Arthritis

Symptoms: Swelling, pain, redness and stiffness in the joints; reduced range of motion, fatigue, tenderness of muscles around the joints, low-grade fever, loss of weight, trouble breathing, rashes, cracking and creaking of joints
Causes: Obesity, genetics, repetitive joint movements, previous joint damage, sports injury, wear and tear of the cartilage, immune system attacking the joint capsule lining
Risk Factors: Age, sex, family history, obesity, previous joint injury, hypermobility, bone deformity, physically demanding professions

Prevalence: Osteoarthritis affected approximately 528 million people worldwide in 2019, representing a 113% increase since 1990. About 73% of people with osteoarthritis are over the age of 55, and 60% are women. Meanwhile, in India, the prevalence of arthritis is 22% to 33%.
Severity: Mild to severe 
Which doctor to consult: Rheumatologist or Orthopaedic Surgeon
 

Overview:

Arthritis is derived from the Greek word "arthron", which means joint, and "itis", which means inflammation. However, simply terming arthritis as a joint inflammation will be an oversimplification. The inflammation of the joints is only one of the significant symptoms of the disease. 

Generally, any disorder of the joints is referred to as arthritis. Arthritis is an umbrella term comprising over 100 types of disorders associated with various conditions. The disease can have many signs and symptoms, depending on the patient's age, ethnicity, and sex. In extreme cases, it can cause permanent disability. 

The most common type of arthritis is osteoarthritis (OA). It causes damage to the joints of the hips, spine, hands, and knees. Osteoarthritis is often considered a wear-and-tear disorder of the cartilage, but recent medical advancements have pushed doctors to consider it as a joint disorder. A primary subtype of the disease is inflammatory OA. 

Autoimmune inflammatory arthritis is another type of arthritis where the body's immune system attacks healthy tissues of the spinal joints. In this disorder, the immune system loses its ability to differentiate between infection or injury and a healthy system. The most common form of this disorder is rheumatoid arthritis (RA). Besides that, psoriatic arthritis (PsA), gout, axial spondyloarthritis (axSpA), and juvenile arthritis are other types. 
The actual causes of inflammatory arthritis in each individual are still unknown. However, viral infections, smoking, and stress have been identified as plausible reasons that can trigger the disorder. 
 

When to Consult a Doctor? 

An individual should seek immediate medical attention in case of the following conditions: 
On Recognizing Symptoms
Although joint pain is rarely considered an emergency, an individual must contact the doctor in case other symptoms are present. Common symptoms include joint pain accompanied by redness, swelling, warmth around the joint and tenderness. 

Severe Injuries

An individual must consult a rheumatologist if she has suffered any severe injury that has caused joint deformity. Also, any movement difficulty in the joint accompanied by severe pain needs immediate medical supervision. Also, joint changes noticed in an X-ray, ultrasound, or MRI must not be ignored. 
 

Diagnosis: 

Diagnosing arthritis and its root cause is challenging due to the various signs and symptoms. A rheumatologist may conduct different examinations and check the medical history to confirm the arthritis and its cause. 
 

1. Physical Examination

A rheumatologist can conduct a primary musculoskeletal examination to inspect the condition of the joints, especially if an individual has recently undergone any joint surgery. Preliminary inspection includes checking the range of motion, swelling, and tenderness of the joints and the affected muscles around the joints. This inspection also gives the doctor a fair idea about the type of arthritis.  
 

2. Diagnostic Tests
 

Blood Tests

Blood tests are widespread and common for checking arthritis, especially rheumatoid arthritis. A higher erythrocyte sedimentation rate of ESR can indicate an inflammatory disorder. Another way to confirm the disease is by checking the C-reactive protein (CRP) level. Other methods include the anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor test. 

