Osteoarthritis (degenerative joint disease)

Chronic condition of the joints in which the cartilage deteriorates and leads to pain, swelling and stiffness. It is the most common joint disorder.

Rheumatoid arthritis

Autoimmune, inflammatory disorder in which the immune cells are signaled by the brain to attack the synovial fluid (the fluid that lubricates the joints). It can affect any joint in the body but it usually appears in the small joints of the hands and feet. The disorder’s evolution is progressive although symptoms can have a rapid manifestation.

 

Ankylosing spondylitis

A type of arthritis that mainly affects the joints in the spine and causes sections of the spine to fuse together. Progressing, it can damage tendons, ligaments, cartilages and bones. The joints and ligaments involved in the back’s mobility become inflamed. When the inflammation subsides new bone is grown in its place. Commonly affects young men between 15 and 30 years old.

Causes

Osteoarthritis

 

Genetic aspects give a predisposition to this disease

 

A rare defect in collagen production (protein that makes cartilage) can cause osteoarthritis to appear as early as 20 years of age

 

Slight defects in the way bones fit together cause cartilage to be damaged faster

 

A gene called FAAH is associated with this disease

 

Being overweight puts additional pressure on the hips and knees and can cause cartilage damage

 

Repetitive movement (in jobs that require standing for long periods, heavy lifting, etc) or injuries (repeated fractures, tears in ligaments, surgeries)

 

Rheumatoid arthritis

 

Metabolic disorders (such as hemochromatosis – excessive iron absorption)

 

Acromegaly (over production of growth hormone)

 

Rheumatoid arthritis

 

The exact cause is unknown but it is believed that a combination of genetic, environmental and hormonal factors is responsible for the disorder

 

A specific gene, HLA-DR4, is associated with rheumatoid arthritis

 

Prolonged smoking is linked to the disorder’s development

 

Viral or bacterial infections may be triggering causes

 

Contraceptives have been linked to the predisposition of rheumatoid arthritis in women

 

Hormonal imbalance

 

Ankylosing spondylitis

 

Specific cause is unknown

 

Gene HLA-B27 is associated with ankylosing spondylitis

Symptoms and signs

Osteoarthritis:

 

Pain and stiffness (mostly in the morning or after resting)

Swelling

Limited range of motion

Cracking sound in the joints

Soreness

Bony growths (at the edge of finger joints)

Redness around the joints

 

 

Rheumatoid arthritis usually affects the small joints in hands and feet and has three stages:

Stage 1 implies swelling, stiffness and pain in the joints due to the swelling of the synovial tissue

Stage 2: cells multiply in the tissue due to the inflammation causing more pain

Stage 3: the inflamed cells start releasing enzymes that affect bones and cartilages causing deformities of the joints

 

Physical symptoms:

Joints feel tender, warm, swollen and are red

Rheumatoid nodules appear under the skin (near elbows or fingers)

Fever

Fatigue

Stiffness that begins in the morning and lasts 30 minutes or more even if there is moderate activity

Weight loss and loss of appetite

Discomfort is differently perceived – it can be constant or mild with flare-ups

Difficulty in performing simple tasks (such as driving or opening a jar)

 

Psychological symptoms:

Anxiety

Depression

Sleeping problems

Low self-esteem

Feeling helpless/incapable

 

Ankylosing spondylitis

 

Sacroiliitis (inflammation of the joint where the spine and pelvis are attached)

Gradual lower back pain

Buttock pain, hip pain

Stiffness and limited movement in the morning

Tenderness in the affected region

Fatigue

Fever and night sweats

Joint pain (in other parts of the body than the back)

Enthesitis (inflammation of the places where ligaments and muscles attach to the bones)

Respiratory difficulties due to an abnormal position

Stiffness in shoulders and knees

Eye pain – eye inflammation (in 25% of the cases)

Advice

Osteoarthritis:

 

Health history and symptoms are assessed – when and how the pain started, how it affects daily activities

 

A physical examination will evaluate the range of motion that the joints have

 

Diagnostic tests: joint aspiration (fluid is withdrawn from the joint for examination), X-rays and MRIs (magnetic resonance imaging)

 

A cure is not available, but treatments help with symptom management

 

Physical activity is highly recommended to improve mobility and reduce pain

 

Medication: analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, hyaluronic acid

 

Alternative therapies: acupuncture, acupressure, massage, relaxation techniques

 

Assistive devices: canes, splints, jar openers, long shoe horns, steering wheel grips

 

Surgical interventions imply repair or replacement of the affected joints especially in the cases of hips or knees

 

 

Rheumatoid arthritis:

 

The doctor will do a physical evaluation and follow the patient’s medical history

 

Tests that can help in diagnosis: blood tests to measure rheumatoid factor levels, erythrocyte (red blood cells) sedimentation rate test, anti-CCP antibody test (can diagnose rheumatoid arthritis before symptoms appear)

