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Arthritis

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Introduction

Arthritis is a form of joint disorder that involves inflammation in one or more joints. There are over 100 different forms of arthritis. The most common form of arthritis is osteoarthritis, other forms of Arthritis are rheumatoid arthritis, Septic arthritis, psoriatic arthritis, & related autoimmune diseases.

The major complaint by individuals who have arthritis is joint pain. Pain is often constant, and may be localized to the joint affected. The pain from arthritis is due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscle strains caused by forceful movements against stiff painful joints and fatigue.

Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. Unlike other types of arthritis, only the joints are typically affected. OA is the most common form of arthritis with disease of the knee and hip affecting about 3.8% of people as of 2010. Among those over 60 years old about 10% of males and 18% of females are affected. Before 45 years of age it is more common in men, while after 45 years of age it is more common in women. It becomes more common in both sexes as people become older.  The most common symptoms are joint pain and stiffness.

Symptoms

Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs. The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips. Joints on one side of the body are often more affected than those on the other. Usually the symptoms come on over years. It can affect work and normal daily activities.

Causes

Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost and the underlying bone becomes affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms, with medical imaging and other tests occasionally used to either support or rule out other problems. In contrast to rheumatoid arthritis, which is primarily an inflammatory condition, in OA, the joints do not typically become hot or red.

Causes include:

  • previous joint injury
  • abnormal joint or limb development
  • inherited factors
  • Risk is greater in those who are overweight
  • Risk is greater in those who have one leg of a different length
  • Risk is greater in those who have jobs that result in high levels of joint stress.

Risk factors

Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of osteoarthritis.

Sources of this stress may include misalignments of bones caused by:

  • congenital or pathogenic causes
  • mechanical injury
  • excess body weight
  • loss of strength in the muscles supporting a joint
  • impairment of peripheral nerves, leading to sudden or uncoordinated movements.

 Exercise, including running in the absence of injury, has not been found to increase the risk. Nor has cracking one's knuckles been found to play a role.

Signs and symptoms

Osteoarthritis most often occurs in the hands (at the ends of the fingers and thumbs), neck, lower back, knees, and hips

The main symptom is:

  • pain
  • loss of ability
  • stiffness.

"Pain" is generally described as a sharp ache or a burning sensation in the associated muscles and tendons, and is typically made worse by prolonged activity and relieved by rest. Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

Stiffness is most common in the morning, and typically lasts less than thirty minutes after beginning daily activities, but may return after periods of inactivity. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid.

OA commonly affects the:

  • hands
  • feet
  • spine
  • The large weight bearing joints, such as the hips and knees
  • In theory, any joint in the body can be affected.

As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain, in part because the cartilage damage in OA is generally painless because cartilage is aneural.

OA is the most common cause of a joint effusion of the knee.

Primary

A number of studies have shown that there is a greater prevalence of the disease among siblings and especially identical twins, indicating a hereditary basis. Although a single factor is not generally sufficient to cause the disease, about half of the variation in susceptibility has been assigned to genetic factors.

The development of OA is correlated with a history of previous joint injury and with obesity, especially with respect to knees. Since the correlation with obesity has been observed not only for knees but also for non-weight bearing joints and the loss of body fat is more closely related to symptom relief than the loss of body weight, it has been suggested that there may be a metabolic link to body fat as opposed to just mechanical loading.

Changes in sex hormone levels may play a role in the development of OA as it is more prevalent among post-menopausal women than among men of the same age.

Secondary

Secondary osteoarthritis (due to an old injury with fracture) of the ankle in a woman of 82 years old

This type of osteoarthritis is caused by other factors but the resulting pathology is the same as for primary osteoarthritis:

  • Alkaptonuria
  • Congenital disorders of joints
  • Diabetes doubles the risk of having a joint replacement due to OA and people with diabetes have joint replacements at a younger age than those without diabetes.
  • Ehlers-Danlos Syndrome
  • Hemochromatosis and Wilson's disease
  • Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g., costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
  • Injury to joints or ligaments (such as the ACL), as a result of an accident or orthopedic operations.
  • Ligamentous deterioration or instability may be a factor.
  • Marfan syndrome
  • Obesity
  • Joint infection
  • Pathophysiology

While OA is a degenerative joint disease that may cause gross cartilage loss and morphological damage to other joint tissues, more subtle biochemical changes occur in the earliest stages of OA progression. The water content of healthy cartilage is finely balanced by compressive force driving water out and hydrostatic and osmotic pressure drawing water in. Collagen fibres exert the compressive force, whereas the Gibbs–Donnan effect and cartilage proteoglycans create osmotic pressure which tends to draw water in.

However, during onset of OA, the collagen matrix becomes more disorganized and there is a decrease in proteoglycan content within cartilage. The breakdown of collagen fibers results in a net increase in water content. This increase occurs because whilst there is an overall loss of proteoglycans (and thus a decreased osmotic pull), it is outweighed by a loss of collagen. Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the synovium (joint cavity lining) and the surrounding joint capsule can also occur, though often mild (compared to the synovial inflammation that occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them.

