Living with arthritis

Dr Vivek Mittal

Arthritis is the world’s leading cause of disability. It refers to more than 100 different diseases, many of them self limiting. Early recognition and appropriate treatment goes a long way in preventing the severity of disease. The word arthritis literally means inflammation of joint (“arthr-” means joint; “-itis” means inflammation). In simple terms, it is the condition where cartilage at the joint surface of bone wears away. Conditions range from wear and tear of cartilage (such as Osteoarthritis) to inflammation as a result of an overactive Immune system (such as rheumatoid arthritis). It usually affects the area in or around joints, but sometimes other parts of the body including the muscles, skin and internal organs can also be affected.

What is arthritis?

FACTS

• Arthritis is inflammation of one or more joints.
• Symptoms of arthritis include pain and limited function of joints.
• Arthritis sufferers include men and women, children and adults.
• Not all arthritis ends up in deformity and disability, many of them are self limiting
• Earlier and precise diagnosis can help to prevent irreversible damage and disability

Arthritis can affect anyone and at any age. Nearly two-thirds of people with arthritis are younger than 65. Arthritis is also more common among adults who are obese. Osteoarthritis (or wear and tear arthritis) is the commonest form of arthritis and usually starts around 60 years of age. There is no data available for India; however, 80 per cent population above 65 years suffers from osteoarthritis. 22 to 39 per cent of Indians are affected by it and is more commonly seen in women as compared to men.

Other common forms of arthritis includes rheumatoid arthritis, lupus, fibromyalgia, and gout. Rheumatoid arthritis and lupus, not only affects joints but can also affect multiple organs and cause widespread symptoms. Rheumatoid arthritis on the other hand develops at a younger age and in fact if you have arthritis under 45, you are more likely to have rheumatoid arthritis than osteoarthritis.

Who is at risk for arthritis?

Certain factors are associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.

Non-modifiable risk factors

Age: The risk of developing most types of arthritis increases with age.

Gender: Most types of arthritis are more common in women; 60 per cent of the people with arthritis are women. Gout is more common in men.

Genetic: Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and ankylosing spondylitis.

Modifiable risk factors

Overweight and obesity: Excess weight can contribute to both the onset and progression of knee osteoarthritis.

Infection: Many microbial agents can infect joints and potentially cause the development of various forms of arthritis.

Joint injuries: Damage to a joint can contribute to the development of osteoarthritis in that joint.

Occupation: Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee.

Dietary factors: Elevated uric acid levels cause gout.

The risk factors and causes of many of the other forms of arthritis are unknown.

What are the common symptoms of hip or knee arthritis?

The first stage of arthritis is usually silent, as mild cartilage damage typically shows no symptoms. It is only when there is significant cartilage loss that one notices real pain and loss of joint function. Common joints affected by arthritis includes weight-bearing joints including the knees and hips, small joints of hands and wrist, elbow joint, shoulder joints, spine, etc.

Warning symptoms of arthritis are pain, swelling and stiffness in the joints. Rheumatoid arthritis initially presented as multiple joints pain and stiffness, which is worse in the morning or after a period of rest, while activities reduces these symptoms. However, as the disease progresses they became constant. On the other hand osteoarthritis present as increase in pain, swelling and stiffness after activities while rest reduces these symptoms. As the disease advances, not only do the symptoms persist all the time but disability, limp and deformity appear. Certain arthritis like gout can present like acute inflammation of toe joints with raised uric acid in blood and gouty crystal in joint fluids.

“Many people assume that arthritis pain is just part of getting old and they have to put up with it – it may not be true.” If you have swelling, stiffness, or pain in your joints for more than three weeks, it’s time to take opinion from an expert.

What can people do to prevent and control arthritis?

We tend to think of heart health as the main reason to keep physically fit and keep our weight down. But we need to consider another good reason—preventing arthritis. There is no cure for most arthritis. However, prevention is the best bet against all form of arthritis.

The three best things are exercises and staying active; maintain appropriate weight; and prevent injuries to your joints.

