Orthopaedics

Arthritis

What is Arthritis?

Arthritis is a disorder of the joints in the human body. A joint is a place where two bones converge and function to facilitate movement. Arthritis is portrayed by inflammation of the joints, be it one or more. One of the prime characteristics of this disorder is  joint pain which is medically referred to as arthralgia. 

Over a 100 different types of arthritis have been discovered. A broad spectrum of arthritis have been found arising due to diverse causes namely osteoarthritis (condition related to the deterioration of cartilage ) and rheumatoid arthritis (an autoimmune condition). This broad spectrum of arthritis is a chronic illness in the Unites States.

Primarily, the cause of arthritis is dependent on the type of arthritis and it could be caused due to injury (which will concurrently lead to osteoarthritis), metabolic abnormalities (gout and pseudogout), genetics, infections (due to bacteria or viruses) and misdirected immune system (autoimmunity).

Arthritis is categorised as a rheumatic disease. Rheumatic diseases are distinct individual conditions, with different characteristics, treatment and therapy, complications and prognosis. Although, they may be different due to several factors, they have similar features too. These include the proneness to affect parts of the body like the joints, muscles, cartilage, ligaments, tendons, etc. In addition, they have the ability to affect other parts of the body.

  • Statistics
  • Risk Factors for Arthritis
  • Signs and Symptoms of Arthritis
  • Arthritis Diagnosis
  • Treatment for Arthritis
  • Prognosis for Arthritis
  • Preventing Arthritis
  • National Financial Impact of Arthritis
  • Who is a Rheumatologist?
  • What is the Arthritis Foundation?
  • Menstrual Periods and Arthritis
  • Conclusion

arthrtis

Statistics

Arthritis can affect men, women and children. Approximately 350 million people worldwide are said to be affected by arthritis. In the United States alone, 40 million people are affected by arthritis which include over 250,000 children.

Furthermore, in the United Stated 27 million people are affected by osteoarthritis. Around 1.3 million, in America, are recorded to be affected by rheumatoid arthritis too. More than half of those who are afflicted with arthritis are said to be under the age of 65 with nearly 60% of the afflicted patients being women.

Risk Factors for Arthritis

There are certain risk factors associated to arthritis. The major risk factor that can contribute to this disorder are the genes which are inherited. Thus, genetics factors have an impact on arthritis and play a major role.  Another type of arthritis is trauma-related. It has the tendency to injure certain areas of the body which can disable a person from performing certain activities.

Signs and Symptoms of Arthritis

Primary symptoms linked to arthritis include pain and restricted joint functions, making movement difficult. Joint inflammation which come about due to arthritis is marked by stiffness of the joints, redness, swelling and warmth. In addition, soreness or pain of the affected joints can also be present.

Various forms of arthritis are present. As they are classed as rheumatic diseases, arthritis has the ability to affect many organs present in the body which may not have any direct links to the joint in question. Thus, patients may manifest symptoms like fever, swelling of glands (swollen lymph nodes), loss of weight, fatigue, feeling indisposed,etc. Patients may also show symptoms related to defects of certain organs like the lungs, heart, kidneys and so on.

Arthritis Diagnosis

The first course of action in the diagnosis of arthritis involves the initial meeting between the doctor and the arthritis sufferer to review symptoms. The medical doctor will analyse the symptoms, examine the joints for inflammation and evaluate joints for deformity. The doctor will also ask a number of questions and examine other parts of the body that may be affected by arthritis, which may be present as an inflammation. Moreover, a number of tests will be performed which include blood, urine, joint fluid and X-rays. These will aid with the diagnosis process which will be based on the symptoms, the spread of the inflammation and the results of the tests performed. Importantly, a number of visits to the doctor may be required before the doctor diagnoses your condition. A rheumatologist is a doctor who has had special training in arthritis and related diseases.

Many types of arthritis are more of a nuisance or an inconvenience rather than a serious illness. Having said that, millions of people suffer from the pain, disability and complications that result from arthritis in a daily basis. Early and accurate diagnosis will be very helpful in preventing the irreparable damage and deformity that may come about. Exercises recommended by therapists, rest, medication, physical therapy and surgery are some of the treatments that can be administered. It can change long term consequences for arthritis sufferers.

It is important to note that, the patient and the doctor should communicate in a regular basis for the most favourable health outcomes before and more specifically after the diagnosis has been made. It allows the doctor to assess patients symptoms as well as his or her response to the treatments prescribed. In addition, the patients get to be well informed of their current situation and its effect on them if they communicate with their respective doctors time to time.

Treatment for Arthritis

Treatment of arthritis is completely dependent upon the type of arthritis present in the patient. Early and accurate diagnosis will improve or increase the possibilities of a successful treatment. Treatments for arthritis generally include physical therapies, splints, ice packs, anti-inflammatory drugs, paraffin wax baths, pain killers, immune targeted medications and surgical treatments.

 Diet for Arthritis  

Generally, for the many types of arthritis present, diet has very little or no role at all. However, fish oil seem to be helpful for arthritis. These oils have anti-inflammatory properties that can play a tremendous role in arthritis patients. Some sufferers of arthritis have reported certain benefits experienced due to the intake of omega-3 fatty acid supplements. 

A type of arthritis that is diet related is gout. Gout is said to worsen due to intake of food that is highly rich in purines. For example, red meats and shellfish are high in purine content. Furthermore, some foods raise the levels of uric acid, like alcohol  (beer). Some foods are loaded with fructose, for example corn syrup present in soft drinks are rich in fructose. In addition, people suffering from celiac disease should have a gluten free diet. Food like wheat, barley, rye, food made with grains, etc are gluten containing and must be avoided as it can aggravate their condition.

