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Arthritis is not a single condition, but rather a group of conditions that affect the health of the bone joints in the body. These disorders are called arthritic diseases.


They include:

  • rheumatoid arthritis and psoriatic arthritis, which are autoimmune diseases
  • septic arthritis, caused by the joint infection
  • osteoarthritis, or degenerative joint disease

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There are several possible causes of arthritis and it is proven that it can be
caused by strains and injuries coming from the repetitive motions, sports, overexertion, and falls. Beside the pain that can be provoked by a single move, arthritic joints can be sensitive to weather changes. The increased sensitivity is thought to be caused by the affected joints developing extra nerve endings in an attempt to protect the joint from further damage. Arthritis limits everyday activities such as walking, dressing and bathing for more than 7 million Americans.

Incidence

Osteoarthritis is one of the most common medical conditions. About 43 million Americans have arthritis or other rheumatic conditions. Arthritis is actually the leading cause of disability in the United States, limiting the activities of more than 16 million adults. Arthritis results in 39 million physician visits and more than a half million hospitalizations each year. Women are affected by osteoarthritis slightly more often than are men.

Types of arthritis

Osteoarthritis
It represents a specific degenerative joint disease in which the cartilage that covers the ends of the bones in the joint is being damaged, causing pain and the loss of movement as the bones begins to rub against each other. This is the most common type of arthritis.

Rheumatoid arthritis
Unlike the previous type, this is an autoimmune disease in which the joint lining becomes inflamed as the part of the body’s immune system activity.

Gout
This is a very common condition which mostly affects men. It is usually the result of a defect in body chemistry and it can be very painful. In most cases, it attacks the small joints, especially the big toe.

Ankylosing spondylitis
This is a type of arthritis that affects the spine and most experts believe it could be the result of inflammation which has got complicated because the bones of the spine grew together.
 
Juvenile arthritis
This is nothing more then a general term for all types of arthritis that occur in children. Children may develop juvenile rheumatoid arthritis or childhood forms of lupus, ankylosing spondylitis or other types of arthritis.

Systemic lupus erythematosus
This is a rather serious autoimmune disorder that can inflame and damage joints and other connective tissues throughout the body.

Scleroderma
This is a famous disease of the connective tissue that causes a thickening and hardening of the skin.

Fibromyalgia
Fibromyalgia is a serious condition characterized by the widespread pain which affects the muscles and attachments to the bone.

Pathophysiology of arthritis

A tissue called cartilage cushions the insides of a joint and prevents the bones from rubbing against each other. Osteoarthritis occurs when the cartilage of a joint erodes or breaks down. The bones begin to rub against each other, causing pain and difficulty when moving the joint. Osteoarthritis can also affect the nearby bones, which can become enlarged in some spots. These enlargements are called bone spurs or osteophytes. Many patients that the medical term which ends in “itis” always reffers to inflammation. While this is the truth and the term arthritis means joint inflammation, there is relatively little inflammation in the joints of most people with osteoarthritis. That’s why many experts and health care professionals prefer to call it degenerative joint disease.

Symptoms of osteoarthritis

The most common and most important sign of arthritis is pain in the joints. Because the osteoarthritis can range from mild to severe, the pain associated with it can also be ranging from mild to severe and it is usually made worse by movement.

Osteoarthritis can affect almost every joint in the body. There are some rules about the pain distribution: Osteoarthritis can be limited to one joint or start in one joint, usually the knee, hip, hand, foot or spine, or it can involve a number of joints. 

The most common symptoms include:

  • Joint pain and swelling after an activity or in response to a change of weather
  • Limited flexibility, especially after not moving for a while
  • Bony lumps at the end of the fingers
  • A grinding sensation when the joint is moved
  • Numbness or tingling in an arm or a leg

Causes and risk factors of arthritis

Although arthritis certainly isn’t caused by a single factor experts are still not sure about the causes of this disorder.

Age
Age is definitely a leading risk factor. This is because osteoarthritis usually occurs as people get older.
 
Hormones
People with diabetes may be prone to osteoarthritis. Other endocrine problems including acromegaly, hypothyroidism, hyperparathyroidism, and obesity may also promote its’ development.

Sport related injuries
There is no doubt that some sports-related injuries caused by the repeated movements may increase the risk of developing osteoarthritis.

Genetics
Genetics also plays a role. Abnormal anatomy such as unequal leg length may be the cause of osteoarthritis. If both parents have this condition, there is a great chance that the child will also develop it.

There are some other factors that can increase the risk of osteoarthritis. Some of the most common are:

  • Joint infection
  • Repeated episodes of gout in which uric acid or calcium crystals in the joint cause episodes of inflammation
  • Non- vascular necrosis, a condition in which the blood supply to the bone near the joint is interrupted, leading to bone death and eventually joint damage.
  • Repeated episodes of bleeding into the joint, as may occur in hemophilia or other bleeding disorders
  • Chronic inflammation caused by previous rheumatic illness, such as rheumatoid arthritis
  • Osteoporosis, which can increase the risk of bone fractures, sometimes leading to osteoarthritis if the fracture is near a joint
  • Metabolic disorders, such as hemochromatosis, in which a genetic abnormality leads to too much iron in the joints and other parts of the body

Diagnosis of arthritis

There are several ways to diagnose arthritis and some of the most common are:

Imaging studies

X-ray
X-ray can show narrowing of the space between the joint, osteophytes, cyst formation, and hardening of the underlying bone.

MRI
This is a very effective and noninvasive imaging technique that doesn’t use radiation like X-rays. It is capable of visualizing all the structures within the joint.
 
CT scan
CT scanning mainly provides information on the bony structures of the joint but in greater detail than plain x-rays.

Joint fluid analysis

A specific fluid may be drawn from the knee with a needle in cases in which the diagnosis is uncertain or if an infection is suspected.

Treatment of arthritis

The overall goals of the treatment are:

  • early elimination of risk factors,
  • early diagnosis and surveillance of the disease,
  • appropriate treatment of pain


Medications


Because the treatment isn’t complicated and it should start with some simple over-the-counter pain relievers followed by NSAIDs.
Some of the most commonly used prescription NSAIDs are the COX-2 medicines.

Self-care at home

Weight loss
Most of the experts agree that it is recommended, especially for women, to loose some weight. Weight loss may reduce the risk for osteoarthritis in the knees.

Exercise
Regular exercise may help strengthen the muscles and potentially stimulate cartilage growth. However, high-impact sports should be avoided. 

Diet
Several studies have proven that antioxidant vitamins C and E may provide some protection. Vitamin D and calcium are recommended for strong bones. The recommended daily dose of calcium is 1000-1200 mg. The current guideline for vitamin D is 400 IU per day.

Heat
Many patients say that a simple hot soak and warm wax application may relieve the pain.

Surgery

Several surgical options are available to relieve the pain and improve the function of the joint.

Arthroscopy is the examination of the inside of a joint using a small camera (endoscope).

Arthroplasty is the repair of a joint in which the joint surfaces are replaced with artificial materials.

Chondroplasty is a surgical repair of the cartilage.

Arthrodesis is a very good and effective procedure. It represents a surgical fusion of the bony ends of a joint which prevents the joint movement. The procedure is performed to help block further pain by preventing any further joint movement.

Joint replacement is the last possible option if all other methods have shown to be ineffective. The diseased or damaged bony ends are being removed and replaced with a manmade joint composed of a combination of metal and plastic. Knee joint replacement and hip replacement are the most common ones.

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