Arthritis
Arthritis is the medical term for any disease that produces inflammation, pain, and stiffness in one or more joints. There are more than 100 different types, all of which are classified as rheumatic diseases.
Arthritis develops when cartilage, the tough, slippery material covering the ends of bones, is destroyed faster than the body can repair it. Aging, excessive wear and tear, infection, and inflammation contribute to the process. As the cartilage roughens and wears down, the ends of the bones become increasingly exposed and eventually damaged.
Osteoarthritis, also called degenerative joint disease, is the most common type. It is caused by natural deterioration from aging, as well as injuries to and overuse of joints in sports or work. Other contributing factors include an inherited predisposition, excessive weight, and skeletal abnormalities.
Rheumatoid arthritis is one of the most serious forms. It is systemic and can affect the blood vessels, heart, and other organs in addition to joints. Though the cause is unknown, most researchers consider it an autoimmune disorder, in which the immune system attacks the body. Its course is unpredictable, but most people experience remissions in which the disease is quiescent, interrupted by flare-ups that cause progressive, irreversible damage.
Some types of arthritis are caused by infection, including such sexually transmitted diseases as gonorrhea and Reiter's syndrome. Autoimmune diseases such as lupus often involve an immune-system attack on joints. Still other types, such as gout, are due to metabol icdefects, which are often hereditary.
Diagnostic Studies and Procedures
A diagnosis of osteoarthritis is based on symptoms, X-ray results, and the extent of pain and loss of mobility found in studies of joint movements. Rheumatoid arthritis is confirmed by an additional finding of the rheumatoid factor, an abnormal antibody, in the blood and joint (synovial) fluid. Rheumatoid factor shows up in about 80 percent of patients with this condition, although several tests, taken at different times, may be needed to detect it. Infectious forms of arthritis usually can be diagnosed by the presence of bacteria or other organisms in joint fluid.
Medical Treatments
An approach that combines medication, exercise, and rest is basic to treating most forms of arthritis, with physical or rehabilitative medicine and alternative therapies as important adjuncts. For more serious types, such as rheumatoid arthritis and lupus, treatment should be coordinated by a Traumatologist, a specialist in these disorders.
Drug Therapy. Arthritis medications suppress inflammation and alleviate pain, but several drugs and dosages may have to be tried to achieve the best results with the least adverse side effects. The two main categories are nonsteroidal anti-inflammatory drugs (known as NSAIDs) and corticosteroids. Of the NSAlDs, aspirin remains the drug of choice for those who can tolerate it in large therapeutic doses of 16 or more tablets a day. Other NSAIDs include: ibuprofen, which is sold in both nonprescription and prescription dosages; and stronger prescription drugs, such as indomethacin (lndocin), ketoprofen (Orudis), naproxen (Naprosyn), piroxi-cam (Feldene), and sulindac (Clinonl).
Osteoarthritis that is free of inflammation can be treated with the nonprescription painkiller acetaminophen. Otherwise, the NSAIDs used for rheumatoid arthritis are prescribed.
The corticosteroids are synthetic versions of cortisone, one of the adrenal hormones. These are powerful drugs intended for short-term use and are reserved for cases that cannot be controlled adequately by NSAIDs. Cortisone injected directly into the affected joints reduces adverse reactions, but even so, overuse can reduce resistance to infections, weaken bones, and cause other serious side effects.
Drugs prescribed for severe rheumatoid arthritis that is not helped by other medications include chloroquine (Aralen), usually employed for malaria, and cyclophosphamide (Cytoxan) and methotrexate, agents that suppress the immune system. Penicillamine (Cuprimine and Depen), a chelating agent normally used to remove copper and other metals from the body, appears to remove rheumatoid factor also; the possible result is a remission of arthritis.
Compounds of gold salts, usually injected, can produce remission of rheumatoid arthritis also, but how or why they work is unknown. Patients receiving all such medications must be closely monitored for adverse effects.
Pain-Control Devices. The use of TENS, short for transcutaneous electrical nerve stimulation, sometimes reduces the need for painkillers. TENS electrodes are placed on the skin at specific trigger points, where they stimulate nerves that block pain signals. TENS battery operated devices are available at surgical or medical supply stores, but a doctor or physical therapist should provide instruction on using them properly.