Prognosis for Arthritis

The prognosis for arthritis patients mainly depends on the severity of the disease, related complications and the presence of other non-joint problems  i.e. organs and other parts of the body involved. For instance, rheumatoid arthritis can affect organs like the lungs, kidneys, eye, etc. Moreover, chronic joint inflammation can give rise to ineradicable damage to the joints involved which will concurrently bring about loss of functions making movement facilitation hard or not at all possible.

Preventing Arthritis

As most forms of arthritis present are inherited to some extent, there is absolutely no possible way you can prevent it. However, arthritis that arise due to injury of joints could be easily avoided by abiding to safety rules and regulations in order to prevent injuries being sustained. Arthritis that follow infection, in the case of septic arthritis, reactive arthritis, Whipple’s disease etc, could be prevented by not being exposed or infected by these causative organisms, be it bacterial or viral. That is the only possible way out from arthritis arising from infections. Nevertheless, the extent to which this is feasible depends on the situation.

National Financial Impact of Arthritis

The national financial impact of arthritis for the United States is recorded to be above $50 billion annually. This figure is inclusive of hospitalisation, medications and drugs, visits to doctors, physical therapies, home care nursing, lost salaries, early death and family discordance. However, it is exclusive of the nearly $2 billion spent annually in the United States on uncertain and unproven treatments by patients who try to handle the arthritis symptoms by themselves.

Who is a Rheumatologist? 

A rheumatologist is a medical doctor who has specialised in the treatment of arthritis and other rheumatic disorders. They show special interest in symptoms such as incomprehensible rash, fever, arthritis, anaemia, feebleness, loss of weight, weariness, joint pain, muscle pain, autoimmune disease and anorexia. Part of their profession is to act as consultants. When other health care professionals request information, they act like investigators acquiring the necessary information.

In addition, they have special skills in evaluating the many types of arthritis that may show up in patients. They have special interest in rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, erythromelalgia, Still’s disease, dermatomyositis, Sjögren’s syndrome, vasculitis,fibromyalgia, scleroderma,  Lyme disease, osteomyelitis, osteoarthritis, osteoporosis, back pain, gout, pseudogout, reactive arthritis, Kawasaki disease,  Raynaud’s disease, iritis, and many others.

To become a rheumatologist one must first complete four years of medical school. After which he or she has to complete one year of internship in internal medicine and two years of internal medicine residency fellowship.  For rheumatology certification there is a sub-specialty board for the certification which is offered by the American Board of Internal Medicine. This board will provide certification for the approved rheumatologists.

Paediatric rheumatologists are also available who are doctors who provide medical care to children who are afflicted with arthritis. They provide additional care and advice to their families as well. They are paediatricians who have completed an extra two or three years of training in paediatric rheumatology which is board certified.

What is the Arthritis Foundation?

The Arthritis Foundation is a nation wide health care organisation providing voluntary services to all forms of arthritis that show up in people. This foundation has national and international related programs which also provide with invaluable support for scientific research, public awareness and education for affected parties, parents and families of arthritis. They also provide training for specialists, public education and local community assistance.

Menstrual Periods and Arthritis

Many women experience worsening of arthritis symptoms before and during their menstrual periods. When treating women with arthritis, it is quite common to come across women complaining of a monthly worsening of joint pain, stiffness and swelling  which is not a coincidence. Many types of arthritis and related rheumatic diseases are known to have a higher prevalence rate in women rather than in men.

Researchers have found that the female reproductive hormones have an effect on the immune system of women. Autoimmunity is said to arise when levels of certain hormones change. These hormones may be testosterone or oestrogen. Autoimmunity is a condition which arise when the immune system, which functions to attack foreign particles (infections), start attacking one’s own normal body tissues like the skin, joints, lungs, liver, etc. A typical feature of an autoimmune disease is the inflammation which can come about in various body parts.

Autoimmune diseases are also portrayed by the abnormal production of antibodies called autoantibodies which attack one’s body tissues. This is a result of a disorder of the immune system. It is important to understand that autoimmune diseases do not occur only in disease states which feature inflammation of the joints such as systemic lupus erythematosus, Sjogren’s syndrome, and rheumatoid arthritis. It can also occur in disease states that feature other organs of the body such as Hashimoto’s thyroiditis and juvenile diabetes mellitus.

 

Video of Arthritis

When women complain about having arthritis symptoms that worsen before or during their monthly cycles, health care professionals will recommend adjusting or even adding medications in order to reduce inflammation selectively at appropriate times. In this case, just before and during the period. The reasoning behind this adjustment (short-term) is that women’s levels of hormones change during this period which affect the immune system and may make it more active temporarily.

Conclusion

Arthritis is a disorder of the joints featuring inflammation. A joint is a place in the body where two bones converge which function to facilitate movement. Arthritis is portrayed by inflammation of the joints, be it one or more. One of the prime characteristics of this disorder is  joint pain. Another symptoms of arthritis include limited function of the joints due to inflammation. Men, women, children and adults are all likely to be afflicted with arthritis. Treatments for arthritis generally include physical therapies, splinting, cold pack application, anti-inflammatory applications, paraffin wax dips, pain medications, immune targeted medications and surgeries. Prognosis for arthritis patients mainly depends on the severity of the disease, related complications and whether there are other non-joint manifestations. Early and accurate diagnosis is important to prevent irreparable damage and deformity.

 

 

 

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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Osteoporosis

What is Osteoporosis?

Osteoporosis is a condition portrayed by the reduction in bone density and its strength which result in fragile bones. Osteoporosis causes abnormally porous bones that will be compressible (sponge- like). In addition, it weakens the bones which will result in frequent fractures of the bones. 

