and Sports Medicine  info@highlands-ortho.com
|
1 ARH Lane Suite 201 P.O Box 235 Low Moor, VA 24445
540-863-4444 (office) |
..........You don't have to live in pain ....
and Sports Medicine info@highlands-ortho.com
|
1 ARH Lane Suite 201 P.O Box 235 Low Moor, VA 24445
540-863-4444 (office) |
..........You don't have to live in pain ....
You don't have to live in painArthritis refers to more than 100 diseases of the joints and muscles. It can cause stiffness, pain, swelling, and limited movement, striking the very young, the very old, and every age in between. Some kinds of arthritis are more common in certain groups of people.
The two most common and best known forms of arthritis are osteoarthritis and rheumatoid arthritis.
Osteoarthritis affects 21 million people. It is caused by wear and tear in the joints, starting slowly and building up gradually over many years. It is common in older adults -- more than 90% of people over age 65 show signs of osteoarthritis on X-rays. Osteoarthritis can involve any joint, although it typically affects the knees, spine, hips, and hands. Pain relief is available in several ways, including therapies and medications.
Rheumatoid arthritis is an autoimmune disease that affects about 1.5% of the population. Rheumatoid arthritis can occur in different ways; it can strike quickly, creep up gradually, or come and go. Rheumatoid arthritis is a system disease, meaning it can affect any joint and also involve other body structures. It usually affects joints in both sides of the body. Rheumatoid arthritis can start at any age, but most often begins between ages 20 and 45. There is also a form of arthritis in children called juvenile rheumatoid arthritis (JRA).Pronunciation .................. ......arth-RYE-tis
Synonyms
- Degenerative joint disease
- Rheumatism
- Psoriatic arthritis
- Osteoarthritis
- Infectious arthritis
- Granulomatous arthritis
- Suppurative arthritis
- Septic arthritis
- Rheumatoid arthritis
- Juvenile rheumatoid arthritis
- Juvenile chronic arthritis
- Still's disease
Detailed Description
Different conditions that include arthritis as a major feature include osteoarthritis (OA), rheumatoid arthritis (RA), spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis, Reiter's syndrome), gout, infectious arthritis, lupus (systemic lupus erythematosus), and juvenile rheumatoid arthritis (JRA).
Osteoarthritis is caused by wear and tear in the joints, starting slowly and building up gradually over many years. Rheumatoid arthritis is a systemic disease, meaning it can affect any joint and also involve other body structures.
The cause of rheumatoid arthritis is not known, though an abnormal immune response is involved. Its long-term consequences can be severe, including greatly reduced mobility, severe deformity, and a shorter life span. A multifaceted treatment is used to relieve symptoms and maintain quality of life.
There is also a form of arthritis in children called juvenile rheumatoid arthritis (JRA), which is treated differently. JRA usually appears between ages 2 and 5 and can be in complete remission by puberty. Four times more prevalent in girls, this disease most often affects the joints of the neck, elbows, knees, and ankles. When it is widespread, JRA typically includes high fever and a characteristic rash. There may also be swollen glands and involvement of other organs as well.
Infectious arthritis occurs from an infection that spreads to the joint from the blood. An acute joint infection is an urgent medical condition. It can be caused either by bacteria or viruses, with a joint swiftly becoming painful and swollen. Fever is common, and there may be shaking chills. If infectious arthritis is suspected, you should seek immediate medical attention.
Lupus, known as systemic lupus erythematosus (SLE), is a disease where the body's own antibodies attack different areas, sometimes including the joints. The effects of lupus range from very mild (skin rashes) to very severe (life-threatening kidney failure, lung disease, and blood vessel inflammation). While it takes many forms, joint ache or inflammation is present in about 95% of cases.
Gout can include an acute arthritis that usually strikes the leg, most commonly the big toe. It occurs predominantly in men during middle age. This condition is due to high levels of uric acid in the bloodstream. In chronic gout, crystals of uric acid are deposited around tendons and soft tissues. High levels of uric acid can also contribute to the formation of kidney stones.
Fibromyalgia is a chronic pain disorder that causes fatigue, sleep disturbances, and widespread pain in the muscles and tendons, particularly in the neck, spine, shoulders, and hips. It affects about 3.7 million people, mostly women.
