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Arthritis

Arthritis

Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where two bones meet. A joint functions to allow movement of the body parts it connects. Arthritis literally means inflammation of one or more joints. Arthritis is frequently accompanied by joint pain. Joint pain is referred to as arthralgia.

 

Arthritis is classified as one of the rheumatic diseases. These are conditions that are different individual illnesses, with differing features, treatments, complications, and prognosis. They are similar in that they have a tendency to affect the joints, muscles, ligaments, cartilage, and tendons, and many have the potential to affect internal body areas as well.

 

There are many forms of arthritis (over 100 have been described so far, and the number is growing). The forms range from those related to wear and tear of cartilage (such asosteoarthritis) to those associated with inflammation as a result of an overactive immune system (such asrheumatoid arthritis). Together, the many forms of arthritis make up the most common chronic illness in the United States.

 

Arthritis sufferers include men and women, children and adults. Approximately 350 million people worldwide have arthritis. Over 40 million people in the United States are affected by arthritis, including over a quarter million children! More than half of those with arthritis are under 65 years of age. Nearly 60% of Americans with arthritis are women.

Symptoms

Symptoms of arthritis include pain and limited function of joints. Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth. Tenderness of the inflamed joint can be present. Loss of range of motion and deformity can result. Certain forms of arthritis can also be associated with pain and inflammation of tendons surrounding joints.

 

Some forms of arthritis are more of an annoyance than a serious medical problem. However, millions of people suffer daily with pain and disability from arthritis or its complications. Moreover, many of the forms of arthritis, because they are rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints.

 

Therefore, symptoms in some patients with certain forms of arthritis can also include fever, gland swelling, weight loss, fatigue, feelingunwell, and even symptoms from abnormalities of organs such as the lungs, heart, or kidneys.

 

When to Seek Medical Care

 

If joint pain, swelling, stiffness, redness, loss of motion or deformity occurs, medical evaluation by a health-care professional is warranted. Even minor joint symptoms that persist unexplained for over one week should be evaluated. For many forms of arthritis, it is essential that patients have an early evaluation as it is clear that this can both prevent damage and disability as well as make optimal treatment easier.

Causes

The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), metabolic abnormalities (such as gout and pseudogout), hereditary factors, the direct and indirect effect of infections (bacterial and viral), and a misdirected immune system with autoimmunity (such as in rheumatoid arthritis and systemic lupus erythematosus).

 

Arthritis is classified as one of the rheumatic diseases. These are conditions that are different individual illnesses, with differing features, treatments, complications, and prognoses. They are similar in that they have a tendency to affect the joints, muscles, ligaments, cartilage, and tendons, and many have the potential to affect other internal body areas.

 

Treatment programs, when possible, are often directed toward the precise cause of the arthritis.

 

More than 21 million Americans have osteoarthritis. Approximately 2.1 million Americans suffer from rheumatoid arthritis.

Treatment

The treatment of arthritis depends on which particular form of arthritis is present, its location, severity, persistence, and any underlying background medical conditions of the patient. Each treatment program must be customized for the individual patient. Treatment programs can incorporate home remedies, nonprescription andprescription medications, joint injections, and surgical operations. 

 

Some treatment programs involve weight reduction and avoiding activities that exert excessivestress on the joint. The goal of treatment of arthritis is to reduce joint pain and inflammation while preventing damage and improving and maintaining joint function.

 

Treatment may not be necessary for arthritis with minimal or no symptoms. When symptoms are troubling and persist, however, treatment might include pain and antiinflammatory medications as below. Furthermore, heat/cold applications and topicalpain creams can be helpful.

 

As a first step, rest, heat/cold applications, and topical pain creams can be helpful. For osteoarthritis, the over-the-counter food supplements glucosamine and chondroitin have been helpful for some, though their benefits are still controversial according to national research studies.

 

These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a two-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements "rebuild" cartilage. This claim has not been adequately verified by scientific studies to date.

 

For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammation properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis. Obesity has long been known to be arisk factor for osteoarthritis of the knee.

