Arthritis

Arthritis

Introduction

Arthritis is inflammation of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is usually caused by normal wear and tear, while rheumatoid arthritis is an autoimmune disorder. Other types of arthritis can be caused by uric acid crystals, infections or even an underlying disease, such as psoriasis or lupus.

Treatments vary depending on the type of arthritis. The main goals of arthritis treatments are to reduce symptoms and improve quality of life.

When is Arthritis Surgery recommended?

Signs and Symptoms:

The symptoms of arthritis depend on the type of arthritis, for example:

  • Osteoarthritis - The symptoms develop slowly and get worse as time goes by. There is pain in a joint, either during or after use, or after a period of inactivity. There will be tenderness when pressure is applied to the joint. The joint will be stiff, especially first thing in the morning. The patient may find it harder to use the joint - it loses its flexibility. Some patients experience a grating sensation when they use the joint. Hard lumps, or bone spurs may appear around the joint. In some cases the joint might swell. The most common affected joints are in the hips, hands, knees and spine.

  • Rheumatoid arthritis - The patient often finds the same joints in each side of the body are painfully swollen, inflamed, and stiff. The fingers, arms, legs and wrists are most commonly affected. Symptoms are usually worst on waking up in the morning and the stiffness can last for 30 minutes at this time. The joint is tender when touched. Hands may be red and puffy. There may be rheumatoid nodules (bumps of tissue under the skin of the patient's arms). Many patients with rheumatoid arthritis feel tired most of the time. Weight loss is common. The smaller joints are usually noticeably affected first. Experts say patients with rheumatoid arthritis have problems with several joints at the same time. As the arthritis progresses it spreads from the smaller joints in your hands, wrists, ankles and feet to your elbows, knees, hips, neck, shoulders and jaw.

  • Infectious arthritis - The patient has a fever, joint inflammation and swelling. He will feel tenderness and/or a sharp pain. Often these symptoms are linked to an injury or another illness. Most commonly affected areas are the knee, shoulder, elbow, wrist and finger. In the majority of cases, just one joint is affected.

  • Juvenile rheumatoid arthritis - The patient is a child. He will experience intermittent fevers which tend to peak in the evening and then suddenly disappear. His appetite will be poor and he will lose weight. There may be blotchy rashes on his arms and legs. Anemia is also common. The child may limp or have a sore wrist, finger, or knee. A joint may suddenly swell and stay larger than it usually is. The child may experience a stiff neck, hips or some other joint.

What are the causes?

In order to better understand what is going on when a person suffers from some form of arthritis, let us look at how a joint works.

Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move.

Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly.

A capsule surrounds the joint. The space within the joint - the joint cavity - has synovial fluid. Synovial fluid nourishes the joint and the cartilage. The synovial fluid is produced by the synovium (synovial membrane) which lines the joint cavity.

If you have arthritis something goes wrong with the joint(s). What goes wrong depends on what type of arthritis you have. It could be that the cartilage is wearing away, a lack of fluid, autoimmunity (your body attacking itself), infection, or a combination of many factors.

Types of Arthritis

There are over 100 types of arthritis. Here is a description of some common ones, together with the causes:

  • Osteoarthritis - cartilage loses its elasticity. If the cartilage is stiff it becomes damaged more easily. The cartilage, which acts as a shock absorber, will gradually wear away in some areas. As the cartilage becomes damaged tendons and ligaments become stretched, causing pain. Eventually the bones may rub against each other causing very severe pain.

  • Rheumatoid arthritis - this is an inflammatory form of arthritis. The synovial membrane (synovium) is attacked, resulting in swelling and pain. If left untreated the arthritis can lead to deformity. Rheumatoid arthritis is significantly more common in women than men and generally strikes when the patient is aged between 40 and 60. However, children and much older people may also be affected. Swedish scientists published their study in JAMA in October 2012, explaining that patients with rheumatoid arthritis have a higher risk of blood clots in the first ten years after diagnosis.

  • Infectious arthritis (septic arthritic) - an infection in the synovial fluid and tissues of a joint. It is usually caused by bacteria, but could also be caused by fungi or viruses. Bacteria, fungi or viruses may spread through the bloodstream from infected tissue nearby, and infect a joint. Most susceptible people are those who already have some form of arthritis and develop an infection that travels in the bloodstream.