Characteristics of Arthritis
- Osteoarthritis:
- Common and usually painful joint condition
- Typically in older adults
- Often involves hips, knees, spine, and hands
- Rheumatoid arthritis:
- Usually involves at least several joints and both sides
- Has many forms, can be severe
- Systemic condition, can involve other tissues
- May have morning stiffness
- More common in women
- Fibromyalgia:
- Causes fatigue and sleep disturbances
- Causes widespread pain in the muscles and tendons, particularly in the neck, spine, shoulders, and hips
- More common in women
- Infectious arthritis:
- An urgent medical situation when acute
- Joint rapidly becomes swollen and painful
- May be accompanied by fever and chills
- Needs immediate medical attention
- Systemic lupus erythematosus (SLE):
- A disease where the body's own antibodies attack the tissues
- Forms can vary from mild to severe
- Many regions (blood vessels, kidneys, lungs, others) can be affected in addition to joints
How Common Is Arthritis?
Arthritis is very common, affecting 43 million people in the United States. Most people will probably be affected by osteoarthritis as they age: caused by the general wear and tear of everyday activities, it is the most common and affects more than 90% of those over age 65. Rheumatoid arthritis occurs much less frequently, affecting about 1.5% of the general population.
There are many different kinds of arthritis. Osteoarthritis primarily affects people over age 65, whereas juvenile rheumatoid arthritis is most common in those between ages 1 and 4 and ages 9 and 14.
What You Can Expect
As you age, the likelihood of developing symptoms increases. A combination of weight loss, physical therapy, nutrition, medication, and surgery may help ease pain.Established Causes
The causes of most types of arthritis aren't known. Some arthritis, falling under the general category of infectious arthritis, is caused by bacteria in the synovial fluid (fluid in the joint). This leads to swelling and pain in the area. Some organisms get to the joints by first infecting other areas then migrating, and others through an injury near the joint, such as skin lesions or bone infections.Theoretical Causes
In osteoarthritis, it is believed that aging of joints and injury to joints may be a factor. The immune system is also known to attack the tissues in the joint. However, it is not known what causes the immune system to attack itself. Genetics can contribute to the risk.
Risk Factors
There are many different factors, both environmental and inherited, which can put you at risk for developing some kind of arthritis.
- Gender: overall, twice as many women as men
- Obesity: stress on joints
- Native-American ancestry
- Family history (heredity)
- Chronic illness (diabetes, malignancy, liver disease)
- Immune-system depression through disease or drugs
- Infections such as Lyme disease
- Injury to joints
- Trauma
- Surgery/puncture on joint
- Work- or sport-related stress to joints
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
Arthritis can be many different disorders. It is generally characterized by the following:
- Pain following use of joint
- Stiffness of the joints
- Stiffness after inactivity
- Limitations in joint movement
- Swelling
However, some kinds of arthritis, such as fibromyalgia, don't affect the joints. These related conditions affect connective tissue in muscles and, sometimes, organs such as the lungs and kidneys.Conditions That May Be Mistaken for Arthritis
Your physician may have a difficult time differentiating between the various types of arthritis:
- Osteoarthritis
- Gout
- Juvenile rheumatoid arthritis
- Rheumatoid arthritis
- Infectious arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Reiter's syndrome
Other diseases that may confuse diagnoses:
- Autoimmune disease
- Rheumatic fever
- Palindromic rheumatism
- Neuropathic arthropathy
- Sarcoidosis
- Avascular necrosis
How Arthritis Is Diagnosed
Your physician will look over your personal and medical history and perform a physical examination. If necessary, your doctor may suggest that you have one or more blood tests, a synovial fluid analysis, or imaging studies such as an X-ray, CT scan, or MRI scan, to further delineate the nature of the problem.Laboratory Work
Laboratory tests are useful in order to rule out other diseases or help determine which type of arthritis an individual has. Your doctor may order these tests:
- Serum rheumatoid factor
- Uric acid test
- Check red blood-cell levels for anemia
- Sedimentation rate (ESR)
- Synovial fluid analysis
- Antinuclear antibody (ANA)
- Extractable nuclear antigens (RNP, SM)
- HLA-B27
Imaging
The imaging techniques that physicians most often use for this condition are X-rays. They allow the physician to determine how much deterioration has occurred to the joint.Goals of Treatment
The goals of treatment differ, depending on the type of arthritis you have. The goal of most treatments is to reduce joint pain and inflammation, and to improve joint use and function. Although infectious arthritis can be cured with early antibiotic use, most kinds of arthritis have no cure. However, many types of arthritis can be managed with medication and exercise.
