Arthritis

Introduction

Arthritis is an inflammatory condition, characterized commonly by aching, pain, swelling, and stiffness in one or more joints of your body. The symptoms of arthritis may develop suddenly or over time. Even though, the term ‘arthritis’ means ‘inflammation of the joints’, it also encompasses 200 different forms that affect joints and other connective tissues. Arthritis is usually common in the elderly people, aged 65 years. But, it can also occur in children and young people.

Arthritis is also considered as one of the major causes of work disability. According to a research article, published by the IOS press, more than 5% of all employment globally, which is approx. 9.8 million of people, between the age group of 18-64 years, experience some limitations in their work due to arthritis. Apart from it, it also limits the range of mobility, impacting the normal activities of daily life hugely.

There are many forms of arthritis, but the most common is Osteoarthritis. The other common types are rheumatoid arthritis, gout, and fibromyalgia.

  • Osteoarthritis: It affects millions of people across the globe. It occurs due to the wearing of the protective cartilage on the ends of the bone. Most patients develop osteoarthritis over time.
  • Rheumatoid Arthritis: It is progressive arthritis that causes joint inflammation, resulting in painful deformity and limits the mobility.
  • Gout: It is a condition that occurs as a result of defective metabolism of uric acid, which in turn, causes arthritis.
  • Fibromyalgia: It is rheumatic disease, characterized mainly by the muscle stiffness and pain. Usually, it occurs in a specific place and causes localized tenderness in the area.
  • Arthritis can effect important joints in several ways
    Diagram showing different between Osteoarthritis and Rheumatoid Arthritis

    Causes of Arthritis

    Arthritis can occur due to various reasons:
  • Cartilage is a protective layer of the joints which allows them to move smoothly. It is a flexible type of connective tissue that absorbs the shock and pressure produced by the activities like walking, running, jumping, etc. So, one may have arthritis symptoms when the cartilage decreases from its normal amount.
  • Arthritis also occurs due to the natural wear and tear of the cartilage tissue, which is common in osteoarthritis. The damage can be aggravated further by an infection or joint injury.
  • Arthritis can occur due to the attack of the body’s own immune system on the tissues. For instance, the immune system affects the synovial fluids in rheumatoid arthritis. The synovial fluids, which are found in the joints, nourishes and lubricates the joints. Depletion of synovial fluids leads to the damage of the bone and the cartilage. The exact cause of the immune system attack is not yet understood, but it is believed that some genetic factors can put you at greater risk of rheumatoid arthritis.
  • Arthritis impact on the palm and knee

    Symptoms of Arthritis

    The most common symptoms of any types of arthritis are:
  • Pain
  • Rigidity (stiffness)
  • Swelling
  • Redness
  • Decreased range of motion
  • Risk Factors of Arthritis

    The common factors which can increase the risk of developing arthritis are:
    Non-modifiable Risk Factors:
  • Age: Age is a major factor which can increase the risk of catching any type of arthritis.
  • Family history: If any of your family members has a history of arthritis like your parents or siblings, then you are at greater risk of developing arthritis.
  • Sex: Women are more likely to have arthritis than men. On the contrary, the majority of the gout arthritis are seen in men.
  • Modifiable Risk Factors:
  • Previous joint injury: People who experienced a joint injury in the past, are more likely to develop arthritis in that joint.
  • Obesity: Carrying excess weight puts stress on the joints, especially the knees, hips, and spine. So, obese people have a higher risk of developing arthritis.
  • Infection: A number of microbial agents can infect joints and can cause the development of arthritis.
  • Occupation: Occupation or work-related movements like repetitive knee bending or squatting can also trigger the disease.
  • Diagnosis of arthritis

