Arthritis: Types, Causes, Risk Factors, Symptoms, Diagnosis and Treatment

It can affect the joints in any part of the body, where two different bones connect.

Inflammation of one or more joints is arthritis. Today, more than a hundred different arthritis are known.

Arthritis is the collective name for any inflammatory joint disease.

Regardless of the causes of arthritis, the metabolism in the joints breaks down and the intra-articular cartilage thins.

This is followed by its inflammation, that is, there is swelling, paralysis or destabilization of the smoothness of the movement, and then the deformation of the joint occurs.

All arthritis is divided into two types: monoarthritis, when only one joint is affected, and polyarthritis, when there are many such joints.

Also, this disease can be acute and chronic.

Types of arthritis

Rheumatoid arthritis is just one of more than 100 types of arthritis.

It is the third most common type of arthritis behind osteoarthritis and gout (or gouty arthritis).

Other common forms of arthritis include psoriatic arthritis, juvenile rheumatoid arthritis or juvenile idiopathic arthritis, and polymyalgia rheumatica .

Osteoarthritis

Osteoarthritis, the most common form of arthritis, is thought to be the result of a complex interplay of several factors, including genetics, history of injury or trauma to the joints, patterns of joint use, and processes that occur. at the cellular level.

Osteoarthritis is subdivided on the basis of apparent cause as idiopathic (not related to another disease or trauma) or secondary (related to trauma or other primary disease).

Idiopathic osteoarthritis can be limited and affect only a local area or it can be general, affecting a variety of joints throughout the body.

Localized disease limited to a single joint can affect the feet, knees, hands, hips, and spine, and less commonly the shoulder, ankle, and wrists.

Generalized disease consists of involvement in three or more joints.

Secondary osteoarthritis is linked to injury or trauma, other musculoskeletal conditions, such as rheumatoid arthritis and gout, and a variety of diseases, including diabetes, hypothyroidism, and congenital disorders.

There are some recognized factors that increase the risk of osteoarthritis.

These include increasing age, female gender, obesity, sports activities, injury history, family history of osteoarthritis, and occupation involving movement that places mechanical stress on the joints.

The strongest risk factor for osteoarthritis is age, with a prevalence greater than 80% in individuals older than 55 years, compared to less than 1% in people between the ages of 25 and 35 years.

After age, female gender is the next strongest risk factor. Women face almost 3 times the risk of developing osteoarthritis compared to men.

Obesity is the strongest of the modifiable risk factors for osteoarthritis, with risk that varies by joint.

The joints that face the highest risk for osteoarthritis include the knees, hands, and hips.

The drop

Gout is a condition associated with significant pain and disability, arising from chronically elevated levels of uric acid in the blood.

Gouty arthritis is one of the most common forms of arthritis, characterized by attacks of acute inflammatory arthritis.

The painful joint symptoms associated with gout are the result of uric acid crystals forming in the joint cavities.

The same crystals can also form in the kidney or urinary tract.

In fact, 15% of people with gout develop kidney stones caused by the formation of uric acid crystals.

Several factors have been identified that increase the risk of developing gouty arthritis.

These include obesity, fasting, high blood pressure, injury, high alcohol consumption, taking medications such as diuretics that increase uric acid levels in the blood, excessive consumption of meats, seafood, and non-diet beverages that contain high corn syrup. fructose as soft drinks.

Additionally, in patients who have a history of gout, several factors have been identified that increase the risk of gout flare-ups.

The goal of treatment for gouty arthritis is to reduce inflammation and associated pain as quickly as possible.

Generally, several anti-inflammatory medications are used to achieve this goal, with the choice of medication based on patient factors, including risk of bleeding, ulcer history, and kidney health.

Nonsteroidal anti-inflammatory drugs used to treat gout include ibuprofen (Advil, Motrin), naproxen (Aleve), or indomethacin (Indocin).

Aspirin is also a non-steroidal anti-inflammatory drug, but it is not used in gout because it can increase blood levels of uric acid.

Nonsteroidal anti-inflammatory drugs are recommended for patients without a history of stomach or intestinal ulcer, who are not using anticoagulant treatment, are at low risk of bleeding, and who do not have a history of liver or kidney disease.

