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BRAIN ATTACK:

Arthritis: Know Thy Enemy

By Dr. Ashish Jain in Orthopaedics & Joint Replacement

Feb 09 , 2024 | 12 min read

What is Arthritis?

Arthritis is a medical condition characterised by inflammation and stiffness of the joints. Affecting millions of people worldwide, it is a leading cause of disability and can impact individuals of all ages, genders, and backgrounds. As the disorder worsens with age, early diagnosis and management are crucial for mitigating its progression and enhancing the quality of life for affected individuals. Moreover, it is also associated with 120 different diseases that can affect muscles, joints and other tissues. Let’s delve deeper. 

What are the different types of arthritis? 

Arthritis is a broad term used for various types of joint inflammation and conditions, out of which two are the most common. These are:

Osteoarthritis (OA)

Primarily caused by the wear and tear of joints over time, Osteoarthritis (OA) is a degenerative joint disease that commonly occurs as people age. Characterised by the breakdown of cartilage in the joints, leading to pain, stiffness, and reduced mobility, OA is the most prevalent form of arthritis and can affect any joint in the body.

Rheumatoid Arthritis (RA)

RA is an autoimmune disorder, wherein the body's immune system mistakenly attacks the lining of the membranes surrounding the joints (called synovium). It often affects multiple joints at the same time, and besides causing chronic inflammation, pain, joint damage, it can also lead to joint deformity and disability.

Other Types of Arthritis

  • Psoriatic Arthritis: This type of arthritis commonly occurs in people who have the skin condition, psoriasis
  • Ankylosing Spondylitis: Ankylosing spondylitis primarily affects the spine and can cause inflammation and fusion of the vertebrae. It can also involve other joints and cause stiffness and pain.
  • Gout: Gout is characterised by the buildup of uric acid crystals in the joints, leading to sudden and severe pain, swelling, and inflammation, often in the big toe.
  • Juvenile Idiopathic Arthritis (JIA): Juvenile Idiopathic Arthritis (JIA) is a group of arthritis conditions that affect children and adolescents and includes several subtypes, each with distinct characteristics.

What are the Stages of Arthritis?

As the specific stages can vary depending on the type of arthritis, here is a general overview of the stages commonly seen in Osteoarthritis (OA) - the most prevalent form of arthritis:

Stage 1: Normal or Preclinical Stage

In this initial stage, there are no clinical symptoms, and joint function is normal. X-rays may show no visible signs of joint damage. However, underlying changes, such as cartilage thinning or minor injuries, may begin.

Stage 2: Mild Arthritis (Mild Joint Space Narrowing)

In this stage, there may be mild joint discomfort, stiffness, or occasional pain, especially after physical activity. X-rays may reveal minor joint space narrowing or the development of small bone spurs (osteophytes). Early signs of cartilage damage become apparent.

Stage 3: Moderate Arthritis (Moderate Joint Space Narrowing)

This stage is characterised by increased joint pain, stiffness, and reduced joint function. X-rays show moderate joint space narrowing, significant osteophyte formation, and potentially more noticeable cartilage loss. Daily activities may become more challenging.

Stage 4: Severe Arthritis (Severe Joint Space Narrowing)

This is an advanced stage that can significantly affect daily life, and joint deformities, such as bone-on-bone contact, are also common. At this stage, surgical intervention, such as joint replacement surgery, may be considered to restore joint function.

Note: the stages mentioned above primarily pertain to osteoarthritis, while other types of arthritis, like rheumatoid arthritis, may have different patterns and stages of progression.

Read more: Rheumatoid Arthritis: Symptoms, Diagnosis and Treatment

What are the Risk Factors for Arthritis?

While the risk factors for arthritis can vary depending on the specific type of arthritis, several common risk factors can increase the likelihood of developing arthritis. These include:

  • Age: The risk of many types of arthritis, including osteoarthritis, increases with age. Joints naturally wear down over time, making them more susceptible to damage and inflammation.
  • Gender: Some types of arthritis, like rheumatoid arthritis, are more common in women than in men. However, gout is more prevalent in men.
  • Genetics: Family history can play a significant role in arthritis risk. Certain genetic markers may make individuals more susceptible to autoimmune forms of arthritis.
  • Obesity: Excess body weight puts added stress on the joints like the knees and hips, increasing the risk of osteoarthritis.
  • Joint Injuries: Past joint injuries, such as fractures or dislocations, can increase the risk of developing post-traumatic arthritis in the affected joints.
  • Occupational Hazards: Jobs that involve repetitive joint movements, heavy lifting, or fixed postures can increase the risk of arthritis. 
  • Infections: Certain infections, such as those caused by bacteria or viruses, can trigger reactive arthritis in genetically predisposed individuals.
  • Autoimmune Conditions: Individuals with autoimmune diseases, such as lupus or psoriasis, may be at a higher risk of developing forms of arthritis that involve autoimmune processes.
  • Hormonal Factors: Hormonal changes, such as those that occur during pregnancy or menopause, can influence the risk of arthritis, especially in women.
  • Smoking: Smoking is a significant risk factor for rheumatoid arthritis and can contribute to the severity of the disease. It may also increase the risk of other types of arthritis.
  • Diet: Consuming a diet high in purines, found in certain foods and beverages, can increase the risk of gout. Alcohol consumption can also raise the risk of gout.
  • Physical Activity: Lack of regular physical activity can contribute to obesity and joint stiffness, potentially increasing the risk of arthritis.
  • Bone Density: Low bone density, which is common in osteoporosis, may increase the risk of fractures and subsequent post-traumatic arthritis.

