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Arthritis
Arthritis (from Greek arthro-, joint + -itis, inflammation) is a group
of conditions that affect the health of the bone joints in the body. One
in three adult Americans suffer from some form of Arthritis and the
disease affects about twice as many women as men. Arthritic diseases
include rheumatoid and psoriatic arthritis, which are autoimmune
diseases; septic arthritis, caused by joint infection; and the more
common osteoarthritis, or degenerative joint disease. Arthritis can be
caused from strains and injuries caused by repetitive motion, sports,
overexertion, and falls. Unlike the autoimmune diseases, osteoarthritis
largely affects older people and results from the degeneration of joint
cartilage. Arthritis may also be caused by gout.
Arthritic joints can be sensitive to weather changes. The increased
sensitivity is thought to be caused by the affected joints developing
extra nerve endings in an attempt to protect the joint from further
damage.
Types of Arthritis
Septic arthritis
Septic arthritis is the proliferation of bacteria in joints and
resultant inflammation. Bacteria are either carried by the bloodstream
from an infectious focus elsewhere or are introduced by a skin lesion
that penetrates the joint.
Septic arthritis should be suspected when one joint (monoarthritis) is
affected and the patients is febrile. In seeding arthritis, several
joints can be affected simultaneously; this is especially the case when
the infection is caused by staphylococcus or gonococcus bacteria.
Diagnosis is by aspiration, Gram stain and culture of fluid from the
joint, as well as telltale signs in laboratory testing (such as a highly
elevated ESR or CRP).
Therapy is usually with intravenous antibiotics.
Osteoarthritis
Osteoarthritis (or arthrosis) is caused by destruction of the synovium
by wear and tear. Contributing factors include congenital hip luxation,
obesity, osteoporosis, and diseases such as Perthes' disease .
The main symptoms are pain and restricted movement.
The diagnosis is made on the basis of the history, restricted movement
and X-rays of the joint.
The joints mainly affected by osteoarthritis are the hip joints and the
knee joints, although in theory any joint in the body can be affected.
Treatment is with NSAIDs or paracetamol, or joint replacement surgery in
patients who would otherwise be mobile and do not benefit from
medication. Recently glucosamine and chondroitin sulphate have been
shown to improve symptoms of osteoarthritis.
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Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disorder that causes the body's
immune system to attack the bone joints. It is a disabling condition,
and often thought of as a disease.
The synovium can become irritated and thickened with this condition, and
sometimes it must be surgically removed.
Diagnosis is with immunological studies, such as rheumatoid factor (a
specific antibody) which can be negative; when this happens the
arthritis is seronegative.
The American College of Rheumatology has defined (1987) the following
criteria for Rheumatoid Arthritis [1]:
Morning stiffness of >1 hour.
Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups
Arthritis of hand joints
Symmetric arthritis
Subcutaneous nodules in specific places
Rheumatoid factor at a level above the 95th percentile
Radiological changes suggestive of joint erosion
Four criteria have to be met, although many patients are treated despite
not meeting the criteria.
Treatment is with NSAIDs, although most patients will proceed to
treatment with steroids, DMARDs (disease-modifying antirheumatic drugs),
and monoclonal antibodies (anti-TNF-alpha, e.g. infliximab or etanercept).
Other therapies are weight loss, physiotherapy and special tools to
improve hard movements (e.g. special tin-openers).
Psoriatic Arthritis
Psoriatic arthritis is non-destructive symmetrical inflammation of
joints as part of the skin disease psoriasis. It occurs more commonly in
patients with tissue type B27. Its treatment is basically identical to
that of rheumatoid arthritis.
Gouty Arthritis and Pseudogout
Gout (podagra) is arthritis due to the accumulation of uric acid
crystals in the joints. The big toe joint is most commonly affected.
Gouty arthritis is immensely painful. The diagnosis is made when
crystals are being detected on fluid aspirated from the affected joint,
although a clinical diagnosis is often made (i.e. without supporting
laboratory evidence).
It is treated in the acute phase with NSAIDs (non-steroidal
anti-inflammatory drugs). If attacks happen more than twice a year,
allopurinol is often prescribed (although not in the acute phase) to
decrease accumulation of uric acid. Colchicine impairs the motility of
granulocytes and can prevent the inflammatory phenomena that initiate an
attack of gout. Its main side-effects (gastrointestinal upset) can
complicate its use. Several other agents are used for gout.
The increased levels of uric acid are often due to increased production
or ingestion (many patients blame organ meat such as liver or thymus for
attacks) or decreased renal excretion. The latter is worsened by the use
of certain (thiazide) diuretics.
Pseudogout (calcium pyrophosphate deposition disease) is very similar
disease, but the crystals look differently on light microscopy and the
accumulated substance is different.
Hemochromatosis
Arthritis of the hand joints occurs in the iron accumulation disorder
hemochromatosis. Its treatment is iron elimination and chelation.
Systemic Lupus Erythematosus
A non-destructive arthritis occurs in lupus erythematosus. Please refer
to the main article.
Juvenile Arthritis
Juvenile arthritis typically affects kids before the age of 16. Most
kids with juvenile arthritis have a form of rheumatoid arthritis. The
symptoms are identical to the adult kind except that in many cases kids
outgrow juvenile arthritis.
Familial Mediteranian Fever
Febrile attacks of FMF include arthritis in many patients. Very rare
variants areHIDS (hyperimmunoglobulinemia D and periodic fever syndrome)
and TRAPS (TNF-alpha receptor associated periodic fever syndrome).
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