Arthritis : Osteoarthritis & Rheumatoid Arthritis


Arthritis (arthro = joint, itis = inflammation) is a inflammatory disease characterized by swelling, stiffness and pain in the one or more joints in the body. Specific symptoms vary depending on the type of arthritis, but usually include joint pain, swelling, stiffness, redness, warmth and decreased range of motion of the affected joints. Arthritis can involve almost any part of the body, most often affecting the hip, knee, spine or other weight-bearing joints, but also found in the fingers and other non-weight-bearing joints. Some forms of arthritis can also affect other parts of the body. Arthritis is a chronic condition: it affects people on an ongoing, constant or recurring basis over months, years, even a lifetime.

Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. In the United States a CDC survey based on data from 2007–2009 showed 22.2% (49.9 million) of adults aged ≥18 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number is expected to increase.

Rheumatoid Arthritis is a chronic systemic disease that affects the joints, connective tissues, muscle, tendons, and fibrous tissue. It tends to strike during the most productive years of adulthood, between the ages of 20 and 40 years and is a chronic disabling condition often causing pain and deformity. The prevalence varies between 0.3% and 1% and is more common in women and in developed countries. Within 10 years on onset, at least 50% of patients in developed countries are unable to hold down a full-time job.

Osteoarthritis is a degenerative joint disease, which mainly affects the articular cartilage. It is associated with ageing and will most likely affect the joints that have been continually stressed throughout the years including the knees, hips, fingers, and lower spine region. Osteoarthritis is already one of the ten most disabling diseases in developed countries. Farming 1-9 years increases the risk of osteoarthritis 4.5 times; farming 10 or more years increases the risk 9.3 times. Worldwide estimates are that 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis. 80% of those with osteoarthritis will have limitations in movement, and 25% cannot perform their major daily activities of life.

There are over 100 types of arthritis. The most common forms are Osteoarthritis (degenerative joint disease), Inflammatory arthritis, and rheumatoid arthritis. Osteoarthritis usually occurs with age and affects the fingers, knees, and hips. Inflammatory forms of arthritis are different from osteoarthritis, in that the source of joint damage is from inflammation.

Most forms of IA are also autoimmune diseases, where the immune system, mistakenly starts to attack the body’s own healthy tissues. These conditions can result in pain, stiffness, restricted mobility, fatigue and damage to joints and other tissues. If not identified and treated swiftly, these conditions tend to progress more quickly and aggressively than Osteoarthritis. Rheumatoid arthritis is an autoimmune disease that often affects the hands and feet. Other types include gout, lupus, fibromyalgia and septic arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. Treatment may include resting the joint and alternating between applying ice and heat. Weight loss and exercise may also be useful. Pain medications such as ibuprofen and acetaminophen (paracetamol) may be used. In some a joint replacement may be useful.

Sign & Symptoms of Arthritis

Arthritis symptoms can range from mild to severe. Most people with arthritis experience chronic pain, fatigue, restricted mobility, lowered mood and other symptoms that can combine to erode their quality of life. Pain, which can vary in severity, is a common symptom in virtually all types of arthritis. Other symptoms include swelling, joint stiffness and aching around the joints. Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. Symptoms may include:

    • Inability to use the hand or walk.
    • Stiffness, which may be worse in the morning, or after use
    • Malaise and fatigue
    • Weight loss
    • Poor sleep
    • Muscle aches and pains
    • Tenderness
    • Difficulty moving the joint - It is common in advanced arthritis for significant secondary changes to occur. For example, arthritic symptoms might make it difficult for a person to move around and/or exercise, which can lead to secondary effects, such as:
    • Muscle weakness
    • Loss of flexibility
    • Decreased aerobic fitness - These changes, in addition to the primary symptoms, can have a huge impact on quality of life.

Causes of Arthritis

Three main types of arthritis — Osteoarthritis, Inflammatory arthritis and Rheumatoid arthritis; damage joints in different ways.

Osteoarthritis :

Osteoarthritis (OA) is a long-term chronic disease characterized by the deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement. The disease most commonly affects the joints in the knees, hands, feet, and spine and is relatively common in shoulder and hip joints. While OA is related to ageing, it is also associated with a variety of both modifiable and non-modifiable risk factors, including obesity, lack of exercise, genetic predisposition, bone density, occupational injury, trauma, and gender.

Rheumatoid arthritis

In Rheumatoid arthritis, the body's immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining, known as the synovial membrane, becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint.

Inflammatory arthritis :

Inflammatory arthritis are different from osteoarthritis, in that the source of joint damage is from inflammation. Most forms of Inflammatory arthritis are also autoimmune diseases, where the immune system, mistakenly starts to attack the body’s own healthy tissues. These conditions can result in pain, stiffness, restricted mobility, fatigue and damage to joints and other tissues. If not identified and treated swiftly, these conditions tend to progress more quickly and aggressively than Osteoarthritis.

