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[Up] [Anatomy joints] [Types of arthritis] [Spondylosis] [Investigations] [Management  arthritis] [Physiotherapy modern] [Joint strengthening] [Exercises 1] [Exercises 2] [Newer medicines] [Questions answered]

Major types of arthritis

 

 What is Osteoarthritis?

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Osteoarthritis , also called degenerative joint disease. 

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Its cause is unknown but may include chemical, mechanical, inborn, metabolic, and endocrine factors. Emotional stress often worsens the condition.

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Osteoarthritis usually affects people who are over 35 years of age. 

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Sometimes it can begin at an earlier age because of joint injury or overuse. 

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Men and women are affected equally before the age of 55, but there is a higher incidence of osteoarthritis in women over 55. 

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Ninety percent of people over 60 show some signs of osteoarthritis. 

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When the cause of osteoarthritis is unknown, it is called primary osteoarthritis.

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When the cause is known, such as injury, and repeated use of the joint (such as the shoulder and elbow joints of baseball pitchers), it is called secondary osteoarthritis.

 

 Disease process in osteoarthritis.

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A common form of arthritis in which one or more joints have tissue changes.

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 Osteoarthritis destroys the joint cartilage of the major weight bearing joints the hips, knees, and spinal column. 

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The disease usually affects only one or two joints. 

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With osteoarthritis, the cartilage of the joints gradually wears away with weight bearing and movement in the joint. Cartilage that normally cushions the joint becomes soft and breaks down. 

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As the disease progresses, so much of the cartilage is destroyed that the bone ends begin to rub against each other. 

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Small pieces of bone and cartilage may become loose and get caught inside the joint, causing pain or forming bony spikes (osteophytes) that project into the joint. 

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Bony spurs develop around the joint, and pain and inflammation result.

 

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Swelling of the membrane lining the joint is common. Lumps (cysts) may form in bone tissue. 

 

 Diagnosis of osteoarthritis.

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Osteoarthritis is diagnosed based on the patient's medical history, a physical examination to determine which joints are affected, blood tests, and x-rays. 

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A sample of synovial fluid from the affected joint may also be taken. 

 

 

 Symptoms of osteoarthritis.

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The main symptom of osteoarthritis is restricted motion in the joint, along with a deep, aching pain during movement and at night, and joint deformity.

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The condition usually begins with pain after exercise or use of the joint. 

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Stiffness, tenderness to the touch, rubbing noises (crepitus), and a large joint develop. 

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Badly formed bones or joints, and joints being forced out of place (subluxation) may occur over time. 

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When the hip, knee, or the spine are involved, this causes more problems of movement and use of joints than osteoarthritis of other areas. 

 

 Treatment 

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Includes rest of the joints that are affected, heat, and anti-inflammatory drugs. 

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Injections of adrenal hormone drugs into the joint may give relief. 

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Surgery is sometimes necessary and may reduce pain and greatly improve the working of a joint. 

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Replacing the hip and fusing the parts of the joint are some of the kinds of surgery that are used in treating serious cases of osteoarthritis. 

 

 

 What is rheumatoid arthritis?

 

       

 

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It is also called arthritis deformans, atrophic arthritis. 

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Rheumatoid arthritis is a chronic disease, meaning that those who have it must live with it the rest of their lives. 

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Rheumatoid arthritis affects children between 8 and 15 years of age and adults between 25 and 55 years of age. 

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Rheumatoid arthritis most commonly, first appears in early middle age, between 36 and 50 years of age. 

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It rarely occurs in those over 55. 

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It is two to three times more common in women than in men, and it has a tendency to run in families. 

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Seventy percent of the people affected are over 30 years of age.

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The cause of rheumatoid arthritis is unknown. A possible explanation is that it is an autoimmune (or self-immune) disorder, which means that the body is attacking itself, especially the lining of the joints. An infectious agent also could be a cause. 

 

 Disease process in rheumatoid arthritis.

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Rheumatoid arthritis affects the smaller joints of the hands, wrists, feet, and ankles before it affects joints such as the hips, knees, and elbows. 

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It is a long term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).

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The disease is symmetric and bilateral, meaning that it affects the same joints on both sides of the body.

