Arthritis

Arthritis:

The word “arthritis” means “joint inflammation.” Inflammation is one of the body’s natural reactions to disease or injury, and includes swelling, pain, and stiffness. Inflammation that lasts for a very long time or recurs, as in arthritis, can lead to tissue damage.

Arthritis is not just a disease of older people – it can affect people of all ages, including children.

Symptoms:

Different types of arthritis have different symptoms and the symptoms vary in severity from person to person. Osteoarthritis does not generally cause any symptoms outside the joint. Symptoms of other types of arthritis may include fatigue, fever, a rash, and the signs of joint inflammation, including:

Arthitics Treatment

  • Pain
  • Swelling
  • Stiffness
  • Tenderness
  • Redness
  • Warmth

Types of arthritis:

I – Polyarthritis of unknown etiology

  • Rheumatoid arthritis
  • Juvenile rheumatoid arthritis (Still’s disease)
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reiter’s syndrome

II – Connective tissue disorders

  • Systemic lupus erythematosus (SLE)
  • Polyarteritis nodosa
  • Scleroderma (progressive systemic sclerosis)
  • Polymyositis and dermatomyositis

III – Rheumatic fever

IV – Degenerative joint disease (osteoarthritis, osteoarthrosis)

  • Primary
  • Secondary

V – Non-articular rheumatism

  • Fibrositis
  • Intervertebral disk and low back syndromes
  • Myositis and myalgia
  • Tendinitis and peritendinitis (bursitis)
  • Tenosynovitis
  • Fasciitis
  • Carpal tunnel syndrome
  • Others (including VIII – shoulder/hand syndrome)

VI – Diseases frequently associated with arthritis

  • Sarcoidosis
  • Relapsing polychondritis
  • Henoch-Schönlein syndrome
  • Ulcerative colitis
  • Regional ileitis
  • Whipple’s disease
  • Sjögren’s syndrome
  • Familial Mediterranean fever
  • Others (including I – psoriatic arthritis)

VII – Associated with known infectious agents

  • Bacterial
    • Borrelia burgdorferi (Lyme disease)
    • Brucella
    • Gonococcus
    • Mycobacterium tuberculosis
    • Pneumococcus
    • Salmonella
    • Staphylococcus
    • Streptobacillus moniliformis (Haverhill fever)
    • Treponema pallidum (syphilis)
    • Treponema pertenue (yaws)
  • Rickettsial
  • Viral
  • Fungal
  • Parasitic (including III – rheumatic fever)

VIII – Traumatic and/or neurogenic disorders

  • Traumatic arthritis (the result of direct trauma)
  • Lues (tertiary syphilis)
  • Diabetes
  • Syringomyelia
  • Shoulder-hand syndrome
  • Mechanical derangement of joints
  • Others (including IV – degenerative joint disease and V – carpal tunnel syndrome).

IX – Associated with biochemical or endocrine abnormalities

  • Gout
  • Ochronosis
  • Hemophilia
  • Hemoglobinopathies (e.g,. sickle cell disease)
  • Agammaglobulinemia
  • Gaucher’s disease
  • Hyperparathyroidism
  • Acromegaly
  • Hypothyroidism
  • Scurvy
  • Xanthoma tuberosum
  • Others (including X – multiple myeloma and Xii – Hurler’s syndrome)

X – Tumor and tumor-like conditions

  • Synovioma
  • Pigmented villonodular synovitis
  • Giant cell tumor of tendon sheath
  • Primary juxta-articular bone tumors
  • Metastatic
  • Leukemia
  • Multiple myeloma
  • Benign tumors of articular tissue
  • Others (including XIII – hypertrophic osteoarthropathy)

XI – Allergy and drug reactions

  • Arthritis due to specific allergens (e.g., serum sickness, nightshade vegetables, other foods)
  • Arthritis due to drugs (eg. Hydralazine syndrome)

XII – Inherited and congenital disorders

  • Marfan’s syndrome
  • Ehlers-Danlos syndrome
  • Hurler’s syndrome
  • Congenital hip dysplasia
  • Morquio’s disease

XIII – Miscellaneous disorders

  • Amyloidosis
  • Aseptic necrosis of bone
  • Behçet’s syndrome
  • Chondrocalcinosis (pseudogout)
  • Erythema multiforme (Stevens-Johnson syndrome)
  • Erythema nodosum
  • Hypertrophic osteoarthropathy
  • Juvenile osteochondritis
  • Osteochondritis dissecans
  • Reticulohistiocytosis of joints (lipoid dermato-arthritis)
  • Tietze’s disease

Rheumatoid Arthritis:

Rheumatoid Arthritis (RA) is the most common form of chronic inflammatory joint disease. In its typical form RA is a symmetrical, destructive and deforming polyarthritis affecting small and large synovial joints, with associated systemic disturbance, a variety of extra-articular features and the presence of circulating antiglobulin antibodies (rheumatoid factors). Characteristically, the course of the disease is prolonged with exacerbations and remissions.

