Dr Vikas Padha
October 12 is celebrated as the World Arthritis Day every year to spread awareness about Arthritis . Word “Arthritis” consists of “Arthr” meaning joint (point of articulation of two or more bones) and “itis” means inflammation thereby meaning “inflammation of joint”. I have observed a general notion prevailing commonly that arthritis is a non treatable condition and one who is diagnosed with arthritis ever has no option but to continue suffering from pain and disability life long where as in reality this is not correct. Through this article ,I am making an attempt to clear myths prevailing about arthritis .
World Arthritis Day
To understand what arthritis is , I would like to quote an example of FEVER about which most of us are aware .As FEVER is not because of single DISEASE but a result of many underlying diseases including variety of infections (depending upon specific cause), ARTHRITIS is also not a single ENTITY but can be classified into numerous types depending upon underlying causes . So , Arthritis is a non specific term denoting acute or chronic inflammation of the joint .
Another prevailing myth about arthritis is that it is a disease of middle age or elderly age group where as in reality, depending upon type and cause , arthritis can involve any age group ranging from newly born children to adolescents to young adults to middle age to elderly age group.
Arthritis has been broadly classified into Inflammatory arthritis and Osteoarthritis in addition to other less common forms of arthritis . The inflammatory arthritis can be further classified into Infective arthritis and Non -infective inflammatory arthritis.
If infection of joints is due to pyogenic (pus forming ) organisms , it is known as Septic Arthritis commonly found in infants presenting with sudden high grade fever,inability to move limbs(due to pain) , refusal of feed etc , and in older children as limp while walking along with high grade fever , pain and swelling in joints with or without history of injury .This is an emergency condition that can also be found in adults and elderly population with low immunity (due to HIV infection or immunosuppressant drugs etc) and in diabetics.This condition requires immediate diagnosis and prompt treatment that most of the times requires emergency surgery (arthrotomy)along with antibiotics and if treatment is delayed , permanent damage to joint can happen. If causative organism is Mycobacterium tuberculosis ,(which is very common in India) , it is known as Tubercular Arthritis that progresses slowly and can be treated with timely administration of Anti tubercular drug therapy if diagnosed timely and may require surgery if detected late and has already damaged the joint .Very rarely viral arthritis can also be found.
Non infective inflammatory arthritis includes Rheumatoid Arthritis , Spondyloarthritis , Metabolic arthritis like Gouty arthritis and very rare forms like Haemophilic arthritis.
Rheumatoid arthritis commonly known as “Gathiya” occuring due to abnormal immune response to body’s own tissues , is very common in females of 30-40 years age group and is characterised by the insidious onset of pain , swelling , morning stiffness in small joints of hands and feet symmetrically along with certain extra skeletal manifestations for the duration of more than 6 weeks.It is important to diagnose Rheumatoid Arthritis at an early stage on clinical suspicion with the help of blood markers like Rheumatoid Factor and Anti CCP Antibody so that we may start treatment with drugs that can modify the course of disease otherwise if it progresses ,it can cause permanent damage to joints and tendon sheaths resulting into crippling deformities. In about 20% cases , markers of Rheumatoid Arthritis can be absent in presence of clinical signs and symptoms and it is known as Seronegative Rheumatoid Arthritis .
Spondyloarthritis or Spondyloarthropathy is family of inflammatory rheumatic diseases that cause arthritis of axial skeleton ( spine) ,enthesis and peripheral joints .This family includes axial spondyloarthritis involving spine and pelvic joints (commonly called Ankylosing Spondylitis ), peripheral spondyloarthritis affecting arms and legs , Reactive Arthritis ( also known as Reiter’s syndrome) , Psoriatic arthritis and enteropathy associated with IBD ( Ulcerative colitis and Crohn’s disease ).It is characterised by slow onset of low back pain of long duration in young adults upto age of 40 years experienced during night time also , morning stiffness , more after taking rest , improved by exercises ( activity) and can be associated with asymmetrical peripheral arthritis along with enthesitis.