Treatment Overview
Therapies include physical and occupational therapy, drug treatment, and surgical replacement of joints. Milder treatments are used as much as possible. In many forms of arthritis, therapeutic exercise and joint protection will be very important in maintaining function and relieving pain.
Treatment will vary with the particular kind of arthritis and the extent of the disease. For instance, in rheumatoid arthritis, a stronger class of medications may be used if the condition doesn't respond to milder drugs quickly.
Severe forms of arthritis are usually treated with a team approach that includes several healthcare professionals. Team members may include several types of physicians and allied health care workers
Drugs most commonly prescribed
Following are several drugs that are generally prescribed for arthritis:Note: Infectious arthritis is treated primarily with antibiotics.
- Tylenol (acetaminophen)
- Aspirin
- Advil, Motrin, or Nuprin (ibuprofen)
- Cataflam (diclofenac potassium)
- Clinoril (sulindac)
- COX-2 inhibitors such as Vioxx (rofecoxib) and Celebrex (celecoxib)
- Daypro (oxaprozin)
- Feldene (piroxicam)
- Indocin (indomethacin)
- Lodine (etodolac)
- Meclomen (meclofenamate)
- Naprosyn, Anaprox, or Aleve (naproxen)
- Oruvail (ketoprofen)
- Relafen (nabumetone)
- Tolectin (tolmetin)
- Voltaren (diclofenac sodium)
Second choices
Other drugs are used according to the type of arthritis being treated. For osteoarthritis:For early stages of rheumatoid arthritis:
- Capsaicin cream: Zostrix and Zostrix-HP
- Corticosteroid injection into joint space: Kenalog (triamcinolone), Depo-Medrol (methylprednisolone), Celestone or Celestone Soluspan (betamethasone)
Prescription NSAIDs such as:
- Aspirin or other OTC NSAIDs (nonsteroidal anti-inflammatory drugs) such as Advil, Motrin IB, or Nuprin (ibuprofen), Aleve (naproxen), and Orudis KT (ketoprofen)
For severe rheumatoid arthritis or flares:
- Cataflam, Voltaren, or Arthrotec (diclofenac)
- COX-2 inhibitors such as Vioxx (rofecoxib) and Celebrex (celecoxib)
- Indocin (indomethacin)
- Motrin (ibuprofen)
- Naprosyn or Anaprox (naproxen)
- Orudis (ketoprofen)
- Relafen (nabumetone)
Disease-modifying antirheumatic drugs (DMARDs), which include:
- Glucocorticoids such as prednisone in pills, or other steroids as injections
New drugs
- Arava (leflunomide)
- Azulfidine (sulfasalazine)
- Cuprimine (penicillamine)
- Gold injections
- Imuran (azathioprine)
- Oral gold (auranofin)
- Plaquenil (hydroxychloroquine sulfate)
- Rheumatrex (methotrexate)
- Enbrel (ethanercept), a biologic response modifier recently approved for RA.
A new generation of nonsteroidal anti-inflammatory drugs, the COX- 2 inhibitors (Celebrex and Vioxx), are now available. These medications are expected to have fewer associated side effects than the previous generation of NSAIDs.
Exercise
Doctors used to think exercise wore joints out faster; now they know some exercise is essential to keep joints healthy. Your doctor will recommend exercises, and will probably send you to a physical or occupational therapist to teach you exercises appropriate for your case of rheumatoid arthritis, age, and overall condition.
Warm-water exercise: Swimming and doing other aerobic water exercises in a heated pool can help you exercise without putting pressure on your joints.
Topical painkillers
If you have only a few joints affected by RA, you might benefit from using an over-the-counter cream, gel, or lotion containing various kinds of pain killers.
Counterirritants distract from the sensation of pain. Some brands include ArthriCare, Eucalyptamint, Icy Hot, and Therapeutic Mineral Ice.
Some creams contain salicylate, which is related to aspirin, and work the same way. Some brands are Aspercreme, Bengay, Flexall, Mobisyl, and Sportscreme (only the "extra-strength"' versions seem to contain aspirin, so read the labels).
