Shoulder Arthritis

There are two joints in the area of the shoulder. One is located where the collarbone meets the tip of the shoulder bone and is called the acromioclavicular or AC joint. The junction of the upper arm bone with the shoulder blade is called the glenohumeral joint.
To provide good and effective treatment, your physician will need to find out which joint is affected and what type of arthritis you have. Three types of arthritis generally affect the shoulder.

Osteoarthritis is a degenerative condition that destroys the smooth outer covering of bone. It normally affects people over fifty years of age and is more common in the AC joint than in the glenohumeral shoulder joint.

Rheumatoid arthritis is a systemic inflammatory condition of the joint lining. It can affect people of all ages and usually affects multiple joints on both sides of the body.

Post-traumatic arthritis is a form of osteoarthritis that develops after an injury such as a dislocation or fracture of the shoulder. Arthritis can also develop after a rotator cuff tear.

Symptoms

The most common symptom of arthritis of the shoulder is pain, which is heightened by activity and worsens progressively. If the glenohumeral shoulder joint is affected, the pain is situated in the back of the shoulder and may intensify with changes in the weather. The pain of arthritis of the shoulder in the AC joint is focused on the front of the shoulder. Patients with rheumatoid arthritis may have pain in all these areas if both shoulder joints are affected.

Limited motion of the shoulder joints is another symptom. You may hear a clicking or snapping sound (crepitus) as you move your shoulder. It may become more difficult to comb your hair, to lift your arm or reach up to a shelf. As the disease furthers, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

Diagnosis

A physical examination and X-rays are needed to properly diagnose arthritis of the shoulder. During the physical examination, your physician will look for:

•    Weakness in the muscles
•    Tenderness and sensitivity to touch
•    Extent of assisted and self-directed range of motion
•    Any signs of injury to the tendons, muscles and ligaments surrounding the joint
•    Involvement of other joints
•    Creaking with movement
•    Pain occurring when pressure is placed on the joint

Arthritis of the shoulder can be confirmed if X-rays of an arthritic shoulder show a narrowing of the joint space, changes in the bone and the formation of bone spurs. If an injection of a local anaesthetic into the joint relieves the pain temporarily, the diagnosis can be confirmed.

Treatment

As with other arthritic conditions, initial treatment of arthritis of the shoulder is quite conservative: Rest or change of activities is suggested to avoid provoking pain - you may need to alter the way you move your arm to do things with your hand.

Taking of non-steroidal anti-inflammatory medications such as aspirin or ibuprofen to reduce inflammation is recommended.

Apply ice on the shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain.  If you have rheumatoid arthritis, your doctor may recommend a series of corticosteroid injections or prescribe a disease-modifying drug such as methotrexate. The taking of dietary supplements such as glucosamine and chondroitin sulfate may also be helpful.

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Rheumatoid Arthritis Medication

Two classes of medications are used in treating rheumatoid arthritis: quick-acting first-line drugs, and slow-acting second-line drugs. The first-line drugs, such as aspirin and cortisone, are used to reduce inflammation and pain. Hydroxychloroquinine and methotrexate are slow-acting second-line drugs which promote disease remission and prevent progressive joint destruction.

Most patients require aggressive second-line drugs, such, as methotrexate in addition to anti-inflammatory agents. Sometimes these are used in combination. In some patients with severe joint deformity, surgery may be required.

First-line Drugs

Acetylsalicylate, ibuprofen, naproxen, etodolacare are examples of non-steroid anti-inflammatory drug. NSAIDs can reduce pain, swelling and tissue inflammation. Aspirin is an effective anti-inflammatory medication for rheumatoid arthritis. It has been used as rheumatoid arthritis medication since ancient times.

The most common side effects of aspirin and other NSAIDs include ulcers, abdominal pain, stomach upset, and sometimes even gastrointestinal bleeding. To reduce side effects on the stomach, NSAIDs are usually taken with food. Some additional medications are often recommended to protect the stomach from the ulcer effects of NSAIDs. These include antacids, proton-pump inhibitors, misoprotosol, and sucralfate.

Rheumatoid arthritis medications like cortisteroids can be injected directly into tissues and joints or be given orally. They are more potent than NSAIDs in reducing inflammation and in restoring joint mobility and function. They are useful for short periods during severe flares of disease activity, or when the disease is not responding to NSAIDs. Their side effects include facial puffiness, weight gain, thinning of the skin and bone, cataracts, risk of infection, muscle wasting, easy bruising and destruction of large joints such as the hips.

Second-line or slow-action Drugs

Rheumatoid arthritis requires medications other than NSAIDs and corticosteroids to stop increasing damage to cartilage, bone, and adjacent soft tissues. The rheumatoid arthritis medications are also referred to as Disease-modifying Anti-rheumatic Drugs or DMARDs. They come in many forms and are listed below.

