Things to Know About Arthritis: Symptoms, Causes, and Treatment

Arthritis, in simple terms, is defined as an inflammation of joints. Arthritis can present as any form of swelling or tenderness (pain to touch) in one or more of your joints. Even milder forms of arthritis can be highly irritating to a person because it interferes with your daily activities. Therefore, understanding arthritis and learning how to manage arthritis is significant, especially if you or someone you love suffers from it.

In some cases, arthritis can be short-lived and easily managed with medications or minor surgeries. But in other cases, such as rheumatoid arthritis, arthritis takes a chronic course and lasts a lifetime. In these cases, it is crucial to understand the nature of the diseases and learn how best to manage the symptoms and improve the quality of life.

Arthritis manifests in different ways in different people, primarily due to the underlying cause. Joint pain, swelling, and decreased movement are the most common symptoms similar to all forms of arthritis. Inflammation of the joints often expresses the cardinal symptoms of inflammation. In general, this includes redness, tenderness, and swelling. Rheumatoid arthritis manifests systemic body symptoms such as weakness, fever, tiredness, a loss

of appetite, and anemia.

The first step to take when you suspect something wrong with your joints is to meet your primary

care physician. Most cases of arthritis can be diagnosed and managed by a general physician.

However, a specialist opinion may be required at times, and more complex examinations may be

necessary. Your primary care physician will then refer you to a rheumatologist. An essential general clinical examination by experienced hands and a thorough history cansuccessfully diagnose many cases. Blood tests that check for the following can confirm the diagnosis in suspected Rheumatoid

arthritis or other autoimmune diseases such as SLE (Systemic Lupus Erythematosus):

• Inflammatory markers such as ESR, CRP

• Specific antibodies like anti-CCP (anti-cyclic citrullinated peptide), RF (Rheumatoid factor), ANA (antinuclear antibody)

• The following imaging modalities are helpful to visualize the anatomy of bones are cartilages up close and to identify the exact location of the pathology;

- X-ray

- MRI

- CT scans

In some cases, such as septic arthritis or gout, synovial fluid analysis is required. Synovial fluid analysis is performed by extracting a part of the fluid within the joint using a needle. Synovial fluid is analyzed for:

• Abnormal cells

• Microorganisms (septic arthritis)

• Crystals (in the case of gout and pseudogout)

The different types of arthritis, the underlying cause, their manifestations, and the management options are discussed individually.

1. Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder. This means it is a long term disease that occurs when the body’s immune system mistakenly attacks its tissues, including the tissues at the joints, hence known as an autoimmune disorder.

Auto-antibodies attack the lining of the joints leading to bony erosions and joint deformities. Commonly identified joint deformities include - ulnar deviation and swan neck deformity. Apart from the general symptoms of arthritis, such as tenderness, warmth, and swelling, joint stiffness in RA manifests early in the morning and after a period of inactivity. The joints initially affected are

the small joints of the hands, such as the metacarpophalangeal joints, which attack the fingers and toes to the hands and toes, respectively. The disease can progress to the joints of the wrist, knees, and elbows as well. The autoantibodies also attack other body systems leading to fatigue, fever, and a loss of appetite.

Why Does Rheumatoid Arthritis Occur?

An autoimmune disease like RA has no identifiable causative factor. Such conditions are labeled idiopathic in the medical community. However, studies performed all over the world have found a few risk factors:

• Sex - women are more likely to develop RA.

• Age - RA usually begins in middle age.

• Family history.

• Smoking and obesity increase the risk of RA.

How is Rheumatoid Arthritis Managed?

RA is a chronic disease with no cure. The latest medical guidelines aims include:

• Weight reduction and physical therapy.

• Reducing the progression of RA using DMARDs (Disease-Modifying Anti-Rheumatic Drugs) such as methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide.

• Pain management using NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

It is essential to consult a physician before starting medications.

2. Osteoarthritis

Osteoarthritis is the most common form of arthritis, and it is a disease of old age. With age, joints start to wear off due to friction. The opposing joint surfaces of cartilages wear off and lead to the bony surfaces rubbing against each other. This leads to severe pain in movement. The most commonly affected joints are the weight-bearing joints of your knees, hips, and spine.

