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Arthritis

Arthritis

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Unfortunately, one in every five Americans suffers from some form of arthritis. This chronic condition interferes with the lives of about 50 million people across the nation. At its most basic level, arthritis involves swelling in the joints-the word "arthritis" comes from the Greek words for "joint" and "inflammation." Arthritis refers to swelling, damage, deficiency, or infection in any component of the joint, which includes: the ligaments, connective tissue that holds the bones together, cartilage, which coats and protects the bones to prevent them from wearing away at each other, the synovial membrane, which covers the joint, and synovial fluid, the liquid produced by the membrane that provides nutrients to the joint. Arthritis can lead to stiffness, discomfort, mobility issues, and other unpleasant symptoms.

Arthritis is the number one cause of disability for patients over 55 years old.

Patients typically become more susceptible to arthritis as they age and their joints begin to deteriorate. In fact, arthritis is the number one cause of disability for patients over 55 years old. Women and overweight patients, as well as those with a family history of this disease or prior joint trauma, are also more prone to developing arthritis. Risk factors for this disorder also include family history, previous orthopedic injuries, immune system issues, and occupational strain.

Arthritis is such a broad and varied condition that there are actually more than 100 different types of this disease. Below, we describe the main three kinds of arthritis to help you better understand, prevent, identify, and treat this condition.

Osteoarthritis

An illustration depicting what happen when a patient suffers from osteoarthritis

Osteoarthritis often progresses and worsens over time.

Most patients diagnosed with arthritis suffer from osteoarthritis. This condition results from deterioration of the cartilage over the joints, which most often affects the spine, hands, knees, and hips. Cartilage provides a smooth surface that allows the bones to shift as people bend, walk, or move. Typically, the body cannot heal or regenerate cartilage once it has been damaged, so osteoarthritis often progresses and worsens over time. In severe cases, patients may be left without any cartilage in their joints, leading the ends of their bones to hit up against and erode each other. While osteoarthritis symptoms can interfere with patients' daily life and wellbeing, this type of arthritis fortunately does not affect other tissues or organs.

Symptoms

Osteoarthritis symptoms can vary based on the severity of the cartilage damage, the patient's age, and the location of the condition. In general, patients with osteoarthritis experience:

  • Joint aching, especially after long periods of repeated movement. For this reason, soreness is usually more severe at the end of the day.
  • Tightness or stiffness in the joints, usually after long periods of rest.
  • Sensitivity upon pressure to the joint.
  • Bone spurs, which are small additional bone segments that can develop at the edges of the bones where the cartilage is damaged.
  • A restricted range of motion for the affected joints.
  • A scraping sensation upon moving the joint, which may also be accompanied by a creaking sound.
  • Changes in joint shape, which may become more pronounced as the disease advances.
  • Mild inflammation in the diseased joints.
  • Muscular weakness around the affected area.
  • Difficulty sleeping due to stiffness and aching.

Localized osteoarthritis is most common in the knee, hands, and hips, in that order.

Diagnosing Osteoarthritis

To diagnose this condition, general practitioners, orthopedists, or neuro-spinal specialists may:

  • Perform a physical assessment, including a test of range of motion and palpation to check for swelling and bone spurs.
  • Analyze blood samples. These can reveal other potential sources of osteoarthritis symptoms (which could include neurological conditions, immune system issues, or more).
  • Use a needle to remove your synovial fluid and test it for infection or other problems.
  • Take x-rays. Radiological imaging can reveal the deterioration of cartilage and resulting malformation of bones, sometimes even before this causes noticeable osteoarthritis symptoms.
  • Perform an MRI, or Magnetic Resonance Imaging test. Using magnetic and radio waves, doctors can generate detailed maps of soft tissues and bones. This diagnostic tool is relatively expensive to use, so it is typically reserved for more complicated cases.

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Treatment Options

At this time, there is no cure for osteoarthritis, but there are many ways to ease and manage the uncomfortable symptoms associated with this disorder. Available treatments for osteoarthritis include:

  • Painkillers such as acetaminophen (the active ingredient in Tylenol). However, these medications lead to liver damage and do not help to reduce swelling.
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), which can alleviate soreness and reduce swelling. NSAIDs are an effective osteoarthritis treatment, but these substances can cause unpleasant side effects such as stomach issues, bleeding disorders, tinnitus, kidney problems, and liver damage.
  • Joint replacement surgery. Replacing joints with prostheses can alleviate symptoms and restore patients' mobility. However, artificial joints often require replacement after a fixed period of time, and joint replacement surgery is a major procedure that can lead to blood clotting, infection, and anesthesia risks.
  • Cortisone shots. Injecting this medication into the joints can limit swelling and alleviate soreness. However, this treatment must be repeated to remain effective and can exacerbate joint deterioration over time.
  • Osteotomy. During this surgery, doctors incise the bone to realign it and shift pressure away from the region of degenerated cartilage.
  • Hyaluronic acid injections. Hyaluronic acid occurs naturally in connective tissue. This compound can help cover and protect the disordered joint. As with cortisone shots, this treatment must be repeated to continue providing relief.
  • Occupational therapy, which helps patients modify their daily routines to avoid worsening joint pain.
  • Physical therapy, a regimen of targeted exercises that can strengthen surrounding muscles to diminish discomfort and expand mobility.
  • Chronic pain management courses and therapy. Specialists can teach techniques to help patients live with osteoarthritis and handle persistent discomfort.
  • Orthopedic assistance devices, such as shoe inserts or braces. These can make motion more comfortable by supporting the damaged joint.
  • Heat and cold therapy, which can be applied at home to improve joint flexibility, limit inflammation, and ease discomfort.
  • Weight loss, which can alleviate pressure on the joints.