It's important to note that while these risk factors can increase the likelihood of developing arthritis, they do not guarantee its development. Many people with one or more risk factors may never develop arthritis, while others without apparent risk factors may develop the condition. 

Read more: Inflammatory Arthritis: Types, Causes and Diagnosis

What are the Signs and Symptoms of Arthritis?

Arthritis symptoms can vary widely depending on the type of arthritis and the specific joints affected. However, some common symptoms of arthritis include:

  • Pain: Persistent or recurrent pain in one or more joints is a hallmark symptom of arthritis. The pain may be dull, aching, or sharp, and it can range from mild to severe.
  • Stiffness: Arthritis often leads to joint stiffness, especially after periods of inactivity, such as waking up in the morning or sitting for an extended period.
  • Swelling: Inflammation of the joint lining (synovium) can lead to visible swelling around the affected joint.
  • Warmth and Redness: In cases of arthritis, inflamed joints may feel warm to the touch and appear red or discoloured.
  • Decreased Range of Motion: Arthritis can limit joint mobility, making it difficult to move the affected joint through its full range of motion.
  • Tenderness: Joints affected by arthritis can become tender to touch, causing discomfort when pressure is applied.
  • Fatigue: Many people with arthritis experience fatigue, which can be both a result of the condition and a response to pain and discomfort.
  • Weakness: Muscles around affected joints may weaken due to reduced use, pain, or inflammation.
  • Morning Stiffness: Arthritis-related morning stiffness often lasts for more than an hour after waking up, making it challenging to start the day.
  • Deformities: Over time, arthritis can lead to joint deformities, particularly in inflammatory types of arthritis. For example, rheumatoid arthritis can cause joint deformities in the hands and feet.
  • Numbness and Tingling: Some forms of arthritis, such as carpal tunnel syndrome associated with rheumatoid arthritis, can lead to numbness and tingling in the affected areas.
  • Systemic Symptoms: In some cases, arthritis can cause systemic symptoms, such as fever, weight loss, and a general sense of feeling unwell. 
  • Skin Changes: Certain types of arthritis, like psoriatic arthritis, may produce symptoms such as ‘psoriasis plaques’ on the skin, appearing as raised, inflamed, and scaly patches.

These symptoms can be mild, moderate or severe. They may stay about the same for years, or may progress or get worse over time. Severe arthritis can result in chronic pain and inability to do daily chores. If someone experiences persistent joint pain, stiffness, or any of the above symptoms, it's advisable to consult an orthopedician as soon as possible.

How is Arthritis Diagnosed?

The diagnosis of arthritis typically involves a combination of medical history, physical examination, laboratory tests, and imaging studies. The specific diagnostic process can vary depending on the type of arthritis suspected. Here's a general overview of how arthritis is diagnosed:

Consideration of Medical History

The doctor begins the diagnosis by taking a detailed medical history, including information about the patient’s symptoms, their onset, and any family history of arthritis or related conditions, to establish a baseline for further evaluation.

Physical Examination

A thorough physical examination is conducted to assess joint function, mobility, and signs of inflammation. The doctor may check for joint tenderness, swelling, warmth, and deformities. This helps identify affected joints and their condition.

Laboratory Tests

To further diagnose the condition, the Arthritis doctor may require some laboratory tests, including:

Blood Tests

Blood tests are often used to detect markers of inflammation and autoimmune responses. Common blood tests prescribed to diagnose for arthritis include:

  • Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies for Rheumatoid Arthritis..
  • Complete blood count (CBC) to check for anaemia and elevated white blood cell count.
  • Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) to measure general inflammation.
  • Uric acid levels to detect gout

Depending on the suspected type of arthritis, additional specialised blood tests, such as HLA-B27 for ankylosing spondylitis or tests for specific antibodies, may be performed.

Imaging Tests

  • X-rays: X-rays can reveal joint damage, erosion, and changes in bone structure, and therefore, are commonly used in diagnosing osteoarthritis and some other forms of arthritis.
  • Magnetic Resonance Imaging (MRI): MRI provides detailed images of soft tissues, cartilage, and bone, and therefore, is useful for assessing joint damage, especially in rheumatoid arthritis.
  • Ultrasound: Ultrasound can help visualise joint inflammation and fluid accumulation. It is often used to guide joint aspiration (removal of synovial fluid for analysis).
  • Joint Aspiration (Arthrocentesis): In some cases, joint fluid may be aspirated (withdrawn) for analysis. This can help diagnose conditions like gout or infection and assess the characteristics of synovial fluid.

In certain cases, additional tests or procedures, such as bone scans or joint biopsies, may be recommended.

Read more: Myths & Facts about Arthritis

What are the Treatment Options for Arthritis?

