Arthritis

Osteoarthritis vs. rheumatoid arthritis	Hip joint replacement - series	Knee joint replacement - series	Osteoarthritis
Osteoarthritis	Rheumatoid arthritis	Rheumatoid arthritis	Rheumatoid arthritis

Alternative names   

Joint inflammation

Definition   

Arthritis is a disease that involves inflammation of one or more joints. ("Arthr" refers to joints, and "itis" to inflammation.) See also joint pain.

Causes and risks   

Joint inflammation is the body’s reaction to various disease processes. These include mechanical injury to a joint (including fracture), the presence of an infection (usually caused by bacteria or viruses), an attack on the joints by the body itself (an autoimmune disease), or accumulated "wear and tear" on joints.

Often, the inflammation goes away after the injury has healed, the disease is treated, or the infection has been cleared by the immune system, sometimes with the help of antibiotics.

With some injuries and diseases, the inflammation does not go away or destruction results in long term pain and deformtiy. This is considered arthritis. There are more than 100 kinds of arthritis with many different possible causes.

Osteoarthritis is the most common variety of arthritis in the United States. This arthritis often results from years of accumulated "wear and tear" on joints, and tends to occur in the elderly in hips, knees, and finger joints.

Gout, seen most often in males over 40 years old, is caused by the formation of crystals in the joints with subsequent inflammation. Gonorrhea is a bacterial infection that causes a so-called infectious arthritis. Autoimmune disorders, such as rheumatoid arthritis, lupus, and scleroderma, can cause arthritis as well. In these diseases, something goes wrong with the immune system, which then attacks healthy parts of the body (such as joints).

Arthritis can occur in males and females of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people. In people over 55 years of age, women are more likely to suffer from osteoarthritis. Other risk factors for osteoarthritis are obesity, a history of trauma, and various genetic and metabolic diseases.

Some of the diseases that cause arthritis include:

• Osteoarthritis
• Systemic lupus erythematosus (SLE)
• Rheumatoid arthritis (in adults)
• Juvenile rheumatoid arthritis (in children)
• Gout
• Scleroderma
• Psoriasis (psoriatic arthritis)
• Fungal infections such as blastomycosis
• Ankylosing spondylitis
• Reiter’s syndrome/Reactive arthritis
• Septic arthritis
• Adult Still’s disease
• Tertiary Lyme disease (the late stage)
• Tuberculosis (tuberculous arthritis)
• Viral infections (viral arthritis)
• Gonorrhea (gonococcal arthritis)
• Other bacterial infections (non-gonococcal bacterial arthritis)

Prevention   

Most cases are not preventable. Find out if you have a family history of arthritis-related conditions. The goal is to diagnose and treat arthritis early.

Some scientists believe that osteoarthritis may develop in some people if they abuse their joints (injure them many times or over-use them while injured). Take care not to over-work a damaged or sore joint, as this may help postpone or eliminate possible development of osteoarthritis.

Excess weight also increases the risk for developing osteoarthritis in the knees, and possibly in the hips and hands. Women are at special risk for this. In men, being overweight increases the risk for developing gout. Maintain your recommended weight, particularly as you get older. Research shows that overweight middle-aged and older women who lose 11 pounds or more over 10 years can cut in half their risk for developing knee osteoarthritis.

Symptoms   

Patients with arthritis may suffer from the following symptoms:

• Joint pain
• Joint swelling
• Early morning stiffness
• Warmth around a joint
• Redness of the skin around a joint
• Reduced ability to move the joint
• Unexplained weight loss, fever, or weakness that occurs with joint pain 

Signs and tests   

A physical examination may show that fluid is collecting around the joint. (This is called an "effusion.") The joint may be tender (when it is gently pressed), and may exhibit warmth and redness, more typically in infectious arthritis and autoimmune arthritis. It may be painful or difficult to rotate the joints in some directions. (This is known as "limited range-of-motion.")

In certain autoimmune forms of arthritis, the joints may become deformed, if the disease is not treated. Such joint deformities are the hallmarks of severe, untreated rheumatoid arthritis.

Tests vary depending on the suspected cause. They may include blood or urine tests, as well as joint X-rays. In septic arthritis, joint fluid is removed from the joint with a needle and examined for the presence of infection. See the specific types of arthritis.