Risk Factors For Osteoarthritis?

• Old age

• Male sex

• Obesity

• Repetitive stress such as weight lifting and similar sports

• Genetical predisposition

Managing Osteoarthritis

• Weight reduction.

• Physical therapy.

• Pain control - Acetaminophen, NSAIDs

• Physical therapy, occupational therapy

• Steroid injections and hyaluronic acid injections can provide pain relief.

• Joint replacement surgery - is the only definitive surgery. Hip replacement and knee replacement surgeries are performed to improve the quality of life in those fit to undergo surgeries.

3. Ankylosing Spondylitis

Ankylosing spondylitis (AS) is an inflammatory disorder that causes fusion of vertebra leading to limited movements and abnormal hunchback posturing. At the level of the thoracic vertebra and affecting the ribs can lead to restrictions in respiration. AS has a genetic basis, and only a few of those with the HLA-B27 gene develop the disease.

Symptoms of AS

AS manifests in early adulthood as pain and stiffness in the lower back and hips, especially in the mornings. Neck pain and fatigue are often associated with AS. The systemic manifestations of AS, such as uveitis (inflammation of the eye), can point the diagnosis towards AS.

Management of AS

• Analgesia with NSAIDs

• Biologic medications to suppress inflammation - Adalimumab, Certolizumab, Etanercept, Golimumab, and Infliximab.

• Physical therapy - to improve the range of movement and improve breathing.

4. Gout

Gout is a common form of arthritis that can manifest as a sudden, severe attack of the big toe which becomes extremely painful, swollen, and red. After the first attack and its successful remission, gout can recur again over and over again.

Gout occurs due to the deposition of uric acid crystals in the joint. Uric acid is formed due to normal metabolic processes involving the breakdown of purines. However, in certain conditions, the balance between the production of uric acid and the excretion of uric acid is deranged, leading to an increased amount of circulating uric acid in the body.

Risk factors of gout

• Diet - a diet rich in red meat, alcohol, shellfish, and other food items containing high amounts of purines.

• Obesity

• Medical conditions - diabetes, metabolic syndrome, kidney failure.

• Drugs - aspirin, thiazide diuretics, ACEI, beta blockers

• Family history

• Male gender

Managing Gout

• Dietary control by minimizing food with high purine levels.

• Exercise and weight control.

• Analgesia with NSAIDs, colchicine, and corticosteroids.

• Reduce uric acid production - allopurinol and febuxostat.

• Increase uric acid excretion by the kidneys - probenecid.

Home remedies and other non-conventional remedies for arthritis are aimed at relieving pain and fighting off inflammation.

1.Turmeric

Turmeric is a yellow spice popular in the Indian subcontinent. Turmeric contains a compound called curcumin which has known anti-inflammatory and antioxidant properties. Turmeric, when consumed through the diet, as a spice in food or mixed with hot milk, can reduce the pain and inflammation of arthritis [1].

2.Boswellia herbal supplements

Boswellia is known as Indian frankincense, is a herbal extract that contains anti-inflammatory properties. Boswellia extracts have been used un-conventionally for osteoarthritis and rheumatoid arthritis, among other inflammatory disorders.

3.Heat therapy

Heat therapy includes a warm shower in the morning, a moist heating pad, or an electric heating blanket. Heat therapy works because heat improves circulation, and flowing blood removes inflammatory mediators at a faster rate.

4.Cold therapy

Cold therapy includes icing a joint with a bag of ice or frozen vegetables. When performed in due time, Icing can reduce the blood supply to the joint, and that can decrease the number of inflammatory mediators arriving.

5.Capsaicin

Capsaicin is the compound that makes chili pepper spicy. Capsaicin is used in topical ointments that can provide relief to joint pain. Arthritis can be a severely debilitating disease that drastically affects the lifestyle of an individual. The symptoms and disability resulting from arthritis can interfere with the social and occupational lives hindering the economical status and mental health among other factors. Early diagnosis and prompt treatment is crucial in certain chronic diseases. Understanding the uses of home remedies and using them appropriately can improve the quality of life.