Imaging tests: Various types of imaging tests need to be conducted to diagnose arthritis. These include: 
X-rays
Computerized tomography (CT) 
Magnetic resonance imaging (MRI) 

Ultrasound 

X-rays are done at a low radiation level to get an image of the bone damage and spurs. However, there are more efficient ways of diagnosing arthritis damage. X-rays are mainly used to confirm the progression of the disorder.
CT scans, on the other hand, provide a much better view of the bone and its surrounding soft tissues.
MRIs help get a picture of the cartilage, ligaments, and tendons, while an ultrasound helps collect joint fluids. The method, also known as arthrocentesis, enables the collection of synovial fluid from the joint capsule. 
 

Lab Tests

Arthritis is diagnosed using various laboratory tests, including the testing of body fluids. This allows a doctor to get to the root cause of the problem. Generally, the fluids used for testing include urine and joint fluid. The doctor collects the joint fluid by injecting a needle into the joint.

3. Advanced Tests

Arthroscopy

Arthroscopy is a minor invasive or surgical procedure for diagnosing joint problems. The method is also helpful in treating joint problems. The most common areas where arthroscopy is done include the hips, wrists, elbows, shoulders, ankles, and knees. The doctor inserts an arthroscope into the joint by making several small incisions and inspects the damage caused. 
 

Treatment:

Home Care

Some home remedies that can provide temporary relief from the signs and symptoms of acute arthritis pain include: 
Exercising regularly has shown positive results in arthritis. It helps a person their/her weight while retaining the flexibility of the joints. Proper exercising also strengthens the ligaments and joints with significantly greater support. 
Heat treatments, like a warm shower or an electric heat pad, can also help. 
Cold treatments and consuming capsaicin in chilli peppers and some ointments can also help. 
Acupuncture is another method which can help reduce arthritic pain in patients. However, an individual must consult a doctor before opting for such options. 

Medication

The medications used to treat arthritis are different depending on the type of arthritis. Some of the most common arthritis medications are: 

NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain relief and inflammation reduction. Naproxen sodium and Ibuprofen are two examples. Stronger NSAIDs can cause stomach irritation and raise your risk of a heart attack or stroke. NSAIDs are also available in creams and gels that can be applied to joints.
Counterirritants: Some creams and ointments contain menthol or capsaicin, which gives hot peppers a spicy flavour. Rubbing these preparations onto the skin over your aching joint may disrupt the transmission of pain signals from the joint.
Steroids: Corticosteroid medications like Prednisone and Triamcinolone alleviate inflammation and pain while slowing joint damage. Corticosteroids can be administered as a pill or as an injection into the painful joint. Side effects may include bone thinning, weight gain, and diabetes. 
Disease-modifying antirheumatic medications (DMARDs): These medications can slow the progression of rheumatoid arthritis while protecting the joints and other tissues from permanent damage. In addition to traditional DMARDs, there are biological agents and targeted synthetic DMARDs. The side effects vary, but most DMARDs increase the risk of infection. Commonly used conventional DMARDs include Methotrexate, Leflunomide, Hydroxychloroquine, and Sulfasalazine.
 

Surgical Treatment

There are a few surgical treatments available for treating arthritis. But most involve treating or replacing the joints since these bear the entire body weight. Arthrodesis: It is the process of joining (fusing) the two bones that make up the joint. Because the fused joint cannot be moved, it no longer hurts. This type of surgery is most commonly performed on ankles, wrists, fingers, and thumbs.
Arthroscopy: It is also known as 'keyhole' surgery. A thin instrument (arthroscope) is inserted into your joint via a small incision in the skin. The arthroscope is a telescope that allows the surgeon to see right into your joint. It can be linked to a camera for a better view of your joint and image recording. The underlying cause of the symptoms can be identified and, in some cases, treated. Arthroscopy is not an effective treatment for knee osteoarthritis and is not recommended unless the knee locks.
Osteotomy: It is a procedure that involves cutting and repositioning a bone. This can help to improve joint alignment and relieve pressure on the affected side of the joint. This type of surgery is typically performed on knees and hips. Resection refers to the removal of a portion or all of a bone or joint. This is frequently performed for damaged joints in the foot and big toe.
Synovectomy: is an operation that removes the joint lining, known as the synovium. This is effective for rheumatoid arthritis, as it reduces pain, swelling, and joint damage. However, the synovium may regrow several years later, and the symptoms may reappear. 
Joint replacement: It is also known as an arthroplasty. This involves removing the damaged joint surfaces. These surfaces are then replaced by metal, ceramic, or plastic components. Total arthroplasty replaces the entire joint, whereas hemiarthroplasty replaces only a portion of the joint. Knees, hips, shoulders, elbows, fingers, ankles, toes, and even the spine can all undergo joint replacement surgery.
 