Most types of moderate, low-impact exercise are helpful, but best are strengthening of muscles around the joints, yoga-training, range of motion exercises, and water exercises. The stronger the muscles around your joints, the greater the pressure they take off those joints. These benefits include less pain and better physical function, mental health and quality of life.

People can reduce their risk of developing osteoarthritis by controlling their weight and avoiding injuries. Weight loss can also reduce symptoms for people with knee osteoarthritis who are overweight or obese. When we walk, our knees absorb a force equal to about three times our body weight. So losing just 10 pounds actually relieves each knee of about a 30-pound load with every stride we take.

What is the treatment for arthritis?

Majority of arthritis can be treated with conservative treatment. Treatment of early arthritis begins with simple things and it does not includes surgical treatment. Rest to the affected part with the use of a splint, ice-pack over the affected joint and range of motion and strengthening exercises, helps. Modification of activities especially, those causing excessive strain on joints should be avoided as much as possible, for example for knee and hip joints squatting (Indian toilet) position, sitting cross-legged, climbing steep steps, high-impact sports activities.

Pain-killer medicines or anti-inflammatory tablets help in pain and stiffness by reducing swelling, and inflammation in the joint. Physiotherapy and reduction of weight also helps over a period of time. Change of diet helps especially, in gouty attacks. Use of a ‘stick’ while walking helps in hip and knee arthritis. Supplements such as Glucosamine and Dycerein also helps in early and moderate arthritis. Specific medicines (disease modifying drugs) are required for diseases such as rheumatoid arthritis, gouty and seronegative spondyloarthropathy like ankylosing spondylitis. Biological injections are also available when disease modifying drugs fail to provide adequate relief. Intra-articular injection with steroids or viscosupplementation is the best alternative if above treatment fails to help.

Operative treatment

Most of us may get respite from pain and stiffness for a very long time following conservative treatment. In advanced stage of arthritis, the pain becomes so severe that a person avoids using the joint and routine activities are not possible. When one has tried all non-operative measures, then one has to resort to operative treatment.

Total joint replacement not only relieves the pain completely, but also allows the person to move pain free and improve the quality of life. Total joint replacement is also called total joint arthroplasty. “Joint replacement surgery not only corrects deformity and mechanically aligns the joint but also gives freedom from pain and movement for life”. Replacement surgery is needed only when conservative management fails despite trying non-operative treatment for a significant period of four to six months (at least). It is not only done for pain but if there is:

• Severe pain in spite of daily analgesics or restricting ordinary activities of daily living and recreations
• Significant instability (constant giving way) of your knee or hip joint
• Significant deformity causing pain and inability to walk.

Total joint replacement has come a long way. With advances in technology (Computer Assisted Surgery (CAS)) and materials like Oxinium, artificial implants last longer and restore functions better after surgery. Elderly patients with severe arthritis do come and ask this question: Is there any harm in living with the damaged joints?

I understand at times it is a difficult situation them and their family members are placed. However, with increase in the longevity of life facts gives better answer to the above question.

1. Joint replacement surgery is considered only for severely damaged knees and when all modes of conservative treatment have been exhausted.
2. Joint replacement surgery not only changes persons life style for better but also brings independence in your activities, thus making it a wonderful operation.
3. However, if you choose to live with your damaged joints:

1. Then you will continue to live rest of the life with pain and walk with difficulty due to the deformed joints.
2. If your damaged joint becomes unstable, then incidence of fracture around your hips or knees increases dramatically. Your osteoporosis will also worsen as a result of inactivity thereby making you furthur prone to fractures.
3. Your deformities and instability will only worsen with your age or passage of time.
4. Also regular consumption of analgesics and anti-inflammatory drugs may damage your kidneys and cause ulcers in stomach.

In the end I would say: one should never ignore arthritis as it can affect us at any age. Not all arthritis are disabling and deforming, hence understanding your arthritis is important. Timely and proper treatment prevent irreversible damage and disability with current non-operative and operative treatments being very effective in restoring function effectively.

You can know more about Dr Mittal on www.drvivekmittal.com