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Arthritis

Overview

Arthritis is defined as swelling of joints due to multiple reasons such as inflammation, autoimmune disease, infection, crystals deposition, mechanical or structural derangements, cancer, etc. Inflammation is accompanied by pain in most cases that may be localized to joints or generalized depending upon the extent of the disease.
Clinical features, a careful history, and some lab investigations help differentiate different types of arthritis.

Causes

The following could be the causes of arthritis:

  • Autoimmune mechanism- in which antibodies are formed against the joint capsule. They attack the synovium of the various joints causing inflammation. Synovium may be destroyed, causing joint erosions.
  • New fibrous bone formation- in some cases of arthritis, the transition zone between bone and ligaments undergoes inflammatory changes that result in deposition of new fibrous bone in that area, causing further inflammation of the synovium and joint capsule. This process is called ossification. Pathological ossification is seen in spondyloarthropathy. The most common site is the hip joint.
  • Crystals such as monosodium urate, calcium oxalate, and calcium pyrophosphate due to metabolic derangements might be deposited inside the joint cavity, causing pain, redness, swelling, and other features of arthritis.
  • Bacterial, viral, and fungal infections can cause infectious inflammation of joints, resulting in cartilage and bony destruction.
  • Mechanical joint derangement occurs due to several factors such as the host’s genetic factors, overactivity, previous trauma, etc. They cause destruction and degeneration of articular cartilage. 

Types

Following are the types of arthritis:

  • Osteoarthritis- due to degeneration of articular cartilage
  • Septic arthritis- due to infections
  • Gout and pseudogout- due to crystals deposition in joint spaces
  • Rheumatoid arthritis- due to an autoimmune mechanism
  • Spondylarthritis- due to ossification of joints
    The most common type is osteoarthritis, followed by rheumatoid arthritis. 

Risk Factors And Epidemiology

  • Arthritis is prevalent worldwide. Osteoarthritis and rheumatoid arthritis are more prevalent in women than in men, and the most common age group is after 45 years of life. Septic arthritis can affect any age group. It is more prevalent in young adults where the infection is commonly acquired secondary to trauma. Certain genetic factors also make people more susceptible to the disease.
    Risk factors for arthritis include:
  • Obesity
  • Increasing age
  • Female gender
  • Smoking
  • Joint trauma
  • Immunosuppression
  • Genetic factors and family history of autoimmune diseases

Signs And Symptoms

  • Common signs and symptoms of arthritis include:
  • Pain
  • Stiffness
  • Swelling
  • Limited range of motion
  • Weakness
  • Fatigue
  • Fever in case of joint infections
  • Pain with motion
    Complications of arthritis include:
  • Osteoporosis
  • Sjogren’s syndrome- that is characterized by dry eyes and mouth
  • Rheumatoid nodules
  • Carpal tunnel syndrome due to impingement of median nerve at the wrist joint
  • Cardiovascular abnormalities such as atherosclerosis
  • Lung diseases
  • Lymphoma
  • Cervical myelopathy 

Diagnosis

  • Nonspecific investigations for arthritis include:
  • Complete blood count
  • ESR and CRP
  • Liver function tests and renal function tests
  • Antinuclear antibodies
  • Rheumatoid factor
  • Serum uric acid
  • Urine analysis
  • Serum ferritin, vitamin D3, calcium and TSH levels, etc.
  • Plain radiography, bone scans, ultrasonography, and MRI imaging, may also be used
    Specific investigations for various types of arthritis include:
  • Plain radiographs for osteoarthritis that show the formation of osteophytes in affected joints
  • Rheumatoid factor is also known as RF with inflammatory markers such as CRP and ESR for rheumatoid arthritis
  • Gram stain culture of synovial fluid for septic arthritis
  • Synovial fluid analysis for the presence of crystals such as calcium pyrophosphate and monosodium urate in case of pseudogout and gout
  • Plain radiographs of the hip joint for ankylosing spondylitis
  • Bone biopsy

Differential Diagnosis

Differential diagnoses of arthritis include:

  • Various types of arthritis such as osteoarthritis, septic arthritis, rheumatoid arthritis, reactive arthritis, psoriatic arthritis, pseudogout, and gout
  • Rotator cuff tendinitis
  • Acute rheumatic fever
  • Trauma
  • Lyme disease
  • Bony tumors such as osteosarcoma etc.
  • Metastatic tumors with mets in bones
  • Amyloidosis
  • Acromegaly

Treatment

  • Acute conditions can be managed with appropriate pain relief, rest, and limited activity for a particular period.
  • Long-term arthritis that has multiple joint involvements, fever, multi-organ involvement, and shows signs of neurological involvement should be actively managed. They may require regular follow-up or even hospitalization.
  • Patient education is extremely important as the success of treatment against arthritis depends upon an optimum balance of psychological, physical, and pharmacologic factors. Where these fail, surgical approaches are considered.
  • Surgical treatment is usually considered for acute septic arthritis, osteoarthritis, and rheumatoid arthritis. The primary indication of surgical intervention is pain relief that drugs have not been achieved.

Medications

Medication against arthritis include:

  • NSAIDs such as aspirin for pain management
  • Corticosteroids
  • Colchicine
  • Disease-modifying anti-rheumatic drugs (DMARDs) that include cyclophosphamide, methotrexate, etc.
  • Systemic antibiotics after appropriate culture results are used accordingly

Prognosis

The prognosis for arthritis is generally good. It depends upon the type of arthritis and its extent and other factors like a person’s age and lifestyle, such as being overweight, smoking, etc. Nevertheless, it can seriously affect a person’s quality of life and life expectancy.

Lifestyle Modifications Preventions

  • Maintaining a healthy weight is important for patients with arthritis, particularly with osteoarthritis, as increased body weight is associated with increased wear and tear at joints resulting in more mechanical damage.
  • It is important to have an optimum balance between the level of activity and rest. Too much activity can be dangerous for the joints causing joint injuries such as articular cartilage degeneration seen in osteoarthritis. On the other hand, lack of exercise and physical activity can also affect joint functions such as range of mobility at certain joints such as shoulder and hip joints. Regular exercises for strengthening muscles and improving joint mobility that does not put too much strain on the body should be included in the daily routine.
  • Avoid injuring your joints. People at risk for joint injuries include players of various sports such as soccer, rugby, hockey, etc. they should be assessed regularly as the chances of developing arthritis increase after getting joint injuries. Joint injuries can also predispose individuals to bacterial infections resulting in septic arthritis and sequelae.
  • A balanced diet rich in vitamin D, calcium, and omega 3 fatty acids should be consumed.
  • Seek medical help in case any symptoms or signs related to arthritis develop. Once diagnosed, it is important to adhere to a treatment regimen and lifestyle modifications for better outcomes.

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