Dr John Anne asked:


What is arthritis?

An inflammation of a body joint or its component tissues, accompanied by pain, soreness, and inflexibility in that area, which is basically a result of causes ranging from infection, distress, degenerative changes or metabolic disorders.

In simple words, affected joints are unable to move smoothly past one another.

In medical parlance, arthritis refers to a collection of more than 100 rheumatic diseases and conditions that can cause pain, stiffness and soreness in the joints. If left untreated, arthritis can cause irreversible damage to the joints.

What are the various forms of arthritis?

Arthritis can appear suddenly or gradually, and occurs in various forms, but osteoarthritis and rheumatoid arthritis are the two most common.

There are four basic types of arthritis:

1. Inflammatory arthritis – inflammation of tissues related to joints. Connective tissue diseases, crystal deposition diseases, infectious arthritis, and spondylitis are examples of inflammatory arthritis. Rheumatoid arthritis is the most common variety. Other types are Ankylosing spondylitis, Reiter’s syndrome, Ehlers-Danlos syndrome.

2. Degenerative joint disease (osteoarthritis) – corrosion of the cartilage lining the joints and lessening of new bone formation underneath the cartilage. The disease is quite common in the latter part of life where the continued slow damage causes increasing disability.

3. Nonarticular rheumatism – sometimes called soft-tissue rheumatism, and includes conditions like tendonitis, bursitis, fibrositis. This condition is related to sleep disturbances or even muscular abnormalities.

4. Other diseases may also give rise to arthritis. There exist neurological, blood and endocrine related disorders giving rise to rheumatic diseases.

How to recognize arthritis?

Symptoms differ from person to person depending on his age, the affected area and the type of arthritis. The most common symptoms include:

§ Swelling in one or more joints

§ Stiffness around the joint that usually occurs in the early morning

§ Constant or recurring pain in a joint

§ Tenderness around a joint

§ Difficulty using or moving a joint normally

§ Redness in a joint accompanied by heat there

Other possible symptoms:

§ Occasional fever

§ Weight loss and fatigue

§ Breathing difficulty

§ Rashes and itching

Who all are at risk of arthritis?

Younger people have a relatively lower risk of having arthritis but still comprise a sizeable portion of affected people.

Prevalence is generally higher among women as compared to men, especially osteoarthritis. Arthritis is the leading cause of mobility limitation in women aged 45 years and above. So all you ladies, remember prevention is better than cure.

What are the common causes?

The causes of arthritis usually depend on the type of arthritis. Common causes include:

§ injury (leading to osteoarthritis),

§ irregular metabolism

§ hereditary

§ some infection

§ unknown reasons in case of rheumatoid arthritis

What treatment procedure to follow?

Early diagnosis and treatment helps……

The most common complication of arthritis is functional disability. However, do not get scared! General health upkeep, rest, and gradual treatment can avoid this situation.

There is no complete remedial treatment, only control through a combination of heat fomentation, massage, and supervised exercise. The various treatment options help manage pain and reduce deformity and disability.

A correct diagnosis of the type of arthritis is important before undergoing any drug therapy. Rheumatoid arthritis, osteoarthritis can be treated with nonsteroidal anti-inflammatory drugs. Do not be your own doctor. Remember, all medications can have side effects, so the dosage and duration of treatment should essentially be under trained medical supervision. Surgical treatment includes arthroscopic surgery and joint replacement.

Tips to control and prevent the condition:

§ Weight reduction accompanied by regular physical activity: Keep your weight under control, as it reduces the risk of getting arthritis, especially osteoarthritis.

§ Strengthen the muscles: through regular exercise – especially weight bearing exercise. It helps maintain physical mobility and slows the development of disability.

§ Prevent stress on a particular joint as well as injuries: Repetitive stress or injuries on any joint increases the risk of osteoarthritis.

What kind of diet regime need to be followed to take care of this condition:

Nutrition is an important aspect in the treatment of arthritis.

For a person suffering from arthritis, his diet should be rich in fruits and vegetables (flavonoid rich foods), especially those that are rich sources of anti-oxidants so as to protect against cellular and joint damage.

Try and avoid all processed foods, complex carbohydrates, including sugar and fruit juices. Increase intake of high fibre foods. Limit fat intake to a minimum.

An important aspect in reducing arthritis pain is elimination of any type of food sensitivity. Get a test for food sensitivity because there may be allergies involved.

Food supplements may be introduced. Anti-oxidants help prevent damage to the cartilage of the bone. Vitamin E slows down the breakdown of cartilage as well as stimulates the manufacture of cartilage components. Vitamin C is necessary for the manufacture of collagen, the major support protein of cartilage.

