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A joint is an area of the body where two or more bones attach to allow movement of body parts. Arthritis is a word used to describe joint diseases that cause pain and stiffness of a joint or multiple joints. Rheumatology is a subspecialty of internal medicine that deals with the disorders of joint, muscle, and connective tissue. There are more than 100 types of arthritis that cause significant morbidity and a decline in the quality of life of affected individuals. Arthritis can affect men and women, young and adults. Prompt diagnosis and treatment can limit the progression of the disease and prevent severe damage.

Today we have articulated this article to provide a brief overview of arthritis to our readers.

Risk Factors

Factors that increase the risk of arthritis are divided into modifiable and non-modifiable.

 

Modifiable Risk Factors Non-Modifiable Risk Factors
  1. Obesity
  2. Smoking
  3. Occupation and Repetitive Stress
  4. Infection
  5. Sedentary Lifestyle
  1. Age
  2. Race
  3. Gender
  4. Genetic Predisposition
  5. Family History of Arthritis

 

Causes

The following are a few common causes of arthritis.

  1. Degenerative changes due to age or trauma.   Example: Osteoarthritis
  2. Dysfunction of the immune system (autoimmune arthritis)    Example: Rheumatoid arthritis
  3. Infections.        Example: Septic Arthritis
  4. Metabolic Abnormalities.         Example: Gout and pseudogout

Signs and Symptoms

The following are the most common signs and symptoms that a patient of arthritis presents with.

  • Joint pain: It can be continuous or intermittent and increase or decrease with activity.
  • Swelling: There may be redness and swelling over the skin of the affected joint and it may also feel warm in touch.
  • Decreased range of motion: Movement of the joint may cause pain leading to decreased range of motion and inability to perform daily activities.
  • Stiffness: Stiffness is a common symptom and may exhibit the following patterns:
  1. Stiffness after physical activity such as exercise.
  2. Stiffness while at rest that improves with physical activity.
  3. Stiffness in the morning that gets better as the day passes
  • Decreased quality of sleep: The pain may cause difficulty in sleeping or disturbed sleep.
  • Other symptoms such as fever, anemia, cough, loss of appetite, fatigue, muscle weakness, weight loss, etc may also be present.

Diagnosis

Arthritis makes it difficult for affected individuals to perform daily tasks, especially if it affects the wrist and finger joints. Weight-bearing joint arthritis will prevent the patient from walking comfortably or from sitting up straight. In severe cases, the joints can get twisted and deformed. This makes getting diagnosis and treatment from a doctor essential to maintain a good standard of living.

History and Physical Examination

The doctor would ask detailed questions about your symptoms and examine the affected joints for swelling, stiffness, and degree of range of motion affected. Most types of arthritis present with a set of clinical symptoms that may point towards the cause.

Laboratory Investigations and Imaging

Your doctor can recommend any of the following tests, depending on the type of arthritis suspected:

Blood tests

Complete blood count (CBC) with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, blood culture, and sensitivity (C/S), etc.

Test for specific antibodies such as rheumatoid factor (RF), antinuclear antibodies (ANA), anti-cyclic citrullinated peptide (Anti-CCP) antibodies, etc.

Synovial fluid assessment

Synovial fluid is found in the synovial cavities of joints. The composition of synovial fluid is analyzed by performing synovial fluid aspiration (arthrocentesis) and synovial fluid C/S  to diagnose different types of arthritis.

X-ray

X-rays can be performed to detect damage to the joints and track the progression of the disease.

Ultrasound (U/S), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)

These imaging modalities may be used to visualize the joints involved along with the muscles, tendons, and ligaments near the diseased joint.

Arthroscopy and Joint Biopsy:

Arthroscopy is a procedure in which a fiber optic camera is inserted through a small incision to visualize the joint. It can also be used to obtain a biopsy specimen from the joint for examination and diagnosis of the joint condition.

Treatment

The treatment for arthritis is based on relieving symptoms, improving joint function, and maintaining a good quality of life.

Lifestyle Modification

The following are some beneficial lifestyle modifications that can help relieve symptoms and prevent long-term damage.

  • Weight Reduction: Reducing weight decreases the pressure on weight-bearing joints and slows down the progression of the disease.
  • Healthy diet: Eating a balanced diet and avoiding processed foods reduces inflammation. Foods with antioxidants are also beneficial.

Fish, nuts, whole grains, olive oil, etc. help maintain good joint health.

  • Exercise: Monitored physical activity reduces stiffness and increases the range of motion of an affected joint. Physiotherapy is now an adjunct to medical therapy to treat arthritis.
  • Smoking: Smoking increases inflammation of joints. Quitting smoking is an essential step in the management of arthritis.

Medical Therapy

Following drugs alone or in combination may help relieve joint pain, reduce inflammation, and limit joint destruction.

  • Analgesics: Pain is the most debilitating symptom of arthritis.
  • Non-steroidal anti-inflammatory drugs (NSAID): NSAIDs, such as ibuprofen, aspirin, diclofenac, etc. are used to reduce pain and inflammation.
  • Corticosteroids: Steroids do not stop the progression of the disease but are useful in reducing inflammation and treating acute flare-ups of the disease.
  • Biologic response modifiers and disease-modifying anti-rheumatic drugs (DMARDs) are used to modulate the immune response and reduce disease progression.

Physiotherapy

Physiotherapy keeps the muscles and joints working, relieves discomfort, and keeps the patients mobile. Physiotherapists assess how arthritis affects the patient and put together a plan of therapy, workouts, and other treatments to reduce pain and prevent joint stiffness and decrease in range of motion.

Occupational therapy teaches individuals how to change the conditions at home and in the workplace to reduce movements that can aggravate arthritis. Splints for the hands or wrists, assistive devices to assist with activities such as driving, bathing, dressing, housekeeping, and some work can be prescribed.

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