Complications:

Bone Death
Osteonecrosis is another bone disorder that can arise from complications due to rheumatoid arthritis. The blood supply in the affected areas is disrupted, causing permanent bone death.  

Stress Fracture
Patients suffering from OA or RA for a prolonged period can suffer from insufficiency fracture or stress fracture. This occurs due to osteoporosis, joint stiffness, or joint deformity. 
Ankylosing Spondylitis
Ankylosing Spondylitis is a spine inflammation that can impact the lower back, hip and pelvic area. Stiffness due to arthritis can cause the bones of these areas to fuse or even cause painful bony outgrowths.  

Spinal Stenosis

Another spinal complication due to arthritis is spinal stenosis or narrowing of the spine. Owing to any outgrowth, the ligaments around the area thicken, narrowing the spinal canal. This compresses the nerves in the spine, causing various other problems, such as poor bladder and bowel movement. 

Sleep Disruption

Most patients who have arthritis have trouble sleeping due to swollen and painful joints. The sensation of tenderness and a poor sleep cycle can intensify the pain.  

Anxiety and Depression

Besides the physiological aspect, arthritis also has a psychological impact on patients. Anxiety and depression are prevalent among OA patients. 

Weight Gain

Pain and stiffness of the joint can limit one's mobility and prevent/her from leading an active life. The reduced ability to walk or exercise can cause sudden weight gain, giving birth to other issues like diabetes and hypertension.

Impact on the Skin

Arthritic inflammation that is caused due to the immune system, like RA, can harm the skin. Patients' most common issues are lesions or rashes on the skin called rheumatoid nodules. 

Heart Complications

The inflammation from RA can spread to the blood vessels, causing them to shrink. This, in turn, causes clots and blockage in the arteries. As a result, patients can suffer from a heart attack or a stroke. 

Lung Complications

Common lung problems from arthritis include developing long-term lung inflammation, chronic cough, breathing difficulties, and rheumatoid nodules on the lungs. 

Kidney Complications

Inflammatory arthritis can even target the kidneys. As a result, patients can experience a loss of appetite, muscle cramping, shortness of breath, frequent urination, skin darkening, etc. 

Risk factors:

Risk factors for arthritis include: 

Family history: Some types of arthritis run in families, so if your parents or siblings have the condition, you are more likely to develop it.
Age: Many types of arthritis, such as osteoarthritis, rheumatoid arthritis, and gout, become more common as people get older. 
Sex: Women are more likely than men to develop rheumatoid arthritis, while men make up the majority of those with gout, another type of arthritis.

Previous joint injuries: People who have injured a joint, possibly while playing sports, are more likely to develop arthritis in that joint.
Obesity: Carrying extra weight puts strain on your joints, especially your knees, hips, and spine. People who are obese are more likely to develop arthritis.
 
 

Additional Information 

Effect of Smoking on Arthritis
Smoking is a harmful habit that can cause damage to cell production in the cartilage. It also increases toxins like carbon monoxide in the blood, aggravating cartilage loss. This disrupts cartilage production and repair, causing increased soreness in arthritic patients.

Effect of Drinking on Arthritis
Moderate drinking can provide some protection against arthritis, especially RA. However, an individual must ensure moderation to reap the benefits.