  • Juvenile rheumatoid arthritis (JRA) - means arthritis that affects a person aged 16 or less. JRA can be various forms of arthritis; it basically means that a child has it. There are three main types:
    1. Pauciarticular JRA, the most common and mildest. The child experiences pain in up to 4 joints.
    2. Polyarticular JRA affects more joints and is more severe. As time goes by it tends to get worse.
    3. Systemic JRA is the least common. Pain is experienced in many joints. It can spread to organs. This can be the most serious JRA.

How will Arthritis affect me?

Arthritis affects people in many different ways. How long the patient is affected and how severely it is depends on the type of arthritis. Arthritis sufferers will find there are good and bad days. Most patients with arthritis will suffer from discomfort, pain, stiffness and/or fatigue.

You may also feel frustrated that you are no longer able to grip things so well or get around like you used to. It is important to remember that if you suffer from arthritis this does not mean you have to give up having an active lifestyle. With some changes to your way of life there is no reason why you cannot continue being active.

Physical therapy and occupational therapy for arthritis.

Physical therapy and occupational therapy help maintain joint mobility and range of motion. How much therapy you need, and what kind of therapy will depend on many factors, such as the severity and type of arthritis you have, your age, and your general state of health. This has to be decided by you with your physician and physical or occupational therapist.

People with arthritis will often avoid moving the affected joint because of the pain. A physical therapist can help the patient work out the joint stiffness without damaging it. In order to perform your daily activity the physical therapist will help you achieve a good range of motion. This may involve building strength in the muscles that surround the affected joint - stronger muscles help stabilize a weakened joint. You will also be taught the best way to move from one position to another, as well as learning how to use such walking aids as crutches, a cane or a walker, if you need one.

Occupational therapy can teach you how to reduce the strain on your joints as you go about your daily activities. The occupational therapist can help you modify your home and workplace so that your movements do not aggravate your arthritis. You may need a splint for your hands or wrists, as well as aids for dressing, housekeeping, work activities, driving and washing/bathing yourself.

An occupational and/or physical therapist can make an enormous difference to your quality of life if you suffer from arthritis. He/she will help you learn more about your arthritis, devise a dietary plan if you are overweight and overstressing the joints as a result, help you make better decisions about what shoes to buy if that part of the body is affected. You will learn how and when to rest - rest is crucial for treating inflammation and pain, especially when many joints are affected and you feel tired. Resting individual joints is very helpful too - custom splints can be made to rest and support affected joints.

Local pain can be relieved with ice packs or heating pads. Ultrasound and hot packs provide deep heat which relieves localized pain and relaxes muscle spasm around the affected joint. You may find that a warm bath/shower makes it easier for you to exercise afterwards.

Physical activity can improve arthritis symptoms - doctors warn that inactivity could harm the health of most patients with arthritis or some kind of rheumatic disease. Inactivity raises the risk of cardiovascular disease and diabetes type 2. Muscles become weaker with no exercise, joints become stiffer, and the patient's tolerance for pain decreases. Balance problems may also become worse.

Arthritis patients who are physically active generally enjoy better health, are happier, live longer, experience improvements in pain, sleep, day-to-day functioning and general energy levels.

How is Arthritis diagnosed?

During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also want to see how well you can move your joints. Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.

Laboratory tests

The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid (aspiration).

Imaging

These types of tests can detect problems within your joint that may be causing your symptoms. Examples include:

  • X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but they are often used to track progression of the disease.

  • Computerized tomography (CT). CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues.

  • Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRI can produce more-detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments.

  • Ultrasound. This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid-containing structures such as bursae. Ultrasound also is used to guide needle placement for joint aspirations and injections.

Arthroscopy
In some cases, your doctor may look for damage in your joint by inserting a small, flexible tube — called an arthroscope — through an incision near your joint. The arthroscope transmits images from inside the joint to a video screen.

What are the treatment options for Arthritis?

Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments, or combinations of treatments, before you determine what works best for you.

Medications

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

  • Analgesics. These types of medications help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others), tramadol (Ultram, Ryzolt, others) and narcotics containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Vicodin, Lortab, others).

