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 of inflammation are redness, swelling, heat and pain.
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 over 100 different types of arthritic diseases. The most common are:
Osteoarthritis: Osteoarthritis is also called as degenerative joint disease and is the most common type of arthritis often occurring in patients as they age. 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. Bone spurs may form as the result of increased pressure between the arthritic bones.
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 the joint. For example, the joints in a person's hand can become deformed causing the fingers 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. About two to three times as many women as men have this disease.
Post-traumatic arthritis: Arthritis developing following an injury to the joint 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.
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 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 a disease in which the body’s own immune system attacks the joints leading to inflammation of the tissue lining the joint (synovium). Rheumatoid arthritis often affects multiple joints and can lead to swelling and destruction of the joint tissue.
Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. Injury to the joint cartilage may trigger the breakdown of cartilage cells and lead to the development of arthritis over time.
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, and different forms of arthritis may affect the joints differently and cause differing symptoms. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints, 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 may also performed to diagnose arthritis.
There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicine and may recommend occupational therapy or physical therapy which includes exercises and heat treatment. In severe cases where non-surgical treatments are ineffective, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. In patients with advanced arthritis for whom other options have failed, 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 brace 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 the arthritis has become disabling, surgery may be recommended.
Surgical options for the treatment of arthritis 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 (Joint Replacement): In this procedure, your surgeon removes the affected joint cartilage 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: Joint fusion, also called arthrodesis involves 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.