    Diagnosis

    Investigations are done to establish the pathological diagnosis.
  • An antero-posterior and lateral view x-rays of the joint are taken.
  • Other appropriate blood tests like RBC, Hb, PCV, WBC total and differential count, ESR and VDRL are done. Occasionally, aspiration of the joint and examination of the fluid is necessary for the diagnostic pfNon-pharmacologic treatmenturpose.
  • Arthroscopy is a modern procedure which helps directly visualize the synovium and the articular cartilage, and also to perform a biopsy.
  • MRI (Magnetic resonance imaging): Combining radio waves with a strong magnetic field, MRI can produce more detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments.
  • CT SCAN (Computerized tomography): CT scan helps to view the structure from different angles, and also helps provide cross-sectional views of the internal structures. CT is good to visualize both the bone and the other surrounding soft tissues.
  • Ultrasound: This technology uses high-frequency sound waves to create images of the soft tissues, cartilage, and the fluid-containing structures such as bursa. Ultrasound is also used as a guide in needle placement for the joint aspirations and injections.
  • Treatment of Arthritis

    There are a number of treatment options available for arthritis, whether it is inflammatory, non-inflammatory or a gout arthritis. The prime focus of the arthritis treatment is to decrease the intensity of the pain and improve the quality of life. According to the American College of Rheumatology, arthritis treatment should involve following steps.

  • Medication
  • Non-pharmacologic treatment
  • Physical therapy
  • Splints and joints assistive aids
  • Patient education and support
  • Weight loss
  • Surgery
  • Medication:

  • For non-inflammatory arthritis: Non-inflammatory arthritis like osteoarthritis is treated with painkillers. In addition, physical exercise and weight loss are also important to manage the problem.
  • For inflammatory arthritis: Inflammatory arthritis like rheumatoid arthritis is managed by anti-inflammatory (NSAIDs) drugs. Some latest inventions like disease-modifying antirheumatic drugs and biologics are also proven to be effective for such arthritis.
  • Some topical medication: Creams and ointments containing menthol or Capsaicin.
  • Corticosteroids: It includes cortisone and prednisolone. It is effective in reducing the inflammation and inhibit the immune system.
  • Hyaluronic acid therapy: It is used in the form of injection. It is beneficial for mild to moderate osteoarthritis. It helps in reducing pain and improving the range of motion.
  • Self-management of arthritis

    Along with the medications/drugs, one should control arthritis by taking care of the following steps:
  • Be active, do regular exercise
  • Maintain a proper weight
  • Visit your doctor
  • Be careful about your joints health
  • Learn strategies for arthritis management
  • Eat a nutritious, balanced diet
  • Improve your sleep pattern
  • Stay organized
  • Joint-friendly physical activity:

    The patients with arthritis should get involved in some joint-friendly activities, which are not only effective for arthritis, but also for the cardiac health. A few of them are:
  • Swimming
  • Brisk walking
  • Riding a bike
  • Surgery:

    When your pain or damage is very severe, and conservative treatments are not working anymore, your health care provider may recommend fsurgery to improve the symptoms and restore the mobility. Some of the popular surgical procedures used in arthritis are:

    Joint Replacement (Arthroplasty)

    Arthroplasty or joint replacement is the best option when you do not have the other choice. In this procedure, the surgeon will replace the damaged cartilage or bone with a plastic or metallic graft. The graft can also be taken from the other body part. Depending upon the condition, it can be partial or total joint replacement.

    Arthroscopy:

    With the help of this procedure, your surgeon can have a view of the joint. During the procedure, the surgeon will make a small incision, and insert a lighted tube along with a very small surgical instrument. Then, through this small cut, the surgeon removes out the damaged bone pieces, cartilage from the joint, swollen tissues, and smoothens the bone spurs or rough surfaces.

    Joint fusion

    Joint fusion is a procedure which is preferred when joint replacement fails. In this procedure, the joint is removed from the ends of the two bones, which connects them. The joints are then replaced with a screw, pins or plates to hold bones together. Gradually, the bones are fused with each other.

    Osteotomy

    Osteotomy is also known as joint reserving surgery. It is usually performed in younger patients with osteoarthritis. In this technique, a section or part of the bone is cut. The procedure is very effective in improving the joint stability and alignment.

    Cortisone injections:

    Corticosteroid injections can relieve joint pain. During this procedure, your doctor numbs the area around the joint, and then places a needle into space inside the joint and injects the medication. The number of cortisone injections can receive each year is limited because the drug can worsen joint damage over time.

    Cartilage graft:

    Normal healthy cartilage tissue can be taken from another part of the knee or a tissue bank to re-attach the articular cartilage of the knee. This procedure is usually considered for younger patients with small areas of cartilage damage.