The earlier treatment with nonsteroidal anti-inflammatory drugs is started (before a flare-up develops), the better.

Other treatments for gout include colchicine, as an alternative to non-steroidal anti-inflammatory drugs.

This medication can be used safely in patients with ulcers and does not interact with anticoagulant therapy.

Used in an appropriate dose, it is not associated with impaired kidney function.

Glucocorticoids (prednisone, prednisolone, methylprednisolone) can also be used to control inflammation associated with gout in patients who are not candidates for treatment with non-steroidal anti-inflammatory drugs or colchicine.

Polymyalgia rheumatica

Polymyalgia rheumatica is an inflammatory arthritis and rheumatic condition that involves morning stiffness and pain, usually concentrated in the hips, neck, shoulders, and upper body.

As well as swelling in the larger joints such as the knees and less commonly, smaller joints such as hands, feet.

Swelling in the wrist can lead to carpal tunnel syndrome.

The condition can affect a patient’s ability to dress or perform certain common tasks, and it can also be associated with symptoms, such as fatigue, fever, decreased appetite, and weight loss.

The symptoms of polymyalgia rheumatica usually appear in patients older than 50 years.

The diagnosis is based on morning pain and stiffness on both sides of the body that lasts at least 30 minutes and has occurred for at least 1 month.

Symptoms should include two out of three areas of the body, including the hips or upper thighs, upper body, and neck, or upper arms and shoulders.

About 15% to 30% of patients who have polymyalgia rheumatica will also develop another inflammatory condition called giant cell arteritis that involves inflammation of the blood vessels in the neck and head and can include headache, jaw, vision, and other pain. symptom.

About half of patients with giant cell arteritis will usually also develop polymyalgia rheumatica.

Treatment for polymyalgia rheumatica usually includes glucocorticoids (commonly prednisone or prednisolone) to reduce inflammation.

Psoriasis arthritis

Psoriatic arthritis is a type of inflammatory arthritis and an autoimmune disease.

It is associated with a variety of symptoms involving joints, nails, and skin.

These include joint pain, with swelling and stiffness; sausage-like swelling (called dactylitis) affecting the fingers and toes.

Ankle or foot pain, damaged nails or a separation of the nail from the nail bed, pain affecting the lower back and coccyx may also occur.

The exact cause of psoriatic arthritis is unknown, but this condition is believed to be the product of a combination of genetic, environmental, and other factors.

Heredity appears to play an important role in the development of the disease and can account for around 40% of the risk of developing psoriatic arthritis.

Other factors such as abnormalities in the functioning of the immune system or exposure to certain bacteria or viruses can also play a role in increasing the risk.

The results of some studies suggest that exposure to streptococcal infection may be related to the development of both psoriasis and psoriatic arthritis.

Psoriatic arthritis is usually treated with a variety of medications that control inflammation and other symptoms, including nonsteroidal anti-inflammatory drugs, glucocorticoids, and disease-modifying antirheumatic drugs, including newer biologic therapies.

Exercise and physical therapy can also relieve joint pain and stiffness.

Juvenile idiopathic arthritis (juvenile rheumatoid arthritis)

Juvenile rheumatoid arthritis, generally known as juvenile idiopathic arthritis, is the most common rheumatic disease and one of the most common chronic diseases that affect children.

Juvenile idiopathic arthritis is distinct from rheumatoid arthritis for adults and covers a variety of forms of chronic arthritis in children, including a broader range of subtypes than the previous term that juvenile rheumatoid arthritis had covered.

As with rheumatoid arthritis for adults, juvenile idiopathic arthritis is believed to be the result of a combination of genetic susceptibility and some environmental or non-genetic factors that trigger the disease.

Juvenile idiopathic arthritis is defined as arthritis affecting a child under the age of 16 that lasts for at least 6 weeks and involves at least one joint.

It is characterized by joint effusion (an increase in the amount of synovial fluid in the joint).

The presence of a combination of symptoms including limited range of motion, pain or tenderness associated with joint movement, and increased heat in at least one joint.

Juvenile idiopathic arthritis subtypes include: systemic-onset juvenile idiopathic arthritis, juvenile idiopathic oligo arthritis; polyarthritis (positive or negative); psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis.