The normal constituents of the bone are the proteins, collagen and calcium. All these elements give the bone its strength. With osteoporosis  the bones are weakened so much so that even a minor injury can lead to fractures which wouldn’t be the case with a normal person. Two-forms of fracture in osteoporosis can be seen: cracking (hip fractures) and collapsing (vertebral compression fractures). These fractures can arise in almost any bone in the skeletal system; but in osteoporosis the more common ones are the spine, hips, wrists, ribs and so on.

ostep

Statistics

44 million people are said to have low bone density in the United Sates alone, in which 10 million have osteoporosis and 34 million have osteopenia. This is about 55% of the total U.S population (50 years and older). It is said that one in two Caucasian women will have a bone fracture as a result of osteoporosis. It is also stated that 20% of those who had a hip fracture will die in the following year. With ageing, in America, osteoporosis related fractures will increase exponentially.  As a result, pain, suffering, impact on general health and economic costs will rise.

Signs and Symptoms

A person who has osteoporosis may not show any signs; as osteoporosis is said to go undetected for decades sometimes. The condition does not show any symptoms until the bone fractures. The symptom that come along with bone fractures is the pain. On an important note, the symptoms that arise in men are similar to those which arise in women.

Spine fractures can cause excruciating pain, which is “band-like”. The pain will spread out from the back of the body to its sides. If a person undergoes repeated spinal fractures he or she will be prone to lower back pain, loss of height and/or spine curving due to the collapse of the vertebrae. A minimal trauma in osteoporosis refers to the fracture that arise while doing normal activity like walking (feet stress fractures). On the other hand, hip fractures occur due to falls like slipping and tripping accidents. Due to poor healing of the bone, hip fractures tend to heal slowly after surgical repair.

Consequences of Osteoporosis 

Bone fractures due to osteoporosis lead to pain, decreased quality of life, loss of workdays and disability. It is shown that approximately 30% of patients who sustained a hip injury due to osteoporosis will be in need of long term nursing-home care. Pneumonia and blood clots (in leg veins) that can go up to the lungs (pulmonary embolism due to long bed rest after a hip injury) are some of the consequences of osteoporosis that may arise in the elderly patients. Osteoporosis has been associated with increased risk of death too. Around 20% of women who had a hip fracture are said to die in the following year after the hip injury. A person who has had a spinal fracture is supposed to be at a high risk of attaining a similar fracture in the next few years. In addition, about 20% of postmenopausal women who had a vertebral fracture in the past are said suffer from a new fracture (vertebral) in the following year.  

Prevention of Hip Fractures in the Elderly

Elderly people are prone to hip fractures which arise due to osteoporosis. Therefore, the FDA has proposed and approved hip protector garments for the elderly with osteoporosis. This would prevent hip fractures. Brand names of such garments include Hipsaver and Safehip. These can be useful for selected patients, the ones who are in nursing homes due to osteoporosis. However, the renal extent of protection against these hip fractures which can be acquired by the use of such garments is disputable.

In addition, it is necessary to check for wear and tear of canes or other supporting aids for walking in elderly patients who use such equipments. Rubber tips of canes should be checked often. If say, the rubber tips wear off, the elderly person is in risk of slipping  which can lead to other harmful conditions, including hip fractures.

Causes and Risk Factors

  • Gender (female)
  • Race- Caucasian or Asian
  • Body frame- Thin and small body frame
  • Family history -family members having osteoporosis
  • Personal history- of fractures as an adult
  • Smoking cigarettes.
  • Excessive alcohol consumption
  • Exercise (Lacking)
  • Low calcium diet
  • Poor general health and nutrition
  • Malabsorption- due to conditions like celiac sprue
  • Low levels of oestrogen (in women due to menopause or removal of ovaries)
  • Low levels of testosterone in men (due to hypogonadism)
  • Chemotherapy
  • Amenorrhea (no menstrual periods)
  • Chronic inflammation (rheumatoid arthritis or diseases of the liver).
  • Immobility (stroke or conditions that inhibit or interfere with walking)
  • Hyperthyroidism
  • Hyperparathyroidism
  • Vitamin E deficiency
  • Certain medications

Diagnosing Osteoporosis

An X-ray can show osteoporosis, if present, as it will reveal the thinner and lighter bones (than normal) which arise in osteoporosis. However, at this stage at least 30% of the bones have already been affected. Also, they are not very accurate in indicating the density of the bone. Therefore, the National Osteoporosis Foundation, the American Medical Association and other organisation have proposed the use of a dual-energy X-ray absorption scan (known as DXA) for osteoporosis diagnosis. DXA has the ability to measure the density of the bone in the hip, spine and forearm regions and the test only takes about 15 minutes. In addition, it exposes the patient to minimal amount of radiation and is more precise.  

After the bone density is obtained it will be compared to the average peak bone density (same sex, same age).  This value or score is known as the “T score”. Osteoporosis is characterised by the T score of -2.5 or below. Osteopenia (between normal and osteoporosis) is characterised by the T score of -1 to -2.5.

Who should have bone testing?

The National Osteoporosis Foundation have stated that certain groups of people should consider a DXA testing:

  • All postmenopausal women over 65 years of age, who are at risk of attaining osteoporosis
  • All women over 65  years of age and older.
  • Postmenopausal women with fractures.
  • Women who have any medical conditions related to osteoporosis. A medical doctor can review your conditions and list out the ones which are linked to osteoporosis.
  • Women who decide to undergo osteoporosis treatment can undergo a DXA to find out if she has osteoporosis.

Treatment and Prevention 

Treatment for osteoporosis is mainly dependant on preventing the fractures of the bones by decreasing bone loss and by increasing bone density and bone strength. The risk of acquiring such fractures can be reduced by early detection and treatment. However, the available treatments today for osteoporosis are not able to completely cure the condition. That is to say rebuilding bones that have been severely weakened by osteoporosis is very difficult. Consequently, prevention becomes very important, as important as the treatment. The following are some of the treatments and preventions methods:

  • Lifestyle changes- Quitting cigarette smoking, reducing consumption of alcohol, regular exercises and having a balanced diet which contains appropriate levels of calcium and vitamin D.
  • Medications- which will increase bone strength and stop bone loss. Medications that will increase the formation of bones can be taken too.

