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Arthritis: Symptoms, types, diagnosis and treatment
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Arthritis: Symptoms, types, diagnosis and treatment

Different types of arthritis can affect different ages
arthritis
Representational image | Shutterstock

Arthritis is the pain and swelling of one or more joints in the body that tends to worsen with age. 

Two bones meeting at a joint are covered at their ends by a slippery tissue called the cartilage. Cartilage acts as a cushion for the smooth actions of the two bones during activity. These joints are usually enclosed within a strong capsule, filled with a lubricating fluid, to keep the bones in the right position. If there is recurrent pain at any joint, it is an indication of arthritis. 

Childhood arthritis: When arthritis affects children before they turn 16 years, it is usually chronic, called Juvenile Idiopathic Arthritis (JIA).   

Gout: It is a typical inflammatory type of arthritis, and starts to affect one joint at a time. It begins with sudden pain, especially in the big toe, and lasts for a few days.  

Osteoarthritis– There is excessive wear and tear of cartilage. As a compensation for loss of this shock absorber, bits of bone begin to grow and the ends of the bones lose their smooth edge. Movement is painful and may create a grating sound when the joint is active. Production of lubricating fluid increases and this causes a change in the shape of the joint. 

Rheumatoid Arthritis(RA) affects many joints at once, like knees and wrists. The lining of the joints undergoes inflammation and damages tissue and causes deformity of joints. 

Symptoms 

  • JIA – Common to all types of JIA are a continuous pain, swelling and warmth of joints. Younger children may not complain of pain but may start limping in the morning due to stiffness, and face difficulty performing normal activities. The symptoms may persist for many weeks to months and subside for some time. Along with joints, eye disorders like cataracts, glaucoma are common in children.  
  • Osteoarthritis – affects women more, and usually after the age of 45. It results in aches while walking and stiffness on rest, particularly of the knees and hips. Patients have difficulty performing routine tasks that involve movement of joints. Affected joints are generally warmer than other normal joints. 
  • Gout – Patients are woken up with intense pain, usually after alcohol consumption or increase in stress. This attack lasts for a few days, and there may be a long gap till the next attack. There is redness, heat, and swelling of affected joints, with stiffness and prolonged discomfort. Besides the big toe, ankles, knees, elbows or fingers may be affected. 
  • Rheumatoid arthritis – Usually occurs bilaterally and starts in the smaller joints. Patients complain of prolonged swelling, loss of balance, pain and stiffness in joints especially in the mornings. There are intermittent periods of relief from symptoms, followed by flare-ups. Patients have a feeling of sickness and fatigue. About 20% of patients develop lumps called rheumatoid nodules on their skin. 

Causes 

  • Childhood arthritis has no definite cause and is believed to be an autoimmune disorder. 
  • Gout is due to excess uric acid in the body. These uric acid crystals start to build up in joints and tissues in the body. Diets which include more red meat and certain seafood contribute to higher uric acid. Alcohol, certain medications, diabetes, obesity also increase the chances of gout. 
  • Osteoarthritis occurs due to the damage to cartilage. It often happens when the patient is overweight. 
  • Rheumatoid arthritis is an autoimmune disorder. It is believed to occur as a response of the patient’s own immune system to an infection. This leads to inflammation and damage of the joints. 

Diagnosis 

  • Gout can be confirmed only when the symptoms are present, and when the affected joint is swollen. Lab tests can then confirm the presence of uric acid crystals in the joint. 
  • Osteoarthritis and Childhood arthritis are confirmed through symptoms, X-rays and lab tests. 
  • Rheumatoid arthritis – Blood tests for high levels of Rheumatoid factor, and other proteins indicate inflammation. AntiNuclear Antibodies(ANA) confirms autoimmune disease. 
  • Routine tests like Complete Blood Count, ESR, C-reactive protein. 
  • X-rays, MRI and ultrasound to study the condition of the joints. 

Treatment 

There is no definitive cure for arthritis. 

Childhood arthritis – After a few flare-ups, some children experience permanent relief. But any damage to joints cannot be reversed. When just a few joints are affected, steroids are injected into the joint. Low doses of oral steroids are given for a short period. Disease modifying antirheumatic drugs (DMARDs) are the next line of treatment. 

Gout – Pain is managed using NSAIDs. Stopping certain medications and changing diet, limiting alcohol and losing weight can help. Allopurinol is given to reduce uric acid levels. 

Osteoarthritis – NSAIDs help to relieve symptoms. Physiotherapy and increase in activity levels are advised. Weight loss is helpful. 

Rheumatoid Arthritis – NSAIDs are given for pain. DMARDs help to slow down the rate of RA. Methotrexate alone with hydroxychloroquine is usually prescribed. Genetically modified drugs called biologics and biosimilars are given when conventional drugs provide little relief. Corticosteroids like hydrocortisone and methylprednisolone are prescribed for flare-ups and for chronic cases. Patients are advised to reach a moderate weight and undertake activity. 

Surgery: In extreme cases involving damage mostly in major joints like knees, elbows and hips, your doctor may advise total joint replacement surgery. 

References: 

https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html  

https://www.niams.nih.gov/health-topics/juvenile-arthritis 

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