What is arthritis?

Arthritis is defined as an inflammation of the joints which often occurs in conjunction with pain and structural damage. In fact, there are more than 100 different types of arthritis whether inflammatory or non-inflammatory. Above all, different types require different treatments. 

Common arthritis features are:

• Inflammation
• Joints stiffness
• Monocyte infiltration
• Synovial swelling
• Articular cartilage breakdown
• Formation of pannus

The most common non-Inflammatory arthritis is:

• Osteoarthritis or degenerative arthritis, a degenerative disorder that leads to bone damage.

Inflammatory arthritis types:

These can be the result of several inflammatory scenarios, the most common are:

• Autoimmune disease where the body attacks joints including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile arthritis, etc...
• Crystallization including basic calcium phosphate disease, gout, and pseudo-gout.
• Infections such as Lyme's, septic and reactive arthritis.

Notably, inflammatory arthritis can come in association with autoimmune connective tissue diseases, some are:

•  Sjogren syndrome
• Celiac disease
• Systemic lupus erythematous
• Scleroderma
• Inflammatory bowel disease
• Myositis

What causes arthritis?

As a matter of fact, different causes are behind different types. For instance, genetics are behind several types of the disease such as rheumatoid and juvenile arthritis. Also, inherited weak cartilage is the cause of osteoarthritis leading to bone-bone friction and severe pain. Therefore, repeated joint injury or other environmental triggers can result in osteoarthritis if the gene exists. Another example is gout which results from uric acid build up in the body. For example, Staphylococcus aureus infection is mostly responsible for septic arthritis in adults.

Symptoms:

In general, it only makes sense that symptoms resides in the joints. Although there's many types of arthritis, the most common symptoms includes:

• Stiffness of the joints
• Joints redness and inflammation
• Pain
• Rash
• Noticeable Swelling
• Restriction of movement
• Deformity

Other non-joint symptoms involve:

• Fever
• Weight loss
• Problematic breathing 
• Instability
• Fatigue

Who gets arthritis (risk factors)?

Depending on the following different factors, you may be more likely to have the disease:

• Age: Many types such as rheumatoid arthritis, osteoarthritis and gout manifests at an old age.
• Sex: When most rheumatoid arthritis patients are women, gout are men.
• Family history: You may inherit the genes responsible for the disease from your parents, where environmental factors triggers the disease onset.
• Obesity: Adding extra weight to your body will add up stress on knees, spine and hips which increase your risk.
• Joint injury: Whether its a sport or an accident that gave you joint injury, it increases the risk.

Diagnosis:

Physical assessment is the most important test for arthritis. To clarify, there are several symptoms of inflammatory arthritis, including swelling, tenderness, effusion, erythema, and warmth. Similarly, osteoarthritis can also cause tenderness, swelling, and effusion, although heat and erythema are typically absent. Add to that, joint deformity and a reduced range of motion are an indication.

Laboratory testing includes joint fluid, urine and blood tests. In fact, blood tests may show if there's inflammation if they contain inflammation proteins. In short, testing these bodily fluids can conclude the specific type.

Finally, imaging gives the specialists a clear image to what is going on with the joints that are causing the pain. Imaging can be x-ray radiation, magnetic resonance imaging (MRI), computerized tomography (CT) scan, and ultrasound. To clarify, these different methods can show cartilage damage, bone damaged structure, and the fluids within the joints.

What does arthritis feel like?

Arthritis affects a person's quality of life, work and even minor body activities. To illustrate, pain is the worse by the end of the day and after activities. The patient may also experience discomfort when awaking and at rest, which can initially improve with activity but deteriorate with prolonged use and activity. Unfortunately, if it renders you inactive, you are at a higher risk of developing life-threatening health conditions. Thus, you must try reducing your symptoms by finding the right combination of treatments from your healthcare provider. Indeed, you must know that the majority of people can manage arthritis well and still participate in their favorite activities via appropriate techniques. Furthermore, cold weathers might make you uncomfortable, so you must dress well or use heat pads. 

How to prevent arthritis?

• Be careful as to not cause yourself a joint injury
• Eat healthy and avoid obesity
• Using weight exercises in moderation and nothing extreme
• Avoid smoking

Is arthritis curable?

In addition to crippling the quality of life and contributing to depression, osteoarthritis does not have a cure and can affect other organs, depending on what type of arthritis is present. However, a direct follow-up with the primary care provider is a good idea for all patients since it is a progressive disease.

Treatment and management:

Other than improving your lifestyle, losing weight or appropriate exercising, medication, physical therapy, and joint surgery are possible treatments. Consequently, your healthcare provider will assess your symptoms and recommend the most appropriate treatment approach for you.

1-Medication:

Includes NSAIDs (non-steroidal anti-inflammatory drugs), steroids, ointments, and DMARDS (disease modifying anti-rheumatic drugs).

• NSAIDs: oral taken as drugs or topical in the shape of creams, can both reduce pain and inflammation. Without doubt, the most used NSAIDs are ibuprofen and naproxen sodium.
• Ointments: contains capsaicin or menthol, and is rubbed gently on the painful joint. In general, the mode of action lies within inhibiting the pain signals within the same joint.
• Steroids: specifically corticosteroids; they are taken as pills or injected into the joint, and they provide pain relief and reduction of joint damage.
• DMARDs: focus on preventing disease progression and joint damage in rheumatic arthritis.

2-Physical therapy:

The goal of physical therapy is to strengthen muscles present around joints giving them a larger range of movement. 

3-Surgery:

When treatment with the previously mentioned methods doesn't show progress, surgery is the final resolve.

• Joint replacement: Replacement of the damaged joint is the most effective healthcare measure to improve patient quality of life. Certainly, joint replacement is expected to increase as people age. Furthermore, more than 90% of hip and knee replacements last between 10 to 15 years. 
• Joint repair: An orthopedist surgeon goal is to correct alignment, stability, and congruence in joints. Consequently, this can restore the joint function and decrease pain.
• Joint fusion: mostly applied for small joints such as fingers, wrists or ankles. Indeed, surgery focuses on removing the damaged cartilage, cutting off the ends of the bones, and fusing the ends together into one bone with metal internal fixations. Also, patients with painful joints, whether or not they have a poor soft tissue condition, may benefit from joint fusion.

Complications:

• Can't sit straight
• Walking becomes hard
• Inactivity leading to other life-threatening diseases such as cancer and diabetes

References:

-Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/

-Arthritis Foundation. Winter and Arthritis Pain. (http://blog.arthritis.org/living-with-arthritis/weather-arthritis-pain/) Accessed 4/10/2021.

-Hart JA. Joint replacement surgery. Med J Aust. 2004 Mar 1;180(S5):S27-30. doi: 10.5694/j.1326-5377.2004.tb05910.x. PMID: 14984360.

-Buckwalter JA, Brown TD. Joint injury, repair, and remodeling: roles in post-traumatic osteoarthritis. Clin Orthop Relat Res. 2004 Jun;(423):7-16. PMID: 15232420.

-Yamamoto M, Chung KC. Joint Fusion and Arthroplasty in the Hand. Clin Plast Surg. 2019 Jul;46(3):479-488. doi: 10.1016/j.cps.2019.03.008. Epub 2019 Apr 12. PMID: 31103091.