 

Imaging tests: X-rays (detect bone damage), extremity MRI (magnetic resonance imaging), ultrasound (erosions are seen at an earlier stage)

 

Treatment options are based on the disorder’s stage, symptom severity and the patient’s preferences

 

The goals are to relieve pain, reduce inflammation, slow down the damaging process and help maintain/improve mobility in the affected joints

 

Exercise is recommended in the case of milder symptoms, while rest and less stress on the joints is recommended in a later stage of the disorder

 

Splints can be used to help support the affected joints and relieve pain and swelling

 

Medication: analgesics, non-steroidal anti-inflammatory drugs, steroids, DMARDS (disease-modifying anti-rheumatic drugs – used to slow down or stop the disease), biologic response modifiers (Etanercept, Infliximab, Anakinra, Rituximab, Abatacept, Tocilizumab, etc)

 

Surgery depends on the affected joint in the body: joint replacement (synthetic replacement for the shoulders, hips, knees), arthrodesis (ankle, wrists, toes, fingers; the joint is removed and the neighboring bones are fused together), synovectomy (the inflamed synoval tissue is removed)

 

 

Ankylosing spondylitis

 

Symptoms can appear years before actual bone growth and section fusion can be seen, thus an accurate diagnosis is often challenging

 

A three-part diagnosis protocol is used by doctors: reviewing the patient’s medical history, performing a physical examination and diagnostic tests such as blood tests, X-rays, CT scans and MRIs (used to see deformation or bone growth)

 

A general practitioner will evaluate a patient’s posture, assess flexibility and range of motion

 

Blood tests: C-reactive protein, erythrocyte sedimentation rate (ESR) – reveal an inflammatory state; testing for the HLA-B27 gene (positive in 90% of the cases that develop ankylosing spondylitis)

 

Treatments only refer to symptom management and slowing the disease’s progression

 

Rest and activity periods must be balanced so that pain and other symptoms can be minimized; tai chi, yoga, swimming are recommended activities

 

Heat/warmth can be applied to ease stiffness or cold packs for swelling

 

Small changes in daily activities can also help: lifting easier weights, changing a workout routine – from running to swimming, taking more breaks (from a passive activity)

 

Medication: non-steroidal anti-inflammatories (NSAIDs) such as aspirin, ibuprofen and naproxen, prescription drugs (celebrex, indomethacin, tolmetin, sulindac), corticosteroids injections, disease-modifying anti-rheumatic drugs (DMARDs) such as sulfasalazine and methotrexate, tumor-necrosis factor alpha blockers (these reduce TNF – a protein that triggers inflammation) such as etanercept, infliximab, adalimumab, golimumab

 

Support devices: lumbar supports such as special pillows, back braces, support mattresses, zero-gravity chairs

 

Surgery is an option only in severe cases

 

There are two types of surgery: joint replacement and osteotomy (surgical correction of the spine itself)

MISCONCEPTIONS
  • Osteoarthritis:

     

    Cracking your knuckles can cause osteoarthritis

     

    Your diet and weight do not affect joints

     

    Exercise should definitely be avoided in this case

     

    Weather (damp, rainy) can cause osteoarthritis

     

    Wearing high heels will almost certainly lead to osteoarthritis

     

    Rheumatoid arthritis:

     

    It is triggered by unhealthy eating, excess weight and stress

     

    Having rheumatoid arthritis means that you will inevitably end up in a wheelchair

     

    It only implies joint pain and damage

     

    Some treatments can be more damaging than the disorder itself

     

    Exercise should be avoided regardless of the disorder’s stage

     

     

    Ankylosing spondylitis:

     

    It is a very rare condition

     

    It only affects your back

     

    Lots of rest is recommended in this situation

     

    It eventually leads to a fused spine no matter what you do

Statistics

 

In the US, 13.9% of adults aged 25 years and older suffer from osteoarthritis

 

Over 2 million Americans suffer from rheumatoid arthritis

 

The HLA-DR4 gene that is associated with rheumatoid arthritis is found in around 67% of Caucasians

 

More than 200,000 Americans are affected by ankylosing spondylitis

Did you know?

 

Bee sting venom apparently reduces rheumatoid arthritis symptoms.

 

Dogs and cats can develop rheumatoid arthritis or other forms of arthritis.

 

Children can also be affected by rheumatoid arthritis. Usual occurrence: between 1 and 3 years old and 8 to 12 years old.

 

In ankylosing spondylitis, if the spine fuses in a “hunched forward” position, the heart and lungs can be affected.

 

Ankylosing spondylitits symptoms often minimize and even disappear with age.

 

Mick Mars (Motley Crue guitarist) suffers from ankylosing spondylitis.