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Arthritis

 

Arthritis is a degenerative condition causing wear of the articulating surfaces resulting in pain at rest, pain with movements, restriction of movements and in severe cases, deformity.

Causes

  • Wear and tear associated with ageing
  • Trauma
  • Over weight
  • Obesity
  • Mal – alignment of the joints
  • Congenital joint deformities (dysplasia)
  • Inflammation of joints
  • Connective tissue disease
  •  Psoriasis
  • Inflammatory bowel disease

Symptoms

  • Joint swelling
  • Pain in the joint
  • Stiffness, especially in the morning
  • Warmth around a joint
  • Redness of the skin around a joint
  • Restricted movement of the joint
  • Loss of appetite
  • Weakness
  • Fever

Treatment

In early stages:

  • Modification of activities
  • Weight reduction
  • Use of stick
  • Exercises
  • Physiotherapy

If these do not work, medications are prescribed. These are generally anti-inflammatory medications (NSAIDs) and opiates.

In inflammatory arthritis, especially, rheumatoid arthritis, aggressive treatment with a combination of DMARS within the first 3-6 months of diagnosis may permanently alter the course of the disease progression. But if there is a delay, this treatment becomes less and less effective.

When oral medications do not give relief, injections in the joint can also be given. Steroid injections are suitable for small joints of hand, and feet. They are generally avoided in large joints and when the arthritis is severe. There is a risk of infection and accelerated degeneration of the lining of the joint cartilage with repeated usage.

ViscoSupplementation with hyaluronic acid injections gives short term relief in easy osteoarthritis. This is less effective when arthritis is advanced or associated with adverse factors like obesity, mal-alignment or deformity. They are not effective for inflammatory types of arthritis.

Surgical options:

  1. Arthroscopy (keyhole surgery) helps by washing the joints debris. Unstable tears of the cushions or joint lining can be trimmed with some relief of pain. Arthroscopy provides temporary benefit. It is not effective when arthritis is advanced. It is generally not done for inflammatory arthritis.
  2. Osteotomy is correcting mal-alignment in order to shift the weight to the more healthy side of the joint which unloads the arthritis part of the joint. This gives relief of pain. This is especially useful in younger patients. The pain relief is not complete because there is some arthritis in the less involved area of the joint. Eventually a knee replacement is required. Other operations like osteochondral auto-grafting, chondrocyte/cartilage transplantation, osteochondral allografting have been described. They are applicable to high selected patients with limited bone/cartilage defects and are generally not applicable to arthritis which is a generalized process.
  3. Joint Replacement: In this the natural bearing surfaces of joint are replaced by artificial bearing surfaces. This provides a lasting relief of pain, restores movements to joints, and deformities are corrected as a part of this procedure. Usually, there is no need for analgesics/other medications after joint replacements. Certain precautions are necessary after the replacement such as avoiding sitting on the floor, squatting position, avoiding vigorous athletic activities/contact sports, avoiding using Indian commode system, etc. Patients might have to take antibiotics if there is infection in any part of the body to prevent it from spreading to the joint.

Prevention

  • Exercising regularly
  • Maintaining healthy weight
  • Maintaining good posture

  
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