Arthritis

Symptoms: Swelling, pain, redness and stiffness in the joints; reduced range of motion, fatigue, tenderness of muscles around the joints, low-grade fever, loss of weight, trouble breathing, rashes, cracking and creaking of joints
Causes: Obesity, genetics, repetitive joint movements, previous joint damage, sports injury, wear and tear of the cartilage, immune system attacking the joint capsule lining
Risk Factors: Age, sex, family history, obesity, previous joint injury, hypermobility, bone deformity, physically demanding professions
Severity: Mild to severe 
Which doctor to consult: Rheumatologist or Orthopaedic Surgeon
 

Overview 

Arthritis is derived from the Greek word "arthron", which means joint, and "itis", which means inflammation. However, simply terming arthritis as a joint inflammation will be an oversimplification. The inflammation of the joints is only one of the significant symptoms of the disease. 
Generally, any disorder of the joints is referred to as arthritis. Arthritis is an umbrella term comprising over 100 types of disorders associated with various conditions. The disease can have many signs and symptoms, depending on the patient's age, ethnicity, and sex. In extreme cases, it can cause permanent disability. 
The most common type of arthritis is osteoarthritis (OA). It causes damage to the joints of the hips, spine, hands, and knees. Osteoarthritis is often considered a wear-and-tear disorder of the cartilage, but recent medical advancements have pushed doctors to consider it as a joint disorder. A primary subtype of the disease is inflammatory OA. 
Autoimmune inflammatory arthritis is another type of arthritis where the body's immune system attacks healthy tissues of the spinal joints. In this disorder, the immune system loses its ability to differentiate between infection or injury and a healthy system. The most common form of this disorder is rheumatoid arthritis (RA). Besides that, psoriatic arthritis (PsA), gout, axial spondyloarthritis (axSpA), and juvenile arthritis are other types. 
The actual causes of inflammatory arthritis in each individual are still unknown. However, viral infections, smoking, and stress have been identified as plausible reasons that can trigger the disorder. 
 

When to Consult a Doctor? 

An individual should seek immediate medical attention in case of the following conditions: 
On Recognizing Symptoms
Although joint pain is rarely considered an emergency, an individual must contact the doctor in case the other symptoms are present. Common symptoms include joint pain accompanied by redness, swelling, warmth around the joint and tenderness. 

Severe Injuries

An individual must consult a rheumatologist if he/she has suffered any severe injury that has caused joint deformity. Also, any movement difficulty in the joint accompanied by severe pain needs immediate medical supervision. Also, any changes in the joints noticed in an x-ray, ultrasound, or MRI must not be ignored. 
 

Diagnosis 

Diagnosing arthritis and its root cause is challenging due to the various signs and symptoms. For this, a rheumatologist may conduct different examinations and check the medical history to confirm the arthritis type and the cause. 
 

1. Physical Examination

A rheumatologist can conduct a primary musculoskeletal examination to inspect the condition of the joints, especially if an individual has recently undergone any joint surgery. Preliminary inspection includes checking the range of motion, swelling, tenderness of the joints and the affected muscles around the joints. This inspection also gives the doctor a fair idea about the type of arthritis.  
 

2. Diagnostic Tests
 

Blood Tests

Blood tests are very common for checking arthritis, especially rheumatoid arthritis. A higher erythrocyte sedimentation rate of ESR can indicate an inflammatory disorder. Another way to confirm the disease is by checking the level of C-reactive protein (CRP). Other methods include the anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor test. 

Imaging Tests

There are various types of imaging tests that need to be conducted for diagnosing arthritis. These include: 
X-rays
Computerized tomography or CT scans 
Magnetic resonance imaging or MRI 

Ultrasound 

X-rays are done at a low radiation level to get an image of the bone damage and spurs. However, there are more efficient ways of diagnosing arthritis damage. X-rays are mainly used to confirm the progression of the disorder.
CT scans, on the other hand, provide a much better view of the bone and its surrounding soft tissues.
MRIs help get a picture of the cartilage, ligaments, and tendons, while an ultrasound helps collect joint fluids. The method, also known as arthrocentesis, enables the collection of synovial fluid from the joint capsule. 
 

Lab Tests

Arthritis is diagnosed using various laboratory tests, including the testing of body fluids. This allows a doctor to get to the root cause of the problem. Generally, the fluids used for testing include urine and joint fluid. The doctor collects the joint fluid by injecting a needle into the joint.

3. Advanced Tests

Arthroscopy

Arthroscopy is a minor invasive or surgical procedure for diagnosing joint problems. The method is also helpful in treating joint problems. The most common areas where arthroscopy is done include the hips, wrists, elbows, shoulders, ankles, and knees. The doctor inserts an arthroscope into the joint by making several small incisions and inspect the damage caused. 
 