Risk factors of Arthritis

Risk factors for arthritis include:

    • Family history (Genetics and Inherited Traits) : Some types of arthritis run in families, so the person may be more likely to develop arthritis if his/her parents or siblings have the disorder. Genes can make more susceptible to environmental factors that may trigger arthritis. People born with specific genes are more likely to develop certain types of arthritis, such as rheumatoid arthritis (RA), Systemic Lupus Erythematous (SLE), and Ankylosing spondylitis. These genes are called HLA (human leukocyte antigen) class II genotypes. These genes can also make your arthritis worse.
    • Age : The age factor is play a very important role for Arthritis. The risk of many types of arthritis including osteoarthritis, rheumatoid arthritis and gout increases with age factor.
    • Sex : Women are more likely susceptible than men to develop rheumatoid arthritis, while most of the people who have gout, another type of arthritis are more susceptible to men.
    • Previous joint injury : People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
    • Overweight and Obesity : Carrying excess weight puts stress on joints, particularly knees, hips and spine. Obese people have a higher risk of developing arthritis. People who are overweight or obese are more likely to get knee osteoarthritis than people who are not overweight. Excess weight can also make knee osteoarthritis worse.
    • Infection : Many microbial agents, like bacteria and viruses, can infect joints and potentially cause the development of some types of arthritis.
    • Occupation : Occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.
    • Smoking : Smoking increases a person’s risk of developing rheumatoid arthritis and can make the disease worse. Smoking can also make it more difficult to stay physically active, which is an important part of managing RA and other types of arthritis.

Diagnosis of Arthritis :

Diagnosis of arthritis is especially important because the signs and symptoms of arthritis are not specific and can look like signs and symptoms of other inflammatory joint diseases. During the physical exam, Doctor will check the joints for swelling, redness and warmth. Physician will also want to see how well patient can move his/her joints. Depending on the type of arthritis suspected, physician may suggest some of the following tests.

  • Laboratory tests : The analysis of different types of body fluids can help pinpoint the type of arthritis patient may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of the joint fluid (mainly synovial fluid), doctor will cleanse and numb the area before inserting a needle in the joint space to withdraw some fluid (aspiration).
  • Imaging tests : These types of tests can detect problems within the joint that may be causing arthritis symptoms. Examples include:
    • X-rays : Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but they are often used to track progression of the disease.
    • Computerized Tomography (CT) : CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues.
    • Magnetic Resonance Imaging (MRI) : 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.
    • Ultrasound : This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid containing structures such as bursae. Ultrasound also is used to guide needle placement for joint aspirations and injections.

Complications of Arthritis :

Severe arthritis, particularly if it affects patient hands or arms, can make it difficult for patient to do daily tasks. Arthritis of weight-bearing joints can keep patient from walking comfortably or sitting up straight. In some cases, joints may become twisted and deformed.

Complication of Osteoarthritis :

Osteoarthritis is a source of chronic pain that can be exhausting and debilitating. It can also lead to problems with anxiety and depression. According to the Centers for Disease Control and Prevention Trusted Source: Adults with arthritis are about 2.5 times more likely to experience a fall or injury. In addition to causing pain, there are a number of ways in which osteoarthritis can impact your life.

    • Sleep disruption : Achy, tender joints interfere with restful, restorative sleep. Not getting a full night’s sleep can make pain seem intensified. Stiffness and limited range of motion can also keep patient from getting comfortable in bed.
    • Reduced productivity : Many people miss multiple days of work per year because of chronic joint pain. Arthritis can also result in a decreased ability to perform normal everyday activities such as household chores, cooking, getting dressed, exercise and other activities. In general, function can be improved with treatment. However, some people with osteoarthritis may need assistance with simple day-to-day activities.
    • Weight gain : Pain and stiffness can decrease patient desire to be active. Person may stop wanting to participate in activities that used to bring joy. Arthritis may cause a decreased ability to exercise or even walk. The lack of activity doesn’t only limit enjoyment of life; it can cause weight gain. Extra weight may exacerbate osteoarthritis symptoms, as well as lead to an increased risk of other complications, including diabetes, hypertension, heart disease etc.
    • Anxiety and depression : Patients having anxiety & depression with osteoarthritis, finding that the pain of osteoarthritis symptoms negatively affected mental health. More than 40 percent of the patients showed increased anxiety and depression as a result of osteoarthritis symptoms.
    • Other complications : Other complications that can arise from osteoarthritis include:
      • Bone death (osteonecrosis)
      • Stress fractures
      • Bleeding or infection in joints
      • Deterioration of tendons and ligaments around joints
      • Pinched nerve, in osteoarthritis of the spine

Complication of Rheumatoid arthritis :

