What Is Arthritis?
SummaryArthritis is not just a disease of older people – it can affect people of all ages, including children. It is not clear what causes arthritis and there is no cure at present. However, there is plenty you can do to manage yourcondition and lead a full and active life.
Arthritis is not just a disease of older people – it can affect people of all ages, including children. It is not clear what causes arthritis and there is no cure at present. However, there is plenty you can do to manage yourcondition and lead a full and active life.
Two of the most common forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis(RA).
Osteoarthritis is a very common condition, affecting the joints, often described as "wear and tear" arthritis. This can start from our teens and gets worse as we grow older. Osteoarthrosis and osteoarthritis are terms which are used virtually interchangeably. Osteoarthrosis means a condition where the joints are affected by degeneration. Osteoarthritis implies the same, but the "itis" adds the meaning that the joints are red, hot, swollen, and painful (inflamed). Most of the time people with this condition do not have inflamed joints, although they may well be painful and, to some extent, deformed. Thus, in truth, osteoarthrosis is probably a more accurate overall description of the condition. However as most people refer to the condition as osteoarthritis, this is the term used below. Osteoarthritis is not usually a progressive and crippling arthritis in the way that some other forms, such as rheumatoid arthritis, can be. It may begin at a very young age, so do not worry too much that it means you are "over the hill". Changes of osteoarthritis have been found in the bones of teenagers.
The joints that are affected ache and you may feel or hear them crunching or cracking. The range of movement of the joints may be reduced, and they may become visibly knobbly. Sometimes the pain gets worse, and the joint becomes swollen. This is usually short lived, and the symptoms return to how they were, but you should see your doctor. Osteoarthritis is more likely to affect your hips or knees, and also the end joints on your fingers, but it can affect any joint.
The standard explanation for osteoarthritis is that it is a result of "wear and tear". This does account for a large percentage of the problem, but there are many examples of people who have had very similar lives, one of whom will have virtually perfect joints, while the other will have really quite severe osteoarthritis. Thus there must be an inbuilt susceptibility to or, on the other hand, protection against osteoarthritis.
Diagnosis is usually made by the doctor from talking to, and examining, the patient. When a particular joint becomes worse, your doctor may arrange X-rays and blood tests, to confirm the diagnosis, and to help rule out the more aggressive types of inflammatory arthritis.
For the most part treatment is to keep mobile and active, taking pain killers (analgesics) such as paracetamol or paracetamol based medications, and if necessary, especially when the joints are swollen, hot and more painful (inflamed), anti-inflammatory drugs, such as aspirin and ibuprofen.
Rheumatoid arthritis (RA) is an autoimmune disease. Usually your body's immune system produces white cells and proteins called antibodies to destroy foreign substances such as viruses and bacteria. With autoimmune diseases, your immune system mistakes your own tissue as foreign and attacks it, leading to inflammation. In RA, your body's immune system attacks the lining of your joints (synovial membrane). The disease may also cause inflammation of the sheaths around your tendons. Eventually, this causes thinning of the cartilage that covers the ends of your bones, and may lead to the bone being worn away.
You will probably find that RA develops quite slowly at first. You may notice some discomfort in your hands and feet, and your joints may be swollen. It's possible that you will feel particularly stiff when you get up in the morning. For some people, the condition comes on quickly and painfully and may make it difficult for you to carry out your daily activities. You may also feel tired and generally unwell. You may develop rheumatoid nodules - fleshy lumps that usually appear on your hands, feet and elbows. These aren't painful but may mean you have difficulty using your hands. RA affects everyone differently and you are likely to find there are times when your symptoms are worse than at others. It's not usually possible to predict when these flare-ups will occur. In general, of people with RA:
- two out of 10 will only have very mild symptoms
- three-quarters will continue to have flare-ups
- one in 20 will develop serious RA, leading to severe disability
If you are a woman, you are nearly three times more likely to get RA than a man. It's common for the symptoms of RA to improve during pregnancy - this suggests that hormones and the immune system may be involved in triggering the condition.
There seem to be some genes that make it more likely that you will get RA, and the disease runs in some families. Certain lifestyle factors may increase your risk, for example, if you smoke or are obese.
If you suspect you have RA, even if your symptoms are mild, it's a good idea to see your GP. If you do have RA, it's important to start treatment soon because the earlier it's started, the more effective it will be. If not treated, the condition may lead to serious disability.
It can be difficult to diagnose RA because many other conditions may make your joints painful. There is no single test that can diagnose it, but your GP will ask about your symptoms and examine you. He or she may refer you for further tests.
Your blood may be tested for a marker called rheumatoid factor. This is present in 80 percent of people who have RA. However, rheumatoid factor is also found in one in 20 people who don't have the condition. A new technique called anti-CCP antibody testing is a very specific test for RA. You may have blood tests to see if you have anaemia (when you have too few red blood cells or not enough haemoglobin in your blood) as 80 percent of people with RA have this. You may have an X-ray of your hands and feet to check for changes in these joints.
There are things you can do to help ease the symptoms of RA. Find a balance between exercise and rest. Swimming is an excellent activity because it strengthens your muscles and joints without putting any strain on them. Try to lose excess weight as this will reduce the pressure on your joints. An occupational therapist can suggest ways of making everyday tasks easier and may be able to provide you with specialist equipment. Try to eat a healthy, balanced diet and cut down on saturated fats. A hot water bottle may help if your joints feel stiff and painful; try an ice pack if they are hot and irritated.
Medicines There is a large range of medicines available that can help relieve the symptoms of RA, although no medicine can cure the condition. Painkillers such as paracetamol may help to relieve pain and stiffness although they won't affect the progression of arthritis. Anti-inflammatory medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg Nurofen) reduce inflammation and so relieve pain and swelling. Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate work to slow down the disease process and delay joint damage. You may have to take a number of DMARDs at the same time and you may need to try several before you find one that suits you. Four new medicines, infliximab, etanercept, adalimumab and rituximab, have been developed recently. You may be eligible to try these if other medicines have been unsuccessful. With all medicines, it's important to follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist or doctor for advice. Your doctor may recommend steroid injections. These are given directly into the specific joint and provide pain relief very quickly.
It's unlikely that you will need surgery to treat your RA. However, if you have severely damaged joints and medication has not helped, your doctor may recommend that you have an operation. The surgery won't cure RA but it may help to reduce pain and discomfort. You may be offered: a hip or knee replacement synovectomy to remove the lining of an inflamed joint removal or repair of severely inflamed tendons surgery to fuse a joint to make it more stable, in your neck for example.