Arthritis is a group of conditions where there is damage caused to the joints of the body. Arthritis is the leading cause of disability in people over the age of 55.

In this article we are going to mainly cover Osteoarthritis.

There are many different forms of arthritis, each of which has a different cause. The most common form of arthritis, osteoarthritis (also known as degenerative joint disease) occurs following trauma to the joint, following an infection of the joint or simply as a result of ageing. Furthermore, there is emerging evidence that abnormal anatomy may contribute to early development of osteoarthritis. Other forms of arthritis are rheumatoid arthritis and psoriatic arthritis, which are autoimmune diseases in which the body is attacking itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation. Additionally, there is a less common form of gout that is caused by the formation of rhomboidal shaped crystals of calcium pyrophosphate. This form of gout is known as pseudogout.


History and Physical Examinaton

All arthritides feature pain. Patterns of pain differ among the arthritides and the location. Osteoarthritis is classically worse at night or following rest. In elderly people and children, pain may not be the main feature, and the patient simply moves less (elderly) or refuses to use the affected limb (children).

Elements of the history of the pain (onset, number of joints and which involved, duration, aggravating and relieving factors) all guide diagnosis. Physical examination typically confirms diagnosis. Radiographs are often used to follow progression or assess severity in a more quantitative manner.

Blood tests and X-rays of the affected joints often are performed to make the diagnosis.

Screening blood tests may be indicated if certain arthritides are suspected. This may include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen and specific antibodies.


Osteoarthritis

Osteoarthritis (also known as degenerative arthritis, degenerative joint disease, or in more colloquial terms "wear and tear"), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints.

As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax.

There has been no cure for osteoarthritis, as cartilage has not been induced to regenerate. However, if the disease is caused by cartilage damage (for example as a result of an injury) Autologous Chondrocyte Implantation may be a possible treatment. Treatment is with NSAIDs, local injections of glucocorticoid or hyaluronan, and in severe cases, with joint replacement surgery.


Signs and symptoms

The main symptom is chronic pain, causing loss of mobility and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated muscles and tendons. Osteoathritis can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid weather increases the pain in many patients.

Osteoarthritis commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As the disease progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. If the disease affects the toes it often leads to the formation of bunions, rendering them red or swollen.

Osteoarthritis is the most common cause of "water on the knee", an accumulation of excess fluid in or around your knee joint.


Causes

Osteoarthritis often affects multiple members of the same family, suggesting that there is hereditary susceptiblity to this condition. A number of studies have shown that there is a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis. Up to 60% of cases are thought to result from genetic factors. Researchers are also investigating the possibility of allergies, infections, or fungi as a cause. There is some evidence that allergies, whether fungal, infectious or systemically induced, may be a significant contributing factor to the appearance of the disease in a synovial sac.


Two types of Osteoarthitis

Primary Osteoarthritis

This type of the disease is a chronic degenerative disorder related to but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease.

As a person ages, the water content of the cartilage decreases due to a reduced proteoglycan content, thus causing the cartilage to be less resilient. Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration.

Inflammation of the surrounding joint capsule can also occur, though often mild (compared to that which occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them.

New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the inflammation, can be both painful and debilitating.

Secondary Osteoarthitis

This type of arthritis is caused by other factors or diseases but the resulting pathology is the same as for primary osteoarthritis:

Congenital disorders, such as:

- Congenital hip luxation

- People with abnormally-formed joints (e.g. hip dysplasia) are more vulnerable to osteoarthritis, as added stress is specifically placed on the joints whenever they move. [However, recent studies have shown that double-jointedness may actually protect the fingers and hand from osteoarthritis.]

- Cracking joints—the evidence is weak at best that this has any connection to arthritis

- Diabetes.

- Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.

- Injury to joints, as a result of an accident

- A joint infection, e.g. from an injury.

- Hormonal disorders.

- Ligamentous deterioration or instability may be a factor

- Obesity. Obesity puts added weight on the joints, especially the knees.

- Osteoperosis (High bone density).

- Sports injuries, or similar injuries from exercise or work. Certain sports, such as running or football, put undue pressure on the knee joints. Injuries resulting in broken ligaments can lead to instability of the joint and over time to wear on the cartilage and eventually osteoarthritis.

- Pregnancy

- Alkaptonuria

- Hemochromatosis and Wilson's disease


Diagnosis

Diagnosis is normally done through x-rays. This is possible because loss of cartilage, subchondral ("below cartilage") sclerosis, subchondral cysts, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes) show up clearly on x-rays. Plain films, however, often do not correlate well with the findings of physical examination of the affected joints.