How does physical therapy help?

Physical therapy is very important in reestablishing joint harmony. Various physical therapy treatments include exercise, heat, cold, and diathermy(heat treatment using electricity); and are beneficial in increasing joint mobility and decreasing pain. Avoid physical activities that excessively put strain on the joints.

Some natural treatment options:

No medicine or drug can completely cure arthritis or slow its progression without causing side effects. But, you can help repair your joints as well as slow degeneration with natural treatment therapies.

Natural Solution: Arthcare Oil – An Anti-inflammatory Herbal massage oil.

Arthcare is anti-inflammatory herbal oil, which not only gives a relief from joint pains but also strengthens the bone tissues, the skeletal and the neuromuscular systems, giving comfortable movements of joints and muscles. http://www.ayurvediccure.com/arthcareoil.htm

Massage with the yellow wonder herb – turmeric. No question of any side effects, plus turmeric also acts as an anti-oxidant to help protect joints.

Ginger, an ayurveda herb, if consumed in small amounts on a regular basis can reduce symptoms and occurrence of rheumatoid arthritis.

Aromatherapy technique involves the use of extracted oil from flowers, plants and trees in combination with massage and steam inhalation – helps relaxation, pain relief.

Yoga involves a combination of breathing exercises and relaxation to help in blood circulation and movement of joints.

Osteopathy includes the manipulation of the body to restore normal action and decrease pain. It is not recommended for those suffering from osteoporosis.

Reflexology involves rubbing the feet and the palm of the hand to help progress the state of rest of the body, and also generate a warm sensation. This is an ideal method for stress management and overall health continuance; factors that cause arthritis.

So, come on get moving, and do not allow this ageless epidemic disease become a debilitating factor in your daily life.



Johnny

Nathan Wei asked:


There are more than 100 different kinds of arthritis. Most of them involve inflammation. When a patient goes to a rheumatologist to get a diagnosis, there is a process of elimination in order to arrive at the proper diagnosis. This process of elimination is called “differential diagnosis.”

Differential diagnosis can be a difficult undertaking because so many forms of arthritis, particularly inflammatory forms of arthritis look alike. The following is a list of types of inflammatory arthritis that can be seen and must be considered when evaluating a patient with inflammatory symptoms of arthritis.

Rheumatoid Arthritis (RA)

RA is an chronic, autoimmune, inflammatory disease, that may affect any joint in the body but preferentially attacks the peripheral joints (fingers, wrists, elbows, shoulders, hips, knees, ankles, and feet. It can also affect non-joint organ systems such as the lung, eye, skin, and cardiovascular system. The onset of RA may be insidious-slow- with nonspecific symptoms, including fatigue, malaise, loss of appetite, low-grade fever, weight loss, and vague aches and pains, or it may have an abrupt onset with inflammation involving multiple joints. The joint symptoms usually occur bilaterally and are symmetric. Damage to joints- called “erosions” can be seen with magnetic resonance imaging early on or by x-ray later in the course of disease. Approximately 80% of patients with RA will have elevated levels of rheumatoid factor (RF) or anti-CCP antibodies.

Juvenile Rheumatoid Arthritis (JRA)

JRA describes a group of arthritic conditions that occur in children under the age of 16. Three forms of JRA exist, including oligoarticular (1-4 joints), polyarticular (> 4 joints), and systemic-onset or Still’s disease. The latter is associated with significant internal organ involvement and may also present with fever and rash in addition to joint disease. Polyarticular JRA is considered to be the type that is most similar to adult RA, and is responsible for approximately 30% of cases of JRA. Most children with polyarticular JRA are negative for RF and their prognosis is usually good. Roughly, 20% of polyarticular JRA patients will have elevated RF, and these patients appear to be at more risk for chronic, progressive joint destruction and damage. Uveitis- an inflammatory condition of the eye- is a common finding in oligoarticular JRA, especially in patients who are antinuclear antibody (ANA) positive. The dangerous feature of uveitis is that it can cause relatively few symptoms so careful screening is recommended in order to avoid blindness.

Systemic Lupus Erythematosus (SLE)

SLE is a chronic inflammatory autoimmune disorder that can involve the skin, joints, kidneys, brain, and blood vessel walls. At least 4 of the following symptoms which have been formulated by the American College of Rheumatology are generally present for a diagnosis to be made:

? Red, butterfly-shaped rash on the face, affecting the cheeks;

? Typical skin rash on other parts of the body;

? Sensitivity to sunlight;

? Mouth sores;

? Joint inflammation (arthritis);

? Fluid around the lungs, heart, or other organs;

? Kidney dysfunction;

? Low white blood cell count, low red blood cell count due to hemolytic anemia, or low platelet count;

? Nerve or brain dysfunction;

? Positive results of a blood test for ANA; and

? Positive results of a blood test for antibodies to double-stranded DNA or other antibodies including anti-Smith antibodies or antiphospholipid antibodies.

