The terms arthritis and rheumatism are both commonly used to describe pain, swelling and stiffness of the joins, but there is a difference between the two. In its strictness sense, arthritis means, literally, inflammation (-itis) of the join (arthro-). Rheumatism, on the other hand, is more general term for pain and stiffness in the muscles, bones, joints and tendons. There are, in fact, many different types of arthritis, all of which are classified, together with connective tissue diseases that can affect not only the joints but the skin and internal organs as well as rheumatic disorders. Doctors who specialize in the diagnosis and treatment of arthritis and other rheumatic disorders – of which there are more than hundred – are called rheumatologists.
The most common type is osteoarthritis, which occurs mainly in people over 40. The next most common, and potentially the most serious, form is rheumatoid arthritis, which affects women more often than men and may strike at any age.
Osteoarthritis, or degenerative joint disease, is very common – almost everyone over 60 has it to some degree. In mild cases, the disease is almost indistinguishable from normal wear and tear on the joints. In others, degenerative process speeds up, suggesting the presence of a still unidentified trigger. Previous injury seems to be a contributing cause, as osteoarthritis often occurs at the site of earlier joint damage. Many people, however, get osteoarthritis in joint that have never been injured.
GOUT
Gout is an arthritic condition brought on by excess uric acid, which lodges in crystal form in the joints, and causes severe pain. The usual site of a first attack is the base of the big toe. There is visible swelling, the skin covering the affected are takes on a dry, red brightness, and the pain may be so acute that not even the touch of a sock can be tolerated. Later attacks may involve the knees, wrists and ankles, and may occur at increasingly frequent intervals. Chronic gout can lead to the formation of kidney stones or of large uric acid deposits, called tophi, under the skin.
There exists a secondary form of gout that isn’t inherited; this may be triggered by other diseases or by certain drugs. Blood pressure medications, for example, may hinder the body’s ability to dispose the uric acid.
WARNING SIGNS
Sometimes the onset of rheumatoid arthritis is preceded by a period of listlessness, muscle pain and appetite loss, after which specific symptoms of joint inflammation - swelling, redness, tenderness, stiffness, pain - appear. This gradual onset may make the disease hard to recognize at first. In other cases, inflammatory symptoms come on suddenly and without warning. The most common initial sites are the hands, feet and knees, with both sides often affected. The disease may also affect the neck, shoulders, elbows, wrists and hips.
SYMPTOMS
Osteoarthritis starts with slow but irreversible erosion of the cartilage layers which line opposing bone ends in a joint and ease joint movement. In the early stages of the disease, the cartilage begins to soften, crack and break loose; this restricts the motion of the joint, causes pain and inflammation, and may induce the bone to compensate by growing new bone. In time, the unprotected, raised ends of the bones may grind together. Mobility may then be further limited by the build-up of cartilage fragments and other debris in the joint. In the later stages of the disease, bone spurs may form at the damaged ends of the bone and, if they press on nearby nerves, the result will be further, severe pain.
Sensation of pain, visible swelling and stiffness in the joint, especially after you use it, are the usual early signs. They may occur sporadically at first, and continue intermittently for years before becoming troublesome enough to warrant medical attention. As the deterioration of the joint continues, however, the symptoms may begin to interfere with daily life. The pain become severe enough to disrupt sleep; osteoarthritis in the hip or knee can make walking difficult; in the spine, it can preclude bending and lifting; in the fingers or hands, it can make simple tasks like brushing teeth or laying the table a misery.
TREATMENT
The treatment of osteoarthritis consists of plenty of rest, to prevent overuse and irritation of the joints; regular moderate therapeutic exercise, to preserve mobility and strengthen the muscles supporting the joints; and aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. Application of moist heat and massage ar also helpful, while swimming and other aquatic activities (in which most of the body’s weight is supported by water) are both soothing and excellent for maintaining long-term condition and flexibility.
For servere discomfort, your doctor may recommend injecting corticosteroids – synthetic hormones with a strong anti-inflammatory affect – into acutely inflamed jointes. In cases of extreme joint degeneration, surgery to remove damaged tissue or replace a joint (usually hte hip or the knee) may be needed. The important thing is to consult the symptoms and to begin a treatment programme that will enable you to manage your arthritis rather than allow it to control you.
The treatment of rheumatic arthritis requires a team effort, involving not only you, the patient, but also your family, your doctor, a rheumatologist, physio- and occupational therapists and an orthopedic surgeon. The basic treatment programme consists of cautious therapeutic exercises, warm compresses and plenty of rest during flare-ups, and anti-inflammatory medication – usually aspirin and non steroidal anti-inflammatory drugs (NSAIDs). But, if necessary, your doctor may also prescribe additional and more powerful medications that require careful monitoring on his part as well as a high degree of cooperaton on yours. These so-called disease-modifying or remissive, agents include gold salts, penicillamine and azathioprine. They can halt and even reverse the course of severe rheumatoid arthritis. Corticosteroid drugs are usually reserved for resistant cases. Because these drugs can all cause potentially serious side effect or adverse reactions, it’s important for a patient to advise his physician immediately of all effects he may experience as a result of taking such drugs.