Arthritis in Man

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The human bones undergo changes that can occur spontaneously and at times induced by certain external factors causing an immunological  reaction, that would affect the bones and joints. The bones and joint together with the spaces in between  become affected , usually with pain,  swelling and much discomfort.
Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. … There are several types of arthritis, but we shall focus on  most common forms  which are
• osteoarthritis  OA  (degenerative joint disease).  Osteoarthritis usually occurs with age and affects the fingers, knees, and hips.  and
• rheumatoid arthritis. RA. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet.
An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Your risk of developing OA may be higher if you have a family history of the disease. Another common form of arthritis, RA, is an autoimmune disorder. It occurs when your body’s immune system attacks the tissues of the body. Osteoarthritis affects more than 3.8% of people while rheumatoid arthritis affects about 0.24% of people .

Signs and symptoms
Pain, which can vary in severity, is a common symptom in virtually all types of arthritis. Other symptoms include swelling, joint stiffness and aching around the joint(s). Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. Symptoms may include:
• Inability to use the hand or walk
• Stiffness, which may be worse in the morning, or after use
• Malaise and fatigue
• Weight loss
• Poor sleep
• Muscle aches and pains
• Tenderness
• Difficulty moving the joint
• It is common in advanced arthritis for significant secondary changes to occur. For example, arthritic symptoms might make it difficult for a person to move around and/or exercise, which can lead to secondary effects, such as:

• Muscle weakness
• Loss of flexibility

Decreased aerobic fitness
These changes, in addition to the primary symptoms, can have a huge impact on quality of life.
Decreased mobility, in combination with the above symptoms, can make it difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease. People with arthritis are also at increased risk of depression, which may be a response to numerous factors, including fear of worsening symptoms.

Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritis potentially features pain. Pain patterns may differ depending on the arthritis and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. Osteoarthritis, on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.

Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, and tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity.
Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritis are suspected. These might include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies.

Treatment
There is no known cure for either rheumatoid or osteoarthritis. Treatment options vary depending on the type of arthritis and include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, and medications. Joint replacement surgery may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.

1. Physical therapy
In general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.

Individuals with arthritis can benefit from both physical and occupational therapy. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities as well as equipment.

2. Medications
There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.
Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Opioids and NSAIDs are less well tolerated.
Rheumatoid arthritis (RA) is autoimmune so in addition to using pain medications and anti-inflammatory drugs, this type uses another category of drug called disease-modifying anti-rheumatic drugs (DMARDs). An example of this type of drug is Methotrexate. These types of drugs act on the immune system and slow down the progression of RA.

3. Surgery
A number of rheumasurgical interventions have been incorporated in the treatment of arthritis .  Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.
Inflammation and arthritis
Some, but not all types of arthritis, are the result of misdirected inflammation. Arthritis is a general term that describes inflammation in joints. Some types of arthritis associated with inflammation include:
• Rheumatoid arthritis
• Psoriatic arthritis
• Gouty arthritis
• Systemic lupus erythematosus

The most common form of arthritis called osteoarthritis (also known as degenerative arthritis) is a bit of a misnomer. It is not believed that inflammation plays a major role in osteoarthritis. Other painful conditions of the joints and musculoskeletal system that are not associated with inflammation include fibromyalgia, muscular low back pain, and muscular neck pain.

 Symptoms of Inflammation
Redness
Joint swelling
Joint pain
Joint stiffness
Loss of joint function
Often, only a few of these symptoms are present.
Inflammation may also be associated with general “flu”-like symptoms including:
Fever
Chills
Fatigue/loss of energy
Headaches
Loss of appetite
Muscle stiffness.
When inflammation occurs, chemicals from the body are released into the blood or affected tissues. This release of chemicals increases the blood flow to the area of injury or infection and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling. This process may stimulate nerves and cause pain.
Results of Joint Inflammation :
Increased blood flow and release of these chemicals attract white blood cells to the sites of inflammation. The increased number of cells and inflammatory substances within the joint can cause irritation, wearing down of cartilage (cushions at the end of bones), and swelling of the joint lining.

Inflammation Affect Internal Organs
Inflammation can affect organs as part of an autoimmune disorder. The type of symptoms depends on which organs are affected. For example:
• Inflammation of the heart  may cause vague chest pain or fluid retention.
• Inflammation of the small tubes that transport air to the lungs  may cause shortness of breath.
• Inflammation of the kidneys  may cause high blood pressure or kidney failure.
• Inflammation of the eye  may cause pain or decreased vision.
• Inflammation of the muscles  may cause achiness or weakness.
• Inflammation of the blood vessels  may cause rash, headaches, or internal organ damage.
Pain may not be a main symptom since many organs do not have pain-sensitive nerves.

Treatment  
There are a number of treatment options for inflammatory joint diseases including medications, rest, exercise, and surgery to correct joint damage. The type of treatment prescribed will depend on several factors including the type of disease, the person’s age, type of medications he or she is taking, overall health, medical history, and severity of symptoms.

Treatment is aimed  to
4. Treat the underlying inflammatory disease and decrease inflammation

5. Relieve pain by medication, activity modification

6. Maintain joint movement, muscle strength and overall function through physical therapy and exercise

7. Decrease stress on the joints by using braces, splints, or canes as needed.
The main focus in any inflammatory bone disease , is to seek help as quickly as possible, to be able to arrest the breakdown of the tissues within the affected areas.