Book menuARTHRITIS - Full extract 

Arthritis means inflammation in one or more joints. It often leads to swelling, pain and stiffness of the joints and is a cause of disability for many people. With an acute arthritis the joint becomes hot and swollen, often with intense pain and difficulty with movement. Chronic arthritis may also cause pain, but there may be associated stiffness and change in the appearance of the joint. 

By far the most common type of arthritis is osteoarthritis, a degenerative condition that is likely to affect us all to some degree as we get older. In contrast, rheumatoid arthritis is a generalized condition in which the arthritis is just one feature. Arthritis can also occur with conditions like gout, psoriasis, viral illnesses, bacterial infections, allergic reactions and a host of other disorders. 

Osteoarthritis is often regarded as a wear-and-tear condition resulting from long-term use of a joint. The smooth cartilage covering the ends of the bones becomes worn off, eventually leaving bone rubbing on bone. With further wear there is narrowing of the joint space and loss of movement. It occurs more frequently with increasing age and when there has been greater than average trauma to a joint. The exact cause of osteoarthritis is not known; it can occur in some joints without an obvious explanation. Aside from the joint problems the person is otherwise well. Many footballers wind up with osteoarthritic knees, and overweight people are prone to osteoarthritis of the hips, knees and other weight bearing joints. It can also affect the small joints of the hands, especially in women. 

Rheumatoid arthritis is a much less common condition. It may occur in younger people and often commences as early morning stiffness in the hands. Usually there is symmetrical involvement of joints on both sides of the body. It is more common in women, and there may be other symptoms such as fever, malaise and loss of appetite. Other parts of the body may also be affected, such as the muscles, the tissues under the skin and even the lungs. Rheumatoid arthritis is said to have an autoimmune basis; somehow the body's immune system turns on itself causing damage to the joints and other organs. 

Gout usually produces a very acute arthritis. It happens when the level of uric acid builds up in the blood and crystallizes out in the joints, most commonly the big toe. Chronic damage to joints and other tissues can occur if the uric acid level remains elevated. 

Psoriasis is a condition where there is markedly excessive turnover of the superficial layers of the skin. Typical scaly patches appear on the elbows, knees and scalp. Sometimes an associated arthritis can also occur. 

Ankylosing spondylitis is a type of arthritis that mainly affects the spine and often starts in early adulthood. It is more common in men and tends to run in certain families. 

The precise type of arthritis can usually be diagnosed with a careful history and examination. X-rays are usually arranged, and sometimes blood tests, especially if a condition such as rheumatoid arthritis is suspected. If there is doubt about the diagnosis or if the arthritis is particularly severe, referral to a specialist rheumatologist may be necessary. 

There are many medications available for arthritis. Because of potential side-effects it is better to try simple analgesics like paracetamol first. Anti-inflammatory medications such as Voltaren and Brufen may be recommended if the joints are acutely inflamed. They should always be taken after food and if indigestion occurs they should be ceased, and the doctor contacted for advice. Anti-inflammatories can cause peptic ulcers and bleeding in some patients. They are sometimes taken in combination with other medications to reduce the likelihood of this occurring. A newer type of anti-inflammatory drug called Cox-2 inhibitors have recently been realeased. These medications, e.g. Celebrex are much less likely to cause stomach disorders. However not everyone is able to take them and they are available only on prescription.

There are many other medications for the various forms of arthritis, especially rheumatoid arthritis. They can be given as tablets or injections. Regular blood tests may be advised to see that there are no adverse side-effects.

Other aspects of treatment like avoidance of excessive strain on joints is also important. Simple appliances can help, for instance grips to open jars, and special kitchen utensils. Reorganizing the way things are done around the house can also reduce the strain on arthritic joints. For non-acute arthritis, exercise is very important to keep joints moving well. Some people find swimming and other heated pool activities helpful. Other forms of treatment such as physiotherapy and acupuncture may be useful. Various other alternative treatments may also be tried.

Sometimes a joint may be so damaged that surgery is suggested as an option. For grossly arthritic hips and knees, joint replacement can provide very good pain relief and improved mobility. Newer techniques have seen surgery applied to joints like the shoulder and the smaller joints in the hand.

Health Tip:
* The management of arthritis often involves a number of different approaches. Ask your GP for advice, and contact the Arthritis Foundation for further information.

Weblink:
Arthritis Foundation of Victoria - www.arthritisvic.org.au


Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001