Rheumatoid arthritis, as an inflammatory autoimmune disease, causes complications in many organ systems and tissues throughout the body including the heart, blood vessels, lungs, bones, eyes, skin, kidneys, salivary glands and nerve tissue etc. The wide range of complications that can arise from rheumatoid arthritis include:

    • Heart disease : Cardiovascular disease is the most common complication of rheumatoid arthritis these are mainly non-joint-related complications of rheumatoid arthritis. The Arthritis Foundation reports that people with RA have twice the risk of most cardiovascular-related problems compared with the general population, including heart attack, strokes and atherosclerosis. The risk of heart failure is also increased.
      The Arthritis Foundation reports that “more than 50 percent of premature deaths in people with rheumatoid arthritis result from cardiovascular disease.” Therefore, “anything can do to reduce cardiac risks of heart attack and stroke,” such as quitting smoking and keeping cholesterol levels normal, exercising and eating right can all reduce the risk of heart disease. It’s also important to note that the cardiovascular disease that develops in people with RA is different from the disease that occurs in people who do not have rheumatoid arthritis, probably because it is the result of the systemic inflammation. It occurs earlier, is more severe and the outlook is worse following an event such as a heart attack or stroke.
    • Lung problems : Rheumatoid arthritis causes inflammation in the body that can lead to scarring within the lungs, lung nodules, pleural disease (inflammation of the tissue surrounding the lungs) & Interstitial lung disease, this complication can lead to breathing problems. Rheumatoid arthritis is also linked with an increased risk of developing Chronic Obstructive Pulmonary Disease (COPD). Using the common autoimmune medication methotrexate may also elevate risk for lung problems.
    • Osteoporosis : Rheumatoid arthritis can cause damage to the bones and the medications commonly used to treat the condition can also have the side effect of osteoporosis (a condition that causes the bones to weaken, become brittle and prone to fracture). Pain and loss of joint function can also lead to inactivity, which increases the risk of osteoporosis even more and also Rheumatoid arthritis itself may cause osteoporosis.
    • Blood vessels : In some patients, especially those who’ve had Rheumatoid arthritis for more than 10 years, a condition called rheumatoid vasculitis can develop in which the blood vessels become inflamed. This serious complication of Rheumatoid arthritis can weaken and narrow blood vessels, causing restricted blood flow that can lead to heart attacks or strokes.
    • Eye problems : Rheumatoid arthritis can cause the eyes to become very dry, and dry eyes are more susceptible to infection. Dry eyes can also be a symptom of Sjogren’s syndrome (an autoimmune disorder that’s often associated with rheumatoid arthritis.” Sjogren’s features dry eyes and decreased saliva production.).
    • Other autoimmune conditions : Patient with Rheumatoid arthritis have a higher risk of developing diseases such as Type 1 Diabetes mellitus, Hashimoto’s thyroiditis, psoriasis, multiple sclerosis and lupus etc. All of these conditions are autoimmune in nature, with the focus of the immune system’s attack falling respectively to the pancreas, the thyroid, the skin, the nervous system and many different organs and tissues. Systemic inflammation is the culprit and it can manifest in many different ways if not controlled adequately.
      Rheumatoid arthritis can also lead to myriad additional complications these are Rheumatoid nodules (these are firm lumps of tissue that can occur throughout the body, including the lungs, although they are most often found around pressure points, such as the elbows.), Infections, Abnormal body composition, Carpal tunnel syndrome, Lymphoma, Sleep difficulties etc.

Treatment of Arthritis :

Arthritis treatment focuses on relieving symptoms and improving joint function. Patient may need to try several different treatments or combinations of treatments.

Medications :

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

    • Analgesics : These medications help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others), tramadol (Ultram, Ultracet, others) and narcotics containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Norco, Vicoprofen, others).
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) : NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB & others) and naproxen sodium (Aleve). Oral NSAIDs can cause stomach irritation and some may increase risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.
    • Counterirritants : Some varieties of creams and ointments contain menthol or capsaicin. Rubbing these preparations on the skin over aching joint may interfere with the transmission of pain signals from the joint itself.
    • Disease-modifying antirheumatic drugs (DMARDs) : Often used to treat rheumatoid arthritis, DMARDs slow or stop patient immune system from attacking joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
    • Biologic response modifiers : Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).
    • Corticosteroids : This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint.

Therapy :

Physiotherapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.

Surgery :

If conservative measures don't help, doctor may suggest surgery, such as:

    • Joint repair : In some instances, joint surfaces can be smoothed or realigned to reduce pain and improve function. These types of procedures can often be performed arthroscopically; through small incisions over the joint.
    • Joint replacement : This procedure removes damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.
    • Joint fusion : This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit.

