Arthritis

Arthritis is a term used to describe a number of painful conditions of the joints and bones. Two of the main types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. Cartilage (connective tissue) between the bones gradually wastes away (degenerates), and this can lead to painful rubbing of bone on bone in the joints. It may also cause joints to fall out of their natural positions (misalignment). The most frequently affected joints are in the hands, spine, knees and hips.

Rheumatoid arthritis

Also known as inflammatory arthritis, rheumatoid arthritis is a more severe, but less common condition. The body’s immune system attacks and destroys the joint, causing pain and swelling. It can lead to reduction of movement, and the breakdown of bone and cartilage.

There are over 200 forms of arthritis. More common forms include:

• ankylosing spondylitis,
• cervical spondylitis,
• fibromyalgia,
• systemic lupus erythematosis (lupus),
• gout,
• psoriatic arthritis, and
• Reiter’s syndrome.

Arthritis is often associated with older people, but it can also affect children. About one in 1,000 children develop arthritis. Arthritis in children is often called juvenile idiopathic arthritis (JIA). The three main types of JIA are:

• Oligo-articular JIA – is the most common form of JIA. It affects four or fewer joints in the body, most commonly the knees, ankles and wrists. This type has good recovery rates and the effects are rarely long term. However, there is a risk of developing eye problems, so children should have regular checks with an eye specialist (ophthalmologist).
• Polyarticular JIA (or polyarthritis) – affects five or more joints, and the symptoms are very similar to adult rheumatoid arthritis. It can quickly spread from one joint to another and can develop at any age. It is often accompanied by a rash or fever.
• Systemic onset JIA – begins with symptoms such as fever, rashes, lethargy and enlarged glands, and later develops into swollen and inflamed joints. It can also affect children of any age.

Symptoms

The main symptoms of all forms of arthritis include:

• stiffness,
• pain,
• restricted movements of the joints,
• swelling, and
• warmth and redness of the skin over the joint.

Osteoarthritis

Osteoarthritis often develops in people who are between 40-60 years of age. Osteoarthritis becomes more common with age with around 12% of people over 65 affected by the condition.

Osteoarthritis begins slowly with pain, stiffness and restricted movement in the affected joints. For some, slight stiffness is all that is experienced, but other people go on to have cracking or creaking joints (crepitation), knobbly bone growths (especially on the hands), and joints that move out of alignment. The pain and loss of movement tends to worsen as the day goes on, as the joints are used more.

Rheumatoid arthritis

Rheumatoid arthritis affects between 1-3% of the population, and often starts between 30-50 years of age. Women are three times more likely to be affected by rheumatoid arthritis than men.

Like osteoarthritis, rheumatoid arthritis begins gradually, with the first symptoms often being felt in small joints, such as fingers or toes. The condition can then progress to cause pain, swelling and stiffness of other joints, causing a lack of mobility. Cold and damp weather may aggravate the symptoms which are often worse in the morning. However, your symptoms may improve during the day as you start using and flexing your joints. Rheumatoid arthritis can also sometimes leave people feeling generally unwell and tired.

What causes arthritis

As everyone experiences arthritis in a different way, individual treatment and management advice is usually given. It is important to start treatment as early as possible after symptoms begin in order to reduce further damage to joints and improve quality of life.

The treatment of arthritis usually involves a range of healthcare professionals. These may include:

• your GP,
• arthritis specialist (rheumatologist),
• physiotherapist,
• occupational therapist,
• nurse specialist,
• dietitian,
• podiatrist,
• pharmacist, and
• social worker.

Treatments for osteoarthritis

The medicines prescribed for osteoarthritis tend to fall into three groups:

• analgesics – such as paracetamol. They help to relieve pain.
• non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and aspirin. However, when taken over long periods, or in high doses, these medicines can lead to digestive problems and bleeding in the stomach. Aspirin should not be given to children under 16 years of age. Cox-2 selective inhibitors are a type of NSAID which are designed to be less harmful to the stomach. However, research has linked the use of Cox-2 inhibitors to an increased risk of strokes, raised blood pressure, heart disease and hear attacks, so it is important to make your GP aware if you have a history of high blood pressure or high cholesterol, or if you smoke.
• corticosteroids – these are injected directly into the affected joint. However, this is not recommended on a long term basis because of serious side effects, such as wasting away of tissue surrounding the joint.

Sometimes, surgery (arthroplasty) may be used to treat severe cases of osteoarthritis. Arthroplasty involves either reconstructing, or replacing, a diseased joint. For arthritis patients it can help restore movement and function to the joint. However, not all joints can be artificially replaced. Other possible procedures might include realignment of the joint (osteotomy).

Treatments for rheumatoid arthritis

The main objective for the treatment of rheumatoid arthritis is to reduce the damaging inflammation. Some of the main treatments are outlined below.

• Disease modifying anti-rheumatic drugs (DMARDs) can help stop the progress of rheumatoid arthritis. Therefore, the earlier these are prescribed, the more effective they are. DMARDs are thought to have fewer side effects than long-term use of drugs, such as paracetamol. However, there are some associated risks including diarrhoea, nausea, skin rash and hair-loss. DMARDs are often used in conjunction with NSAIDs
• Relaxation techniques and physiotherapy can be effective in treating some types of arthritis, particularly those that involve swelling of the joints.
• Some alternative techniques include low-level laser therapy (LLLT), and low doses of orally administered corticosteroids, although the evidence of these treatments being beneficial is limited.
• New medicines, such as tumour necrosis factor (TNF ) blockers, are in development and are showing very promising results. However, this type of medicine is not appropriate for everyone with arthritis.

There are a number of other therapies that have been used to treat arthritis. However, not all of them have been clinically proven to be effective. These therapies include:

• massage,
• acupuncture – the insertion of fine needles at chosen points on the skin,
• osteopathy – a mixture of gentle and forceful massage techniques aimed to reduce pain and swelling,
• chiropractics – involves careful manipulation of the joints, muscles and tendons to provide pain relief,
• hydrotherapy – exercise programmes in either a warm shallow swimming pool or a special hydrotherapy bath,
• electrotherapy – uses electrical impulses (tiny electrical shocks) to stimulate the nervous system, and
• nutritional supplements – such as glucosamine sulphate, chondroitin and fish oil.

Complications of arthritis

Some treatments for arthritis have side effects that may cause additional problems. NSAIDs may damage the stomach and digestive system and are also associated with kidney problems in some people. Corticosteroids can cause reduction in bone density (osteoporosis) leading to increased risk of fractures and may also lead to the development of shingles, cataracts, and diabetes.

In the long term, arthritis can produce worsening pain, loss of mobility, and sometimes make walking difficult, or impossible. As a result, depression may accompany this condition.

General effects of rheumatoid arthritis may include:

• loss of appetite and weight,
• tiredness,
• muscle pain,
• lumps (nodules) under the skin,
• inflammation of tendons,
• sight problems,
• anaemia (blood disorder), and
• vasculitis (inflammation of the blood vessels)

Preventing arthritis

Controlling your weight may help to ease pressure on your joints. Weight control can also help avoid stress, or injury, to your joints and can prevent, or reduce, the severity of osteoarthritis.

It is not true that avoiding exercise will help reduce joint problems in later life. Weight-bearing exercises, such as walking, will help to prevent osteoarthritis by increasing the strength of the muscles that support your joints. Good posture can assist the strengthening of healthy joint structures.

Having physiotherapy, and using a walking stick, can help prevent existing osteoarthritis from becoming worse. There is no known way to prevent rheumatoid arthritis.