Extra articular manifestations include uveitis in eyes , Psoriasis and Inflammatory bowel disease .Early diagnosis of Ankylosing Spondylitis is possible with markers like HLA-B27 , MRI of Spine & SI joints and USG of enthesis . Early treatment with drugs along with physiotherapy can stop progression of disease and can prevent patient from crippling disabilities .
Metabolic Arthritis like Gouty arthritis commonly involving first metatarsophalangeal joint of foot , is crystal arthropathy leading to deposition of uric acid crystals in joints due to increase in Uric acid levels . Haemophilic arthritis is found in patients suffering from bleeding disorders .
Osteoarthritis a very common type of arthritis and usually diagnosed in elderly age group is a chronic disorder of joints in which there is progressive softening and disintegration of articular cartilage (protective covering of ends of bones) resulting into damage of joint resulting into pain and deformity . One of the commonly involved joints in Osteoarthritis is the knee joint . If we see X-ray of Knee joint ,the black space between articulating bones which people call as “gap” represents the width of articular cartilage .This “gap” decreases with the progression of osteoarthritis.
Factors like joint dysplasia ,trauma , obesity and family history of OA can predispose for Osteoarthritis.Here pain is the presenting complaint which starts insidiously , increases gradually over months or years , aggravates by exertion and is relieved by rest although with time relief is less and less complete . In advanced stage , patient may have pain even in bed at night . Stiffness is also common and occurs after period of inactivity .With time , it becomes continuous and progressive. Swelling in joint may be intermittent ( due to effusion during acute exacerbation) or continuous (due to thickening of capsule or formation of new osteophytes) . At later stages , deformity is there due to capsular contracture or joint instability and finally , there is loss of function including limp , difficulty in climbing stairs , restriction in walking distance and progressive inability to perform every day tasks.Typically symptoms of osteoarthritis follow an intermittent course with periods of remission sometimes lasting for months .
X-rays of joints are enough to confirm diagnosis of osteoarthritis .
In early stages , the treatment includes
oMaintaining joint mobility and improving muscle strength with the help of physiotherapy under the guidance of physiotherapist .
oProtecting joint from excessive load can slow down the rate of cartilage loss and can relieve pain using measures like weight reduction in obese patients , wearing shock absorbing shoes , avoiding activities like climbing stairs and using walking aids like sticks .
Medicines are used in relief of pain and inflammation ranging from paracetamol to non steroidal anti inflammatory drugs .
Chondro protective agents are the supplements that have shown promising results in very early stages of Osteoarthritis with possible role in regeneration of articular cartilage.
In intermediate stage , steroids and hyaluronic acid can be locally injected into joints but give temporary relief only .
In the advanced stage of osteoarthritis when there is severe pain even on bed during night ,deformity of joint has also become severe resulting in difficulty in activities of daily living , Joint Replacement Surgery is the best treatment . One should opt for joint replacement surgery like Total Knee Replacement Surgery without second thought as it is the most successful surgery and commonest surgery being done in India and the world . It is basically joint resurfacing surgery in which damaged articular cartilage is removed and is replaced with artificial components that results in full correction of deformities of joint and the cause of joint pain is removed from its roots . After undergoing joint replacement surgery , one can lead a comfortable and productive life .
To sum up , it is quite possible to lead normal life if someone is diagnosed with arthritis . In early stages , early diagnosis and start of timely treatment with disease modifying drugs along with physiotherapy can help in management of early arthritis stopping progression of arthritis and preventing joint from getting damaged permanently .
In late or advanced stage of arthritis , by undergoing joint replacement surgery one can lead normal , comfortable and productive life. If you experience any symptom related to your joint , immediately contact your doctor (orthopeadic surgeon , rheumatologist or physician) to make possible timely diagnosis and treatment because a stitch in time saves nine .
(The author is Senior Consultant Orthopaedics and Joint Replacement Shri Mata Vaishno Devi Narayana Hospital Katra )
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