Question

    Arthritis (Arthritides)

    Rheumatoid Arthritis[1]

    Arthritis is the inflammation of one or more joints. The main symptoms are joint pain, swelling and stiffness.

    Presentation

    Most patients with arthritis present with symptoms of inflammation. The commonest presentation of arthritis is pain. Other symptoms include:

    Other symptoms are peculiar to the type of arthritis.

    Entire body system
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  • neurologic
    Insomnia
    • Already, millions of Americans ingest probiotics—cocktails of supposedly beneficial bacteria that claim to treat everything from acne to insomnia.[theatlantic.com]
    • Other adverse effects include cataracts, glaucoma, diabetes, fluid retention, susceptibility to infections, weight gain, hypertension, capillary fragility, acne, excess hair growth, wasting of the muscles, menstrual irregularities, irritability, insomnia[umm.edu]
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  • musculoskeletal
    Ankle Arthritis
    • Treatment of Arthritis of the Foot and Ankle Proper treatment of foot and ankle arthritis addresses both pain and joint deformity.[aofas.org]
    Arthralgia
    • […] artrită (ro) f , artroză (ro) f Russian: артри́т (ru) m ( artrít ) Slovak: artritída (sk) f Spanish: artritis (es) f Swahili: jongo (sw) Tagalog: magansugpong Tamil: மூட்டழற்சி ( mūṭṭaḻaṟci ) Turkish: artrit (tr) See also [ edit ] arthrosis rheumatism arthralgia[en.wiktionary.org]
    • Joint torment is alluded to as arthralgia.[omicsgroup.org]
    • Joint pain is referred to as arthralgia.[medicinenet.com]
    • Signs and symptoms In most patients with RA, onset is insidious, often beginning with fever, malaise, arthralgias, and weakness before progressing to joint inflammation and swelling.[emedicine.medscape.com]
    Back Pain
    • They fall into five main groups: inflammatory arthritis, degenerative or mechanical arthritis, soft tissue musculoskeletal pain, back pain and connective tissue disease (CTD).[arthritisresearchuk.org]
    • For example, back pain or neck pain can cause problems getting to sleep or waking during the night.[arthritiswa.org.au]
    • In the end my evaluation of the dog’s limbs showed a reduced range of motion in the hips, the stifles (knees) were normal, and there was no evidence of back pain when I pushed and probed along the spine.[petmd.com]
    • Back pain Back pain can arise from the muscles, discs, nerves, ligaments, bones or joints.[medicalnewstoday.com]
    • Joint pain, back pain, arthritis cause by chronic dehydration, says doctor 10/11/2004 - Dr.[naturalnews.com]
    Foot Pain
    • Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease.[foot.com]
    Joint Deformity
    • Joint deformity and changes on X-rays may be found in approximately 40% of people with psoriatic arthritis.[dermnetnz.org]
    • Treatment of Arthritis of the Foot and Ankle Proper treatment of foot and ankle arthritis addresses both pain and joint deformity.[aofas.org]
    • Severe RA can cause joint deformity if left untreated.[healthline.com]
    • The physical exam may show: Fluid around a joint Warm, red, tender joints Difficulty moving a joint (called "limited range of motion") Some types of arthritis may cause joint deformity.[nytimes.com]
    • Fibromyalgia is a type of soft tissue or muscular rheumatism and does not cause joint deformities.[arthritis.about.com]
    Joint Stiffness
    • "Arthritis" describes many different diseases that cause tenderness, pain, swelling, and joint stiffness.[spine-health.com]
    • Other symptoms include:  Swelling  Joint stiffness  Redness Other symptoms are peculiar to the type of arthritis.[symptoma.com]
    • Common symptoms include: Pain or tenderness in the joints Swelling in one or more joints Warmth and redness in a joint Stiffness or difficulty using or moving the joint Severe rheumatoid arthritis (shown above right) can destroy the joints and deform[cedars-sinai.edu]
    • Joint inflammation from arthritis is characterized by joint stiffness , swelling , redness , pain, and warmth .[medicinenet.com]
    Joint Swelling
    • Common symptoms include: Pain or tenderness in the joints Swelling in one or more joints Warmth and redness in a joint Stiffness or difficulty using or moving the joint Severe rheumatoid arthritis (shown above right) can destroy the joints and deform[cedars-sinai.edu]
    • LIFESTYLE CHANGES Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint swelling.[nytimes.com]
    • Signs and symptoms The main symptoms are pain at the joint, swelling of the joint, stiffness and inability to move the joint.[symptoma.com]
    • But for others, the virus causes the immune system to overreact and trigger inflammation, joint swelling, and pain.[healthychildren.org]
    • Symptoms and signs associated with joint pain can include joint redness, joint swelling, joint tenderness, joint warmth, limping, locking of the joint, loss of range of motion of the joint, stiffness, weakness.[medicinenet.com]
    Knee Pain
    • Hear from real patients who treated their knee pain with injectables » Your massage therapist should be experienced with working on people who have arthritis.[healthline.com]
    • In rheumatoid arthritis the synovial membrane that covers the knee joint begins to swell, This results in knee pain and stiffness.[orthoinfo.aaos.org]
    • All these diseases are so different, so the next time you hear arthritis, remember that's not the stereotypical knee pain that we're thinking of.[khanacademy.org]
    Low Back Pain
    • Medical schools and the National Institutes of Health now recommend acupuncture as a natural treatment for low back pain and many other conditions, including osteoarthritis. ( 6 ) Many chiropractic offices offer several additional holistic services, including[draxe.com]
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  • Workup