Surgical Treatments. With surgical advances in arthroplasty -- the repair or replacement of joints -- mobility can now be restored to many severely disabled arthritis patients. It is possible to restructure certain joints, such as those in the feet and wrists, using grafted cartilage and other tissue, and to replace badly diseased hips, knees, shoulders, and fingers with artificial ones made of metal and plastic.
Microsurgery employing arthroscopy, a tube with fiberoptic magnifying devices, has further revolutionized joint surgery. An arthroscope is inserted into the joint through a small incision, and a magnified view of interior tissues is projected on a television screen. While viewing the screen, the surgeon manipulates tiny instruments inside the arthroscope to repair the joint.
Other surgical procedures include osteotomy, in which a bone is cut and then reset to improve alignment, and synovectomy, in which portions of the diseased synovial membrane -- the sac surrounding the joint -- are removed.
Alternative Therapies
Many alternatives, included as pan of arthritis treatment, can help to relieve pain. A word of caution, however: Most forms of arthritis are incurable and arthritis quackery is common. Be wary of any healers who promise a cure.
Acupuncture. Pain relief is the major benefit of acupuncture, although some practitioners claim that their treatments reduce inflammation and induce remissions of rheumatoid arthritis. Since spontaneous remissions are common in this disease, it is impossible to attribute them to any particular therapy
Chiropractic. Spinal manipulation and massage temporarily alleviate the stiffness and pain of some types of arthritis, but a chiropractor should not be considered a substitute for a rheumatologist.
Herbal Medicine. To promote bone repair and cartilage elasticity, herbalists recommend comfrey. As natural anti-inflammatories, they advocate devil's claw, licorice, wild yam, willow bark, and yucca. Because tension and stress can trigger an arthritis flare-up, herbal teas are advised as substitutes for beverages that contain caffeine.
Hydrotherapy. Water therapies, including underwater exercise, hot and cold wet packs, and powerful directional showers, can improve circulation, help retain joint mobility, and possibly slow tissue deterioration and fusing of joints.
Massage Therapy. Massage can relax stiff joints but it cannot restore lost function and mobility.
Nutrition Therapy and Megavitamins. There is renewed medical interest in the effects of high-dose vitamin supplements and trace minerals on rheumatic diseases. Even so, there still are no nutritional cures for arthritis. Before taking high-dose vitamins, consult a doctor or qualified nutritionist; some supplements interact with arthritis medications and others, such as high-dose vitamin A, are potentially toxic.
Yoga and T'ai Chi. These and other gentle routines such as dance therapy utilize body movements and postures that reduce physical stress. Combined with meditation and breathing exercises, these movement therapies also help to strengthen muscles around joints, promote flexibility, and manage pain.
Self-Treatment
Self-care plays a critical role. Only an individual can judge the best balance of rest and exercise, heat and cold, and medication adjustments.
Rest. Fatigue exacerbates arthritis; even mild tiredness is an important warning that your body needs rest. Rest individual joints as needed by using a cane, for example, to relieve stress on hips and knees, orthotic devices in footwear to ease stress on ankles and feet, and splints to support wrists and hands. Strive for a balance when using splints, however, because excessive immobilization can result in a frozen joint.
Exercise. Putting all arthritic joints through a daily range-of-motion routine minimizes stiffness and retains joint function. Special resistance exercises promote muscle strength, and also help maintain mobility. A physical therapist or rehabilitative specialist can recommend the best exercises.
Special Accommodations. Review your daily routine and rearrange access to key elements, such as clothing and kitchen supplies, to minimize uncomfortable or difficult movements. There are also numerous aids, such as special eating utensils, jar openers, raised toilet seats, combs and toothbrushes, among others, to make routine tasks easier.
Weight Control. Excessive weight increases stress on joints, and speeds up the destructive course of arthritis. Consult a nutritionist to work out a sensible weight-loss diet.
Other Causes of Joint Disease
Infections, including Lyme disease, rheumatic fever, and gonorrhea, should be ruled out when diagnosing arthritis.