    Uni-compartmental knee replacement:

    About 30 percent of people with osteoarthritis of the knee have a disease that is restricted to a joint area. In these cases, uni-compartmental knee replacement (also called partial knee replacement) can provide the same function and improvement as total knee replacement, but with less trauma and better range of motion.

    Physiotherapy

    Arthritis of the knee is a degenerative disease. Physiotherapy treatment is to improve symptoms of the disease (i.e., knee pain, swelling, stiffness). With physiotherapy, one may start noticing a positive difference in one or a few sessions of physiotherapy.

    Physiotherapy can help delay serious symptoms

    The main objectives of physiotherapy for knee arthritis are:

  • Reduce knee pain and inflammation.
  • Normalize knee range of joint motion.
  • Strengthen the knee quadriceps esp (esp VMO) and the hamstrings.
  • Strengthen your lower extremity: calf muscles, hip and pelvis.
  • Improve your patella-femoral (kneecap) alignment and function.
  • Normalize muscle lengths.
  • Improve your proprioception, agility and balance.
  • Improve your technique and function such as walking, squatting.
  • The knee braces and assistive devices

    Your physiotherapist may recommend you to use a knee brace to support and help to de-load certain structures. There are many different styles of knee braces available. It is important to find the perfect one that suits your needs. You can take help from your expert in choosing that.

    Assistive Devices

    Assistive devices can help you in function and mobility. It includes canes, walkers, splints, orthopedic shoes, etc. But some elements such as knee braces and wedges shoes should be prescribed by a doctor and also should be equipped with a physical or occupational therapist.

    Physiotherapy for relieving Osteoarthritis

    Exercises

    People with Osteoarthritis should do different kinds of exercise for different benefits to the body.

    Quadriceps Setting

    This exercise helps strengthen the quadriceps (the large muscle on the front of the thigh), which is an important stabilizer of the knee.

    Lie on your back with your leg that you wish to exercise, straight. Place a small rolled towel under the knee. Slowly squeeze the muscle at the top of the thighs (quadriceps) and push the back of the knee down on the rolled towel. Hold the contraction for 5 seconds and then release slowly; resting 5 seconds between each contraction. Perform 4 sets of 10 repetitions, 1 time a day.

    Straight leg raise

    This exercise also helps to strengthen the quadriceps muscle.

    Lie on your back with your leg straight that you wish to exercise. The other knee must bow to support your lower back. Tighten the muscle at the top of your thigh and lift the level of the other knee. Then lower it slowly. Perform 5 sets of 10 repetitions, 1 time a day.

    Hamstring Stretch

    When you have osteoarthritis of the knee, hamstrings (the muscles that run along the back of the thigh to knee) tend to be tight. This exercise helps to stretch the hamstring muscles, improve range of motion of the knee and helps you feel more flexible.

    Lie on your back with the leg straight, with a strap around the bottom of your foot. With the help of the belt support, raise the leg until you feel a gentle stretch in the back of the knee and thigh. Hold for up to 30 seconds. Then lower it slowly. Repeat it 5 times and 1 time a day.

    Gluteal Strengthening

    This exercise will help strengthen the muscles of the buttocks (the large muscles in the back of the hip), control trunk, and also improve the stability and balance of the legs while standing up and walking.

    Lie face down with your hips over a pillow to support your back. Keep the leg to be exercised straight, squeeze the gluteus and lift your leg slightly off the bed. Lower it slowly. Perform 4 sets of 10 repetitions, 1 time a day.

    Calf Stretch

    This exercise will help your leg and ankle remain flexible, and help to improve balance and gait.

    Stand to face a wall with the leg extended behind you and the other leg in front. Place your hands or forearms on the wall for support. Slowly bend the knee, keeping the heel of the back leg on the ground. Once you feel a stretch in the calf muscles of the back of the ankle, hold for 30 seconds. Slowly relax. 5 reps 1 time per day.

    Conclusion

    Living with arthritis can be quite frustrating due to its impact on daily activities. Arthritis affects a large population but can be managed well by utilizing various treatment modalities. A proper management of arthritis can help in delaying a serious damage to your joints and also help you enjoy a better quality of life than otherwise.