What is Arthritis

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• Arthritis is inflammation of one or more of your
  joints. The main symptoms of arthritis are joint
  pain and stiffness, which typically worsen with
  age.
• Arthritis can take many forms, but three of the
  common diseases that make up arthritis are
• Osteoarthritis (OA), the most common form of
  arthritis, is a progressive degenerative joint
  disease characterized by the break- down of joint
  cartilage associated with risk factors, such as
  overweight/obesity, history of joint injury and
  age.
• Rheumatoid Arthritis (RA), a systemic disease
  characterized by the inflammation of the
  membranes lining the joint, which causes pain,
  stiffness, warmth, swelling and sometimes severe
  joint damage.
• Juvenile Arthritis (JA) is an umbrella term used
  to describe the many autoimmune and inflammatory
  conditions that can develop in children ages 16
  and younger.
• Treatments vary depending on the type of
  arthritis. The main goals of arthritis treatments
  are to reduce symptoms and improve quality of
  life.

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Prevalence
Of the more than 50 million Americans with
arthritis, more than 36 million are Caucasians,
more than 4.6 million are African-Americans
and 2.9 million are Hispanic.
Arthritis is not just a disease of old
age. Two-thirds of people with arthritis are
under the age of 65, including 300,000 children.
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Risk factors

• Risk factors for arthritis include
• Family history. Some types of arthritis run in
  families, so you may be more likely to develop
  arthritis if your parents or siblings have the
  disorder. Your genes can make you more
  susceptible to environmental factors that may
  trigger arthritis.
• Age. The risk of many types of arthritis
  including osteoarthritis, rheumatoid arthritis
  and gout increases with age.
• Your sex. Women are more likely than are men to
  develop rheumatoid arthritis, while most of the
  people who have gout, another type of arthritis,
  are men.
• Previous joint injury. People who have injured a
  joint, perhaps while playing a sport, are more
  likely to eventually develop arthri- tis in that
  joint.
• Obesity. Carrying excess pounds puts stress on
  joints, particularly your knees, hips and spine.
  Obese people have a higher risk of developing
  arthritis.

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Reasons
OSTEOARTHRITIS Osteoarthritis is the most common
type of arthritis over the world. It often
develops in people who are over 50 years of age.
However, it can occur at any age as a result of
an injury or another joint-related
condition. Osteoarthritis initially affects the
smooth cartilage lining of the joint. This makes
movement more difficult than usual, leading to
pain and stiffness. The cartilage lining of the
joint can then thin and tissues within the joint
can become more active. This can then lead to
swelling and the formation of bony spurs, called
osteophytes. In osteoarthritis, the cartilage
(connective tissue) between the bones gradually
erodes, causing bone in the joints to rub
together. The joints that are most commonly
affected are those in the hands, spine, knees and
hips.
RHEUMATOID ARTHRITIS Rheumatoid arthritis often
starts when a person is between 40 and 50 years
old. Women are three times more likely to be
affected than men. Rheumatoid and osteoarthritis
are two different conditions. Rheumatoid
osteoarthritis occurs when the body's immune
system targets affected joints, which leads to
pain and swelling. The outer covering (synovium)
of the joint is the first place affected. This
can then spread across the joint, leading to
further swelling and a change in the joint's
shape. This can cause the bone and cartilage to
break down. People with rheumatoid arthritis can
also develop problems with other tissues and
organs in their body.
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• Reasons
• JUVENILE RHEUMATOID ARTHRITIS
• Juvenile rheumatoid arthritis, also known as
  juvenile idiopathic arthritis, is the most common
  type of arthritis in children under the age of
  17. Juvenile rheumatoid arthritis causes
  persistent joint pain, swelling and stiffness.
  Some children may experience symptoms for only a
  few months, while others have symptoms for the
  rest of their lives.
• Some types of juvenile rheumatoid arthritis can
  cause serious complications, such as growth
  problems and eye inflammation. Treat- ment of
  juvenile rheumatoid arthritis focuses on
  controlling pain, improving function and
  preventing joint damage.
• Juvenile rheumatoid arthritis occurs when the
  body's immune system attacks its own cells and
  tissues. It's unknown why this happens, but both
  heredity and environment seem to play a role.
  Certain gene mutations may make a person more
  susceptible to environmental factors such as
  viruses that may trigger the disease.
• OTHER TYPES OF ARTHRITIS AND RELATED CONDITIONS
• Ankylosing spondylitis a long-term inflammatory
  condition that mainly affects the bones, muscles
  and ligaments of the spine, leading to stiffness.
  Other problems can include the swelling of
  tendons, eyes and large joints.
• Fibromyalgia causes pain in the body's muscles,
  ligaments and tendons.
• Lupus an autoimmune condition that can affect
  many different organs and the body's tissues.
• Gout a type of arthritis caused by too much
  uric acid in the body. This can be left in joints
  (usually affecting the big toe) but can develop
  in any joint. It causes intense pain and
  swelling.
• Psoriatic arthritis an inflammatory joint
  condition that can affect people with psoriasis.
• Enteropathic arthritis a form of chronic,
  inflammatory arthritis associated with
  inflammatory bowel disease (IBD), the two best-
  known types being ulcerative colitis and Crohn's
  disease. About 1 in 5 people with Crohn's or
  ulcerative colitis will develop entero- pathic
  arthritis. The most common areas affected by
  inflammation are the peripheral (limb) joints and
  the spine.
• Reactive arthritis this can cause inflammation
  of the joints, eyes and urethra (the tube that
  urine passes through). It develops shortly after
  an infection of the bowel, genital tract or, less
  frequently, after a throat infection.
• Secondary arthritis a type of arthritis that
  can develop after a joint injury and sometimes
  occurs many years afterwards.
• Polymyalgia rheumatica a condition that affects
  people over 50 years of age, where the immune
  system causes muscle pain, stiffness and joint
  inflammation.
• Septic arthritis is an intensely painful
  infection in a joint. The joint can become
  infected with germs that travel through your
  blood- stream from another part of your body.
  Septic arthritis can also occur when a
  penetrating injury brings germs directly into the
  joint. Infants and older adults are most likely
  to develop septic arthritis. The most common
  joints affected are the knees and hips.

