Arthritis

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body's natural response to injury. The warning signs that inflammation is present are redness, swelling, heat and pain.

The cartilage is a specialised connective tissue that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of bones rubbing on each other.

There are many different types of rheumatic diseases. The most common are:

Osteoarthritis: Osteoarthritis is also called as degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called an osteophyte or “bone spur”.

Osteoarthritis causes joint pain and can limit a person's normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, Knees, and Hips.

Rheumatoid Arthritis: This is an auto-immune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.

Rheumatoid Arthritis commonly affects joints of the hands and feet and is often symmetrical. This means the disease affects the same joints on both sides of the body (both the hands or both feet) at the same time and with the same symptoms. About two to three times as many women as men have this disease.

Post-traumatic arthritis: Arthritis developing following an injury is called post-traumatic arthritis. The condition may develop years after trauma such as a fracture, severe sprain, or ligament tears.

Psoriatic arthritis: This form of Arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved. Hips and knees are also commonly affected.

Causes of arthritis

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Rheumatoid arthritis is often caused when the genes responsible for the disease is triggered by infection or any environmental factors. With this trigger, the body produces antibodies, usually these are the body’s defence mechanism, however in this situation, the antibodies are directed against the body’s joints resulting in a painful inflammatory arthritis.

Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. It is considered that your body secretes certain hormones following injury which may cause death of the cartilage cells.

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.

Symptoms of arthritis

There are many different forms of arthritis. Symptoms vary depending on the exact variety of arthritis you suffer from. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

Diagnosis

Doctors diagnose arthritis with a medical history, physical exam and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to help diagnose arthritis.

Treatment Options

There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicines and pain killers to help you cope with your symptom. You may be recommended occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested. The type of surgery will depend on your age, the severity of the disease and the location of the arthritis. In the elderly with severe arthritis, joint replacement can give good results.

Initial treatment for arthritis is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms, a cane or braces may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted, offer no relief, and when pain has become disabling, surgery may be recommended. Surgery is usually considered if nonsurgical treatment fails to give relief resulting in sleeping changes. There are different surgical procedures that can be used and may include:

Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.

Arthroplasty: In this procedure, your surgeon removes the affected joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis.  The goal of the surgery is to relieve pain and restore the normal functioning of the joint. Total joint replacement can be performed through an open or minimally invasive approach.

Arthrodesis: A fusion, also called an arthrodesis involves removal of the cartilage from the joint and joining the bones of the joint together using metal wires, screws, plates or nails. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, when heavy manual use is expected or when there has been a failed previous arthroplasty.

Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.