The specific treatment of arthritis can vary depending on the type of arthritis and the severity of the condition. Here are some of common approaches for the treatment of arthritis:

Medications

  • Pain Relievers (Analgesics): Over-the-counter pain relievers, such as acetaminophen can help manage mild to moderate pain.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen or naproxen, reduce pain and inflammation. Prescription NSAIDs may be recommended for more severe symptoms.
  • Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs, such as methotrexate and sulfasalazine are used to treat autoimmune forms of arthritis, such as rheumatoid arthritis. 
  • Corticosteroids: These potent anti-inflammatory drugs can be administered orally, topically, or through injections directly into the affected joint, as prescribed by the physician.
  • Uric Acid-Lowering Medications: Medications such as allopurinol or febuxostat are often used to reduce uric acid levels in gout patients.
  • Pain-Relieving Creams and Topical Medications: These can provide relief for localised pain and inflammation.

Lifestyle Changes

  • Exercise: Regular physical activity helps maintain joint function, strengthen muscles, and reduce stiffness. Low-impact activities like swimming and cycling are often recommended.
  • Weight Management: Maintaining a healthy weight can reduce stress on weight-bearing joints, particularly in osteoarthritis.
  • Joint Protection Techniques: Learning proper joint protection techniques can help minimise strain on affected joints during daily activities.
  • Heat and Cold Therapy: Applying heat or cold to affected joints can provide pain relief and reduce inflammation.
  • Assistive Devices: Assisted devices such as braces, splints, or orthopaedic shoes can help support and protect affected joints.
  • Physical Therapy: Physical therapists can design customised exercise programs to improve joint function, increase range of motion, and reduce pain.
  • Occupational Therapy: Occupational therapists can teach adaptive techniques and recommend assistive devices to help individuals with arthritis perform daily tasks more easily.

Read more: Exercising and Its Benefits for Arthritis

Surgery

In severe cases or when conservative treatments are ineffective, surgical interventions may be considered. Common procedures to treat arthritis include:

  • Joint Replacement Surgery: While hip replacement and knee replacements are common for severe osteoarthritis, joint replacements can also be performed for other affected joints.
  • Arthroscopy: This is a minimally invasive procedure that involves inserting a small camera (arthroscope) to visualise and treat joint conditions such as damaged cartilage.
  • Joint Fusion (Arthrodesis): In some situations, joint fusion may be necessary to stabilise and relieve pain in a severely damaged joint.

Complementary and Alternative Therapies

  • Acupuncture: Some people find acupuncture helpful in managing arthritis pain and stiffness.
  • Dietary Supplements: Glucosamine, chondroitin, and fish oil supplements are commonly used, but their effectiveness varies.
  • Patient Education and Self-Management: This involves understanding the condition, its triggers, and self-care strategies for effective management of arthritis.

How to Prevent Arthritis?

While some risk factors for arthritis, such as genetics and age, cannot be controlled, there are steps you can take to help reduce the risk of developing arthritis or to manage its symptoms. These include:

  • Maintain a Healthy Weight: Excess weight puts extra stress on the joints. Maintaining a healthy weight, therefore, reduces the risk of osteoarthritis and eases symptoms if someone already has the condition.
  • Exercise Regularly: Engage in regular physical activity to strengthen the muscles around the joints and improve flexibility. Low-impact exercises such as swimming, cycling, and walking are excellent choices.
  • Protect Your Joints: Use proper body mechanics and joint protection techniques when engaging in activities that stress your joints. Avoid overuse and minimise repetitive motions that can lead to joint wear and tear.
  • Balanced Diet: Eat a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Omega-3 fatty acids found in fatty fish such as Salmon and Trout may help reduce inflammation.
  • Stay Hydrated: Drinking enough water can help maintain joint health by keeping cartilage lubricated and preventing dehydration-related joint issues.
  • Say No to Smoking: Smoking has been linked to an increased risk of rheumatoid arthritis and can worsen symptoms if someone already has arthritis. 
  • Limit Alcohol Consumption: Excessive alcohol intake can contribute to gout and may exacerbate arthritis symptoms. 
  • Manage Stress: Chronic stress can also contribute to inflammation and worsen arthritis symptoms. Practice stress management techniques such as meditation, deep breathing, and relaxation exercises.
  • Joint-Friendly Ergonomics: Ensure that your workplace and living environment are ergonomically designed to reduce strain on your joints. This includes using proper seating and workstation setups.
  • Right Footwear: Wear comfortable, supportive shoes that provide proper arch support and cushioning to reduce the risk of joint pain, especially in the knees, hips, and lower back.

Remember that while these lifestyle choices can help reduce the risk of arthritis, not all forms of arthritis are preventable. The onset of genetic or autoimmune types of arthritis may not be preventable through lifestyle modifications. 

Final Words

Orthopaedic specialists say that the damage to the bone begins two years after the disease is detected. It is, therefore, essential to identify the symptoms at an early stage and seek medical help. If you or someone you know has been experiencing any of the symptoms we have discussed in this blog, waste no time in booking a consultation with an orthopedician at a Max Hospital near you.