Arthritis
What Is Arthritis?
There are over 100 forms of arthritis and other rheumatic
diseases. These diseases may cause pain, stiffness, and swelling in joints
and other supporting structures of the body such as muscles, tendons,
ligaments, and bones. Some forms can also affect other parts of the body,
including various internal organs.
Many people use the word "arthritis" to refer to all
rheumatic diseases. However, the word literally means joint inflammation;
that is, swelling, redness, heat, and pain caused by tissue injury or
disease in the joint. The many different kinds of arthritis comprise just
a portion of the rheumatic diseases. Some rheumatic diseases are described
as connective tissue diseases because they affect the body's connective
tissue--the supporting framework of the body and its internal organs.
Others are known as autoimmune diseases because they are caused by a
problem in which the immune system harms the body's own healthy tissues.
Examples of some rheumatic diseases are:
Osteoarthritis, Rheumatoid arthritis,
Fibromyalgia, Juvenile rheumatoid arthritis,
Ankylosing spondylitis, Gout
Osteoarthritis
Osteoarthritis is the most
common type of arthritis, especially among older people. Sometimes it is
called degenerative joint disease or osteoarthrosis.
Osteoarthritis is a joint disease that mostly affects the
cartilage. Cartilage is the slippery tissue that covers the
ends of bones in a joint. Healthy cartilage allows bones to glide over one
another. It also absorbs energy from the shock of physical movement. In
osteoarthritis, the surface layer of cartilage breaks down and wears away.
This allows bones under the cartilage to rub together, causing pain,
swelling, and loss of motion of the joint. Over time, the joint may lose
its normal shape. Also, bone spurs--small growths called osteophytes--may
grow on the edges of the joint. Bits of bone or cartilage can break off
and float inside the joint space. This causes more pain and damage.
People with osteoarthritis usually have joint pain and
limited movement. Unlike some other forms of arthritis, osteoarthritis
affects only joints and not internal organs. For example, rheumatoid
arthritis--the second most common form of arthritis--affects other parts
of the body besides the joints. It begins at a younger age than
osteoarthritis, causes swelling and redness in joints, and may make people
feel sick, tired, and (uncommonly) feverish.
How Do You Know if You Have
Osteoarthritis?
Usually, osteoarthritis comes on slowly. Early in the
disease, joints may ache after physical work or exercise. Osteoarthritis
can occur in any joint. Most often it occurs at the hands, knees, hips, or
spine.
Hands: Osteoarthritis of the fingers is one
type of osteoarthritis that seems to have some hereditary characteristics;
that is, it runs in families. More women than men have it, and they
develop it especially after menopause. In osteoarthritis, small, bony
knobs appear on the end joints of the fingers. They are called Heberden's
nodes. Similar knobs, called Bouchard's nodes, can appear on the
middle joints of the fingers. Fingers can become enlarged and gnarled, and
they may ache or be stiff and numb. The base of the thumb joint also is
commonly affected by osteoarthritis. Osteoarthritis of the hands can be
helped by medications, splints, or heat treatment.
Knees: The knees are the body's primary
weight-bearing joints. For this reason, they are among the joints most
commonly affected by osteoarthritis. They may be stiff, swollen, and
painful, making it hard to walk, climb, and get in and out of chairs and
bathtubs. If not treated, osteoarthritis in the knees can lead to
disability. Medications, weight loss, exercise, and walking aids can
reduce pain and disability. In severe cases, knee replacement surgery
may be helpful.
Hips: Osteoarthritis in the hip can cause
pain, stiffness, and severe disability. People may feel the pain in
their hips, or in their groin, inner thigh, buttocks, or knees. Walking
aids, such as canes or walkers, can reduce stress on the hip.
Osteoarthritis in the hip may limit moving and bending. This can make
daily activities such as dressing and foot care a challenge. Walking
aids, medication, and exercise can help relieve pain and improve motion.
The doctor may recommend hip replacement if the pain is severe and not
relieved by other methods.
Spine: Stiffness and pain in the neck or
in the lower back can result from osteoarthritis of the spine. Weakness
or numbness of the arms or legs also can result. Some people feel better
when they sleep on a firm mattress or sit using back support pillows.
Others find it helps to use heat treatments or to follow an exercise
program that strengthens the back and abdominal muscles. In severe
cases, the doctor may suggest surgery to reduce pain and help restore
function.
Features of Osteoarthritis
-
Steady or intermittent pain in a joint
-
Stiffness in a joint after getting out of bed or sitting for
a long time
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Swelling or tenderness in one or more joints
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A crunching feeling or the sound of bone rubbing on bone
-
Hot, red, or tender? Probably not osteoarthritis. Check with
your doctor about other causes, such as rheumatoid arthritis.
-
Pain? Not always. In fact, only a third of people whose x
rays show evidence of osteoarthritis report pain or other symptoms.
Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory disease that
causes pain, swelling, stiffness, and loss of function in the joints. It
has several special features that make it different from other kinds of
arthritis. For example, rheumatoid arthritis generally occurs in a
symmetrical pattern, meaning that if one knee or hand is involved, the
other one also is. The disease often affects the wrist joints and the
finger joints closest to the hand. It can also affect other parts of the
body besides the joints. In addition, people
with rheumatoid arthritis may have fatigue, occasional fevers, and a
general sense of not feeling well.
Rheumatoid arthritis affects people differently. For some
people, it lasts only a few months or a year or two and goes away without
causing any noticeable damage. Other people have mild or moderate forms of
the disease, with periods of worsening symptoms, called flares, and
periods in which they feel better, called remissions. Still others have a
severe form of the disease that is active most of the time, lasts for many
years or a lifetime, and leads to serious joint damage and disability.
Features of Rheumatoid
Arthritis
-
Tender, warm, swollen joints
-
Symmetrical pattern of affected joints
-
Joint inflammation often affecting the wrist and finger joints closest
to the hand
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Joint inflammation sometimes affecting other joints, including the
neck, shoulders, elbows, hips, knees, ankles, and feet
-
Fatigue, occasional fevers, a general sense of not feeling well
-
Pain and stiffness lasting for more than 30 minutes in the morning or
after a long rest
-
Symptoms that last for many years
-
Variability of symptoms among people with the disease
The pain of arthritis may come from different sources.
These may include inflammation of the synovial membrane (tissue that lines
the joints), the tendons, or the ligaments; muscle strain; and fatigue. A
combination of these factors contributes to the intensity of the pain.
The pain of arthritis varies greatly from person to
person, for reasons that doctors do not yet understand completely. Factors
that contribute to the pain include swelling within the joint, the amount
of heat or redness present, or damage that has occurred within the joint.
In addition, activities affect pain differently so that some patients note
pain in their joints after first getting out of bed in the morning,
whereas others develop pain after prolonged use of the joint. Each
individual has a different threshold and tolerance for pain, often
affected by both physical and emotional factors. These can include
depression, anxiety, and even hypersensitivity at the affected sites due
to inflammation and tissue injury. This increased sensitivity appears to
affect the amount of pain perceived by the individual.
What Are Some Pain Relief Methods
for People With Arthritis?
There are known methods to help stop pain for short
periods of time. This temporary relief can make it easier for people
who have arthritis to exercise. The doctor or physical therapist can
suggest a method that is best for each patient. The following methods
have worked for many people:
Magnet therapy: The application of high
strength rare earth magnets at the point of pain. The magnets should be
applied continuously over a period of at least 3 weeks.
Magnets can be applied in the form of straps,
wraps, insoles, jewellery, pillows, mattress
covers.
Moist heat supplied by warm towels, hot packs, a bath, or
a shower can be used at home for 15 to 20 minutes three times a day
to relieve symptoms. A health professional can use short waves,
microwaves, and ultrasound to deliver deep heat to non
inflamed joint
areas. Deep heat is not recommended for patients with acutely
inflamed joints. Deep heat is often used around the shoulder to
relax tight tendons prior to stretching exercises.
Cold supplied by a bag of ice or frozen vegetables
wrapped in a towel helps to stop pain and reduce swelling when used
for 10 to 15 minutes at a time. It is often used for acutely
inflamed joints. People who have Raynaud's phenomenon should not use
this method.
Hydrotherapy (water therapy) can decrease pain and
stiffness. Exercising in a large pool may be easier because water
takes some weight off painful joints. Community centers, YMCAs, and
YWCAs have water exercise classes developed for people with
arthritis. Some patients also find relief from the heat and movement
provided by a whirlpool.
Mobilization therapies include traction (gentle, steady
pulling), massage, and manipulation (using the hands to restore
normal movement to stiff joints). When done by a trained
professional, these methods can help control pain and increase joint
motion and muscle and tendon flexibility.
TENS (transcutaneous electrical nerve stimulation) and
biofeedback are two additional methods that may provide some
pain relief, but many patients find that they cost too much money
and take too much time. In TENS, an electrical shock is transmitted
through electrodes placed on the skin's surface. TENS machines cost
between $80 and $800. The inexpensive units are fine. Patients can
wear them during the day and turn them off and on as needed for pain
control.
Relaxation therapy also helps reduce pain. Patients can
learn to release the tension in their muscles to relieve pain.
Physical therapists may be able to teach relaxation techniques. The
Arthritis Foundation has a self-help course that includes relaxation
therapy. Health spas and vacation resorts sometimes have special
relaxation courses.
Acupuncture is a traditional Chinese method of pain
relief. A medically qualified acupuncturist places needles in
certain sites. Researchers believe that the needles stimulate deep
sensory nerves that tell the brain to release natural painkillers
(endorphins). Acupressure is similar to acupuncture, but
pressure is applied to the acupuncture sites instead of using
needles.
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