    Despite the advent of better imaging techniques like CT scan and MRI, the plain radiograph remains the investigation of choice in suspected cases. This is because of its availability and cost effectiveness. The most common feature of arthritis on the plain radiograph is the loss of joint space. Other features are specific to the type of arthritis.

    Laboratory studies are mainly used as an adjunct since diagnosis is mostly through clinical and radiological findings. Laboratory studies usually find their use in the rheumatoid type and are mainly used for monitoring the progression or remission of the disease [7].

    Treatment

    There is no definite cure for most forms of arthritis. Treatment is mainly supportive and includes:

    • Exercise
    • Diet
    • Massage
    • Counseling
    • Stress reduction 
    • Physical therapy [8]

    Patient with the rheumatoid type arthritis may benefit from corticosteroid use. Selected surgical procedures have also been shown to be beneficial in the treatment of this disease condition.

    Prognosis

    Arthritis is generally a chronic condition with the only exception being septic arthritis. The prognosis varies for patients with the different types of arthritis. The best prognosis is with septic arthritis if treated early while the rheumatoid type carries the worst prognosis. Other factors like age, lifestyle modification, obesity, other chronic diseases like diabetes and hypertension can also greatly affect prognosis.

    Complications

    Bursitis
    • See: bursitis ; monoarthritis ; osteoarthritis ; polyarthritis ; rheumatism Treatment Anti-inflammatory drugs, corticosteroids, monoclonal antibodies, antibiotics, joint aspiration, surgery, and occupational or physical therapies may play a role in the[medical-dictionary.thefreedictionary.com]
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  • Etiology

    Arthritis, as defined earlier is an inflammation of the joint. Therefore anything that can cause pain, swelling and loss of function in a joint can be said to be a cause of arthritis. Some of these factors that may cause or predispose to arthritis are obesity, infections, age, allergies, autoimmune diseases, diet, physical activity, and genetics [2].

    Epidemiology

    There are different forms of arthritis and the commonest is osteoarthritis. Arthritis in any of its forms is the leading cause of disability worldwide in individuals aged 18 years and older. The exact incidence is dependent on the type of arthritis.

    The prevalence, according to age distribution is about 7.3% in individuals aged between 18 and 44, and 30.3% in individuals aged between 45 and 64. In individuals 65 years and older, the prevalence is as high as 49.7%[3]. Arthritis is generally more common in women.

    Sex distribution
    Age distribution

    Pathophysiology

    To understand the pathophysiology of arthritis, we need to understand the anatomical makeup of joints. A joint is where two bones are come together. These bones are held together by ligaments. The bones are covered by cartilages which allow painless and smooth movement at the joints. There is a thin film of fluid, the synovial fluid, in the joint space and this provides nutrition for the joint and cartilage. The joint is covered by a capsule. If anything goes wrong with the components of a joint, it will lead to arthritis. Most types of arthritis involve more than one of the components. The individual pathophysiology depends on the type of arthritis.

    For the most common one, osteoarthritis, there is initial cartilage damage due to some of the factors listed in etiology. The chondrocytes then attempt to repair this cartilage damage which causes an increased synthesis of proteoglycans which are responsible for the resilience of the cartilages. The increased synthesis leads to a hypertrophic repair of the cartilage which causes the visible swelling in patients with osteoarthritis. Eventually, due to a long term increase in chondrocyte metabolism, degradative enzymes associated with inflammation are released which results in a loss of proteoglycans which causes the cartilage, now increased in size, to soften and lose its elasticity leading to stiffer joints and loss of joint space.