 

Video of Osteoporosis

There are many health benefits linked to regular exercises. Having said that, exercise will not bring about considerable bone density in a patient. For osteoporosis, exercise helps by decreasing the risk associated with falls. This is related to acquiring proper balance and  improved muscle strength. Moreover, research has not yielded any results on what kind of exercise will be best for an individual suffering from osteoporosis or the duration of an exercise which should be performed to get the beneficial results. Most medical doctors talk in favour of weight bearing exercises (walking). Although, exercise is good it should be noted that it is crucial to avoid exercises that can injure the already weakened bones of osteoporosis. Physician’s monitoring and prescription of exercises is necessary in patients who are over 40 years of age and those with heart diseases, diabetes mellitus, high blood pressure, obesity, etc. Vigorous exercises, like marathon running, is not good for the bones. Osteoporosis may be promoted due to marathon running in young women which may lead to weight loss and loss of menstrual periods.  

Calcium Supplements

For strong and healthy  bone formation one should take adequate amount of calcium from childhood and adolescence regardless of the gender. It is important to note that calcium alone is not sufficient to treat osteoporosis. National Institute of Health Consensus Conference of Osteoporosis recommends the following for all people (with or without osteoporosis):

  • Children (1-10 years)- 800 mg/day
  • Men, Premenopausal women, Postmenopausal women (taking oestrogen)- 1000 mg/day
  • Teenagers and young adults (11-24 years)- 1200 mg/day
  • Postmenopausal women not taking oestrogen- 1500 mg/day
  • Pregnant and nursing mothers- 1200-1500 mg/day

The total calcium intake for a day should not go beyond 2000 mg.

Statistics show that the average woman in the United States consume calcium less than 500 mg per day. This is less than the amounts which are recommended. Calcium can always be consumed by drinking more milk, eating more yoghurt or cottage cheese or by taking calcium supplements. Other sources of calcium include the calcium-fortified foods (orange juice). Moreover, calcium supplements are usually safe and well tolerated. Indigestion and constipation are the associated side effects. If these side effects occur with consumption of calcium carbonate supplements, then an alternative, calcium citrate can be consumed.

Vitamin D

Vitamin D is obtained by the diet and the skin which relies on adequate sunlight exposure. Importance of vitamin D:

  • Helps in dietary calcium absorption from the intestines.
  • Vitamin D deficiency can lead to osteomalacia (calcium depleted bone) which will weaken the bones further and increase risk of fractures.
  • Vitamin D with adequate levels of calcium has shown to improve bone density and decrease the risk of fractures. This has been demonstrated in studies involving postmenopausal women but not in premenopausal women.

In the United States vitamin D deficiency is common where a study conducted in the general medical ward showed that 57% of patients had vitamin D deficiency. Approximately 50% of elderly women are said to consume vitamin D which is far less than the recommended value. The Food and Nutrition Board of the Institute of Medicine has recommended the following vitamin D intake:

  • Men and Women over 71 years- 800IU/day
  • Women (other ages), men and children- 600IU/day
  • Infants (under 12 months)- 400IU/day

Appropriate levels of calcium and vitamin D are important for bone health. However, excessive vitamin D levels can result in toxicity, high levels of calcium levels in blood and urine and may cause kidney stones. It is important to note that calcium and vitamin D alone are not sufficient in treating osteoporosis, other treatments should be considered too.

Hormone Therapy (Menopausal Hormonal Therapy)

The use of oestrogen hormone therapy after menopause has ben shown to prevent loss of bones and fractures and increase density of bones. This therapy is helpful in avoiding osteoporosis in postmenopausal women. Oestrogen can be taken orally or as a skin patch. In addition, it is available with progesterone as patches and pills. Progesterone is administered with oestrogen to prevent cancer of the uterus which may come about due to administration of oestrogen alone. Women who have surgically  removed their uterus may take oestrogen only. Currently, effects of nasally transporting oestrogen and lower doses of oestrogen and progesterone are being researched.

Most importantly, due to adverse effects arising due to this therapy it is not recommended as a long term therapy. It is only used as a short term therapy, mainly for menopausal women to relieve them from hot flashes. The adverse effects include increased risk of heart attacks, blood clots (in veins), stroke and breast cancer. 

Complications of Osteoporosis

The prime concern and complication of osteoporosis is the fracture of the bone. Recurrent bone fractures can result in collapse and deterioration of the skeletal system. Spinal (vertebral) fractures can thrust the bone into nearby nerves and/or spinal cord which could be detrimental. Neurosurgery will be required to correct this state. Vertebroplasty (kyphoplasty) procedures can also be applied for osteoporotic vertebral fractures. The procedure focuses on reforming the structure of the vertebra by using cement (methylmethacrylate). Recurrent vertebral compression fractures will result in deformity of the spine (chest area) which can be quite severe. It will lead to breathing difficulties and loss of height. It can also increase risk of respiratory infections due to compromised spine.

Prognosis

The prognosis of osteoporosis patients depends on the area of the fracture. The outlook will be generally good  if treatment is administered in early stages. Hip fractures is a dangerous repercussion of osteoporosis in the elderly. Statistics show that only one-third of hip fracture sufferers will regain function of the fractured area as it was before the fracture. The future is promising for osteoporosis as newer medication,  different methods of delivery of medication and research will bring about better alternatives to treat this condition.

Conclusion

Osteoporosis is a condition portrayed by the reduction in bone density and its strength resulting in fragile bones. This condition weakens bones and increases the risk of fractures. The prime risk factors for osteoporosis include genetics, lack of exercise, vitamin D and calcium deficiency, prone to fractures as an adult,smoking cigarettes, excessive consumption of alcohol, rheumatoid arthritis, small and thin body frame, etc. Patients do not tend to have any symptoms until they sustain a fracture. You can diagnose osteoporosis with the help of X-rays which can be further confirmed by bone density measuring tests. Osteoporosis is treated with medication, lifestyle changes, exercise and a diet which comprise adequate amounts of calcium and vitamin D.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

Click here for PDF

 

 

We welcome your comments at the end of the article.