Osteoarthritis By The Numbers

The following statistics may help patients better understand osteoarthritis:

  • 33.6 percent: the percentage of adults over 25 that suffer from osteoarthritis.
  • 500: the number of patients who die from osteoarthritis each year.
  • 814,900: the number of people who were hospitalized for osteoarthritis in 2006 alone.
  • 80 percent: the proportion of osteoarthritis sufferers who report mobility restrictions from this disorder.

Rheumatoid Arthritis

An illustration depicting what happen when a patient suffers from rheumatoid arthritis

Rheumatoid arthritis is the number one cause of serious joint inflammation.

Patients with rheumatoid arthritis suffer from joint pain because their immune systems accidentally damage their own tissues, particularly the synovial membrane. This can lead to swelling as the membrane coagulates, cartilage damage, and ligament elongation. Rheumatoid arthritis usually manifests in smaller joints, such as wrists, hands, ankles, feet, and knees, and then spreads outward. This immune system disorder can also affect other organs, disrupting patients' bodily function and quality of life. Rheumatoid arthritis is the second most common form of arthritis, but it is the number one cause of serious joint inflammation.

Rheumatoid arthritis affects patients of all ages, but those over 40 are at higher risk for this disorder. Doctors are not entirely sure what triggers this condition, but it is likely congenital. In addition, certain bacterial and viral infections may spark this progressive disorder.

Symptoms

Patients who suffer from rheumatoid arthritis often experience:

  • Joint stiffness, tightness, and rigidity, especially upon waking or after long periods of inactivity.
  • Sensitivity in the affected joints.
  • A warm sensation in the disordered area.
  • Inflammation in the diseased joints.
  • Rheumatoid nodules, which are raised, hard tissue growths that can develop beneath the arm skin. These may be painful or not. They can also develop in the organs, such as the lungs or heart. Rheumatoid nodules occur in about 35 percent of patients and typically signal the advancement of this disease.
  • Exhaustion.
  • Weight loss.
  • Anemia.
  • Fever.
  • Joint malformation, especially as the disorder progresses.

Diagnosing Rheumatoid Arthritis

It can be challenging for doctors to pinpoint rheumatoid arthritis as the cause of joint pain because this disorder presents similar symptoms to many other conditions (such as other forms of arthritis). To assess for rheumatoid arthritis, doctors, orthopedists, and neuro-spinal specialists may:

  • Examine patients' joints, checking for inflammation and warmth. They may also test patients' muscle strength, range of motion, and reflexes, particularly in the hands and feet (since this is where this disorder usually begins).
  • Perform radiography. X-rays can reveal the swollen membranes, cartilage loss, and stretched ligaments associated with rheumatoid arthritis. These images can also reveal how this disease is advancing.
  • Sample patients' blood. There is no single clear indicator of rheumatoid arthritis, but people with this condition often have higher levels of anti-CCP (anti-cyclic citrullinate d peptide) antibodies. Doctors may also assess patients' erythrocyte sedimentation rate, which may be increased in patients with rheumatoid arthritis.

Treatment Options

There is no cure for rheumatoid arthritis, but doctors can help patients remain comfortable, enjoy a fuller range of motion, and experience a higher quality of life by recommending one or more of the following treatments:

  • Corticosteroid medications. These oral drugs can minimize swelling and slow the progression of this disorder. However, they can also lead to diabetes, bone loss, and weight gain, so they are typically considered a temporary solution until the patient's symptoms can be better controlled.
  • DMARDs, or disease-modifying antirheumatic drugs. These medications can decelerate the advancement of rheumatoid arthritis, but they can cause bone marrow disorders, liver damage, and potentially life threatening lung infections.
  • Biologic response modifying drugs. These substances prevent the immune system from causing swelling, limiting the impact of rheumatoid arthritis. However, they can raise patients' risk for infection. These are often prescribed in combination with DMARDs.
  • NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs. These can lower swelling and diminish discomfort, but they can cause unpleasant and unhealthy side effects such as cardiovascular conditions, liver damage, and stomach irritation, especially when taken over long periods of time.
  • Joint replacement surgery, replacing the deteriorated joint with prostheses.
  • Joint fusion surgery. This is an alternative to joint replacement therapy that can help relieve pressure and reduce swelling.
  • Tendon repair procedures. Surgeons may be able to suture together or strengthen torn or overly stretched tendons.
  • Physical therapy, which can help patients maintain greater range of motion, learn new methods of executing routine tasks, and strengthen surrounding muscles.
  • Assistive devices. These are household items or aids designed especially for patients with rheumatoid arthritis. They are particularly useful for patients whose hand function has been disrupted by rheumatoid arthritis.  

