</li>
	<li>Maintain a healthy body weight. 
	&nbsp;</li>
</ul>

Research has proven that molecular profiling of joint tissues that are diseased can impact the outcome of specific drugs for treating RA. Moreover, they also identified that genes associated with resistance to available therapies, known as refractory disease, can provide the key to developing drugs for treatment<a href="#accordion">[9]</a>. 
&nbsp;

Key Points

<ul>
	<li>Working on reducing the risk of joint injuries can reduce the risk of arthritis.</li>
	<li>Arthritis comprises of over two-hundred rheumatic conditions and diseases, which affect the joints. For example, lupus and RA.</li>
	<li>It can impair people from performing their daily tasks with ease and affect their mental health.</li>
	<li>Physical activities positively impact arthritis and help patients in improving their function and reducing pain.</li>
	<li>Abnormal metabolism, infections, dysfunction of the immune system, and genetic predispositions can lead to the development of arthritis.</li>
	<li>Treatment involves controlling the symptoms and improving the quality of life of the patient. 
	&nbsp;</li>
</ul>

[1] Tiwari, V., Jandu, J.S. and Bergman, M.J., 2021. Rheumatoid Factor. In StatPearls [Internet]. StatPearls Publishing.

[2] Liu, X., Machado, G.C., Eyles, J.P., Ravi, V. and Hunter, D.J., 2018. Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. British journal of sports medicine, 52(3), pp.167-175.

[3] Kuusalo, L., Felson, D.T., Wang, N., Lewis, C.E., Torner, J., Nevitt, M.C., Neogi, T. and Multicenter Osteoarthritis Study Group, 2021. Metabolic osteoarthritis–relation of diabetes and cardiovascular disease with knee osteoarthritis.

[4] Doré, A.L., Golightly, Y.M., Mercer, V.S., Shi, X.A., Renner, J.B., Jordan, J.M. and Nelson, A.E., 2015. Lower‐extremity osteoarthritis and the risk of falls in a community‐based longitudinal study of adults with and without osteoarthritis.

[5] Allaire, S., Wolfe, F., Niu, J., LaValley, M.P., Zhang, B.I.N. and Reisine, S., 2009.

[6] Sharma, A., Kudesia, P., Shi, Q. and Gandhi, R., 2016. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open access rheumatology: research and reviews, 8, p.103.

[7] Tschon M, Contartese D, Pagani S, Borsari V, Fini M. Gender and sex are key determinants in osteoarthritis not only confounding variables. A systematic review of Clinical Data. Journal of clinical medicine.

[8] Kuo CF, Grainge MJ, Valdes AM, See LC, Yu KH, Shaw SWS, Luo SF, Zhang W, Doherty M. Familial aggregation of rheumatoid arthritis and co-aggregation of autoimmune diseases in affected families: a nationwide population-based study. Rheumatology (Oxford). 2017 Jun 1;56(6):928-933. doi: 10.1093/rheumatology/kew500. PMID: 28160009; PMCID: PMC5850742.

[9] Rivellese, F., Surace, A.E.A., Goldmann, K. et al. Rituximab versus tocilizumab in rheumatoid arthritis: synovial biopsy-based biomarker analysis of the phase 4 R4RA randomized trial. Nat Med 28, 1256–1268 (2022).