Arthritis

What is arthritis?

Arthritis is by definition an inflamed joint. It causes stiffness, swelling, loss of motion, and pain in the affected joint(s) which may be in the hand, wrist, knee, or back.

What types of arthritis are there and what are some treatments?

Osteoarthritis

Osteoarthritis is a degenerative joint disease in which the cushioning cartilage that covers bone surfaces at the joints begin to wear out. This can be caused simply by normal wear and tear on the body as well as post-trauma. There are three main sites where osteoarthritis may begin to develop. First, at the base of the thumb (or the basal joint). Second, at the end of the joint closest to the finger tip (distal interphalangeal or DIP joint). And third at the middle joint of the finger (proximal interphalangeal or PIP joint).

The first course of treatment is the use of anti-inflammatory or other analgesic medication. A finger or wrist splint may also be advised to wear at night or during more strenuous activities. If these options do not produce results, hand therapy, activity modification, or steroid injection into the joint may be prescribed. If there is still too much pain or too little function, surgery may be utilized as a last resort.

The first surgical option is arthrodesis. This is a process in which a bone fusion is accomplished in order to relieve pain. This type of surgery is generally performed on the ankle, wrist, fingers, and thumb. The two bones which form a joint are joined together so that the resulting fused joint loses flexibility. This loss of flexibility is actually a benefit because the fused joint can bear weight better and is more stable. Most importantly, this procedure will allow the joint to become much less painful.

The next surgical option is arthroplasty or joint reconstruction. This process is literally re-building the joint. This is necessary when cartilage has worn away and bone has been destroyed. The surgery is completed by removing the degenerated joint surface in order to eliminate the rough, irregular bone-to-bone contact which causes pain and restricts motion. Once the surface has been cleared it is then replaced by rolled up soft tissue (such as tendons) or a joint replacement implant (such as metal, ceramic, or plastic parts).

If a patient undergoes joint reconstruction, revision joint surgery is often necessary in the future. This procedure is simply the replacement of the worn-out joint replacement. This surgery is more difficult and time-consuming than the initial joint replacement.

The final surgical option for osteoarthritis is an osteotomy. This option corrects bone deformity by cutting and repositioning the bone. This process is generally used for mild osteoarthritis and people with misalignment of certain joints.

Psoriatic Arthritis

This less-known type of arthritis affects about 10-30 percent of patients with the skin condition psoriasis. Psoriatic arthritis affects people of all ages, but mainly adults between the ages of 30 to 50. It is characterized by joint inflammation, tendonitis and a sausage-like swelling of the digits (also known as dactylitis).

Although the causes are unknown, it has been found that there are five different types of psoriatic arthritis: symmetric, which is similar to rheumatoid arthritis; asymmetric; arthritis mutilans  (a severe deforming and destructive form); spondylitis (similar to symmetric), which causes a stiffness in the spine or neck although it may also affect the hands and feet, and DIP predominant, or inflammation and stiffness of the joints nearest to the ends of fingers and toes.

There is no cure for psoriatic arthritis. It is simply treated to try and alleviate some of the pain associated with it. Non-steroidal anti-inflammatory drugs (NSAIDs) help with the pain, swelling, and stiffness. Corticosteroids are used for a more mild form of psoriatic arthritis. They may be taken orally or injected directly into the bone.

Disease-modifying antirheumatic drugs (DMARDs) not only reduce pain and inflammation, but also prevent further damage to the affected joint.

Immunosuppressant medications are also utilized in the treatment of psoriatic arthritis. Although this type of medication suppresses the immune system, it prevents the body from attacking healthy tissues in patients with this form of arthritis.

TNF-alpha inhibitors are often prescribed in patients with severe psoriatic arthritis. This drug blocks the protein which causes inflammation in joints.

Surgery is rarely performed on a patient with this type of arthritis; however, a joint replacement surgery may be necessary.

Septic Arthritis

This type of arthritis is an infection of a joint. The joint infection occurs when bacteria, or fungi, from another part of the body invades the joint. Because joints have little protection from bacteria, once inside the synovium (the soft tissue that lines the non-cartilaginous within joints) the bacteria may easily begin destroying the cartilage.

The infection most commonly affects the knee, but may also harm the ankle, hip, wrist, elbow, and shoulder. Like a regular infection, some of the symptoms of septic arthritis are fevers and chills. Severe pain and swelling or warmth around the joint are also signs of this type of arthritis.

Treating septic arthritis is similar to treating any other type of infection. That treatment is intravenous antibiotics. Another form of treatment is draining the joint. This removes the bacteria from the joint, reduces pressure on the joint, and also allows the doctor to test the fluid to find what type of bacteria is present. Surgery is generally not performed on patients with septic arthritis.

Rheumatoid Arthritis

Rheumatoid arthritis (or RA) is a systemic inflammatory disorder that may affect many tissues and organs, but principally joints, producing an inflammatory synovitis (or inflammation of the synovial membrane). It often progresses to the destruction of the articular cartilage and ankylosis, causing stiffness in the joint. It is three times more likely to occur in women rather than men.

The cause of rheumatoid arthritis is unknown although we do have a general idea of how it forms. RA occurs when white blood cells move from your bloodstream into the membranes that surround your joints. It appears that the blood cells cause the synovium to become inflamed, which in turn causes the release of proteins. These proteins over time cause the synovium to thicken as well as damage the cartilage, bone tendons, and ligaments near your joint. Gradually, the joint begins to lose its shape and alignment, causing pain and discomfort.

Some of the symptoms of RA include joint pain and swelling, tenderness around a joint, firm bumps of tissue under the skin (rheumatoid nodules), fatigue, and morning stiffness. Diagnosis of rheumatoid arthritis is typically accomplished by symptoms and signs although blood tests and x-rays may also be used. One characteristic of RA is that it generally affects more than one joint at a time, starting with the smaller joints first.

There are multiple treatments for rheumatoid arthritis. At first, NSAIDs may be prescribed in order to dull the pain.

Corticosteroid medications, such as prednisone and methylprednisolone, may reduce inflammation and pain as well as slow joint damage. Corticosteroids are good for short term use; however, when used for months or years they may become less effective and even cause serious side effects.

Doctors may also prescribe DMARDs to limit joint damage caused by RA. Typically, these drugs are used in the early stages of arthritis in an effort to slow the disease and save the joints and other tissues from permanent damage. DMARDs generally take several weeks to take affect; therefore, doctors may combine them with other medications so that more immediate relief is accomplished.

Immunosuppressants may help to keep the body’s immune system in balance. Several of these medications actually attack and eliminate cells associated with this disease.

If medications do not alleviate the painful symptoms of rheumatoid arthritis, surgery may be necessary. One surgical option is an arthroplasty. This again is the removal of damaged parts of the joint with tendons or artificial parts.

Tendon repair is another surgical option. This procedure allows the surgeon to repair damaged joints where tendons may have become too tight or loose due to the disease.

Finally, doctors may recommend a synovectomy. This procedure is the removal of the synovium, or the tissues lining the joints. It reduces pain and swelling associated with RA as well as prevents and slows down the destruction of joints. The synovium often grows back and the problem may reoccur.

Contact our office for more information.

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