Click on the links below to take go to the particular part of the section.
- What is arthritis?
- What are the different types of arthritis?
- What causes osteoarthritis?
- Predisposing factors to Osteoarthritis of hip
- Predisposing factors to osteoarthritis of knee
- What are the symptoms of arthritis?
- How can a doctor diagnose arthritis?
- What you can do?
- What your doctor can do for you?
- Treatment Options
- Does exercise really help those who have arthritis?
- Can special diets treat arthritis?
- Stem Cells
What is arthritis?
The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body's natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.
The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.
What are the different types of arthritis?
There are over 100 different types of rheumatic diseases. The most common are: Osteoarthritis. Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.
Osteoarthritis causes joint pain and can limit a person's normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees, and hips.
Rheumatoid arthritis. This is an autoimmune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.
Rheumatoid arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (like both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.
Fibromyalgia. This chronic disorder causes pain throughout the tissues that support and move the bones and joints. Pain, stiffness, and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Fatigue and sleep disturbances may also occur.
Gout When a person has gout, they have higher than normal levels of uric acid in the blood. The body makes uric acid from many of the foods we eat. Too much uric acid causes deposits, called uric acid crystals, to form in the fluid and lining of the joints. The result is an extremely painful attack of arthritis. The most common joint gout affects is the big toe. This disease is more common in men than in women.
Infectious arthritis. Arthritis can be caused by an infection, either bacterial or viral, such as Lyme disease. When this disease is caused by bacteria, early treatment with antibiotics can ease symptoms and cure the disease.
Reactive arthritis. This is arthritis that develops after a person has an infection in the urinary tract, bowel, or other organs. People who have this disease often have eye problems, skin rashes, and mouth sores.
Psoriatic arthritis.Some people who have psoriasis, a common skin problem that causes scaling and rashes, also have arthritis. This disease often affects the joints at the ends of the fingers and can cause changes in the fingernails and toenails. Sometimes the spine can also be affected.
Systemic lupus erythematosus. Also called lupus or SLE, this is an autoimmune disease. When a person has an autoimmune disease, the immune system attacks itself, killing healthy cells and tissue, rather than doing its job to protect the body from disease and infection. Lupus can inflame and damage a person's joints, skin, kidneys, lungs, blood vessels, heart, and brain. African American women are three times more likely to get lupus than Caucasian women. It is also more common in Hispanic, Asian, and American Indian women.
Ankylosing spondylitis. This disease most often affects the spine, causing pain and stiffness. It can also cause arthritis in the hips, shoulders, and knees. It affects mostly men in their late teenage and early adult years.
Juvenile rheumatoid arthritis.The most common type of arthritis in children, this disease causes pain, stiffness, swelling, and loss of function in the joints. A young person can also have rashes and fevers with this disease.
Polymyalgia rheumatica. Because this disease involves tendons, muscles, ligaments, and tissues around the joint, symptoms often include pain, aching, and morning stiffness in the shoulders, hips, neck, and lower back. It is sometimes the first sign of giant cell arteritis, a disease of the arteries characterized by inflammation, weakness, weight loss, and fever.
Polymyositis. Causing inflammation and weakness in the muscles, this disease can affect the whole body and cause disability.
Psoriatic arthritis. This form of arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.
Bursitis. This condition involves inflammation of the bursa, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursa. Bursitis produces pain and tenderness and may limit the movement of nearby joints.
Tendinitis. Also called tendonitis, this condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.
What causes osteoarthritis?
Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity.
Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.
Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.
Some people may have congenital abnormalities of the joints-for example, Perthes' disease of the hips-that cause early degeneration and subsequently cause osteoarthritis.
Predisposing factors to Osteoarthritis of hip.
Some conditions may predispose the hip to osteoarthritis, It tends to affect people as they get older and particularly affects joints that have to take a lot of stresses and strains.
- A previous fracture that involved the hip
- Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
- Some childhood hip problems later cause hip arthritis (for example, a type of childhood hip fracture known as a Slipped Epiphysis; also Legg-Perthe's Disease)
- Inactive lifestyle- Obesity (overweight) Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles and feet
Predisposing factors to Osteoarthritis of Knee.
Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear - just like the out-of-balance tire that wears out too soon on your car.
There are more than 150 different forms of arthritis, symptoms vary according to the form of arthritis. Each form affects the body differently.
Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of a joint, early morning stiffness, and skin changes, including rashes.
How can a doctor diagnose arthritis?
Doctors diagnose arthritis with a medical history, physical exam and x-rays of the hip.
There is no blood test for osteoarthritis.
What you can do?
Consult a doctor who will determine the type of arthritis you have.
Rest the joint until the pain subsides to prevent further inflammation.
Take painkillers or anti-inflammatories, as recommended by your doctor.
If you are overweight, try to reduce weight to lighten the load on weight-bearing joints.
Participate in regular exercise.
There is no cure for arthritis, so beware of 'miracle cures'. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy,
which includes exercises and heat treatment. In severe cases, surgery may be suggested, such as a hip or knee replacement. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results.
Initial treatment for osteoarthritis of the hip or knee is conservative, consisting of rest,
avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and or anti inflammatory medications. With worsening symptoms a cane or a knee brace may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted and are no longer helpful, and the arthritis has become disabling, surgery may be recommended.