Hot pepper might cool your pain as well. A cream or gel that contains capsaicin, an ingredient in cayenne pepper, interrupts substance P, a neurotransmitter believed to carry pain messages to the brain. Brands include Zostrix, Zostrix HP, and Capzasin-P.
Physical therapy and joint protection
Strategies to protect your joints from further damage include:Assistive devices
- Avoiding prolonged positions and activities
- Using larger muscles and joints to do a task whenever possible
- Using splints and other joint protection devices to reduce pain and improve function
- Applying therapeutic hot and cold treatments to ease pain
- Taking paraffin baths (warm wax is poured over the sore joint, holding in heat)
- Having a massage to relieve stress and relaxed tense muscles
- Using TENS (transcutaneous electrical nerve stimulator) and other pain-relief measures
Canes, splints, braces, and other assistive devices that help support your joints or relieve stress and pain can help you get around better. If you have RA in your hands or wrists, specially designed kitchen tools, doorknobs, and other gadgets make day-to-day tasks less painful.
Surgery
In some cases your physician may recommend a replacement of a joint. This surgical procedure is usually successful and has led to great improvements in function, as well as decreased pain in the joints. For infectious arthritis, the joints may be drained in a surgical procedure.Appropriate Healthcare Settings
Diet changes, physical therapy, and medication are given on an outpatient basis. Surgical intervention usually requires a hospital stay.
Healthcare Professionals Who May Be Involved in Treatment
The following are a number of health workers who coordinate their efforts to best treat this condition:
- Family physicians
- General internists
- Pediatricians
- Rheumatologists
- Clinical immunologists
- Hand surgeons
- Orthopedic surgeons
- Physiatrists
- Occupational and physical therapists
Activity and Diet Recommendations
Activities used for treatment range from more activity to no activity. Once again, it all depends on what kind of arthritis you have.
The role of diet in arthritis has been the subject of much discussion. Most agree on a diet that promotes a lean body that minimizes stress on the joints. Adequate protein may help preserve muscle bulk. For those using corticosteroid medications, extra calcium and Vitamin D may help.
There have been reports of improvement in rheumatoid arthritis patients who eliminated certain foods from their diets. However, no one food has been identified as a factor for everyone. These included milk products, corn, wheat, nitrates, and nightshade vegetables (potatoes, tomatoes, eggplant, and bell peppers). The anti-inflammatory effects of different omega-3 oils (fish oils, flaxseed oil) and gamma linoleic oils (borage) have also been established for some kinds of arthritis.Monitoring the Condition
Monitoring is dependent on the type of arthritis you have.Possible Complications
There are a number of complications that may arise from arthritis. The ones seen in most types of arthritis include:
- Joint deformation
- Severely decreased joint use
- Destruction of the joint
Some forms of arthritis, such as rheumatoid arthritis and lupus (SLE), can involve many other organ systems.
Quality of Life
Movement is a big part of everyday life. When some motions are limited, special accommodations may be necessary. There is increasing availability of equipment, facilities, and situations for those with reduced mobility. Finding informal or professional emotional support can help in facing the loss of independence that may accompany severe impairment.
Assistive devices that make daily activities easier include special footwear, canes, walkers, reachers, and ergonomic utensils.
Pregnancy
Inform your physician if you are pregnant or are planning on becoming pregnant. Some medications used to treat arthritis may need to be discontinued during pregnancy, or months before conception is attempted. Some of these also affect men.Breastfeeding
Inform your physician if you plan to breastfeed while taking medications for arthritis. Some medications can be passed through the breast milk.
Supplements
SAM-e: An antidepressant that also eases arthritis and detoxifies the body? That's what some researchers are saying about SAM-e, a substance only recently gaining public attention in the United States despite its use abroad and many positive studies.
Vitamin E: Like vitamin C, vitamin E is an potent antioxidant. In one study, 32 people with osteoarthritis took either a placebo or vitamin E (600 IU/day). Participants in the vitamin E group experienced significantly greater relief. [1]
Glucosamine and chondroitin: About one-half to two-thirds of people with osteoarthritis who try these supplements benefit. Both relieve pain.
Glucosamine may help repair damaged cartilage. Experts suggest 500 mg three times a day for a month. If it helps, feel free to keep taking it. [2] If not, stop after a month.