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Symptoms

• The most common signs and symptoms of arthritis
  involve the joints. Depending on the type of
  arthritis you have, your signs and symptoms may
  include
• Pain
• Stiffness
• Swelling
• Redness
• Decreased range of motion

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Diagnostic

• During the physical exam, your doctor will check
  your joints for swelling, redness and warmth. He
  or she will also want to see how well you can
  move your joints. Depending on the type of
  arthritis suspected, your doctor may suggest some
  of the following tests.
• LABORATORY TESTS
• The analysis of different types of body fluids
  can help pinpoint the type of arthritis you may
  have. Fluids commonly analyzed include blood,
  urine and joint fluid. To obtain a sample of your
  joint fluid, your doctor will cleanse and numb
  the area before insert- ing a needle in your
  joint space to withdraw some fluid (aspiration).
• IMAGING
• These types of tests can detect problems within
  your joint that may be causing your symptoms.
  Examples include
• X-rays. Using low levels of radiation to
  visualize bone, X-rays can show cartilage loss,
  bone damage and bone spurs. X-rays may not reveal
  early arthritic damage, but they are often used
  to track progression of the disease.
• Computerized tomography (CT). CT scanners take
  X-rays from many different angles and combine the
  information to create cross-sectional views of
  internal structures. CTs can visualize both bone
  and the surrounding soft tissues.

• Magnetic resonance imaging (MRI). Combining radio
  waves with a strong magnetic field, MRI can
  produce more-detailed cross-sectional images of
  soft tissues such as cartilage, tendons and
  ligaments.
• Ultrasound. This technology uses high-frequency
  sound waves to image soft tissues, cartilage and
  fluid-containing structures such as bursae.
• Ultrasound also is used to guide needle placement
  for joint aspirations and injections.
• ARTHROSCOPY
• In some cases, your doctor may look for damage in
  your joint by inserting a small, flexible tube
  called an arthroscope through an incision near
  your joint. The arthroscope transmits images from
  inside the joint to a video screen.