Hydroxychloroquinine is used over extended periods as rheumatoid arthritis medication. Side effects include skin rashes, muscle weakness, upset stomach and vision changes. Though vision changes are rare, patients taking hydroxychloroquine should consult an ophthalmologist.

For the treatment of mild to severe inflammatory bowel diseases, like Crohn’s colitus and ulcerative colitus, sulfasalazine is a widely used oral medication. Azulfidine is used to treat rheumatoid arthritis in combination with anti-inflammatory medications. Azulfidine is generally well tolerated and side effects include rash and upset stomach. Azulfidine is made up of sulfa and salicylate compounds and it should be avoided by patients with known sulfa allergies.

Methotrexate has gained popularity among doctors as an initial second-line drug because of both its infrequent side effects and effectiveness. It also has dose flexibility. Methotrexate is an immune suppression rheumatoid arthritis medication. It affects the bone marrow and the liver, even rarely causing cirrhosis. Persons taking methotrexate require blood test monitoring regularly of blood counts and liver function blood tests.

Gold salts are a popular rheumatoid arthritis medication throughout most of the past century. Gold thiomalate and gold thioglucose are given by injection, initially on a weekly basis for long durations. Side effects of gold – both oral and injectable, include mouth sores, skin rash, kidney damage with seepage of protein in the urine, and bone marrow damage with anaemia and low white cell count. Patients receiving gold treatment are routinely monitored with urine and blood tests.

D-penicillamine can be a helpful rheumatoid arthritis medication in some patients with progressive forms of the disease. Side effects include fever, chills, mouth sores, a metallic taste in the mouth, skin rash, stomach upset, kidney and bone marrow damage, and easy bruising. Patients on this rheumatoid arthritis medication require routine blood and urine tests. D-penicillamine rarely causes symptoms of other autoimmune diseases.

A number of immunosuppressive drugs are used as rheumatoid arthritis medication. They include methotrexate as described above along with, chlorambucil, azathioprine, cyclophosphamide and cyclosporine. Because of rather serious side effects, immunosuppressive medicines are generally kept aside for patients with very aggressive forms of the disease, or those with serious complications. The exception is methotrexate, which is not frequently associated with serious side effects and can be carefully monitored with blood testing.

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Rheumatoid Arthritis

Rheumatoid arthritis is a disease that causes chronic inflammation of the joints. It can also cause inflammation of the tissue around the joints, as well as other organs in the body. Autoimmune diseases are illnesses which occur when the body tissues are attacked mistakenly by the body’s own immune system. Patients with these types of diseases have antibodies in their blood which attack their own body tissues, where they can be associated with inflammation.

Rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. It is a chronic illness which can last for years and patients may experience long periods without symptoms. Rheumatoid arthritis is a progressive illness that has the potential to cause functional disability and joint destruction.

Causes of rheumatoid arthritis

The real cause of rheumatoid arthritis is not known and it is a very active area of worldwide research. Scientists believe the tendency to develop rheumatoid arthritis may be genetically inherited. Suspicions are that certain infections or factors in the environment might trigger the immune system to attack the body’s own tissues, resulting in inflammation in various organs of the body like the lungs or eyes.

Immune cells, called lymphocytes, are activated and chemical messengers, such as tumour necrosis factor are expressed in the inflamed areas. Environmental factors also play some role in the cause of rheumatoid arthritis. Recently, scientists have reported that smoking increases the risk of developing the disease.

Symptoms of rheumatoid arthritis

The symptoms of rheumatoid arthritis depend on the degree of tissue inflammation. When body tissues are inflamed, the disease becomes active. When the inflammation subsides, the disease goes into a remission. Remissions occur spontaneously or with treatment, and can last weeks, months, or years.

During remissions, symptoms of the disease go away, and patients normally feel well. When it becomes active again, the symptoms return. The return of disease symptoms and activity is called a flare or relapse. The course of a flare varies from patient to patient, and periods of flares and remissions are typical.

When the disease is active, symptoms include lack of appetite, low grade fever, fatigue, muscle and joint aches, and stiffness. Joint and muscle stiffness are usually most notable in the morning and/or after periods of inactivity. During flares, joints frequently become tender, swollen, red, and painful. This occurs because the lining tissue of the joint becomes inflamed, resulting in the production of excessive joint fluid. The synovium also thickens with inflammation.

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Psoriatic Arthritis

According to a survey by the Psoriasis Foundation, psoriatic arthritis is a type of arthritis that has been diagnosed in about 23 percent of people who have psoriasis. It normally affects the ends of the fingers and toes and the spine. The disease can be difficult to diagnose, especially in its milder forms and earlier stages. An early diagnosis is important for preventing long-term damage to joints and tissue.

Most people with psoriatic arthritis also have psoriasis. In very rare cases, a person can have psoriatic arthritis without having psoriasis.