Chondroitin helps draw fluid into cartilage, improving its shock-absorbing ability. Experts suggest 400 mg three times a day for a month. [3] If it helps, feel free to keep taking it. If not, stop.
Neither glucosamine nor chondroitin supplements has been reported to cause significant side effects.Herbs
Ginger: Ginger is an age-old treatment for pain and inflammation. Indian researchers had arthritis sufferers (18 with osteoarthritis, 28 with rheumatoid arthritis) take ginger powder daily (500 to 4,000 mg). Two years later, most participants reported significant pain relief, with no side effects.Yoga
Stretch your hands. Researchers at the University of Pennsylvania gave people with osteoarthritis of the hands either pain medication or a weekly yoga class. After eight weeks, the yoga group reported significantly less hand pain.
An ancient Hindu discipline, yoga provides gentle stretching and strengthening exercises combined with controlled breathing, focused concentration, and meditation.Acupuncture
At the University of Maryland, researchers gave standard care to a group of 58 people with osteoarthritis of the knee. In addition, half of the group also received acupuncture treatment for eight weeks. Afterwards, the acupuncture group reported significantly less pain.
An ancient Chinese practice, acupuncture consists of inserting very fine needles into the skin along a series of energy channels or paths known as meridians. It stimulates particular areas or systems of the body to promote healing and wellness.
Preventing Arthritis
Some kinds of arthritis can't be prevented. However, you can reduce some risks:
- Avoid or take caution when participating in sports that put strain on your joints
- Protect your joints when you're participating in activities that may expose the joints to sudden shocks.
- If overweight, lose weight to take some pressure off of the joints
- Get early medical treatment for infections in joints and in the body
- Protect yourself from sexually transmitted diseases
Self-Care Measures
Move around. Try not to stay in one position for long periods of time.
Exercise daily. Inactivity leads to loss of cartilage, which aggravates osteoarthritis pain. Walking is great exercise for osteoarthritis of the knee. At the Hospital for Special Surgery in New York City, researchers recruited 102 people with osteoarthritis of the knee and had some of them take regular walks. After eight weeks, the non-walkers reported the same amount of pain, but the walkers reported 27% less, plus less need for pain medication.
Spare your joints. Invest in household items that reduce joint strain: an electric can opener, various step stools, and so on. Place frequently used items on shelves you can reach easily.
Avoid overexertion. Learn your limits and don't push yourself beyond them. Be kind to your body.
Win by losing. The more you weigh, the greater the stress on your joints, especially your hips, knees, and ankles. At the Boston University School of Medicine, researchers monitored 598 older people for 10 years. The participants' risk of osteoarthritis was clearly linked to how much weight they gained. If you are overweight, losing even 10 to 15 pounds can help reduce your pain.Diet
Eat a balanced, low-fat diet rich in fresh vegetables and fruit.
Take vitamin C. Antioxidant nutrients, including vitamin C, help prevent the cell damage linked to many age-related conditions, including osteoarthritis. For 10 years, researchers at the Arthritis Center of the Boston University Medical Center surveyed the diets of 640 older adults who had osteoarthritis of the knee. Compared with those who consumed the least vitamin C in foods, those who ate the most had just one-third the risk of their osteoarthritis getting worse. Among other things, vitamin C helps prevent cartilage loss. Foods high in vitamin C include broccoli, bell peppers, citrus fruits, cabbage, cauliflower, spinach, and strawberries.
Take vitamin D. The same researchers of vitamin C also investigated their subjects' vitamin D intake. It, too, significantly decreased the risk of osteoarthritis progression. Vitamin D also helps preserve cartilage. Foods high in vitamin D include fortified dairy products and the following fish: salmon, halibut, sea bass, tuna, cod, and herring.
Websites & Organizations
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American Juvenile Arthritis Organization www.arthritis.org>www.arthritis.org>www.arthritis.org
Arthritis Foundation Information Line
National Institute of Arthritis and
Thurston Arthritis Research Center
University of Birmingham Rheumatology
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General Orthopaedic Information and Additional Websites
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and Sports Medicine info@highlands-ortho.com
|
1 ARH Lane Suite 201 P.O Box 235 Low Moor, VA 24445
540-863-4444 (office) |
Thank you for your time
Created Dec. 6, 1999
Last update Dec. 6, 1999