 

 

The Team Manager Web Diseases

 

 

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Rheumatoid Arthritis (RA)

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is an autoimmune disease which results in chronic inflammation of joints. The characteristic features of rheumatoid arthritis include inflammation of tissue around the joints, inflammatory arthritis and injury of other organs of the body. As this is an autoimmune disease, the patient will have antibodies circulating in their blood that will target and attack his or her own body tissues which can result in inflammation. Rheumatoid Arthritis is a systemic illness that has the ability to affect multiple organs in the body.

Although, RA is a chronic illness that can last for years, patients may show no signs of symptoms for a long period of time. Nevertheless, RA which is referred to as rheumatoid disease is a progressive condition which can result in joint and functional impairment. A part of the body where two bones meet in order to facilitate movement is called a joint. Inflammation of the joints is known as arthritis. Thus, inflammation of the joints in RA can cause swelling, pain, stiffness and redness. The inflammation is not restricted to this area only; it can also occur in tissues close to the joints (tendons, ligaments and muscles).  In some individuals, chronic inflammation can lead to the deformity of joints due to destruction of cartilage, bone and ligaments.

  • Statistics
  • Causes and Risk Factors
  • Signs and Symptoms of RA
  • Complications of RA
  • Diagnosis of RA
  • Available Treatment for RA
  • Prognosis and Prevention
  • Conclusion

RA

Statistics

RA is a common rheumatic disease that is said to affect approximately 1.3 million people in the United States alone, according to current data. Statistically, women are said to be more affected than men where RA prevalence in women are three times more compared to men. In addition  the disease can start off at any age although previous cases show that it is more common in people after 40 years of age and before 60 years. Juvenile rheumatoid arthritis affects children. Moreover, some individuals report that multiple members of the family have been affected by RA showing a genetic factor for the disorder.

Causes and Risk Factors

The exact cause that gives rise to RA is still not known.  Viruses,bacteria and fungi have been suspected as the cause for a long time but has not been proven as of yet. RA research is an active field of worldwide research. Scientists have suggested that RA might be hereditary (genetical) as they have identified certain genes which increase the risk of one attaining RA. It is also presumed that certain environmental factors and infections may elicit an immune response in people who are vulnerable to RA. Therefore, it triggers an autoimmune reaction which results in one’s immune system attacking one’s normal tissue. This concurrently lead to the inflammation of the joints and some organs (lungs, eyes). Immune cells such as the lymphocytes are activated and the chemical messengers (cytokines, TNFs) manifest in the area of inflammation.

Environmental factors are believed to be a cause of RA. These factors can be tobacco smoking, silica exposure, chronic periodontal  disease; which can all be risk factors of developing RA.

 Signs and Symptoms of RA

The symptoms of RA is dependant on the degree of the inflammation incurred. The active stage of the disease is during inflammation and the inactive stage when inflammation go down, that is in remission. These remissions are sometimes spontaneous or when treatment is prescribed it can last for years, months or weeks. During this phase symptoms of the disease disappear making the patient feel better. When the disease is once again active (called a flare) the symptoms comes along with it.

Symptoms of RA include fatigue, energy loss, loss of appetite, fever (low grade), aches of muscles and joints and rigidity or stiffness. Rigidity or stiffness of muscles and joints can be experienced in the morning or after being inactive for a period of time. During disease flares arthritis is common and joints become red frequently as well as swollen, painful and tender. This occurrence is due to the result in inflammation of the joint (synovium) which will produce excess joint fluid called synovial fluid as a result. During inflammation the synovium is said to thicken causing synovitis.

RA generally affects many joints affecting both sides of the body. Early symptoms of RA can be stiffness and pain of joints which are more commonly experienced in the morning. RA of the hands will result in difficulty of performing simple tasks such as turning door knobs, opening jars and containers, etc. The tiny joints of the feet are also affected which will result in pain while walking (particularly in the morning).  Periodically only one joint is inflamed. In this case, the arthritis may resemble other forms of arthritis like gout, infection of the joint, etc. Damage to body tissues like cartilage and bone is sustained due to chronic inflammation. Chronic inflammation will thus lead to cartilage loss, erosion and weak bones and muscles which will lead to deformity of joints resulting in loss of function.

 Complications of RA 

Inflammation of RA can affect other organs and joints. Sjogren’s syndrome is a complication of RA which arise due to the inflammation of glands of the eyes and mouth. Inflammation of the lining of the lung called pleuritis can cause chest pains with deep breaths and coughing. Inflammation of the pericardium tissue which surround the heart can cause pericarditis; characterised by chest pain. Increased risk of heart attacks are linked to RA. Anaemia is another complication where the number of erythrocytes or red blood cells and white blood cells are reduced. Felty’s syndrome is portrayed by the decrease in WBCs which increase the risk of attaining infections. Also, lymphomas, cancers of the lymph glands, is also another complication of RA. Carpal tunnel syndrome can arise due to the nerves in the wrists becoming ‘pinched’.

Diagnosis of RA

RA is diagnosed on the basis of the joints involved, joint stiffness in the morning, appearance of rheumatoid factors and citrulline antibody. In addition, rheumatoid nodules and X-rays findings are evaluated. Primarily, a health care professional will look into the history of the symptoms, examine the joints in order to look for inflammation,tenderness, swelling, and any deformity. He/She will examine the skin for any rheumatoid nodules, which are firm bumps found under the skin, elbows or fingers,  and other areas of the body for inflammation.

Joint inflammation distribution is important to a medical doctor for diagnosis purposes. Joint inflammation in RA occur in a symmetrical fashion i.e. affecting both sides of the body. Joints susceptible to such inflammation include the knees, feet, wrist, hands,etc. When only one of the joints are inflamed (unsymmetrical), the diagnosis becomes quite cumbersome. A medical doctor will have to do other tests to rule out arthritis (due to gout or infection). Rheumatoid nodules arising in elbows and fingers indicate RA, making diagnosis easier.

