Introduction

Arthritis is a term used to describe a number of painful conditions of joints. The two main types of arthritis are osteoarthritis and inflammatory arthritis (e.g. rheumatoid arthritis).

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It is a degenerative condition where the cartilage between bones gradually wears away leading to rubbing of bone on bone in the joints. It can also result in mal-alignment and deformity of the joints. The most commonly affected joints include the hips, knees, spine and hands.

Inflammatory Arthritis

Rheumatoid arthritis is the most common form of inflammatory arthritis. It is a disorder of the body’s immune system, where the immune system attacks and damages the joints, resulting in loss of bone and cartilage. This leads to pain, swelling and stiffness.

There are other forms of arthritis. The more common ones are ankylosing spondylitis, gout, psoriatic arthritis, reactive arthritis.

Symptoms of arthritis

The main symptoms of arthritis include pain, swelling of joint, stiffness, warmth and redness of skin over the joint.  Osteoarthritis often develops in people over 40 years old. It becomes more common with older people. Over 12% of people over 65 are affected by the condition. It begins slowly with pain, stiffness and restricted movement in the affected joints. Over time, some people develop creaking joints (crepitations) and joint deformity. The pain and swelling generally get worse with activities.

Rheumatoid arthritis affects between 1 – 3% of the population. It usually starts between 30 – 50 years of age. It is three times more common in females than males. It also begins gradually with first symptoms in small joints such as fingers or toes. There is pain, stiffness and swelling of joints. Symptoms are worse in the morning, and cold and damp weather may aggravate the symptoms. Stiffness may improve during the day as the joints are used. Rheumatoid arthritis can sometimes leave people feeling generally tired and unwell.

Causes

The cause of osteoarthritis is not completely known.  Some people seem genetically predisposed to developing osteoarthritis, but this has not been proven. There are some factors that may contribute to the development of osteoarthritis. They include:

• Being overweight, putting excess strain on joints
• Jobs and activities that put repetitive and excess strain on the joint
• Previous injury to the joint

Rheumatoid arthritis is caused by a disorder of the immune system where the body attacks its own tissues.

Diagnosis

Arthritis can be diagnosed by the symptoms and signs.

X-rays are particularly useful for identifying osteoarthritis; they can show the loss of cartilage resulting in the narrowed space between the bones in a joint. It can also show bone spurs (osteophytes) and bone cysts associated with osteoarthritis.

Sometimes, other investigations such as a bone scan, CT scan or MRI scan and blood tests are used to identify arthritis.

Treatment

Rest – Osteoarthritis symptoms are typically worsened by activity and improved with rest. However, a complete lack of activity can lead to loss of muscle bulk and joint stiffness.

Weight loss – It is not known if weight loss slows the progression of osteoarthritis, but weight loss may reduce joint pain from weight-bearing joints such as hips and knees.

Physiotherapy and Exercise Programs – Physiotherapy and exercise programs can improve flexibility and strengthen the muscles around the joints. People who have regular exercise will typically have less pain and better function than those who are inactive.

Orthoses – Orthoses are devices that help to keep the joints aligned and function properly. They include well-cushioned shoes and orthotic shoe inserts, splints that immobilize joints, and braces that help stabilize joints.

Assistive Devices – Walking sticks, walkers, electric powered seat lifts, raised toilet seats and tub and shower bars can reduce stress on joints and make it easier to perform activities of daily living.

Medications – Osteoarthritis

Analgesics such as Paracetamol help to relieve pain, as do Non-steroidal anti-inflammatory drugs (NSAIDs) – such as Ibuprofen. However, when taken over a long period or in high doses this can lead to bleeding in stomach. It is important to make your GP aware if you are taking these medications. Corticosteroids (Cortisone) – these can be injected into the affected joint. This is not recommended on a long term basis and should not be done too frequently, because of potential side effects.

Medications – Rheumatoid Arthritis

The main objective for treatment of rheumatoid arthritis is to reduce the damaging inflammation. Some of the medications used include disease modifying anti-rheumatic drugs (DMARDs) which can help stop the progress of rheumatoid arthritis. They are often used in conjunction with NSAIDs.

Surgery

Surgery is usually reserved for severe arthritis that significantly affects activities and does not respond to other treatments.

Arthroscopic Surgery

Arthroscopic surgery is useful for people with inflammation of the joint lining (synovium). Surgical removal of synovium (synovectomy) can be performed. It may also be helpful for people with mechanical symptoms such as clicking and locking.

Realignment Surgery

Surgery may be used to realign bones and joints that have become mal-aligned in long-standing arthritis. For the knee, realignment may shift weight bearing to healthier cartilage to relieve pain, and may be suitable for younger and more active patients with osteoarthritis.

Fusion (arthrodesis)

Surgery may be used to permanently fuse two or more bones together at a joint. This may be suitable for badly affected joints where joint replacement is not appropriate. Fusion may be recommended for joints of the wrist and ankle and small joints of the hand and foot.

Joint replacement

Surgery may be used to replace a damaged joint with an artificial joint. Joint replacement surgery dramatically relieves pain in people with severe arthritis of the hips and knees. It may take up to a year before the benefits of joint replacement become fully apparent.