Patients with lupus can have significant inflammatory arthritis. That is why lupus can be difficult to distinguish from RA, especially if other signs and symptoms of lupus are minimal.

Inflammatory Muscle Disease

Polymyositis (PM) and dermatomyositis (DM) are types of inflammatory muscle disease. These conditions typically present with bilateral (both sides) large muscle weakness. In the case of DM, rash can be a presenting sign. Diagnosis consists of four major features, including elevation of creatine kinase (CPK), signs and symptoms such as muscle weakness, elevated muscle enzymes (creatine kinase, aldolase), electromyograph (EMG) abnormalities, and a positive muscle biopsy. Often, laboratory test abnormalities can be seen including the presence of autoantibodies such antinuclear antibody (ANA), and the myositis-associated antibodies.

In both PM and DM, inflammatory arthritis can be present and can look like RA — including lung involvement. In RA, however, unless an overlap syndrome – ie., a patient having both RA as well as muscle disease) is present, muscle function should be normal. Also, in PM and DM, erosive joint disease is unlikely. RF and anti-CCP antibodies are typically elevated in RA and not PM or DM.

Spondyloarthropathies (SA)

A group of arthritic conditions called the spondyloarthropathies which include psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and enteropathic arthritis are a category of disease that cause inflammation throughout the entire body, particularly in parts of the spine and at other joints where tendons attach to bones. They also can cause pain and stiffness in the neck, upper and lower back, tendonitis, bursitis, heel pain, and fatigue. They are often called seronegative arthritis. The term ’seronegative’ means that tests for lab markers such as rheumatoid factor are negative. Symptoms of adult SA include:

? Back and/or joint pain;

? Morning stiffness;

? Tenderness near bones;

? Sores on the skin;

? Inflammation of the joints on both sides of the body;

? Skin or mouth ulcers;

? Rash on the bottom of the feet; and

? Eye inflammation.

In some cases of SA, peripheral arthritis resembling RA can be present. Careful history and physical examination can usually distinguish between these syndromes, especially if an obvious disease that is aggravating inflammation is present (psoriasis, inflammatory bowel disease). In addition, since RA rarely affects the end joints of the fingers (DIP joints), if these joints are involved from inflammatory arthritis, the diagnosis of an SA is favored. Usually, RF and anti-CCP antibodies are negative in SA, although in some cases of psoriatic arthritis there may be elevations of RF and anti-CCP antibodies.

Crystal Associated Arthritis

Monosodium Urate Disease (Gout)

Gout is due to deposition of monosodium urate crystals in a joint. Gouty arthritis is typically sudden in onset, very painful, with signs of significant inflammation on exam (red, warm, swollen joints). Gout can affect almost any joint in the body, but typically affects “cooler” regions including the toes, feet, ankles, knees, and hands. Diagnosis is made by withdrawing fluid from a joint and examining the fluid under a polarizing microscope. Patients may also have elevated serum levels of uric acid.

In most cases, gout is an acute disease that affects one joint and is easily distinguished from RA. However, in rare cases, chronic erosive inflammation can develop and affect multiple joints. And, in cases where tophi (deposits of uric acid under the skin) are present, it can be difficult to distinguish from erosive RA. However, crystal analysis of joints or tophi and blood tests should be helpful in distinguishing gout from RA.

Calcium Pyrophosphate Deposition Disease (CPPD; Pseudogout)

CPPD disease is caused by deposits of calcium pyrophosphate dehydrate crystals in a joint. The body’s reaction to these crystals, leads to significant inflammation. Diagnosis includes:

? Detailed medical history and physical exam;

? Withdrawing fluid from a joint using a needle;

? Joint x-rays to show crystals deposited on the cartilage (chondrocalcinosis);

? Blood tests to rule out other diseases (e.g., RA or osteoarthritis).

In most cases, CPPD arthritis presents with acute arthritis affecting one or more joints. However, in some cases, CPPD disease can present with chronic symmetric multiple joint erosive arthritis similar to RA. RA and CPPD disease can usually be distinguished by joint fluid examination demonstrating calcium pyrophosphate crystals, and by blood tests, including RF and anti-CCP antibodies, which should be negative in CCPD arthritis.