Abnormal antibodies arise with RA. Rheumatoid factor (RF) is such an antibody which is found in approximately 80% of RA patients. ‘Seronegative rheumatoid arthritis’ is a term given to a condition where RA patient’s test does not render positive results for the antibody. Citrulline antibody is another type of antibody used to diagnose RA when evaluating unexplained inflammation of joints. These antibodies represent early stages of RA and have been linked to aggressive cases of RA. ANA is another type of antibody which can be found in RA patients.

Sedimentation rate (sed rate) is a blood test which will measure the joint inflammation crudely. This test will measure the speed at which RBCs fall or settle at the bottom of a test tube and are said to be faster in disease flare states and slower in remissions. C-reactive protein is used to measure the degree or the extent of RA. Blood test can indicate anaemia too, which is one of the complications of RA.

X-rays of joints may be normal or sometimes indicate swelling of soft tissues (early stages). Later on, X-rays will show the erosion of the bones which indicates RA. These X-rays is useful to follow disease progression and damage incurred to the bone over a period of time.  Inflammation of the bones can also be found out using bones scans, a procedure that uses radioactive substance (small amounts). MRIs can also indicate and show joint damage.

The American College of Rheumatology has invented a system which can classify RA. This is based on X-rays of joints. The stages are as follows:-

Stage I – X-rays show no damage, signs of bone thinning may be seen. 

Stage II- bone thinning seen around a joint with or without presence of damage to bone. Possibility of Cartilage damage (not severe). Mobility of joint limited where deformities are not seen. Atrophy of muscles adjacent to site. Possibility of soft tissue (around joint) abnormalities.

Stage III-Cartilage, bone damage and bone thinning around a joint is observed. Joint deformity (absence of permanent stiffness or fixation of joint). Considerable atrophy muscles. Possibility of soft tissue (around joint) abnormalities.

Stage IV- Damage to cartilage and bone. Osteoporosis around joint. Ankylosis. Considerable atrophy of muscles. Possibility of soft tissue (around joint) abnormalities.

 

Video of  Rheumatoid Arthritis

The functional status of such patients are classified by Rheumatologists:

  • Class I- Ability to execute daily day to day activities.
  • Class II-Ability to execute self and work activities but cannot perform other activities (sports, household chores)
  • Class III- Ability to execute self care activities but cannot perform or limited in work and other activities.
  • Class IV- Cannot or limited in performing self care, work related and other activities.

 Available Treatment for RA

Unfortunately, there is no cure for RA. Treatment for RA involves reducing pain and inflammation of the joints, restore joint function, avoid destruction and deformity of the joint. Medications, rest, exercises, joint protection, education of patient and family are some of the procedures used in a treatment plan for RA. Treatment takes into consideration ones disease activity, kind of joint involved, general health, age and the occupation of the patient.

Two categories of medications are used to treat RA. The first one is the fast acting ‘first-line drugs’ and other is the slow acting ‘second-line drugs”. The fast acting drugs are prescribed in order to decrease pain and inflammation. The slow acting drugs are prescribed to stimulate disease remission and to avoid the continuing joint destruction. Many newer and useful medications for different conditions of RA are available today.

There is no special diet that can cure RA which in fact is believed by some. Studies have shown that fish oil can be beneficial and curcumin (yellow pigment in curry) provides anti inflammatory effects which have the ability to reduce some of the symptoms of RA.

Topical creams can releive pain when rubbed into skin. Clinical trials of antibiotics have shown mild to moderate betterment of the symptoms. Regular exercises can help in joint mobility and in making muscles around the joint area more stronger. Swimming is the most beneficial form of exercise as it exerts less stress on the joints. Therapists will provide exercise routines specific to your needs. They can provide splinting supports, for say, your wrist and fingers which can be very useful in inflammation reduction and maintaining the proper position of the joint. Heat and cold therapies can help with the symptoms too.

To re-establish joint mobility and to repair joints that are damaged, surgery may be recommended by your doctor. Joint surgery include arthroscopy to part of or complete replacement of the joint. Arthroscopy is a surgical procedure where the surgeon will insert a tube like equipment into the joint. In  replacement surgeries, artificial materials are utilised to replace a destroyed joint. Large joints are replaced with metals in the case of hip or knee joints. Plastic material can be used to replace the small joints of the hand.

 Prognosis and Prevention

The prognosis for RA can be very good if early and aggressive treatment can be administered. Health care professionals try to get rid of any signs of active stages of the disease. Optimal health can be reached in a relatively short period of time owing to the cooperation of the doctor and the patient and the effective control of the disease.

The prognosis is poor for patients who have deformity, disability or progressive joint inflammation which cannot be controlled or RA which affects other organs. It has been demonstrated that RA can have severe damaging effects when rheumatoid factor or citrulline appears in the blood test.

As of yet, no specific prevention plan is available for RA. Certain factors and conditions which are risk factors for RA should be avoided; these include smoking cigarettes, silica mineral exposure, chronic periodontal disease,etc.

Conclusion

Rheumatoid Arthritis (RA) is an autoimmune disease which results in chronic inflammation of joints or other areas of the body. It can affect people of all ages and the cause of RA is still not known. It is a chronic disease which is portrayed by the flares and remission phases of the disease. In RA inflammation of the joints, most of the time, occur in a symmetrical fashion involving multiple joints. Chronic inflammation has the tendency to lead to destruction of joints and deformity. Treatment for RA involves a combination of education of patient and family, rest, exercise, joint protection procedures, medications and sometimes surgery. For optimal outcome, early detection and treatment is advised.

 

 

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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Arthrosis

   

What is  arthrosis?