Treatment   

There are many different kinds of arthritis. Treatment varies, depending on the particular cause, how severe the disease is, which joints are affected, to what degree the patient is affected, and the person’s age, occupation, and daily activities.

Treatment may focus on eliminating the underlying cause of the arthritis. However, the cause usually is NOT curable. Treatment therefore aims at reducing pain and discomfort and preventing further disability. It is critical to follow the prescribed therapy.

The symptoms are treated as necessary. They may be helped with simple modifications in daily activities, along with adequate rest and appropriate forms of exercise. For example, low impact aerobic exercise (such as swimming) significantly relieves joint strain. In other cases, more extensive therapies are needed. Treatment usually consists of exercise, heat or cold treatments, methods to protect the joints, various medications, and possibly surgery.

MEDICATIONS:

Medications to reduce joint pain and joint swelling may include acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other immunosuppressive drugs (drugs that slow the immune system).

• Acetaminophen -- recommended by the American College of Rheumatology as the first line treatment for osteoarthritis. Taken in doses of up to 4 grams a day, it can provide significant relief of arthritis pain without many of the side effects of the drugs discussed below. However, do not exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol, because these pose risks for liver damage.
• Aspirin and NSAIDs -- are available over-the-counter, and are often effective in combating arthritis pain. Though these medications can be prescribed in stronger doses by physicians, they may have many side effects. Therefore, they should not be taken in any amount without consulting with your health care provider. The most dangerous side effects of NSAIDs are the formation of stomach ulcers, bleeding from the digestive tract, and kidney damage. Patients with kidney or liver disease, or a history of gastrointestinal bleeding should not take these medicines without consulting their physicians.
• New prescription medications -- drugs, such as Celecoxib and Rofecoxib, treat arthritis pain in a fashion similar to traditional NSAIDs. However, they seem to cause less stomach irritation and confer a lower risk of ulcers and gastrointestinal bleeding. Because these drugs can still effect the digestive tract and can be toxic to the kidneys, they should be taken under careful medical supervision.
• Oral glucosamine and chondroitin -- these form the building blocks of cartilage, the substance that lines joints. They are available at health food stores or supermarkets without a prescription. Early studies indicate that these compounds are quite safe and may improve symptoms relating to arthritis.
• Corticosteroids (or "steroids") -- are medications that suppress the immune system and symptoms of inflammation. They are commonly used in severe cases of osteoarthritis, and they can be given orally, by injection, or occasionally injected directly into an affected joint. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, hypertension, thinning of bones, cataracts, and increased infections. These risks are most pronounced when steroids are taken for long periods of time or at higher doses. Close supervision by a physician is essential.

A number of other immunosuppressive drugs are used to treat autoimmune diseases that cause arthritis, including rheumatoid arthritis, scleroderma, and lupus. Rheumatoid arthritis traditionally has been treated with drugs that modify the immune system, such as gold salts, penicillamine, and hydrochloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritisand improve the patient’squality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on the medication.

The most recent breakthrough in rheumatoid arthritis has been the development of so-called "anti-biologics"that target individual molecules to reduce inflammation. Such medications, including etanercept (Enbrel) and infliximab (Remicade), are administered by injection or vein (intravenously) and can confer dramatic improvements in the patient’s quality of life.

SURGERY AND OTHER APPROACHES:
In some cases, surgery to rebuild the joint (arthroplasty) or to replace the joint (such as a total knee joint replacement) may help maintain a more normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective.

Normal joints contain a lubricant called "synovial fluid." In joints with arthritis, this fluid is not produced in adequate amounts. A relatively recent approach is to inject arthritic joints with a manmade version of joint fluid known as hylan G-F 20 (Synvisc). This synthetic fluid may postpone the need for surgery at least temporarily and improve the lifestyle ofarthritis patients. Many studies are evaluating the effectiveness of this type of therapy.

LIFESTYLE CHANGES:
Both rest and exercise are important. Warm baths, massage, and stretching exercises may be helpful. Modifications in daily activities or using assistive devices to protect the joints are often recommended.

OTHER THERAPY:
Physical therapy for muscle and joint rehabilitation may be recommended in severe cases.

Prognosis   

A few arthritis-related disorders can be completely cured with treatment. Most are chronic (long-term) conditions, and treatment aims at controlling the pain and minimizing joint damage. Chronic arthritis frequently goes in and out of remission.