Treatment 

Home Care

Some home remedies that can provide temporary relief from the signs and symptoms and acute arthritis pain, include: 
Exercising regularly has shown positive results in arthritis. It helps a person manage his/her weight while retaining the flexibility of the joints. Proper exercising also strengthens the ligaments and joints for greater support. 
Heat treatments, like a warm shower, or an electric heat pad, can also help. 
Cold treatments, and consuming capsaicin, present in chilli peppers and some ointments, can also help. 
Acupuncture is another method which can help reduce arthritic pain in patients. However, an individual must consult a doctor before opting for such options. 

Medication

Medication for arthritis mainly depends on the diagnosis of the arthritis type. 
Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and decrease inflammation. Common medicines in this group are ibuprofen, naproxen, sodium, etc. However, these can upset the stomach and increase the chances of heart attack, so an individual must consume these only if a doctor prescribes. 
Some creams and ointments contain counterirritants like capsaicin or menthol. Rubbing these ointments on the skin over the joint can disrupt the painful sensations, providing some relief. However, these are not cures for the disease. 
Corticosteroid medications are the most effective medication for reducing the rate of joint damage, inflammation, and pain. In case of severe arthritic pain, these are injected to relieve the patient’s pain. However, these have significant side effects, such as weight gain, diabetes, and bone thinning. 
It has been observed that DMARDs or disease-modifying antirheumatic drugs can slow the progress of rheumatoid arthritis. This is effective in preserving the remaining joints and other tissues. These are high-risk medications that only a licensed rheumatologist can prescribe, depending on the severity of the condition. 

Surgical Treatment

There are a few surgical treatments available for treating arthritis. But most involve treating or replacing the joints since these bear the entire body weight. Other methods involve shoulder surgery, elbow joint replacement, and hip replacement. 
Joint Replacement: Joint replacement surgery is the last option available when no other method brings fruitful results. The damaged joint is removed surgically and replaced with an artificial one. Knee and hip replacement surgeries are the most common ones.  
Joint Repair: If doctors feel that smoothening or realigning the joint surface can improve the condition, they may go for joint repair surgery. The procedures are performed arthroscopically by cutting small incisions over the joint. 
Joint Fusion: Joint infusion therapy is an alternative treatment for patients on whom traditional medication does not work. This surgical method is most useful for smaller joints, such as the ones in the wrists, fingers, and ankles. The rheumatologist may remove the end of the two bones in a joint and then fuse them till they heal and become a singular unit. 
 

Risk and Complications if Left Untreated 

Bone Death
Osteonecrosis is another bone disorder that can arise from complications due to rheumatoid arthritis. The blood supply in the affected areas is disrupted, causing permanent bone death. 
 

Stress Fracture
Patients suffering from OA or RA for a prolonged period can suffer from insufficiency fracture or stress fracture. This occurs due to osteoporosis, joint stiffness, or joint deformity. 
Ankylosing Spondylitis
Ankylosing Spondylitis is an inflammation of the spine which can impact the lower back, hip and pelvic area. Stiffness due to arthritis can cause the bones of these areas to fuse or even cause painful bony outgrowths. 
 

Spinal Stenosis

Another spinal complication due to arthritis is spinal stenosis or narrowing of the spine. Owing to any outgrowth, the ligaments around the area thicken, narrowing the spinal canal. This compresses the nerves in the spine, causing various other problems, such as poor bladder and bowel movement. 
 

Sleep Disruption

Most patients who have arthritis have trouble sleeping due to swollen and painful joints. The sensation of tender joints, along with a poor sleep cycle, can intensify the pain. 
 

Anxiety and Depression

Besides the physiological aspect, arthritis also has a psychological impact on patients. Anxiety and depression are prevalent among OA patients. 

Weight Gain

Pain and stiffness of the joint can limit one’s mobility, preventing him/her from leading an active life. The reduced ability to walk or exercise can cause sudden weight gain, giving birth to other issues like diabetes and hypertension.

Impact on the Skin

Arthritic inflammation that is caused due to the immune system, like RA, can harm the skin. Patients' most common issues are lesions or rashes on the skin called rheumatoid nodules. 

Heart Complications

The inflammation from RA can spread to the blood vessels, causing them to shrink. This, in turn, causes clots and blockage in the arteries. As a result, patients can suffer from a heart attack or a stroke. 

Lung Complications

Common lung problems from arthritis include developing long-term lung inflammation, chronic cough, breathing difficulties, and rheumatoid nodules on the lungs. 

Kidney Complications

Inflammatory arthritis can even target the kidneys. As a result, patients can experience a loss of appetite, muscle cramping, shortness of breath, frequent urination, skin darkening, etc. 

Additional Information 

Effect of Smoking on Arthritis
Smoking is a harmful habit that can cause damage to cell production in the cartilage. It also increases toxins like carbon monoxide in the blood, aggravating cartilage loss. This disrupts cartilage production and repair, causing increased soreness in arthritic patients.

Effect of Drinking on Arthritis
Moderate drinking can provide some protection against arthritis, especially RA. However, an individual must ensure moderation to reap the benefits.