Treatment for juvenile idiopathic arthritis usually involves a combination of drug therapy (non-steroidal anti-inflammatory drugs, Cox-2 inhibitors, disease-modifying antirheumatic drugs, biologics).

And other modalities, including physical and occupational therapy and psychosocial interventions.

Early detection and treatment are crucial to avoid damage to joints and other structures and impaired growth.

Recent advances in treatment, including the advent of biologic therapies, have improved the outlook for patients with juvenile idiopathic arthritis and, in many cases, can limit the damage and allow patients to lead normal, active lives.

Causes and risk factors for arthritis

Joint inflammation can be the result of:

  • Autoimmune diseases.
  • Consequences of injuries and fractures.
  • Joint wear.
  • Infections, bacteria, or viruses.

The risk factors can be various.

There may be a malfunction in the immune system of the nervous system or a metabolic disorder.

Most often, the trigger for arthritis is trauma, hypothermia, infection, or a lack of vitamins.

When a harmful bacteria, virus or fungus enters the human body, the body tries to get rid of them independently.

For this, a person has a special weapon – immunity.

Here is our immune system and it begins to prepare an arsenal: it produces special substances or immune complexes that conflict with “foreign” particles.

But it is worth it that the immune system is weakened or has a defect, its own “troops” multiply very quickly and begin to destroy everything without understanding where their enemy is and where.

This ability to destroy does not happen even when the infection has already left the body, and the protective substances of the body do not want to recognize that the war is over and attack the joints.

This is a classic arthritis scheme.

Symptoms of arthritis

The main symptoms of arthritis can include:

  • Joint pain
  • Edema in the joint area.
  • Swelling of the joints
  • Stiffness and restriction of movements in the joint.
  • Redness of the skin around the joint.
  • Numbness of the joints, especially in the morning.
  • Increase in local temperature.

Diagnosis of arthritis

The doctor must first look at what condition the joints are in.

He will determine the presence of liquid around you.

You will pay attention to the skin: if there is redness, if the elevated temperature is felt around the joint.

The patient must “demonstrate dexterity” and the ability to move.

Then blood tests will be recommended.

An arthritis diagnosis is the first step to successful treatment.

To diagnose arthritis, the doctor will consider the symptoms, perform a physical exam to check for joint swelling or loss of movement, and use blood tests and X-rays to confirm the diagnosis.

X-rays and blood tests also help distinguish the type of arthritis you have.

For example, most people with rheumatoid arthritis have antibodies called rheumatoid factors in their blood, although rheumatoid factors can also be present in other disorders.

X-rays are used to diagnose osteoarthritis, which usually reveals a loss of cartilage, bone spurs, and, in extreme cases, rubbing of bone against bone.

Sometimes joint aspiration (using a needle to remove a small sample of fluid from the joint for analysis) is used to rule out other types of arthritis.

If your doctor suspects that infectious arthritis is a complication of some other disease, analysis of a sample of fluid from the affected joint will usually confirm the diagnosis and determine how it will be treated.

The most common blood tests used to help diagnose and treat arthritis include the following:

Complete blood count

The complete blood count is a series of blood tests that provide information about the different fractions of the blood, including red blood cells, white blood cells, and platelets.

Automatic machines quickly count cell types.

The results of complete blood count tests can help diagnose diseases and also determine the severity of the disease.

Under normal conditions, the white blood cell count is between 4,000 and 11,000.

A high white blood cell count could mean that there is inflammation, which can be caused by rheumatoid arthritis.

However, infections, stress, and exercise will also temporarily increase your white blood cell count.

A complete blood count also measures hemoglobin, a component of red blood cells that contains iron and carries oxygen.

Hematocrits are the percentage of the total blood volume that is made up of red blood cells.

Normal hematocrit values ​​are 39% to 51% for men and 36% to 46% for women.

A lower hematocrit can be caused by a number of factors or conditions, including rheumatoid arthritis.

Erythrocyte sedimentation rate

The erythrocyte sedimentation rate is a test in which a sample of blood is put into a tube to see how far red blood cells settle in an hour.