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Rheumatoid Arthritis By The Numbers

The following statistics provide more information about rheumatoid arthritis:

  • 1.5 million: the number of Americans suffering from this disease, as of 2007.
  • 4 percent: the general proportion of women who will suffer from rheumatoid arthritis (men have a 3 percent risk).
  • 22 percent: the proportion of arthritis-related deaths that result from rheumatoid arthritis.

Gout

An illustration depicting what happen when a patient suffers from gout

Gout is becoming increasingly common among Americans, most likely due to dietary changes.

In certain circumstances, uric acid crystals can build up in the joint tissue, creating an attack of severe inflammation. This condition is called gout, and it can occur as a result of an unhealthy diet (high in steak, seafood, sugary beverages, and alcohol), improper kidney function, or overproduction of uric acid. Men are more likely to develop gout than women, as are patients who suffer from obesity, diabetes, hypertension, kidney disease, and cardiovascular issues. Patients with a family history of this disease may also be more likely to suffer from gout. In rare cases, patients without elevated uric acid levels develop symptoms of this disease. Gout usually manifests in the feet, but it can also impact patients' elbows, wrists, fingers, knees, and ankles. It is one of the most acutely painful forms of arthritis. Unfortunately, gout is becoming increasingly common among Americans, most likely due to dietary changes.

Symptoms

Gout is a variable condition, so each patient has a different experience. For example, some may have acute attacks of this disease, while others may suffer from more chronic discomfort. However, in general, the symptoms of gout include:

  • Severe joint ache and sensitivity, which may begin in a specific area and spread throughout the body.
  • A heavy or hot sensation in the affected joint (most often localized to the big toe areas).
  • Restricted range of motion in the disordered joint.
  • Purple or red skin tissue near the diseased region.
  • Irritated, peeling skin around the affected joint (this is typically a sign of gout healing).
  • Swollen joints.
  • Firm, movable nodules on the ears, hands, or elbows, which result from an accumulation of uric acid crystals in these tissues.

Diagnosing Gout

In some cases, gout may be difficult to diagnose, since it presents many of the same symptoms as rheumatoid arthritis. In addition, some patients suffer from "pseudogout," a less severe but similar condition caused by an accumulation of calcium pyrophosphate rather than monosodium urate crystals. To determine if a patient suffers from gout, a doctor may:

  • Examine and palpate the patient's problematic joints.
  • Take x-rays, which are primarily used to rule out other conditions (such as osteoarthritis).
  • Perform a joint fluid test, extracting a small amount of this liquid to assess for urate crystals.
  • Measure the level of uric acid in a patient's blood (although this is not a perfect indicator of gout, since patients who suffer from this condition may have deceptively low levels, and those not diagnosed with gout may have elevated uric acid).
  • Use ultrasound imaging or, in rare cases, an expensive dual energy CT (computed tomography) scan to look for urate crystals.

Treatment Options

Gout cannot be cured, but doctors can prescribe medications to manage the symptoms of this condition, ward off attacks, and prevent complications. These drugs include:

  • Colchicine. This substance very successfully reduces gout symptoms, but it often causes extremely unpleasant side effects, including diarrhea, nausea, and vomiting.
  • Corticosteroids, which can treat gout symptoms such as swelling and discomfort, but may cause hypertension, blood sugar issues, and mood swings.
  • NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs. These temporarily reduce swelling and can alleviate discomfort. However, they can lead to ulcers, bleeding, and stomach irritation, especially with long-term use.
  • Probenecid, a drug that enhances kidney function to help this organ filter uric acid. This substance can unfortunately lead to kidney stones, rash, and stomach problems.
  • Xanthine oxidase inhibitors. These medications prevent the body from making uric acid, which can alleviate gout symptoms, if this is the cause of the disorder. However, the potential side effects of this drug include poor liver function, rash, and nausea.
  • Dietary changes. The body produces uric acid in the process of digesting purines, which are commonly found in seafood, organ meats, mushrooms, mackerel, dried beans, anchovies, and steak. Beer and fruit drinks can also exacerbate gout. Avoiding these foods and drinks can help reduce gout symptoms.
  • Regular exercise. Since obesity is a risk factor for this disease, losing weight may help lower patients' risk for gout episodes.

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Gout By The Numbers

The following statistics can help patients better comprehend the dynamics and prevalence of gout:

  • 8.3 million: the number of Americans who suffer from gout.
  • 5 percent: the proportion of arthritis cases diagnosed as gout.
  • 1.2 percent: the increase in the number of American gout sufferers over the past 20 years.
  • 3.9 percent: the proportion of Americans who have been diagnosed with this disorder. 

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