The word Arthrosis” is derived from the greek word “arthros” which means “joint”. Arthrosis is a disease of bone joint. It is a degenerative condition associated with aging, where the cartilages of the joints are affected by wear and tear. Nearly half of the population in the world is suffering from some degree of arthrosis after the age of 65 years. Arthrosis is a progressive degenerative disease of the joints like knees, hips, spine, toes and fingers manifested by pain, stiffness and swelling of the joint.

Arthrosis simply means the joint of two bones. Otherwise arthrosis refers to the junction, where the two bones meet each other for the purpose of allowing the movement of the body. Bone joint is formed of cartilage and fibrous connective tissue. Arthrosis is a chronic degenerative disease of bone joint development, due to the disparity between the production and deterioration of bone cells.

Arthrosis is not an acute condition but it is progressive in onset. Normally cartilage in the joint form protective covering at the end which allows the movement of the joint with minimum friction. Breaking down of the cartilage begins with cracks that gradually become deeper until the holes or ulcers are made at the end of the bone. As a result the client may develop severe pain, stiffness and swelling of the joint. This degenerative process on the   cartilage at the joint can result in loss of free movement in the joint.

 Arthrosis

 

  •  Causes of arthrosis.

  •  Common symptoms of arthrosis.

  •  Pathophsiology of arthrosis.

  •  Diagnostic measures available for arthrosis.

  •  Prevention of arthrosis.

  •  Self care method of arthrosis.

  • Dietary management of arthrosis.

  • Different types of arthrosis and its management.

  • Conclusion.

 

 Causes of arthrosis.

  • Increasing age: – As aging is physiological process, where there is degenerative changes occurs in the body, wear and tear can lead to arthrosis. Inspite of these even younger peoples are also developing arthrosis due to traumas or serious misalignments.
  • Heredity: - Various studies have shown that genetic predisposition in developing arthrosis.
  • Obesity: – Another cause for developing arthrosis is obesity, overweight causes more stress to the joints leading to arthrosis. Over weight is mainly causing more pressure to the lumbar spine and joints of the lower limb.
  • Hormonal imbalance:-Hormones also plays a vital role in the development of arthrosis. Many studies revealed that, in menopausal women prevalence of arthritis is more due to the lack of oestrogen.
  • Environment: - Some of the working condition can lead to the development of arthrosis. Those who are driving  lot is more prone to get cervical and lumbar arthrosis, those working with pneumatic drill are more likely to have arthrosis in hand, elbow and shoulder. The persons who use the computers for many hours are also at a risk of developing the cervical and hand arthrosis. In modern society arthrosis is considered as professional illness, when the body is kept in “fixed” or incorrect positions.

Common symptoms of arthrosis.

        Arthrosis is a common degenerative disease of the joint that begins in the cartilage and subsequently moves into the bone tissue.

  • Pain

The most common sign of arthrosis is pain that is increasing progressively. It is mainly experienced in the affected joint.

Pain increases with the activity and subsides with rest.

  • Stiffness

As the proper functioning of the joint is altered due to degenerative process, the person may experience unusual stiffness in

the joint which may go on increasing with time.

  • Swelling

Inflammation or swelling in the affected joint will be there, due to the wearing of the cartilage. This can be very painful at

night.

  • Functional disabilities

Pain and swelling in the affected joint can lead to the functional disabilities in the client with arthrosis.

Pathophsiology of arthrosis.

      Cartilage is a protective cushion that covers the area between two bones as they move. Arthrosis is a degenerative disease of the joints. It occur when the cartilages is damaged through injury, illness or repeated stress and strain. This damage can lead to pain, stiffness and swelling of the joint.

Arthrosis occurs when there is reduction and changes in the protein components of the cartilages. Normally the body attempt to reverse these changes by producing new cartilage cells. Due to the repeated episodes of destruction and production of cartilage cell, it loses its smooth characteristics causing bone surfaces to come into direct contact.  Crack is developed in the articular surface of the cartilage as a result   local inflammatory response develops in the joint. Adjacent bones are also at a risk of developing the degenerative changes. Every component of the joint goes through hypertrophy due to local inflammatory response. As a result of this tendon, muscles and ligaments increase in sizes which give warmth, pain and swollen appearance to the joint.

Diagnostic measures available for arthrosis.

    Diagnosis is made on a

  • Detailed case history.
  • Physical examination : should evaluate the alignment and posture of the back and lower limb. Do thorough examination of painful joint for possible swelling,strength,articulation and neurological deficit.
  • Instrumental diagnosis: X-ray (it shows presence of alterations such as reduction of the joint, reabsorption areas and sclerotic areas.
  • MRI and CAT scan.

 

Prevention of arthrosis.

  •  Prevention is always better to limit complications .Firstly correct the axial and postural defects such as scoliosis, dysmetria, incorrect plantar support by using corrective orthosis, specific arch supports and postural exercises.
  • Always maintain correct posture and do not overload the joint with excessive pressure and working. Always maintain ideal body weight because overweight places an excess pressure on the joint of the lower limb.
  •  Regular and continous motor activity is important for preventing the complications of arthrosis.  Usually continuous Low impact sports activity is recommended. Along with the motor activity, pharmacological management is also recommended to relieve the symptoms. Medicines like anti inflammatory, decontracting and analgesics can be used to relieve symptoms like pain, swelling or muscle contraction.

Another method is  is using a substance called condroprotections, which is present more or less in the joint cartilage is also found to be effective. This can be taken as oral or infiltration directly to the affected joint.

Self care method of arthrosis

If the disturbances are slight, it may be useful to do the following:

  • Perform and continuous aerobic activity, but do not overload the joints.
  • Follow a well-balanced diet.
  • Improve the ergonomics in the work place, correcting and maintaining your posture.
  • Do not carry out dangerous movements.
  • Do not remain seated or standing for long periods in the same position.

