What is 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 presents are redness, swelling, heat, and pain.
The cartilage is a padding 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 raw bones rubbing on each other.
There are 100 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 a 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 affects mostly joints of the hands and feet and tends to be 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. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.
Post-traumatic arthritis: Arthritis developing following an injury to hand, wrist, or elbow is called post-traumatic arthritis. The condition may develop years after the 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.
What is the cause 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 aging 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 triggered by infection or any environmental factors. With this trigger, the body produces antibodies, the defense mechanism of the body, against the joint and may cause rheumatoid 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 more than 150 different forms of arthritis. Symptoms vary according to the form of Arthritis. Each form affects the body differently. 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.
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 diagnose arthritis.
There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicine. They may recommend 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 and the severity of the disease. 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 have become disabling, surgery may be recommended. Surgery is usually considered if nonsurgical treatment fails to give relief. 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 arthrodesis involves the removal of the joints and fusing the bones of the joint together using metal wires or screws. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and when heavy manual use is expected.
Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.
Osteoarthritis Frequently Asked Questions
Osteoarthritis (OA) is a common disorder that affects the joints and is caused by a loss of cartilage. Cartilage is the covering over the ends of bones that serve to provide a smooth gliding surface. When this cartilage surface is lost or destroyed, the underlying bone becomes exposed. As the disease progresses, more cartilage is lost and eventually bone rubs against bone within the joint. The disease is generally progressive and often results in pain, deformity, and stiffness. These problems can have a major impact on your quality of life and activity level. Osteoarthritis affects over 27 million individuals in the United States alone.
The cause of osteoarthritis is unclear, but several factors often contribute to its development including obesity, genetics, trauma/ injury, instability, and age:
- The global rise in obesity correlates with a significant rise in the frequency of arthritis, particularly in the knee joint.
- Genetics clearly plays a role and has been correlated with osteoarthritis, especially in the joints of the hand and wrist.
- Trauma and injury can result in damage to the cartilage, and poor alignment of the bones can contribute to the development of osteoarthritis.
- Instability of the joints related to poor ligaments or weakness can also lead to cartilage loss and ultimately osteoarthritis.
- Age has been associated with osteoarthritis. Although the frequency of OA increases with age, it does not occur in all individuals and should not be considered inevitable.
Although osteoarthritis is the most common form of arthritis, there are many other forms. Rheumatologists and orthopaedic surgeons study and treat the spectrum of arthritic problems including osteoarthritis and rheumatoid arthritis. Osteoarthritis results in loss of cartilage due to mechanical overload or poor underlying cartilage that is not capable of withstanding normal loads and wears out prematurely. Rheumatoid arthritis (RA), in contrast, is the most common form of inflammatory arthritis. In individuals with RA, the body’s own immune system and the joint lining (synovium) for unclear reasons destroy the joints cartilage (an autoimmune reaction). In general, both RA and OA are progressive problems that can result in cartilage loss, joint deformity, stiffness, and pain.
If you have osteoarthritis, you generally complain of pain related to activity. As the disease progresses, you might feel pain when you're at rest and asleep at night. Additional symptoms often include joint stiffness and deformity often limiting your joint function and quality of life. In some individuals, osteoarthritis progresses slowly and can be managed for years with non-operative care. In other individuals, osteoarthritis can progress rapidly and cause severe pain – sometimes prompting the need for surgery when other measures fail to control the symptoms.
If you are experiencing joint pain, it is important for you to discuss this with your doctor. A careful history, physical exam, and x-rays of the affected joint are the main ways your doctor makes an accurate diagnosis of osteoarthritis. Treatment will be based on how far the disease has progressed and how bad and how long your joint has hurt.
Depending on your findings, appropriate follow-up tests and treatment maybe prescribed. Managing osteoarthritis of the hip and knee follows a progressive algorithm that starts with the least invasive management and ending with surgery in those with an indication for a specific procedure. It is important to understand that not all hip and knee pain is osteoarthritis, and there are other diagnoses and treatment options depending on the underlying cause of your pain.
At this time there is no cure for osteoarthritis, and all of our non-operative measures are targeted towards treating your symptoms. Despite recent claims of injections that can “cure” your osteoarthritis, we currently have no disease-modifying agents for osteoarthritis of the hip and knee. Even though there is no cure for the disease, we can treat the symptoms you’re experiencing and provide significant pain relief and improvement in function. It is important to understand the extent of your osteoarthritis and how this relates to your symptoms and treatment options.
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AMERICAN ASSOCIATION OF HIP and KNEE SURGEONS
This article has been written and peer-reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence-Based Medicine Committee.