<h1>Arthritis- Causes & treatment</h1>

Joint pain is a very common condition. It can be due to

Rheumatoid arthritis

Osteoarthritis

-

Many old people get affected especially LADIES after 40 years of age. Arthritis is a chronic and disabling condition and it limits the patient’s activities. So this can become a “Crippling disease’

Rheumatoid arthritis –

Rheumatoid arthritis is a systemic autoimmune disease which causes inflammation and tissue damage in
joints (arthritis), cartilages, synovitis and tendon sheaths,
An association exists between RA and Human Herpes Virus (HHV6 )
Epstein-Barr virus (EBV) infection
It’s a polyarthritis affecting women 3 times more commonly than men
Joints involved-
Small joints of hand, feet and cervical spine are affected
Larger joints - shoulder and knee
Morning stiffness of joints creates a lot of discomfort and problems.

Systemic manifestations of RA

Anemia.
Inflammation in the
Sclera of the eye
Pericardium,
Pleura, and
Lungs,

Skin –
The most characteristic sign - subcutaneous rheumatoid nodule
• Erythema nodosum
• Pyoderma gangrenosum, a necrotizing dermatosis

Heart
Pericarditis,
Endocarditis
Cardiac failure

Kidneys
Vasculitis causes glomerululopathy.
Amyloidosis due to chronic inflammation.

Lungs
Pleural effusions
Lung fibrosis

Vasculitis

Eye
. Scleritis-
Its a very painful eye condition. Eye becomes red, congested. Necrotising scleritis can occur
. Episcleritis
. Keratoconjunctivitis sicca leads to dry eye, dry mouth. This is called as Sjogren's syndrome
. Seronegative arthritis can be associated with many eye problems like conjunctivitis, uveitis, etc.



Hematological ( changes in blood)
Anemia
Neutropenia.


Constitutional symptoms
Low grade fever, weight loss, malaise, morning stiffness, loss of appetite and
Fatigue,

Investigations -

. Rheumatoid factor (RA) – This is an autoantibody
. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein
. Liver enzymes, renal function,
and other immunological tests (e.g. antinuclear antibody/ANA)


American College of Rheumatology Diagnostic criteria
• 1, 2, 3, 4 for at least 6 wks
• 1. Morning stiffness of >1 hour most mornings
• 2. Arthritis and soft-tissue swelling of >3 of 14 joints joint groups
• 3. Symmetric arthritis
• 4. Arthritis of hand joints
• 5. Subcutaneous nodules in specific places
• 6. Rheumatoid factor - level above the 95th percentile
• 7. Radiological changes of joint erosion

Management -
It is not a curable disease. Rx is aimed at reducing symptoms.

Orthopedic & immunological consultation is necessary.


Rheumatoid arthritis is a systemic disease . Joints involved- Small joints of hand
Morning stiffness of joints creates a lot of problems.

Finger deformities occur in longstanding cases

Boutonniere fingers

The finger is painful and swollen around the PIP ( proximal interphalangeal joint) joint in early stages.
Orthpedician will advise X-ray to rule out any avulsion fracture.
Other conditions that can cause the boutonniere deformity are - burns and prolonged inflammation of proximal interphalangeal joint


Swan-neck deformity


Joints involved- Small joints of hand

Finger deformities occur in longstanding cases


Boutonniere fingers
Swan-neck deformity

Seronegative arthritis can be associated with many eye problems like conjunctivitis, uveitis, etc.

Osteoarthritis-

It occurs due to calcium deficiency which leads to bone weakness. Bones get fractured easily. Old people should be careful to avoid falls in bathroom ( which is very common), etc as they develop fracture femur easily. This again limits activity




Nonsteroidal anti-inflammatory analgesic drugs offer symptomatic relief but they don’t cure the disease.
Disease modifying anti-rheumatoid drugs like
Chloroquine, hydroxychloroquine, D-penicillamine are used.

Hydroxychloroquine is preferred over chloroquine as it has less eye related side effects.


Corticosteroids

– Act as immunosuppressants & try to reduce tissue damage

Recent advances in management

Joint replacement surgery –
Done for hip and knee joints.
People who have these types of problems can join online support groups and discuss their problems
Physiotherapy has an important role in management.



Immunomodulators

Read more-

Joint Pain

Lipids-Enemy of health
Arthritis can become a chronic problem.
For help - contact drsrb1@gmail.com