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Arthritis

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Arthritis

What is arthritis?

Arthritis is not a single disorder but rather the name for joint disease from a number of causes. Arthritic disease causes painful inflammation of one or several joints, with the inflammation destroying the cartilage in the joints.

What are the different types of arthritis?

Osteoarthritis

Also known as degenerative joint disease or osteoarthrosis, osteoarthritis is the most common arthritic disease. The majority of Irish people over the age of 55 have evidence of osteoarthritis at some joint in their body.

Osteoarthritis develops when cartilage (a slippery tissue that coats the ends of the bones) in a joint deteriorates. As the disease progresses, the cartilage loses elasticity and becomes increasingly prone to damage due to wear and tear, leaving the ends of the bone within the joint unprotected. Unlike some other types of arthritis, such as rheumatoid arthritis, osteoarthritis does not spread through the entire body but instead concentrates in one or several joints, usually the fingers, feet, knees, hips and spine.

Although it is most common in the elderly, it is not just a result of the ageing process, as osteoarthritic cartilage is chemically different from normal aged cartilage. Genetic factors, muscle weakness and obesity may all contribute to the development of the disease.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. There have been suggestions that the disease may be caused by an infection, but this has never been proved. Genetic, as well as environmental factors may be involved. Although it usually begins between the ages of 30 and 40 it can occur in older people for the first time. It occurs more commonly in women than in men.

Seronegative arthritis

If you have signs of inflammatory arthritis in your joints, but blood tests for rheumatoid arthritis are negative, you may be diagnosed with ‘seronegative arthritis’. Seronegative arthritis can be associated with disorders such as psoriasis or Crohn’s disease.

Infectious arthritis

Also known as reactive, septic or pyogenic arthritis, this type of arthritis is caused by bacteria invading a joint from an infected wound near the joint or from an infection in the bloodstream.

Ankylosing spondylitis

This is another form of inflammatory arthritis, which affects the pelvic joints and the spine. It is commoner in men and women appear to get a less aggressive form of this condition.

Gout

The arthritis associated with this disorder results from crystals of uric acid being deposited in joints, causing inflammation. Gout usually affects one joint at a time and the big toe is the most commonly affected joint.

What are the symptoms of arthritis?

  • Pain in the joints, which may be accompanied by feelings of weakness and fatigue. The joints most likely to be affected will vary depending on the type of arthritis present.
  • The joints usually swell and become red, stiff and sore.
  • Discomfort and stiffness are usually worse early in the day and are eased by moving around.

Who is affected by arthritis?

One in every six people in Ireland are affected by arthritis. All age groups can develop the disease, including children. It is more common in women than men.

How is arthritis diagnosed?

Your doctor will make the diagnosis based on your symptoms and a physical examination. Sometimes, your GP may be able to make a diagnosis right away, but in other cases you may be referred to a specialist at a hospital. X-rays may be used to assess the extent of joint damage. Blood tests (such as a full blood count, ESR or rheumatoid factor) are helpful in distinguishing the different types of arthritis.

How is arthritis treated?

Arthritis is an unpredictable disease and treatment can be difficult. The approach and success will vary according to the type of arthritis being treated. There is no known cure for arthritis, so treatment is aimed at reducing joint pain and inflammation, improving joint function and preventing progression of the disease. This is achieved through a combination of lifestyle factors and drug therapy.

Lifestyle factors

  • Exercise — a graduated exercise programme that is within your capacity is essential to maintain the function in your joints. Walking and swimming are particularly suitable forms of exercise.
  • Diet — if overweight, it is important to lose weight; carrying extra weight puts a lot of strain on the joints. People who suffer from gout will be advised about avoiding certain foods and reducing their alcohol intake.
  • Heat — a hot water bottle, a warm bath or an electric blanket can be very helpful in reducing stiffness and easing pain.
  • Physiotherapy — can be very useful in maintaining joint mobility and function.
  • Occupational therapy — advice on aids to use in the home and more efficient ways to carry out normal daily activities to protect the joints.

Arthritis Medications

The type of medication used will depend on the type of arthritis you have. Osteoarthritis is often treated with simple painkillers, such as paracetamol or paracetamol combined with codeine. Anti-inflammatory drugs such as aspirin or ibuprofen are best reserved to treat acute flare-ups, as long-term, continuous use of these drugs may cause serious side effects such as bleeding from the stomach or bowel.

In rheumatoid arthritis simple painkillers and anti-inflammatory drugs are also widely used. In recent years, a new generation of anti-inflammatory drugs called Cox-2 inhibitors were introduced, which promised to give less side effects than those seen with the older anti-inflammatory drugs. However, the Cox-2 inhibitors have since been associated with heart problems, restricting their use in certain ‘at risk’ patients.

In addition, there are a number of disease-modifying drugs available, which reduce pain, swelling and stiffness in people with rheumatoid arthritis. A group of drugs called anti-TNF drugs, which act to reduce inflammation, are sometimes used in patients with rheumatoid arthritis who have not responded to other medications.

Steroids can also sometimes be prescribed, but doctors normally try to avoid them because of the side-effects they can produce with long-term use.

Joint injections and joint replacements are other treatment options.

What can I do?

  • Visit your doctor regularly so that your arthritis can be monitored and medication changed when necessary.
  • Ask a physiotherapist for advice on an exercise programme that is suitable for you.
  • Watch your weight, particularly if you have arthritis in weight-bearing joints.

What is the outlook?

There are many types and degrees of severity in arthritis, but it is not usually a crippling disease, particularly if diagnosed and treated early. Recent advances in drug therapy will also help some sufferers.

Reviewed: November 2, 2006

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Last Reviewed: 2nd November 2006



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