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Rheumatoid arthritis affects the synovium, the lining of the joints, which becomes inflamed (red, swollen, painful, and warm) as if reacting to an infection. 

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The synovium secretes more synovial fluid, making the joint more swollen.. 

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This leads to thickening of the synovial membrane and swelling of the joint.

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Later, the cartilage also becomes involved and eventually becomes rough and pitted.

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Ligaments and tendons also become inflamed, scarred, and shortened by the disease, contributing to the deformities often noticed in the hands and wrists of people with rheumatoid arthritis.

 

 Course of the disease 

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The course of the disease varies. 

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There are times when it goes away (remission), and times when it gets worse (exacerbations).

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Rheumatoid arthritis is not always progressive or deforming. Thus, early treatment may help the patient to recover and perhaps to avoid future attacks.

 

 Rheumatoid arthritis is divided into four stages. 

  1. Stage I, early effects, is based on x-ray films showing the first bone changes. 

  2. Stage II, moderate rheumatoid arthritis, shows signs of some muscle wasting and loss of movement, in addition to x-ray findings. 

  3. Stage III, severe rheumatoid arthritis, shows joint defects, much muscle wasting, soft tissue tumors, and bone and cartilage destruction. 

  4. Stage IV, the terminal category, has all of the Stage III signs plus fiber like or bony fixation of a joint (ankylosis). 

 

 Staging of Rheumatoid arthritis on basis of functional capacity. 

 Rheumatoid arthritis cases may also be named for functional capacity. 

  1. Class I is patients with no loss of function. 

  2. Class II is minor damage of functional capacity with some pain and stiffness. 

  3. Class III is capacity limited to a few tasks. 

  4. Class IV is the patient confined to a bed or a wheelchair. 

 

 Symptoms in rheumatoid arthritis.

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The main symptoms of rheumatoid arthritis are pain and loss of function in the joints.

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Rheumatoid arthritis may first begin with general symptoms, as fatigue, weakness, and poor appetite. Early signs may also include mild fever, anemia, and red blood cell changes. 

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Other symptoms include morning stiffness in one or more joints, warmth in the joints, swelling in at least one or two joints, a tingling or prickling sensation in the hands or feet, tiredness, weight loss, and a feeling of ill health.

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As the disease progresses, nodules form under the skin, cysts (water-filled masses) develop in the synovium and bone, and the joints and surrounding bone and tissue become deformed.

 

 

 The symptoms listed by the American Rheumatism Association are

  1. Morning stiffness,

  2. Joint pain or tenderness, 

  3. Swelling of at least two joints;

  4. Arthritic nodes found at pressure points (as the elbows), 

  5. Changes in the joint seen on x-ray films, 

  6. A positive rheumatoid factor blood test, and 

  7. Changes in the content of synovial fluid. 

 

 Diagnosis of rheumatoid arthritis.

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Rheumatoid arthritis is diagnosed based on the symptoms, a physical examination, x-rays, blood tests, and other laboratory tests.

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Rheumatoid factor (RF) is in blood and synovial fluid of most patients with rheumatoid arthritis. Higher amounts are found in the more severe forms of the disease.

 

 Treatment.

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The basic treatment is rest,

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Exercise to help joint function, 

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Drugs for pain relief and lowering the swelling, 

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Surgery to prevent or correct defects, and a 

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Good diet-with weight loss, if needed. 

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Aspirin-type drugs are given.

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If the patient does not get better, other anti swelling drugs may be used. Steroids are given with caution because of side effects. These are peptic ulcer, slowed adrenal glands, and bone weakening (osteoporosis). 

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Other treatments, as diathermy, ultrasound, warm paraffin applications, and exercise under water are used. 

 

 Ankylosing spondylitis

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Also called Marie-Strumpell disease. 

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A long-term swelling disease of unknown cause. 

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It first affects the spine and nearby structures. 

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It often progresses to a joining together (ankylosis) of the bones of the spinal column. 

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In extreme cases the patient stoops forward, which is called a "poker spine" or "bamboo spine." 

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The disease affects mostly men under 30 years of age. 

