|
Other Names Degenerative Joint Disease, Joint Inflammation What is Arthritis? Inflammation of one or more joints is termed as arthritis. Synovial membranes line the articulating surfaces of the bones forming a joint. Any disease involving the synovial membranes or causing degeneration of the cartilage may cause arthritis. Over 200 diseases are known to cause arthritis. Arthritis may affect one or multiple joints. Mono or oligoarthritis is inflammation of one joint; pauciarthritis is inflammation of a few joints (4 or less) and polyarthritis of many joints. Incidence, Causes and Risk factors Nearly 10% of the general population has some form of arthritic inflammation. Arthritis may be due to an infectious cause or a metabolic cause. It may also be due to rheumatoid arthritis or osteoarthritis. Risk Factors: - Trauma
- Obesity
- Type of occupation
- Steroid therapy
- Underlying malignancy
- Low socioeconomic conditions
Almost all the joints are involved in the case of arthritis. It is the pattern of involvement that varies with the disease causing arthritis. In rheumatoid arthritis the same joints are affected symmetrically in both the limbs and mostly involve small joints. In infectious arthritis the bigger joints like the knee, ankle, elbow and shoulders may be involved one after the other. Symptoms - Affected joint is tender to touch
- Pain (intermittent or constant), swelling and warmth
- Loss of function and a limitation in the range of motion across the joint
- Change in the style of walking is observed if the hip joint is involved
- General symptoms of infection such as fever, malaise and lethargy may be present
Screening and Diagnosis Physical Examination:
Examination reveals a swollen joint with or without joint deformity. Radiological Investigations:
X-ray shows a joint with narrowing of joint space and erosion of articular cartilages. Tests and Procedures: - Synovial fluid (joint fluid) is examined by removing fluid from joint with a sterile needle and syringe. This procedure is called joint aspiration.
- Synovial biopsy
- Lab Tests, such as culture or gram stain. These tests help to identify the specific bacteria causing the infection and inflammation.
Treatment Physicians first look to treat arthritis medically, rather than with surgery. This medical treatment includes prescription drugs specific to the particular cause of the arthritis. Drug therapy is given in conjunction with physiotherapy, occupational therapy and rehabilitative measures. If the joint function is poor and joint deformity is extensive, then surgery is suggested. Surgical treatment of severe arthritis can be divided into: - Preventive surgery - to prevent damage to the joint and nearby tendons
- Palliative surgery - these procedures do not typically remove the underlying cause of the arthritis, however they do provide comfort and prolong the time before reconstructive surgery is needed. Examples include bone block operations and tendon lengthening procedures.
- Reconstructive surgery - removal of inflamed or arthritic joint, includes tendon transfers, arthroplasties, or total joint replacement.
- Salvage surgery - procedures performed to prevent further loss of function or total loss of limb or joint. Joint fusion, revision joint replacement, or Girdlestone procedure are examples.
Outlook The prognosis of mild acute arthritis is excellent with simple treatment such as non-steroidal anti-inflammatory drugs (NSAIDs). Chronic arthritis can be managed with broader treatments centered on the specific cause of the arthritis. Severe arthritis benefits from the various surgical interventions. Complications: - Joint destruction
- Pathological dislocation
- Osteoarthritis, where articular cartilage is replaced by bone
- Ankylosis (fusion of bones)
- Septicemia, Pyemia and acute osteomyelitis in infective arthritis
- Amyloidosis
Prevention - Reduce weight as obesity puts extra strain on the joints
- Regular exercise helps build up joint endurance and muscle strength.
- Avoid extreme sports and use a structured workout suitable for your lifestyle.
- Maintain a good work environment
- Early diagnosis and appropriate management
References - Pages 324-327, Disorders of joints, Textbook of orthopedics, John Ebnezer, 2nd edition.
|