    Another common form of arthritis is rheumatoid arthritis. The exact pathway that leads to the development of this condition is unclear. An external factor, like trauma, triggers an autoimmune response that leads to synovial hypertrophy and chronic joint inflammation. There are many cellular factors involved in this process like phagocytes, fibroblasts, and inflammatory mediators amongst others that eventually lead to inflammation and excess proliferation of the synovium resulting in the destruction of cartilage and many surrounding tissues [4].

    Infectious arthritis is another common form of arthritis and is also known as septic arthritis. There are three ways in which the microorganism invades the joint. It could be via the blood stream, which is the most common form of infection. It could also be through contiguous spread from infectious tissues or by direct inoculation. Because the synovial fluid has adequate bactericidal activity, this condition is more commonly seen in more susceptible individuals. This susceptibility could be as a result of previous damage due to rheumatoid arthritis or an immunosuppressive state like systemic lupus erythematosus. Previously damaged joints are especially susceptible due to neovascularization which increases the chance of infection via the blood stream. Organisms responsible for this condition are mostly bacteria like Staphylococcus aureus and Neisseria gonorrhoeae, although viruses like rubella have also been implicated. The main effect of bacteria invasion is damage to articular cartilage either due to the organism’s pathologic processes or the host’s response. As the damage progresses, pannus formation begins and eventually there is cartilage erosion at the lateral margins of affected joints. These processes can be seen very early into the course if an untreated disease [5].

    Juvenile rheumatoid arthritis affects patients aged 16 years and under. It is included because, even though the exact disease causing mechanism is not clearly understood, it remains one of the common chronic disease of childhood. It is however said that there is an overlap between the pathophysiology and this condition and other autoimmune diseases of childhood.

    Prevention

    Many of the causes of arthritis are beyond human control and as such no clear preventive measures can be instituted. Some healthy diet and lifestyle choices could however help in preventing this condition [9].

    Summary

    Arthritis, by virtue of the origin of the Greek word athron (joint) and the Latin suffix -itis (inflammation), can simply be defined as an inflammation of joints. Arthritis is commonly viewed as a disease of the older age group. In industrialized countries, it has been reported to be the major cause of disability in those aged 55 years and over. However, it is important to note that there are other types of arthritis that can be seen in the younger age groups [1]. Arthritis can affect any joint in the body, from the larger hip joints to the smaller interphalangeal joints. There are numerous types of this condition.

    Patient Information

    Definition

    Arthritis is a disease of the joints. It is mostly seen in the elderly but can also be present in children.

    Cause

    There is no specific cause of this disease. Many factors contribute to the development of arthritis. It however has a familial history.

    Signs and symptoms

    The main symptoms are pain at the joint, swelling of the joint, stiffness and inability to move the joint.

    Treatment

    There is no known cure for most types of arthritis. It would however be beneficial to eat healthy and have healthy lifestyle practises like regular exercise [10].

    Self-assessment

    References

    1. Jewell FM, Watt I, Doherty M. Plain radiographic features of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, eds. Osteoarthritis. New York, NY: Oxford University Press; 1998:217-37.
    2. Kraus VB, McDaniel G, Worrell TW, Feng S, Vail TP, Varju G, et al. Association of bone scintigraphic abnormalities with knee malalignment and pain. Ann Rheum Dis. Nov 2009;68(11):1673-9
    3. Lee P, Rooney PJ, Sturrock RD, Kennedy AC, Dick WC. The etiology and pathogenesis of osteoarthrosis: a review. Semin Arthritis Rheum. Spring 1974;3(3):189-218. 
    4. Radin ER, Paul IL, Rose RM. Pathogenesis of primary osteoarthritis. Lancet. Jun 24 1972;1(7765):1395-6.
    5. Mankin HJ. The reaction of articular cartilage to injury and osteoarthritis (first of two parts). N Engl J Med. Dec 12 1974;291(24):1285-92. 
    6. Hartmann C, De Buyser J, Henry Y, Morère-Le Paven MC, Dyer TA, Rode A. Nuclear genes control changes in the organization of the mitochondrial genome in tissue cultures derived from immature embryos of wheat. Curr Genet. May 1992;21(6):515-20. 
    7. Zgoda M, Paczek L, Bartlomiejczyk I, Sieminska J, Chmielewski D, Górecki A. Age-related decrease in the activity of collagenase in the femoral head in patients with hip osteoarthritis. Clin Rheumatol. Feb 2007;26(2):240-1. 
    8. de Boer TN, van Spil WE, Huisman AM, Polak AA, Bijlsma JW, Lafeber FP, et al. Serum adipokines in osteoarthritis; comparison with controls and relationship with local parameters of synovial inflammation and cartilage damage. Osteoarthritis Cartilage. Aug 2012;20(8):846-53.
    9. Patra D, Sandell LJ. Recent advances in biomarkers in osteoarthritis. Curr Opin Rheumatol. Sep 2011;23(5):465-70.
    10. Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Rheum Dis Clin North Am. Aug 2008;34(3):713-29.

    • Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis - MS Cohen, SH Kozin - The Journal of hand surgery, 2001 - Elsevier
    • Cervical degenerative arthritis. Possible cause of neck and arm pain. - LF Hirsh - Postgraduate medicine, 1983 - ncbi.nlm.nih.gov
    • Cervical spondylosis and nerve root lesions. Incidence at routine necropsy. - S Holt, PO Yates - The Journal of bone and joint surgery. British , 1966 - ncbi.nlm.nih.gov
    • Characterisation and pharmacological sensitivity of antigen arthritis induced by methylated bovine serum albumin in the rat - RJ Griffiths - Inflammation Research, 1992 - Springer
    • Disease activity scores that include twenty‐eight‐joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis - MLL Prevoo, MA Van't Hof, HH Kuper - Arthritis & , 2005 - Wiley Online Library
    • A clinical, serological and neurophysiological study of restless legs syndrome in rheumatoid arthritis - AM Salih, RES Gray, KR Mills, M Webley - Rheumatology, 1994 - Br Soc Rheumatology
    • Of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis - F Wolfe - Rheumatology, 1999 - Br Soc Rheumatology
    • Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy - D McGonagle, W Gibbon, P O'Connor - Arthritis & , 2004 - Wiley Online Library
    • Proposed 30-45 minute 4 page standard protocol to evaluate rheumatoid arthritis (SPERA) that includes measures of inflammatory activity, joint damage, and longterm - T Pincus, RH Brooks, LF Callahan - Journal of rheumatology, 1999 - cat.inist.fr
    • Back pain and sciatica - JW Frymoyer - New England Journal of Medicine, 1988 - Mass Medical Soc
    • Moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain - DE Hurwitz, AB Ryals, JP Case - Journal of , 2006 - Wiley Online Library
    • Of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis - F Wolfe - Rheumatology, 1999 - Br Soc Rheumatology
    • Magnetic resonance and radiographic imaging in relation to symptoms and clinical findings of the temporomandibular joint in children with juvenile idiopathic arthritis - TK Pedersen, A Küseler, J Gelineck - The Journal of , 2008 - jrheum.org
    • Chronic arthritis in the adult, associated with splenomegaly and leucopenia - AR Felty - Hematology: Landmark Papers of the Twentieth , 2000 - books.google.com
    • Ankle arthritis - RH Thomas, TR Daniels - The Journal of Bone & Joint Surgery, 2003 - jbjs.org
    • Body mass index and mortality in the elderly. - K Mattila, M Haavisto, S Rajala - British medical journal (Clinical research , 1986 - bmj.com
    • Ambulatory devices for chronic gait disorders in the elderly - FW Van Hook, D Demonbreun, BD Weiss - American family physician, 2003 - aafp.org
    • Arthritis/arthralgia and hypermobility of the joints in schoolchildren. - IL Arroyo, EJ Brewer, EH Giannini - The Journal of rheumatology, 1988 - ncbi.nlm.nih.gov
    • Of outcome measures and process variables in early rheumatoid arthritis. A comparison of radiologic damage, physical disability, joint counts, and acute phase - MA Van Leeuwen, DM Van der Heijde - The Journal of , 1994 - ukpmc.ac.uk
    • Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. - MT Hannan, DT Felson, T Pincus - The Journal of rheumatology, 2000 - ukpmc.ac.uk
    • A prospective clinical study of the effect of pregnancy on rheumatoid arthritis and ankylosing spondylitis - G Husby - Arthritis & Rheumatism, 2005 - Wiley Online Library
    • Acetabular labrum tears: a cause of hip pain and degenerative arthritis - AR ALTENBERG - Southern medical journal, 1977 - journals.lww.com
    • A randomized controlled trial of foot orthoses in rheumatoid arthritis. - J Woodburn, S Barker, PS Helliwell - The Journal of rheumatology, 2002 - jrheum.org
    • Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty - BJ McGrory, BF Morrey, TD Cahalan - of Bone & Joint , 1995 - bjj.boneandjoint.org.uk
    • Ankle arthrodesis in patients with rheumatoid arthritis - NA Felix, HB Kitaoka - Clinical orthopaedics and related research, 1998 - journals.lww.com

    Media References

    1. Rheumatoid Arthritis, CC BY-SA 3.0

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