Other structures within the joint can also be affected. The ligaments within the joint become thickened and fibrotic and the menisci can become damaged and wear away. Menisci can be completely absent by the time a person undergoes a joint replacement. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces in the absence of the menisci. The subchondral bone volume increases and becomes less mineralized (hypomineralization). All these changes can cause problems functioning. The pain in an osteoarthritic joint has been related to thickened synovium and subchondral bone lesions.

Diagnosis

Diagnosis is made with reasonable certainty based on history and clinical examination. X-rays may confirm the diagnosis. The typical changes seen on X-ray include: joint space narrowing, subchondral sclerosis (increased bone formation around the joint), subchondral cyst formation, and osteophytes.

Treatment

Treatment includes:

  • exercise
  • efforts to decrease joint stress
  • support groups
  • pain medications
  • Efforts to decrease joint stress include resting and the use of a cane.
  • Weight loss may help in those who are overweight.
  • Pain medications. Contact your Doctor
  • Joint replacement surgery may help. An artificial joint, however, only lasts a limited amount of time. Outcomes for most people with osteoarthritis are good.

Rheumatoid Arthritis (RA)

Introduction

Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is triggered by a faulty immune system (the body’s defense system) and affects the wrist and small joints of the hand, including the knuckles and the middle joints of the fingers.

People have long feared rheumatoid arthritis as one of the most disabling types of arthritis. The good news is that the outlook has greatly improved for many people with newly diagnosed (detected) RA. It still however remains a serious disease, and one that can vary widely in symptoms and outcomes. Even so, treatment advances have made it possible to stop or at least slow the progression of joint damage. Rheumatologists now have many new treatments that target the inflammation that RA causes. They also understand better when and how to use treatments to get the best effects.

Treatment

Treatments have improved greatly and help many of those affected. For most people with RA, early treatment can control joint pain, swelling, and lessen joint damage.

Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active life. They also are less likely to have the type of joint damage that leads to joint replacement.

Low-impact aerobic exercises, such as walking, and exercises can boost muscle strength & will improve your overall health and reduce pressure on your joints.

Expert advice is vital to make an early diagnosis of RA and to rule out diseases that mimic RA, thus avoiding unneeded tests and treatments. Rheumatologists are experts in RA and can design a customized treatment plan that is best suited for you.

Septic Arthritis

Septic arthritis is also known as infectious arthritis, and is usually caused by bacteria, or fungus. The condition is an inflammation of a joint that's caused by infection. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Less frequently, septic arthritis can affect multiple joints.

Causes

Septic arthritis usually is caused by bacteria that spread through the blood stream from another area of the body. It can also be caused by a bacterial infection from an open wound or an opening from a surgical procedure, such as knee surgery.

In adults and children, common bacteria that cause acute septic arthritis include Haemophilus influenza, staphylococcus, and streptococcus. These foreign invaders enter the bloodstream and infect the joint, causing inflammation and pain.

Other infections, such as those caused by viruses and fungi, can also cause arthritis. Viruses include:

  • Hepatitis A, B, and C
  • Parvovirus B19
  • Herpes viruses
  • HIV (AIDS virus)
  • HTLV-1
  • Adenovirus
  • Coxsackie viruses
  • Mumps

Fungi that can cause arthritis include histoplasma, coccidiomyces, and blastomyces. These infections are usually lslower to develop than bacterial infections.

Who's at Risk?

Young children and elderly adults are most likely to develop septic arthritis. People with open wounds are also at a higher risk for septic arthritis. In addition, people with a weakened immune system and those with pre-existing conditions such as cancer, diabetes, intravenous drug abuse, and immune deficiency disorders have a higher risk of septic arthritis. In addition, previously damaged joints have an increased likelihood of becoming infected.

Symptoms

Symptoms of septic arthritis usually come on rapidly with intense pain, joint swelling, and fever. Septic arthritis symptoms may include:

  • Chills
  • Fatigue and generalized weakness
  • Fever
  • Inability to move the limb with the infected joint
  • Severe pain in the affected joint, especially with movement
  • Swelling (increased fluid within the joint)
  • Warmth (the joint is red and warm to touch because of increased blood flow)

Diagnoses

A procedure called arthrocentesis is commonly used to make an accurate diagnosis of septic arthritis. This procedure involves a surgical puncture of the joint to draw a sample of the joint fluid, known as synovial fluid. Normally, this fluid is sterile and acts as a lubricant.

Psoriatic Arthritis

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling.

Symptoms

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.

Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.

However, psoriatic arthritis is more likely to also cause:

  • Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
  • Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
  • Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).

When to see a doctor

If you have psoriasis, be sure to tell your doctor if you develop joint pain. Psoriatic arthritis can come on suddenly or develop slowly, but in either case it can severely damage your joints if left untreated.

Causes

Psoriatic arthritis occurs when your body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.