Subcutaneous nodules are seen in 5% to 10% of cases in India compared to 25% in Western counterparts. These nodules vary in size and are seen over the pressure points like the olecranon process, scapula, sacrum and the occiput.

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Juvenile rheumatoid arthritis (Still’s disease):

Arthritis in children is not uncommon. Rheumatic problems in children account for 7%-8% of cases attending rheumatology clinics.

Juvenile rheumatoid arthritis is diagnosed as per the following criteria

1.Age of onset less than 16 years.

2.Arthritis in one or more joints defined as swelling or effusion, or the presence of two or more of the following signs : limitation of range of motion, tenderness or pain on motion, and increased heat.

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Ankylosing spondylitis:

Ankylosing spondylitis (AS) is a progressive, chronic, seronegative inflammatory disease involving the spine and the sacroiliac and peripheral joints. It is commonly seen in the age group 15-40 years and develops in approximately 0.5-1 percent of the general population. Classical AS is two to three times more common in men than in women. The onset is usually gradual and delay in its diagnosis is rather common, especially in women.

View point that each individual patient is considered different from others, although all are suffering from the same disease.

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Psoriatic Arthritis:

Psoriatic arthritis is a seronegative inflammatory disorder; approximately 5% of psoriatic patients develop arthritis. HLA B27 is present in 40% of psoriatics with spondylitis whereas HLA DR3 and HLA DR4 correlate with more severe and erosive peripheral disease.

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Reiter’s Disease:

Reiter’s disease is characterised by a symptom complex of urethritis, arthritis and conjunctivitis. Adult males are most commonly affected, though there may be under-diagnosis in females. The peak incidence is in the 3rd and 4th decades. AIDS-related Reiter’s disease is on the increase.

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Systemic lupus erythematosus (SLE):

Most people with SLE will develop arthritis during the course of their illness. Arthritis in SLE commonly involves swelling, pain, stiffness, and even deformity of the small joints of the hands, wrists, and feet. Sometimes, the arthritis of SLE can mimic that of rheumatoid arthritis.

Polyarteritis nodosa:

Polyarteritis nodosa is a rare autoimmune disease (immune system attacking its own body) featuring spontaneous inflammation of the arteries (arteritis). Because arteries are involved, the disease can affect any organ of the body. The most common areas of involvement include the muscles, joints, intestines (bowels), nerves, kidneys, and skin.

Scleroderma:

Scleroderma (Systemic sclerosis) is a rare chronic disease of unknown cause characterized by diffuse fibrosis, degenerative changes, and vascular abnormalities in the skin, joints, and internal organs (especially the esophagus, lower GI tract, lung, heart, and kidney). Common symptoms include Raynaud’s syndrome, polyarthralgia, dysphagia, heartburn, and swelling and eventually skin tightening and contractures of the fingers. Lung, heart, and kidney involvement accounts for most deaths. Diagnosis is clinical, but laboratory tests help with confirmation. Specific treatment is difficult, and emphasis is often on treatment of complications.

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Rheumatic fever:

Fever, cardiac symptoms and signs, and migrating inflammation of the large joints, usually starting in the legs and migrating upward

Can occur 2–6 wk after streptococcal pharyngitis.

Rheumatic fever is a non-suppurative, acute inflammatory complication of group A streptococcal infection, causing combinations of arthritis, carditis, subcutaneous nodules, erythema marginatum, and chorea.

Osteoarthritis (Degenerative joint disease, osteoarthrosis):

Degenerative joint disease is a disorder of cartilage and bone characterised by cartilage loss and bony overgrowth. Other names used are osteoarthritis (OA) when it affects the peripheral joints and spondylosis or spondylitis when it affects the spine.

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Fibromyalgia (Fibrositis):

The term fibromyalgia is preferred as there is no inflammation. The condition is most commonly seen in young women (3rd or 4th decades); children and men are not immune, though. Typically the patient is an otherwise healthy young woman who is often stressed, tense, depressed and anxious. Symptoms are often worsened by emotional or physical stress. There is history of poor sleep and lack of freshness on waking up. The onset of symptoms is usually gradual.

Low Backache:

Non-specific low back pain of mechanical origin is the second only to the common cold as a cause of self-limiting symptoms and disability in the community.
Incidence :
It has been calculated that more than three-quarters of world’s population experience the back pain at some times in their lives.

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