Treatment of osteoarthritis focuses on decreasing pain and improving joint movement, and may include:
- Exercises to keep joints flexible and improve muscle strength
- Many different medications are used to control pain, including corticosteroids and NSAIDs. Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDS
- For mild pain without inflammation, acetaminophen may be used
- Heat/cold therapy for temporary pain relief
- Joint protection to prevent strain or stress on painful joints
- Surgery (sometimes) to relieve chronic pain in damaged joints
- Weight control to prevent extra stress on weight-bearing joints
Exercise is very important because it increases lubrication of the joints and strengthens the surrounding muscles, putting less stress on joints. Exercise in heated swimming pools-hydrotherapy-can bring enormous relief from pain and stiffness.
Also studies have shown that exercise helps people with arthritis by reducing joint pain and stiffness and increasing flexibility, muscle strength and energy. It also helps with weight reduction and offers an improved sense of well-being.
Can special diets treat arthritis?
But what if you have arthritis - are diet and nutrition still such a simple matter?
Can what you eat cure your arthritis? Can food prevent it from occurring?
Are there foods that can cause your arthritis to 'flare' or go into remission?
What role do vitamins and nutritional supplements play in the treatment of arthritis?Will losing (or gaining) weight help ease your symptoms?
These are the sorts of questions that people with arthritis often ask, and they're valid questions. Some questions (Can what you eat cure your arthritis?) have simple answers (No). Some questions (Are there foods that can cause your arthritis to 'flare' or go into remission?) aren't so straightforward (Perhaps...).
Most of what you need to know about diet and nutrition is common sense; healthy eating is pretty much the same for anyone, whether you have arthritis or not. But there are exceptions.
THE TRUTH ABOUT STEM CELLS
There is a lot of mis information on the internet. Advertisers entice people to try stem cells.. the reality is that only those selling the product benifit as scientific research has shown no proven benefit in knee (or hip) arthritis. The study below has recenty been published. It is a double blinded controlled trail where the patients and doctors and evaluators do not know wether stem cells or saline were injected into the knee joint. The results show NO DIFFERENCE between saline (water) and stem cells.
A Randomised Placebo Controlled Pilot Study of Autologous Non-Expanded Adipose-Derived Mesenchymal Stem Cells in the Treatment of Knee Osteoarthritis
1 - MARCH, Lyn. University of Sydney Institute of Bone and Joint Research, Department of Rheumatology,
2 - HUNTER, David. University of Sydney Florance and Cope Chair of Rheumatology and Institute of Bone and Joint Research
To determine the efficacy and safety of using autologous adipocyte-derived mesenchymal stem cells (MSCs) for relief of pain in patients with knee osteoarthritis (OA).
Patients with Grade 1 or 2 knee OA were self-referred to a randomised controlled trial (ACTRN12611001046998). All participants underwent liposuction to collect 250mls of fat under intra-venous vancomycin cover. An independent radiologist injected either the cell suspension or saline prepared in identical syringes. The participants and investigators remained blinded to treatment allocation throughout the trial. Primary outcomes were OMERACT-OARSI responder criteria and total pain score measured by Intermittent and Constant Osteoarthritis Pain (ICOAP) at six months’ post-treatment after adjusting for baseline. Data analysis was conducted according to intention-to-treat principles.
Both treatment (N=20; Mean [SD] Age: 57.3 [9.1] years, 60% female, 55% previous arthroscopy) and placebo groups (N=20; Mean [SD] Age: 59.3 [7.9] years, 45% female, 40% previous arthroscopy) experienced a significant decrease in ICOAP total pain score from baseline (mean score: 21.8 vs 23.6 respectively; difference -1.67 [95% CI: -0.28 to 0.78]; p=0.78). There was no difference between groups in OMERACT-OARSI responder criteria (responders 45% both groups; P=1.00). Residual lumpiness from the liposuction occurred in three patients (1 in treatment and 2 in placebo) at 6 months. One cell suspension tested positive for staph caprae and this was treated with no residual effects.
To our knowledge, this is the first RCT evaluating the effect of autologous non-expanded MSCs on reducing pain in human knee OA. The treatment process was well tolerated and there were no major medium-term safety concerns. The effect on symptom modification at 6 months was similar in both groups. Adipocyte derived MSCs warrant further investigation to determine whether sub-groups of patients may be more likely to respond. Analyses to evaluate 6 and 12 months structure modification and secondary outcomes are ongoing.
From learning about the importance of exercising regularly to fully understanding your arthritis medications, the information contained in this section is meant to provide you with insights, information and tips that can be used by you to help make living with arthritis a little bit more manageable.
For people with arthritis, learning to make it part of your life can be difficult. But learning as much as you can about your arthritis and actively working with your arthritis treatment team are two very effective ways of regaining control over your life. There is plenty of information, some specific to arthritis and some not, that can be very helpful to someone facing the challenges associated with having a chronic or lifelong disease.
Our suggestion is - don't let arthritis beat you. Take control. How? Arm yourself with as much information as possible. Learn from the experiences of others in similar circumstances. What we're presenting here is a virtual toolbox of tips for living well with arthritis. Some may work for you one day and not the other. Some may work for you but not others. That's why we've tried to cover several topics. There are plenty of tools or tips here. Use them or refer to them when you need them. Call upon them when you require help.