With or without other techniques, such as MRI (magnetic resonance imaging), arthrocentesis and arthroscopy, diagnosis can be made by a careful study of the duration, location, the character of the joint symptoms, and the appearance of the joints themselves. As yet, there are no methods available to detect the disease in its early and potentially treatable stages.


Treatment

Generally speaking, the process of clinically detectable osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of the disease and thereby improve the function of the joint.

Application of heat — often moist heat — eases inflammation and swelling in the joints, and can help improve circulation, which has a healing effect on the local area.

No matter what the severity, or where the disease lies, conservative measures, such as weight control, appropriate rest and exercise, and the use of mechanical support devices are usually beneficial to sufferers. In the case of osteoarthritis of the knees, knee braces, a cane, or a walker can be a helpful aid for walking and support. Regular exercise, if possible, in the form of walking or swimming, is encouraged. Applying local heat before, and cold packs after exercise, can help relieve pain and inflammation, as can relaxation techniques.

Weight loss can relieve joint stress and may delay progression . Proper advice and guidance by a health care provider is important in management of the disease , enabling people with this condition to improve their quality of life.

Dealing with chronic pain can be difficult and result in depression.

Communicating with other patients and caregivers can be helpful, as can maintaining a positive attitude. People who take control of their treatment, communicate with their health care provider, and actively manage their arthritis experience can reduce pain and improve function.


Dietary

Supplements which may be useful for treating osteoarthritis include:

- Glucosamine

- Chondroitin

Other supplements :

- Omega 3 Fish oils,a vitamin supplement comprised of important oils derived from fish to relieve symptoms in a natural way.

- Boswellia, an herbal supplement known in Aryuvedic medicine. It is widely available in health food stores and online.

- Antioxidants, including vitamins C and E in both foods and supplements, provide pain relief.

-Hydrolyzed collagen (hydrolysate) (a gelatin product) may also prove beneficial in the relief of symptoms, as substantiated in a German study by Beuker F. et al. and Seeligmuller et al. In their 6-month placebo-controlled study of 100 elderly patients, the verum group showed significant improvement in joint mobility.

- Ginger (rhizome) extract - has improved knee symptoms moderately.

- Methylsulfonylmethane (MSM): A small study by Kim et al. suggested that MSM significantly reduced pain and improved physical functioning in osteoarthtitis patients without major adverse events (Kim et al). The authors cautioned that although this short pilot study did not address the long-term safety and usefulness of MSM, they suggest that physicians should consider its use for certain patients.

- S-adenosyl methionine: small scale studies have shown it to be as effective as NSAIDs in reducing pain, although it takes about four weeks for the effect to take place.

- Selenium deficiency has been correlated with a higher risk and severity of the condition, therefore selenium supplementation may reduce this risk.

-Vitamins B9 (folate) and B12 (cobalamin) taken in large doses significantly reduced hand pain, presumably by reducing systemic inflammation.

- Vtamin D deficiency has been reported in patients with osteoarthritis, and supplementation with Vitamin D3 is recommended for pain relief.

- Bone Morphogenetic Protein 6 (BMP-6) has recently been shown to have a functional role in the maintenance of joint integrity and is now being produced in an orally ingested form.

Other nutritional changes shown to aid in the treatment of the disease include decreasing saturated fat intake and using a low energy diet to decrease body fat. Lifestyle change may be needed for effective symptomatic relief, especially for arthritis of the knee. Reducing sugar, processed foods, fatty foods and nightshade vegetables in the diet has helped many. According to Dr. John McDougall, a low fat vegetarian diet can reduce symptoms. A macrobiotic diet has been known to reduce symptoms as well.


Medications

These drugs need to be prescribed by a doctor.

Acetaminophen. A mild pain reliever.
Non-steroidal anti-in flammatory drugs. In more severe cases may reduce both the pain and inflammation.

Corticosteroids. Their effect is modest and the adverse effects may outweigh the benefits.

Narcotics. Reserved for severe pain, and are rarely medically necessary for chronic pain.

Topical treatments"designed for local application and action. Creams and lotions. (can be bought at the pharmacy).

Severe pain in specific joints can be treated with local lidocaine injections and may temporarily reduce the pain.

Surgery

If the above management is ineffective, joint replacement surgery may be required.


Acupuncture

Treatment is by insertion of very fine needles into the series of channels called meridians situated beneath the skin. Said to treat the whole person as well as the affected area.

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