Alternative medicine :

Many people use alternative remedies for arthritis, but there is little reliable evidence to support the use of many of these products. The most promising alternative remedies for arthritis include:

    • Acupuncture : This therapy uses fine needles inserted at specific points on the skin to reduce many types of pain, including that caused by some types of arthritis.
    • Glucosamine : Although study results have been mixed, it now appears that glucosamine works no better than placebo. However, glucosamine and the placebo both relieved arthritis pain better than taking nothing, particularly in people who have moderate to severe pain.
    • Yoga or Tai-chi : The slow, stretching movements associated with Yoga and tai-chi may help improve joint flexibility and range of motion in people with some types of arthritis.
    • Massage : Light stroking and kneading of muscles may increase blood flow and warm affected joints, temporarily relieving pain. Make sure massage therapist knows which joints are affected by arthritis.

Prevention of Arthritis :

Arthritis is the most common problem in the world, affecting abounded number of people in the developed country as well as developing country. Persons diagnosed with osteoarthritis often worry about the progressive nature of the disease and wonder if they will one day end up needing joint replacement surgery. By making a few, simple changes in life, anyone can greatly avoid these concerns. Here are few simple fixes that may help....

    • Drink plenty of water : Cartilage of the joints works as shock absorbers and osteoarthritis leads to the deterioration of that cartilage. Since this material is made up of 70 percent water, Patient can improve the health of it by always drinking at least 64 oz. (1.9 l) of water per day.
    • Consume superfruits : Superfruits, which mostly refer to deep-colored berries and other richly colored fruits, contain high amounts of antioxidants (substances that protect cells from the effects of free radicals). Free radicals are considered harmful compounds which can damage the cells and possibly cause certain diseases. Many studies have suggested that a high-antioxidant diet lowers the risk of heart disease, cancer and osteoarthritis.
      Coffee, tea and soda may contain water but also act as a diuretic, encouraging body to expel fluids more quickly, before they have had time to adequately hydrate body. Do not replace water with these beverages.
    • Increase amount of calcium intake : Make sure patient have a diet rich in dairy products like milk, cheese and yogurt. If the person are lactose intolerant, supplement diet with non-dairy foods that are rich in calcium, like broccoli, salmon, spinach, black beans, peanuts, almonds, tofu, sardines and sesame seeds.
    • Increase vitamin intake : Vitamins C and D have been shown to support healthy joints. Vitamin D specifically may prevent onset of rheumatoid arthritis. Unfortunately, people who do not get direct sunlight or live in northern climates may be at risk for vitamin D deficiency or insufficiency. Vitamin D helps calcium to be absorbed into the body and bones. Patient can also eat foods rich in vitamin D, like salmon, tuna, fortified orange juice or milk, yogurt, eggs and beef.
      Ask doctor before taking any dietary supplements, overdosing on supplements can put at risk for other ailments. Maintain body weight. Increased weight on the load-bearing joints like knees, ankles and hips makes highly susceptible to osteoarthritis. Luckily, losing weight cuts the risk of arthritis. Studies have shown that obesity also hurts the renewal process cartilage. When damaged cartilage is not replaced quickly enough by new cartilage, it leads to the onset of osteoporosis.
    • Exercise regularly with both cardiovascular and light weightlifting exercises : Not only can exercise reduce body weight, but it keeps muscles strong and joints flexible. A sedentary lifestyle leaves far more susceptible to arthritis as person age.
      Anything else is considered insufficient against protecting against early onset arthritis.
      Choose exercise carefully. Heavy weightlifting and repetitive motions like running can cause undue stress on the joints and increase the likelihood that will get osteoarthritis. Make sure that patients are incorporating low-impact exercise like swimming, biking, elliptical use or Pilates into routine life.
    • Practice yoga or simple stretching : These exercises strengthen the muscles around joints. When these muscles are strong, they lift some of the weight burden from the joint. Stretching also improves and maintains range of motion as person get older.
    • Treat injuries adequately : Repetitive injuries, such as ankle sprains can lead to arthritis in the nearby joints in later years. Make sure patient give the joint time to heal properly and train with a physical therapist after serious injuries.
    • Reduce repetitive motions in your daily life : Work, sports and other activities can often include harmful repetitive motions. These motions can lead to micro trauma in surrounding joint tissue, which can then lead to osteoarthritis.
      Pay attention to biomechanics of the body, such as posture in daily routine. Improper knee bending, squatting, bending over and kneeling can cause the repetitive stress and micro trauma. Sitting still for long periods of time is considered similar to a repetitive motion because it causes more stress on the joints and spine.
    • Quit Smoking : Smoking can weakens bone health and structure. Arthritis patients who quit smoking see an improvement in how many joints that hurt, as well as the level of pain they experience.
    • Avoid excess alcohol consumption : Alcohol consumption habit is similar to smoking as it weakens vitamin absorption and bone structure.

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