Major physical problems can be extremely miserable for people in this world, especially if they are painful and chronic. With 10 million cases each year in India, arthritis is one of the many diseases that are very prevalent. Let’s talk about its causes, symptoms, and possible treatments.
What is Arthritis?
We need to first define arthritis in order to discuss its causes and other related topics.
Arthritis, in simple terms, is the degeneration of bones over time. The place where two bones join is known as the joint. The caps of these bones are covered by a special tissue called cartilage. Cartilage is a very smooth tissue, which provides very little friction when two cartilages move past each other. It doesn’t have any nerve endings in it, and hence we don’t experience any feelings when it moves.
Arthritis is the loss of that cartilage at the ends of the bones. Now that the cartilage is gone, the bones rub against each other. The bone has a very rough surface in comparison to cartilage, and thus experiences friction. It also has many nerve endings in it, unlike cartilage, so when these two bones rub against each other, people sense that as pain.
Common Types of Arthritis and their Causes
There are multiple causes of arthritis. Again, arthritis is a generic term that means degradation or destruction of a joint, but there are multiple things that can cause the destruction of the joint.
The most common cause of arthritis is the wearing down of cartilage over time simply from the use of joints. The more and the longer we use those joints, the more worn down the cartilage will be, just like how the tread on our tires or the grip of the slipper goes away with time. This process is known as osteoarthritis.
Another common cause of arthritis is inflammatory arthritis. An individual has more inflammation in their body than normal. When there’s a lot of inflammation in a joint, it can lead to the destruction of that joint over time more rapidly than we would normally expect. Gout, or gouty arthritis, is also a common and complex form of arthritis.
Common examples of inflammatory arthritis would be Rheumatoid Arthritis, Psoriatic Arthritis associated with psoriasis, and Ankylosing Spondylitis, which is a form of systematic inflammation that tends to affect young men.
So, while osteoarthritis typically affects anyone over a certain age, rheumatoid arthritis is more common in women who are in their 20s, 30s, and 40s, and if left untreated, it can affect multiple joints in their body quite rapidly.
Symptoms of Arthritis
The primary and most common symptom of any type of arthritis is pain. The common areas to feel pain are in the joints, hands, hips, knees, lower back, or neck. Other symptoms people may notice are a subtle deformity in a limb, like a bump on the finger, or bony outgrowths in fingers or toes. People with arthritis of the knee, in particular, can notice that they may be becoming more “bow-legged” or more “knock-kneed” slowly over time.
Another symptom is stiffness, like a lack of motion at the joint as compared to what it was prior to the development of arthritis. Patients will also sometimes notice with hip arthritis a leg-length discrepancy, which means the leg that is affected by arthritis can be slightly short compared to the other side that does not have that problem.
Treatment of Arthritis
Arthritis is not a disease that we can stop or a disease in which we can completely halt the progression. Although it is a disease which we can symptomatically control, usually for a long period of time, before major interventions have to be undertaken. Unfortunately, arthritis typically gets worse and worse over time.
So the treatment of arthritis is basically divided into two categories.
There is non-operative management, and then there is surgery.
The treatment usually begins with non-operative management because it is usually low risk. Common non-operative management includes “activity modification,” which is just a way of saying to avoid activities that bother the joint affected by arthritis. Like if going up or down stairs are troublesome for a patient, then they should avoid it and use the elevator.
Besides activity modification, there are also common medications that are used for the treatment of arthritis. These are things that are available over the counter that you can get without a prescription from a physician, and these include anti-inflammatory medications like Advil, ibuprofen, naproxen, and then there’s also Tylenol.
In addition to the medications, other things that people try are braces, particularly for the knee, to help stabilize that joint, which can provide some patients with some relief, and also physical therapy. Physical therapy just strengthens the muscles and tendons around the joint, and that can provide some people with symptomatic relief, but it doesn’t reverse the process of degradation.
The final non-operative treatment in our arsenal is steroid injections. Steroid injections basically take a large dose of anti-inflammatory medication and put it right to where it’s needed in the joint, and that can provide people with a few weeks to several months of quite effective pain relief.
The decision to have surgery by the orthopaedic surgeon is ultimately taken by the patient. A physician may guide him to an appropriate choice but it is taken by the patient. The decision is not dictated by how good or bad the X-ray looks, but rather by how severe the patient’s symptoms are. Again, specifically pain, and how well it is being managed by the non-operative treatment. So if someone feels like they’re able to do most of their activities at a high functional level with non-operative management, then we continue with non-operative management.
After a certain time, though, most people will reach their limit, and they will find the symptoms and causes of intolerable arthritis. They are unable to do things at the level they want to function at, despite attempting non-operative management. At this point, doctors suggest they go through with the surgery.