Dietary management of arthrosis

Diet is an important factor for preventing many illnesses. Diet for arthrosis should include high fiber, protein, vitamins, minerals and essential oils,

        Foods to be avoided

  • There are certain foods to be avoided to prevent the occurance of artherosis. These are fast foods, processed food and red meat as they contain unhealthy fats. Solanine is another food that found to increases inflammation of the joint. Foods from the solanine family include potato, pepper, tomato, paprika and eggplant. When   these food are avoided in the client with arthrosis, they found to have less inflammation of joint. The condition worsens in the client who smokes as it contains solanine.

     Highly recommended foods

  • Foods that contain anti-inflammatory properties like turmeric and ginger helps to relieve inflammation. Green leafy vegetables, legumes, olive oil, nuts (almonds and walnuts) seeds such as flaxseed, fruit and kefir. Whole grains such as brown rice, bulgur wheat, oatmeal, fish such as salmon, tuna and sardines, is also found to be effective.

 

Different types of Arthrosis and its management

        Arthrosis is classified according to the site of joint. It can be cervical arthrosis, facet arthrosis , AC joint ,Lumbar arthrosis and coxarthrosis.

Cervical Arthrosis

          It is otherwise called as cervicarthrosis. Cervical arthrosis  is a chronic degeneration of the cartilage in the cervical area .it is     more common in people after the age of 4oyears. It is present in almost all individual but more common in women. It is degenerative process occur between the cervical vertebrae locally at the neck. The disease is more common in people who are working for long hour in front of the computer by bending their head.

 

       Cervical Arthrosis Symptoms

The most common manifestation of cervical arthrosis is  pain at the root of the neck. This pain can radiate to the arm and shoulder. Head movement becomes more and more difficult due to the stiffness of the neck

In some client, the condition can be asymptomatic. The cervical arthrosis is common in people who work for long hours with their head bent such as those involved in computer jobs.

 

     Treatment of Cervical Arthrosis

Treatment of Cervical Arthrosis usually depends on the severity and progress of the syndrome. Mild cases are treated with the aid of rest, drugs and regular exercises. In order to relieve the symptoms like pain and swelling, Non-steroidal anti-inflammatory drugs like Ibuprofen or Aspirin and non-narcotic analgesics are quite useful

Home remedial measures for Cervical Arthrosis include rest, hot showers and aerobic exercises. Over-the-counter drugs are also very useful in providing symptomatic relief from the syndrome.

   Facet Arthrosis

             It is also known as Facet Joint Syndrome or Facet Syndrome. The facet arthrosis is more common in elderly people. Its results    from an injury. Facet joints are bone joints with smooth cartilage surface. Facet Arthrosis is due to the degeneration of the smooth cartilage. It occurs when facet joints in the posterior part of the spine wears out

     Facet Arthrosis Symptoms

Facet arthrosis mainly affects the neck and lower back. The symptoms of Facet Arthrosis involve headache, back pain ,neck pain and reduced range of spinal movement.

    Facet Arthrosis Treatment

Facet arthrosis is treated by various ways. Medications and posture correction can be used for the treatment of Mild cases. Severe cases are treated with exercise, physical activity, and activity modification.

Coxarthrosis

          Coxarthrosis is a degenerative Arthrosis disease affecting the hip joint. It is also known as Arthrosis of the hip joint.

   Coxarthrosis Causes

Coxarthrosis occurs due to increasing degeneration of the joint cartilage. The loss of cartilage in bone joint leads to the wear and tear of joint give rise to this discomforting condition.

    Coxarthrosis Symptoms

The most common manifestation is pain and increasing stiffness of the hip joint. This pain and discomforts .impairs daily activities and even mobility. So the activities like walking, prolonged sitting will be difficult.

     Coxarthrosis Treatment

Surgery is the main stream of management for Coxarthrosis. If medical management fails then, hip joint replacement is recommended.

 

   Lumbar Arthrosis

        Lumbar Arthrosis is a chronic degenerative disease of the spine between the lumbar vertebrae. So it is also known as “Arthrosis of the spine”or “Lumbar Spine Arthrosis .

      Lumbar Arthrosis Causes

This disease developed due to the abnormal posture or bad position during work hour or sports. As a result of this, wear occur       between the lumbar vertebrae and also in the intervertebral disk.

    Lumbar Arthrosis Symptoms

 Lumbar Arthrosis is characterized by “backache” or pain in the spinal region. This pain is mainly perceived during movement   and workouts. Rubbing of the vertebrae during the physical activity can result in temporary pain.

    Lumbar Arthrosis Treatment

 Lumbar braces are available to immobilize spinal muscle and keeps the back in a good posture. Another treatment modality is  using lumbar support belt which decreases the pressure exerted on the vertebrae.

 AC Joint Arthrosis

It is a common degenerative disease of the shoulder joint that leads to pain and discomfort during shoulder movement. The AC joint arthrosis is the leading cause of osteoarthritis in middle aged sufferers.

   AC Joint Arthrosis Causes

It can results from an injury due to a fall or activities like weight lifting may lead to hyperextension of the shoulder.

   AC Joint Arthrosis Symptoms

Tenderness and pain in shoulder joint is the early sign of AC joint Arthrosis. Pain is increased in the activities like heavy weight lifting that require arm extension. A mild pain may also be felt in other regions like the front of the chest and the neck.

    AC Joint Arthrosis Treatment

Prolotherapy is a natural medical therapy found to be effective for the treatment of AC joint arthrosis.

 

Conclusion

        Arthrosis is a common degenerative disease occurs due to aging. As a result of this cartilage which becomes irregular, rugged    and worn out. This wearing out of cartilage can lead to pain, stiffness of the joint, loss of mobility and loss of muscle strength. By doing regular exercises and staying active, you can contribute directly to the nutrition of the cartilage of your joints. The cartilage which protects the extremities of bones needs regular activity to absorb nutrients and to improve the lubrication of joints.  So always be active help to keep your joints healthy.

     We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

Click here for PDF

 


 

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