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Treatment
PHYSICAL THERAPY AND OCCUPATIONAL
THERAPY Physical therapy and occupational therapy
help maintain joint mobility and range of motion.
How much therapy you need, and what kind of
therapy will depend on many factors, such as the
severity and type of arthritis you have, your
age, and your general state of health. This has
to be decided by you with your physician and
physical or occupational therapist. People with
arthritis will often avoid moving the affected
joint because of the pain. A physical therapist
can help the patient work out the joint stiffness
without damaging it. In order to perform your
daily activity the physical therapist will help
you achieve a good range of motion. This may
involve building strength in the muscles that
surround the affected joint - stronger muscles
help stabi- lize a weakened joint. You will also
be taught the best way to move from one position
to another, as well as learning how to use such
walking aids as crutches, a cane or a walker, if
you need one. Physical therapy, apart from
significantly improving function and reducing
pain, has been shown to delay the need for
surgical intervention in advanced cases.
Occupational therapy can teach you how to reduce
the strain on your joints as you go about your
daily activities. The occupational therapist can
help you modify your home and work- place so that
your movements do not aggravate your arthritis.
You may need a splint for your hands or wrists,
as well as aids for dressing, housekeeping, work
activities, driving and washing/bathing
yourself. An occupational and/or physical
therapist can make an enormous difference to your
quality of life if you suffer from arthritis.
He/she will help you learn more about your
arthritis, devise a dietary plan if you are
overweight and over-stressing the joints as a
result, help you make better decisions about what
shoes to buy if that part of the body is
affected. You will learn how and when to rest -
rest is crucial for treating inflammation and
pain, especially when many joints are affected
and you feel tired. Resting individual joints is
very helpful too - custom splints can be made to
rest and support affected joints. Local pain can
be relieved with ice packs or heating pads.
Ultrasound and hot packs provide deep heat which
relieves localized pain and relaxes muscle spasm
around the affected joint. You may find that a
warm bath/shower makes it easier for you to
exercise afterwards.
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• Treatment
• Physical activity can improve arthritis symptoms
  - doctors warn that inactivity could harm the
  health of most patients with arthri- tis or some
  kind of rheumatic disease. Inactivity raises the
  risk of cardiovascular disease and diabetes type
  2. Muscles become weaker with no exercise, joints
  become stiffer, and the patient's tolerance for
  pain decreases. Balance problems may also become
  worse.
• Arthritis patients who are physically active
  generally enjoy better health, are happier, live
  longer, experience improvements in pain, sleep,
  day-to-day functioning and general energy levels.
• MEDICATIONS
• NSAIDs - NSAIDs (nonsteroidal anti-inflammatory
  drugs) are the most commonly prescribed drugs for
  arthritis patients. These may be either
  prescription or over-the-counter (OTC). At low
  doses NSAIDs help a vast range of ailments, from
  headaches, muscle aches, to fever and minor pain.
  At a higher dose - prescription dose - NSAIDs
  also help reduce joint inflammation. There are
  three main types of NSAIDs and they all work by
  blocking prostaglandins - hormone-like substances
  that trigger pain, inflam- mation, muscle cramps
  and fever

• Traditional NSAIDs - these are the largest subset
  of NSAIDs. As is the case with most drugs, they
  do carry a risk of side-effects, such as stomach
  upset and gastrointestinal bleeding. The risk of
  side effects is significantly higher if the
  patient is over 60. A patient should take this
  type of drug at high doses under the supervision
  of a doctor.
• NSAID Risks - Arthritis Research UK6 says that
  people who have had a heart attack or stroke,
  have heart disease, or have peripheral vascular
  disease are unlikely to be prescribed NSAIDs.
  Doctors should be cautious about prescribing
  NSAIDs to patients with hypertension (high blood
  pressure), hyperlipidemia (high cholesterol),
  diabetes, and regular smokers.
• COX-2 inhibitors - these also reduce pain and
  inflammation. However, they are designed to have
  fewer stomach and gastrointestinal side-effects.
  In 22004/2005 Vioxx and Bextra were taken off the
  market after some major studies showed Vioxx
  carried increased cardiovascular risks, while
  Bextra triggered serious skin reactions. Some
  other COX-2 inhibitors are also being
  investigated for side-effects. The FDA asked
  makers of NSAIDs to highlight warnings on their
  labels in a black box.

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Treatment

• Salicylates - includes aspirin which continues to
  be the preferred medication of many doctors and
  patients. Patients need to consult their doctor
  if they plan to take aspirin more than just
  occasionally.
• Long term high dosage usage of aspirin carries
  with it a significant risk of serious undesirable
  side effects, such as kidney problems and
  gastrointestinal bleeding. For effective control
  of arthritis pain and inflammation frequent large
  doses are needed. Nonacetylated salicylate is
  especially designed to have fewer side effects
  than aspirin.
• Some doctors may prescribe nonacetylated
  salicylate if they feel aspirin is too risky for
  their patient. However, nonacety- lated
  salicylate does not have the chemical aspirin has
  which protects against cardiovascular disease.
  Some doctors prescribe low dose aspirin along
  with nonacetylated salicylate for patients who
  they feel need cardiovascular protection.
• Glucocorticoids are anti-inflammatory steroids
  and are very effective at combating inflammation
  and can be extremely helpful when used properly.
  The patient needs to consider the potential for
  undesirable side-effects with this type of drug.
• Anti-malarials, such as hydroxychloroquine and
  chloroquine are commonly used for treating mild
  inflammatory arthritis. Minocycline - an
  antibiotic that is sometimes used as antibiotic
  therapy for rheumatoid arthritis. Its use is
  controversial. Sulfasalazine - commonly used for
  many types of inflammatory arthritis.
  Sulfasalazine is a sulfa derivative.
• Methotrexate - works by blocking the metabolism
  of rapidly dividing cells. It is commonly used
  for treating more serious types of inflammatory
  arthritis.
• Azathioprine - used for severe forms of
  inflammatory arthritis. Azathioprine also blocks
  the metabolism of rapidly dividing cells.
• Gout medications - some physicians may use gout
  medications to treat some forms of arthritis.
• Leflunomide - used to treat rheumatoid arthritis
  and psoriatic arthritis. It also blocks cell
  metabolism. However, biologic therapy is
  gradually taking over.
• Cyclosporine - an immunosuppressant drug - it
  makes your immune system less aggressive.
  Cyclosporine is commonly used by transplant
  patients so that their bodies do not reject their
  transplanted organs. Cyclosporine is usually used
  in combination with methotrexate for arthritis
  patients. Although effective, this may be limited
  by its toxicity.

