Arthritis

"Arth" comes from "arthro" (Greek), meaning joint.  The suffix "itis" designates inflammation. Simply put, arthritis refers to inflamed joints.  The term is applied to various diseases of the joints and their surrounding soft tissues. A fibrous envelope called the synovium, which produces a fluid that helps to reduce friction and wear, encloses the joint. Ligaments connect the bones and keep the joint stable. Inflammation is one of the body's normal reactions to injury or disease. In an injured or diseased joint, this results in swelling, pain, and stiffness. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability.

There are over 100 forms of arthritis, including:

• Rheumatoid -- a chronic, systemic, inflammatory disease that chiefly affects the synovial membranes of multiple joints in the body.
• Gout -- when excess uric acid in the body forms needle-like crystals in joints, leading to painful, acute attacks.
• Osteoarthritis -- the most common type, described in detail below.
• Psoriatic -- thought to be caused by a malfunctioning immune system, leading to inflammation in and around joints.  Most of those who have psoriatic arthritis also have psoriasis.
• Septic -- infection of a joint, affecting the synovium.          

Osteoarthritis is often associated with aging, since the older we get, the more wear and tear accumulates on our bodies’ mechanical parts.  Among older people, it is the most common cause of pain handicap.  However, arthritic problems can occur in very young people as well, especially at sites of previous injury, repetitive stress, or fractures.  For example, a baseball catcher endures enormous stress on his knees, potentially leading to wear-and-tear changes, which precede arthritis.

Diagnosing arthritis often includes evaluating symptoms, a physical examination, and X-rays, which are important to show the extent of damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis.             

Onset.  Physical changes of arthritis begin long before pain begins.  Ninety-five percent of people older than 15 already have arthritic changes in their elbow joints.  By the time pain is experienced damage is often quite advanced.  The usual wear and tear damage begins with fraying of the surfaces of cartilage, which becomes increasingly “raggedy”. The changes in the cartilage are perceived as foreign bodies by the immune system, which releases destructive enzymes further damaging the cartilage.  Tearing or thinning or changing of the shape of the cartilage can then result.  In later stages, with the cartilage virtually worn away, bone on bone grinding occurs, accelerating damage to the bone itself.

Pain. There are many ways in which arthritis joint changes can lead to pain: inflammation from the immune system’s attempt to heal the damage can spread to and involve surrounding tissues, e.g. muscles, nerves, ligaments, tendons, veins.  Osteophytes are bony growths often generated by the body in an attempt to patch up an injury.  These can lead to compression of nerves and other tissues.  Discs between the back vertebrae can protrude into other spaces compressing and interfering with nearby tissues.  With over 200 separate joint surfaces in the body, and their surrounding soft tissue structures, one can see that arthritic pain can be generated in multiple ways, and in virtually any location in the body.            

Affected sites. The three most common sites of arthritic pain are the back, the hips, and the knees.  Other common sites include elbows, neck, hands, thumb, ankle, toe, foot, sacroiliac, heal, and shoulder.  Almost any of the joint facets in the body can be affected. Which sites are affected can vary according to factors such as occupation and previous injury.  Gender also can be a factor.  Arthritis of the hands, for example, is more common among women.            

Treatment of arthritis includes prescription medications such as anti-inflammatories and painkillers, joint injections, surgery, physical therapy, biofeedback, various nutritional supplements, over-the-counter (OTC) medications, herbs, and others. The goals of treatment are to provide pain relief, increase motion, and improve strength.

OTC medications. Useful remedies include soothing topicals (e.g., mentholatum) and anti-inflammatory topicals.  Aspirin, Advil® (ibuprofen), and Aleve® (naproxen) are widely used to control pain and inflammation. Tylenol® (acetaminophen) may be used to control pain. However, not all sufferers can tolerate the side effects of long-term use of those medications in high enough doses to control pain and inflammation.  Patients with ulcers, asthma, kidney, or liver disease may not be able to safely take anti-inflammatory medications. Many new prescription medications have been developed that are generally safe and effective.

Glucosamine is available over the counter.  Recent research suggests that is can be used to help in the body’s repair of damaged joint surfaces.  Improved mobility and lessened pain were reported for many patients when glucosamine was taken as directed over an extended period of time.

Injections of liquid cortisone directly into the joint may temporarily help to relieve pain and swelling. It is important to know, however, that repeated frequent injections into the same joint can damage the joint and have undesirable side effects.  

• Bextra® (valdecoxib)
• Celebrex® (celecoxib)
• Ultram® (tramadol)
• Vioxx ® (rofecoxib)

What’s Ahead? As our population ages, we can expect arthritis-generated costs in suffering and medical expense to mushroom. Hopefully, there will be a proportional increase in research into slowing the progression of this non-fatal but potentially disabling disease. We will be attempting to provide a useful source of information for staying updated on current arthritis management and treatment.

In the News

Arthritis Prevalence in Patients Over 65 Will Double Over a 25 Year Period   (June, 2003, summary)