 

Weight reduction is recommended for patients  who areoverweight and have early signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees. Of note, even modest weight reduction can be helpful.

 

Pain medications that are available over the counter, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis and are often recommended as the first medication treatment. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal antiinflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis.

 

Some patients get significant relief of pain symptoms by dipping their hands in hot wax (paraffin) dips in the morning. Hot wax can often be obtained at local pharmacies or medical supply stores. It can be prepared in a Crock-Pot and be reused after it hardens as a warm covering over the hands by peeling it off and replacing it into the melted wax.

 

Warm water soaks and wearing nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms. Gentle range of motion exercises performed regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.

 

Pain-relieving creams that are applied to the skin over the joints can provide relief of daytime minor arthritis pain. Examples include capsaicin (Arthricare, Zostrix),diclofenac cream, salycin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall). For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.

 

There are a few forms of arthritis, such as gout, that can be impacted by dietary changes.

 

Finally, when arthritis symptoms persist, it is best to seek the advice of a doctor who can properly guide the optimal management for each individual patient.

 

Medical Treatment

 

Not every person with arthritis requires medical attention. For example, some patients with osteoarthritis have minimal or no pain and may not need treatment. However, for those with persisting joint symptoms, the ideal steps to take should lead to a proper diagnosis and an optimal long-term treatment plan. This plan must be customized for each person affected, depending on the joints involved and the severity of symptoms.

 

For many patients with arthritis, mild pain relievers such as aspirin and acetaminophen (Tylenol) may be sufficient treatment. Studies have shown that acetaminophen given in adequate doses can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis.

 

Since acetaminophen has fewer gastrointestinal side effects than NSAIDS, especially among elderly patients, acetaminophen is often the preferred initial drug given to patients with osteoarthritis. Pain-relieving creams applied to the skin over the joints can provide relief of minor arthritis pain. Examples include capsaicin, salycin, methyl salicylate, and menthol.

 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that are used to reduce pain as well as inflammation in the joints. Examples of NSAIDs include aspirin (Ecotrin), ibuprofen (Motrin), nabumetone (Relafen), and naproxen (Naprosyn). It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects.

 

This is more often possible with osteoarthritis because the symptoms vary in intensity and can be intermittent. The most common side effects of NSAIDs involve gastrointestinal distress, such as stomach upset, crampingdiarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. Newer NSAIDs called cox-2 inhibitors have been designed that have lesstoxicity to the stomach and bowels.

 

Some studies, but not all, have suggested that the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some people with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the FDA. The U.S. National Institutes of Health (NIH) is studying glucosamine and chondroitin in the treatment of osteoarthritis.

 

Their initial research demonstrated only a minor benefit in relieving pain for those with the most severe osteoarthritis. Further studies, it is hoped, will clarify many issues regarding dosing, safety, and effectiveness of these products for osteoarthritis. Patients taking blood-thinners should be careful taking chondroitin as it can increase the blood-thinning effect and cause excessive bleeding.

 

Fish oil supplements have been shown to have some anti-inflammation properties, and increasing the dietary fish intake and/or taking fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.

 

Cortisone is used in many forms to treat arthritis. It can be taken by mouth, given intravenously, and injected directly into the inflamed joints to rapidly decrease inflammation and pain while restoring function. Since repetitive cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.

 

For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise, or medications, a series of injections of hyaluronic acid (Synvisc, Hyalgan, and others) into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors.

 

Arthritis that is characterized by a misdirected, overactive immune system (such as rheumatoid arthritis or ankylosing spondylitis) frequently requires medications that suppress the immune system. Medications such as methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) are examples. Newer medications that target specific areas of immune activation are referred to as biologics (or biological response modifiers).

 

Treatment costs

 

It has been estimated that the total cost of the arthritis bill for the United States, in terms of hospitalization, doctor visits, medications, physical therapies, nursing-home care, lost wages, early death, and family discord is over $50 billion dollars annually.

 

This does not include the nearly $2 billion spent each year in the United States on unproven remedies by patients addressing their symptoms on their own.

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