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.

  • Counterirritants. Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.

  • Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).

  • Biologics. Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).

  • Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint.

Therapy

Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.

Surgery

If conservative measures don't help, your doctor may suggest surgery, such as:

  • Joint replacement. This procedure removes your damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.

  • Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit.

What are the risk factors for Arthritis?

Risk factors for arthritis include:

  • Family history. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger arthritis.

  • Age. The risk of many types of arthritis — including osteoarthritis, rheumatoid arthritis and gout — increases with age.

  • Your sex. Women are more likely than are men to develop rheumatoid arthritis, while most of the people who have gout are men.

  • Previous joint injury. People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.

  • Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. Obese people have a higher risk of developing arthritis.

Can Arthritis be prevented?

Prevention of arthritis focuses on avoiding joint injury and early diagnosis and treatment. Research clearly demonstrates that early diagnosis and treatment can result in less damage, deformity, disability, and even mortality in rheumatoid disease. The treatment of rheumatoid disease is not only more effective but easier when administered early.

Additionally, maintaining overall good health and strength with exercise and good nutrition can be helpful in preventing joint disease.

How fast can you recover?

To be shared by the doctor.

After Discharge?

Write down your questions so you remember to ask them during your visits.

Manage your symptoms:

  • Get physical therapy: A physical therapist can teach you exercises to help improve movement and strength, and to decrease pain. An occupational therapist can teach you skills to help with your daily activities.

  • Use support devices: You may be given splints to wear on your hands to help your joints rest and to decrease inflammation. While you sleep, use a pillow that is firm enough to support your neck and head.

  • Rest when needed: Rest is important if your joints are painful. Limit your activities until your symptoms improve. Gradually start your normal activities when you can do them without pain. Avoid motions and activities that cause strain on your joints, such as heavy exercise and lifting.

  • Use ice or heat: Both can help decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on your joint for 15 to 20 minutes every hour or as directed. You can apply heat for 20 minutes every 2 hours. Heat treatment includes hot packs, heat lamps, warm baths, or showers.

The following devices may help you move and prevent falls:

  • Orthotic shoes or insoles: Ask about shoes or insoles that can support your feet when you walk.

  • Crutches, cane, or a walker: These devices may help decrease your chance of falling or being hurt. They also decrease stress on affected joints. Ask for more information about how to choose and use crutches, a cane, or a walker.

  • Devices to prevent falls: These include raised toilet seats and bathtub bars to help you get up from sitting. Handrails can be placed in areas where you need balance and support.

Self-care:

  • Eat a variety of healthy foods: Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask if you need to be on a special diet. A diet rich in calcium and vitamin D may decrease your risk of osteoporosis. Foods high in calcium include milk, cheese, broccoli, and tofu. Vitamin D may be found in meat, fish, fortified milk, cereal and bread. Ask if you need calcium or vitamin D supplements.

  • Maintain a healthy weight: This may help decrease strain on joints in your back, knees, ankles, and feet. Ask your primary healthcare provider how much you should weigh. Ask him to help you create a weight loss plan if you are overweight. Maintain a healthy weight to help decrease strain on the joints in your back, knees, ankles, and feet.

  • Do not smoke: If you smoke, it is never too late to quit. This may help to reduce the severity of your symptoms and your risk of osteoporosis. Ask your primary healthcare provider for information if you need help quitting.

What are the results of the surgery?

To be provided by the doctor.

What are the complications?

Severe arthritis, particularly if it affects your hands or arms, can make it difficult for you to take care of daily tasks. Arthritis of weight-bearing joints can keep you from walking comfortably or sitting up straight. In some cases, joints may become twisted and deformed.

Cost of Surgery?

The cost of surgery for Arthritis depends on many factors. They include the cost of being in the hospital for several days. Unexpected events that result in an extended hospital stay will also increase the overall cost.

Costs also vary depending on the type of insurance coverage you have. Many insurance companies cover the cost of the surgery, the hospital stay, and the instruments to straighten the spine. You may owe a co-payment or you may be billed the balance of what your insurance does not cover.

Be sure to contact your insurance provider prior to surgery to discuss the extent of your coverage. Discuss with your surgeon, as well as the hospital billing department to make sure you understand all the costs involved.

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