Inflammation in the body produces proteins in the blood, which causes red blood cells to clump together and causes them to fall faster than healthy blood cells.

Because inflammation can be caused by conditions other than arthritis, the red cell sedimentation rate test alone does not diagnose arthritis.

Rheumatoid factor

Rheumatoid factor is an antibody found in many patients with rheumatoid arthritis.

It is one of several methods used to diagnose rheumatoid arthritis (80 percent of rheumatoid arthritis patients have a rheumatoid factor in their blood), although other inflammatory or infectious diseases can also be the cause.

Antinuclear antibody

Patients with certain rheumatic diseases, such as lupus, produce antibodies that target the nucleus of the body’s cells.

These antibodies, known as antinuclear antibodies, are discovered by looking at the patient’s blood serum (a clear fluid separated from the blood) under a microscope.

More than 95 percent of lupus patients have a positive antinuclear antibody test.

However, patients with other diseases can also test positive for antinuclear antibody, and even perfectly healthy people can test positive for antinuclear antibody, so other tests must be completed before a test can be done. diagnosis.

When all these tests have been carried out, the doctor will prescribe the treatment.

Treatment of arthritis

Change in lifestyle

The most important thing that awaits the patient from the treatment is to get rid of the pain.

The patient hopes to restore the functions of his limbs.

At the same time, for a treatment participation plan the patient must first assume a “healthy lifestyle.”

When starting to treat arthritis, the following should be done:

Physical exercises

Nothing that requires the patient to overdo it, or that the doctor does not recommend.

Resistance exercises should be done at a moderate level of exposure to aerobic loads, in which the pulse and level of muscular effort are controlled so that an undesirable set of muscle mass is not produced.

These aerobic activities are intended to improve blood circulation, lift and strengthen muscles.

They will help burn excess calories and fat.

As a rule, these are quick and easy movements, like combinations of dances and physical exercises.

You will need to pay attention to developing flexibility with the help of a greater variety of movements.

It will be necessary to include strength training for muscle tone.

Physiotherapy

From physiotherapy, it will be advised to alternate heat and ice and will teach how to do it correctly. The massage will work very well.

Sleep normalization

Those who are used to surviving on minimal sleep need longer, deeper sleep, 8-10 hours per day.

You can mitigate the negative effect of the arthritis flare that has already struck and warn the next one.

Assume correct postures and movements

It is necessary to control the change of positions and movements. With arthritis, the patient cannot stay in one position for long.

Learning how to dose the load on sore joints is very important.

Even something seemingly “insignificant”, such as a railing in a bath or shower, will be your helpers in the fight for health. Use yoga and meditation.

Balance diet

Make an audit of what you eat and try to include in the daily diet vegetables and fruits, which contain many vitamins and minerals, especially vitamin E.

Get used to eating foods that are high in omega-3 fatty acids: such as fish (salmon, herring, mackerel), flax seeds, rapeseed oil, soybeans, soybean oil, pumpkin seeds, and walnuts.

Eliminate excess weight

You should try to lose weight, and thus feel a significant improvement, including greater ease of movement in the legs and feet.

Anesthetic creams and ointments

A special doctor-recommended cream can be rubbed on painful joints.

After 3 to 7 days, you can feel that the pain is decreasing.

Medicines

The drugs prescribed by the doctor must be used.

The first medicine for arthritis is acetaminophen.

And it should be taken as prescribed.

In this case, the dose should not be increased and the drugs should not be combined with alcohol: the liver will not support this mixture.

Aspirin, ibuprofen or naproxen are non-steroidal anti-inflammatory drugs, which belong to the group of drugs that have analgesic, antipyretic and anti-inflammatory effects, reduce pain, fever and inflammation.

However, they have many potential risks, especially if they are used for a long time.

Possible side effects include heart attack, stroke, stomach ulcer, gastrointestinal tract bleeding, and kidney damage.

There is a complete group of medications that are exclusively dispensed by prescription such as: enterecept, infliximab, adalimumad, abatacept, rituximab, among others.

But they have side effects. Depending on the type of arthritis, the medications can vary.

Your doctor may also prescribe corticosteroids (“steroids”): biologically active tetracyclic compounds produced by the cortical layer of the adrenal glands.