Sarcoid Arthritis

Sarcoidosis is an inflammatory type of arthritis. The majority of patients with this disease have lung disease, with eye and skin disease being the next most frequent signs of disease. In most cases, the diagnosis of sarcoidosis can be made on clinical and x-ray presentation alone. Patients will have acute arthritis, painful nodules under the skin on the shins (erythema nodosum), and a chest x-ray showing enlargement of lymph niodes. In some cases, the demonstration of a specific type of inflammation change, called a noncaseating granuloma on tissue biopsy, is necessary for definitive diagnosis.

Arthritis can be present in approximately 15% of patients with sarcoidosis, and in rare cases can be the only sign of disease. In acute sarcoid arthritis, joint disease is usually rapid in onset, symmetric, involving the ankle joints. The knees, wrists, and small joints of the hands can be involved. In most cases of acute disease, lung and skin disease are also present. Chronic sarcoid arthritis typically involves one or maybe a few joints and due to its often erosive nature can be difficult to distinguish from RA.

Polymyalgia Rheumatica (PMR) / Temporal Arthritis

PMR is a form of arthritis that leads to inflammation of tendons, muscles, ligaments, and tissues around the joints. It is characterized by large muscle (shoulders, hips, thighs, neck) pain, aching, morning stiffness, fatigue, and in some cases, fever. It can be associated with temporal arthritis/giant-cell arthritis (TA/GCA) which is a related but more serious condition in which inflammation of large blood vessels can lead to complications such as blindness, aneurysms and cramping pain in the arms or legs (limb claudication) due to inflammation and narrowing of the large blood vessels in the chest and extremities. PMR is diagnosed when the clinical picture is accompanied by elevated markers of inflammation (ESR and/or CRP). If temporal arthritis is suspected (headache, vision changes, limb claudication), biopsy of a temporal artery may be necessary to make the diagnosis.

PMR and TA/GCA can present with symmetric inflammatory arthritis similar to RA. These diseases can usually be distinguished by blood tests. In addition, headaches, acute vision changes, and large muscle pain are uncommon in RA, and if these are present, PMR and/or TA/GCA should be considered.

Infectious Arthritis

Many infections can present with arthritis either due to direct joint infection or due to autoimmune joint inflammation. In most cases, infections lead to acute single joint arthritis; however, in some cases, chronic arthritis affecting a few or many joints can be present. Because missed infections can lead to significant complications, it is crucial to have a high index of suspicion for infection in any patient presenting with acute or chronic arthritis.

Lyme disease

Lyme disease is an infection due to a type of bacteria called a spirochete. The disease is manifested by a skin rash, swollen joints and flu-like symptoms, caused from the bite of an infected tick. Symptoms may include:

? A skin rash, often resembling a bulls-eye (target lesion);

? Fever;

? Headache;

? Muscle pain;

? Stiff neck; and

? Swelling of knees and other large joints.

The diagnosis of Lyme disease is typically made by blood testing. If, however, chronic single joint arthritis develops, joint fluid analysis or joint tissue biopsy may be necessary for diagnosis. Lyme arthritis can usually be distinguished from RA by clinical presentation and blood tests.

Acute rheumatic fever (ARF)

Acute rheumatic fever is an inflammatory disease that may develop after an infection with the Streptococcus bacteria (strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain. Symptoms include:

? Fever;

? Joint pain;

? Arthritis (mainly in the knees, elbows, ankles, and wrists);

? Joint swelling; redness or warmth;

? Abdominal pain;

? Skin rash

? Skin nodules;

? A peculiar movement disorder (Sydenham’s chorea)

? Nosebleeds;

? Heart problems, which can be asymptomatic.

The diagnosis of ARF is made by clinical assessment and blood testing for antibodies against streptococcal proteins. ARF and RA can have similar clinical features including arthritis and nodules. However, ARF can usually be distinguished from RA by clinical presentation. Rash and migratory arthritis are unusual in RA. The use of blood tests is also helpful.

Viral arthritis (hepatitis B and C, parvovirus, EBV, HIV)

Arthritis may be a symptom of many viral illnesses. This makes viral infections a great masquerader. The duration is usually short, and it usually disappears on its own without any lasting effects. Clinical features in adults:

? Joint symptoms occur in up to 60%. These can be symmetric and affect the small joints of the hands, wrists, and ankles as well as the knees. Morning stiffness is also present.

? Parvovirus B19 is a very common viral infection that looks like RA.

? Diagnosis of viral arthritis is made by serologic testing. A high percentage of patients with hepatitis C may have elevated titers of RF. Therefore, RF testing is not helpful in distinguishing between hepatitis C infection and RA. However, in these situations, testing for anti-CCP can be helpful as anti-CCP antibodies have not been shown to be significantly elevated in isolated hepatitis C infections.

So as you can see… “it ain’t easy…”



Jon