It's not entirely clear why the immune system turns on healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Risk factors

Several factors can increase your risk of psoriatic arthritis, including:

  • Psoriasis. Having psoriasis is the single greatest risk factor for developing psoriatic arthritis. People who have psoriasis lesions on their nails are especially likely to develop psoriatic arthritis.
  • Your family history. Many people with psoriatic arthritis have a parent or a sibling with the disease.
  • Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.

Complications

A small percentage of people with psoriatic arthritis develop arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in your hands, especially the fingers, leading to permanent deformity and disability.

Autoimmune Diseases

Autoimmune Diseases are a broad range of related diseases in which a person's immune system produces an inappropriate response against its own cells, tissues and/or organs, resulting in inflammation and damage. There are over 80 different autoimmune diseases, and these range from common to very rare diseases.

An autoimmune disease develops when your immune system, which defends your body against disease, decides your healthy cells are foreign. As a result, your immune system attacks healthy cells. Depending on the type, an autoimmune disease can affect one or many different types of body tissue. It can also cause abnormal organ growth and changes in organ function.

There are as many as 80 types of autoimmune diseases. Many of them have similar symptoms, which makes them very difficult to diagnose. It’s also possible to have more than one at the same time. Autoimmune diseases usually fluctuate between periods of remission (little or no symptoms) and flare-ups (worsening symptoms). Currently, treatment for autoimmune diseases focuses on relieving symptoms because there is no curative therapy.

Autoimmune diseases often run in families, and 75 percent of those affected are women,

Most Common Autoimmune Diseases

The following are some of the more common autoimmune diseases:

  • rheumatoid arthritis: inflammation of joints and surrounding tissues
  • systemic lupus erythematosus: affects skin, joints, kidneys, brain, and other organs
  • celiac sprue disease: a reaction to gluten (found in wheat, rye, and barley) that causes damage to the lining of the small intestine
  • pernicious anemia: decrease in red blood cells caused by inability to absorb vitamin B-12
  • vitiligo: white patches on the skin caused by loss of pigment
  • scleroderma: a connective tissue disease that causes changes in skin, blood vessels, muscles, and internal organs
  • psoriasis: a skin condition that causes redness and irritation as well as thick, flaky, silver-white patches
  • inflammatory bowel diseases: a group of inflammatory diseases of the colon and small intestine
  • Hashimoto’s disease: inflammation of the thyroid gland
  • Addison’s disease: adrenal hormone insufficiency
  • Graves’ disease: overactive thyroid gland
  • reactive arthritis: inflammation of joints, urethra, and eyes; may cause sores on the skin and mucus membranes
  • Sjögren’s syndrome: destroys the glands that produce tears and saliva causing dry eyes and mouth; may affect kidneys and lungs
  • type 1 diabetes: destruction of insulin producing cells in the pancreas

Causes

The cause of autoimmune disease is unknown. There are many theories about what triggers autoimmune diseases, including:

  • bacteria or virus
  • drugs
  • chemical irritants
  • environmental irritants

Also, you may be more susceptible to developing an autoimmune disease if you have a family member with one.

Symptoms

Because there are so many different types of autoimmune disease, the symptoms vary. However, common symptoms are fatigue, fever, and generally feeling ill. Symptoms worsen during flare-ups and lessen during remission.

Autoimmune diseases affect many parts of the body. The most common organs and tissue affected are:

  • joints
  • muscles
  • skin
  • red blood cells
  • blood vessels
  • connective tissue
  • endocrine glands

Diagnoses

Ordinarily, your immune system produces antibodies (proteins that recognize and destroy specific substances) against harmful invaders in your body. These invaders include:

  • viruses
  • bacteria
  • parasites
  • fungi

When you have an autoimmune disease, your body produces antibodies against some of your own tissues. Diagnosing an autoimmune disease involves identifying the antibodies your body is producing.

The following tests are used to diagnose an autoimmune disease:

  • autoantibody tests: any of several tests that look for specific antibodies to your own tissues
  • antinuclear antibody tests: a type of autoantibody test that looks for antinuclear antibodies, which attack the nuclei of cells in your body.
  • complete blood count: measures the numbers of red and white cells in your blood; when your immune system is actively fighting something, these numbers will vary from the normal
  • C-reactive protein (CRP): elevated CRP is an indication of inflammation throughout your body
  • erythrocyte sedimentation rate: this test indirectly measures how much inflammation is in your body

Treatment 

Autoimmune diseases are chronic conditions with no cure. Treatment involves attempts to control the process of the disease and to decrease the symptoms, especially during flare-ups. The following is a list of things you can do to alleviate the symptoms of an autoimmune disease:

  • eat a balanced and healthy diet
  • exercise regularly
  • get plenty of rest
  • take vitamin supplements
  • decrease stress
  • limit sun exposure
  • avoid any known triggers of flare-ups

Medical interventions include:

  • hormone replacement therapy, if necessary
  • blood transfusions, if blood is affected
  • anti-inflammatory medication, if joints are affected
  • pain medication
  • immunosuppressive medication
  • physical therapy

The following alternative therapies have provided relief for some people:

  • herbs
  • chiropractic therapy
  • acupuncture
  • hypnosis

References

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