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There is a strong chance that it can be inherited. 

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As well as the spine, the joints of the hip, shoulder, neck, ribs, and jaw are often involved.

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When the joints where the ribs join the spine are involved, it may be hard for the patient to expand the rib cage while breathing. 

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Many patients with the disease also have bowel disease that involves swelling, heat, redness, and pain. 

 

 Treatment

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The aim of treatment is to relieve pain and swelling in the joints, usually with drugs. 

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Physical therapy aids in keeping the spine as erect as possible. 

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In advanced cases surgery may be done to straighten a badly bent spine. 

 

                                                                                               

              Ankylosing spondylosis, seen in lumbar vertebrae 

 

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Bamboo spine, poker spine, also called poker spine. The typically rigid spine of advanced ankylosing spondylitis.

 

  

 

 Gout 

 

 

                                   

 

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or gouty arthritis, a state of hyperuricemia, a disease of uric acid processing. 

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A primary or secondary recurrent, acute arthritis of the peripheral joints, particularly the great toe.

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It increases production or interferes with the passing of uric acid.

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Excess uric acid is converted to sodium urate crystals that settle into joints and other tissues.

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Men are more often affected than women. 

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The great toe is a common site for the buildup of urate crystals. 

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The condition can result in painful swelling of a joint, along with chills and fever.

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The disease is crippling and, if untreated, can lead to joint breakdown.

 

 Treatment 

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Treatment usually includes drugs, a diet that excludes purine rich foods, as organ meats, and may include surgery.

 

 Causes and Incidence 

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The precise causal mechanism in gout is unknown. 

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However, a host of factors act as precursors to overproduction or under secretion of uric acid, including genetic factors (hyperactivity of hypoxanthine guanine phosphoribosyl transferase, superactivity of phosphoribosyl pyrophosphate, fructose intolerance); environmental factors (ethanol abuse, diuretic use, severe muscle exertion); underlying disease processes (diabetes mellitus, polycythemia, hypertension, renal disease, leukemia, sickle cell anemia); and the evolutionary absence of the enzyme uricase. 

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Gout occurs most often in men. 

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Gout is rare in women before menopause. 

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The incidence of gout is increasing in developed countries.

 

 

 Disease Process 

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Some factor triggers an overproduction or under secretion of uric acid. 

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The plasma becomes supersaturated with uric acid, and a crystal urate precipitate is formed and deposited in avascular tissues (e.g., cartilage, tendons, and ligaments of peripheral joints) and in cooler tissues (e.g., the ears). 

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Through some undefined mechanism, the crystals are released at various times, causing an acute inflammatory reaction in the joint with extension to the periarticular tissues. 

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Repeated acute attacks lead to chronic arthritis and deformed joints.

 

 Symptoms

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Acute pain, redness, swelling, tenderness, and heat at the affected joint are typical presenting features.

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Fever, chills, and malaise may also be present. 

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Limited motion is present in the affected joint or joints.

 

 Potential Complications

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Complications include infection of ruptured deposits, renal involvement with formation of renal calculi, and secondary degenerative arthritis.

 

 Diagnostic Tests 

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A tentative diagnosis is made by clinical examination and elevated serum uric acid levels and confirmed with needle aspiration of synovial fluid, which is positive for urate crystals.

 

 Treatments 

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Treatment is aimed at terminating the acute attack and 

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Preventing future attacks by lowering uric acid levels and resolving existing deposits.

 

 Surgery

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Removal of large crystal deposits (tophi)

 

 Drugs

  1. Colchicine for long-term prophylaxis and to reduce inflammation in acute attack; 

  2. Nonsteroidal anti-inflammatory agents to reduce inflammation in established gout;

  3. Antihyperuricemic drugs for those with frequent attacks or chronic disease to reduce uric acid levels or increase excretion of uric acid (lifelong treatment); 

  4. Sodium bicarbonate to alkalize urine in patients who form calculi

 

 General

  1. Rest of joint

  2. Avoidance of alcohol and purine rich foods;

  3. Weight reduction if necessary to reduce wear and tear on joints; 

  4. Increased fluid intake;

  5. Instruction in long-term use of medications and their side effects

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