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• Treatment
• ALTERNATIVE MEDICINE
• Many people use alternative remedies for
  arthritis, but there is little reliable evidence
  to support the use of many of these products. The
  most promising alternative remedies for arthritis
  include
• Acupuncture. This therapy uses fine needles
  inserted at specific points on the skin to reduce
  many types of pain, including that caused by some
  types of arthritis.
• Glucosamine. Although study results have been
  mixed, it now appears that glucos- amine works no
  better than placebo. However, glucosamine and the
  placebo both relieved arthritis pain better than
  taking nothing, particularly in people who have
  moderate to severe pain.
• Transcutaneous electrical nerve stimulation
  (TENS). Using a small device that produces mild
  electrical pulses, TENS therapy stimulates nerves
  near the aching joint and may interfere with the
  transmission of pain signals to the brain.
• Yoga or tai chi. The slow, stretching movements
  associated with yoga and tai chi may help improve
  joint flexibility and range of motion in people
  with some types of arthritis.
• Massage. Light stroking and kneading of muscles
  may increase blood flow and warm affected joints,
  temporarily relieving pain. Make sure your
  massage therapist knows which joints are affected
  by arthritis.

• SURGERY
• If conservative measures don't help, your doctor
  may suggest surgery, such as
• Joint replacement. This procedure removes your
  damaged joint and replaces it with an artificial
  one. Joints most commonly replaced are hips and
  knees.
• Joint fusion. This procedure is more often used
  for smaller joints, such as those in the wrist,
  ankle and fingers. It removes the ends of the two
  bones in the joint and then locks those ends
  together until they heal into one rigid unit.

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Usefull advice
THE IMPACT OF DIET, EXERCISE AND
BODYWEIGHT Experts say that eating a
well-balanced diet is vital when you have
arthritis. Not only will you be receiving
critical nutrients, you will also be either
maintaining or arriving more quickly at a healthy
bodyweight. If you are overweight you will be
adding extra pressure on weight-bearing
joints. Many patients have found that losing just
a few pounds made a significant difference to
their quality of life. Doctors and nutritionists
are more frequently advising arthritis patients
to keep sugary and/or fatty foods to a minimum -
such as red meat, cream and cheese. You should
make sure you are eating plenty of fruit and
vegetables, as well as whole grains.
Omega-3 essential fatty acids have been shown to
relieve some extent the symptoms of rheumatoid
arthritis. A common source of Omega-3 fatty acids
is oily fish, such as sardines, herring, trout,
and salmon. Many of us tend to place large
portions on our plate. If you reduce the size of
the portions you may lose weight more
effectively. Make sure that vegetables and fruit
make up a large part of your portion. LIVING WITH
ARTHRITIS Although arthritis can make daily tasks
more difficult and exhausting, there are many
techniques and therapies, which added together,
can give you a much better quality life, compared
to no therapy at all. It is important that people
with arthritis seek medical health and treatment.
Although there is no cure for arthritis, there is
a lot you can do to minimize its overall effects
on your everyday life. You may wish or have to
continue working, and with the right techniques
and help from an occupational therapist you may
find it is not as daunting as you first thought.
There is a lot you can do to minimize the impact
your arthritis might have on family life and
raising your children. A person with arthritis
will need to remember that being there for the
child is much more important than being a super
active parent. If you pace yourself and
prioritize you will be surprised at how much you
can achieve successfully. Be open with your
family members about your arthritis - explain how
it affects you so that they recognize when you
may need extra understanding and support.