Symptoms of psoriatic arthritis:
• Reduced motion range
• Pain and redness of the eye, similar to conjunctivitis
• Swelling, pain, stiffness and tenderness of the joints and surrounding soft tissue
• Nail changes, including lifting of the nail or pitting
• Morning tiredness and stiffness

Psoriatic arthritis can develop at any time. On a normal average, it appears about ten years after the first signs of psoriasis. It appears between the ages of 30 and 50 and affects men and women equally. Arthritis symptoms normally occur before any skin lesions, in about one of seven people with psoriatic arthritis. Psoriatic arthritis is thought to be caused by a malfunctioning immune system. It is usually milder than rheumatoid arthritis, but some patients have as severe a disease as patients with rheumatoid arthritis.

Psoriatic arthritis may start gradually with mild symptoms, or it can arise quickly. It is important to have an early and accurate diagnosis, as far as possible. If left without proper treatment, psoriatic arthritis can be a progressively disabling disease. As a matter of fact, one half of those with psoriatic arthritis already have bone loss by the time the disease is diagnosed.

There are no definitive tests for psoriatic arthritis but the onset of joint swelling and pain in persons with psoriasis should be a warning signal. Treatment involves disease-modifying and anti-inflammatory medications. Methotrexate is probably a good starting point. Additionally, drugs like etanercept, adalimumab, and infliximab are usually commenced soon after methotrexate.

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Osteoarthritis

Osteoarthritis is caused by the breakdown and eventual loss of the cartilage of the joints. Osteoarthritis is a kind of degenerative arthritis. Osteoarthritis is the most common type of arthritis, affecting over 20 million people in the United States. Osteoarthritis occurs more frequently with ageing. Osteoarthritis occurs more frequently in males before 45 years of age.

After fifty five years, it occurs more frequently in females. This type of arthritis commonly affects the feet, hands, large weight-bearing joints, such as the hips and knees and the spine. Osteoarthritis, which has no known cause, is normally referred to as primary osteoarthritis. When the cause is known, the condition is referred to as secondary osteoarthritis.

Primary osteoarthritis is normally related to aging. When we age, the water content of the cartilage increases and the protein makeup of cartilage degenerates. Continued use of the joints over the years inflames the cartilage, causing joint pain and swelling. Slowly, cartilage begins to degenerate by flaking or forming tiny crevasses. In later stages, there is a total loss of the cartilage cushion between the bones of the joints. Inflammation of the cartilage may also stimulate new bone growths to form around the joints. Osteoarthritis occasionally can be found in many members of the same family, implying a genetic basis for this condition.

Unlike other forms of arthritis osteoarthritis does not affect other organs of the body. The most common symptom of osteoarthritis is pain in the affected joints after prolonged repetitive use. Joint pain usually worsens later in the day. This can cause swelling, warmth, and creaking of the affected joints. Stiffness and pain of the joints can also occur after long periods of inactivity, for example, sitting in a movie hall. In severe cases, complete loss of cartilage cushion causes friction between bones, causing pain at rest or pain with limited motion.

Symptoms of osteoarthritis differ a great deal from patient to patient. Some persons can be debilitated by their symptoms. Others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on x-rays. Symptoms may also be intermittent. Patients with osteoarthritis of the hands and knees may also have years of pain-free intervals between symptoms.

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Knee Osteoarthritis

Knee osteoarthritis is a progressive condition usually found to occur among older patients. Knee osteoarthritis is characterized by a gradual degeneration of the surface cartilage of the knee. This, over a period of time slowly leads to further deformity of the knee and may result in complete loss of joint function.

Though the reasons leading to knee osteoarthritis is not known, there seems to be a genetic component. Obesity, trauma and even a fracture can lead to this form of arthritis.

Osteoarthritis affects each person differently. In some people, it progresses quickly; in others, the symptoms are more serious. Scientists do not know yet what causes the disease, but there can be a combination of factors, including being overweight, the aging process, joint injury, and stresses on the joints from certain jobs and sports activities

Even though osteoarthritis does not produce many initial symptoms, morning stiffness, pain with activity and mild swellings may occur over a period of time. A dull toothache like pain, especially with weather changes is common in the intermediate stages. No single test can diagnose osteoarthritis. Most doctors use a combination of the following methods to diagnose the disease and rule out other conditions:

A combination of tests, both physical and clinical are carried out before the doctor actually determines the nature of the condition and the subsequent treatment processes for knee osteoarthritis. The patient’s general health, including his reflexes, muscle strength and joints of the patient will be examined. The ability of the patient to walk, bend, and carry out activities of daily living will also be considered.

The main objectives of the treatment are to maintain normal physical function and reduce symptoms. This can be done with anti-inflammatory medications, carefully planned exercise programs, weight control and occasional steroid injections.  Injections of some of the precursors of cartilage and oral supplements such as glucosamine sulfate and chondrotin sulfate are other nonoperative therapies that have shown promise in the treatment of knee osteoarthritis.

Most people with knee osteoarthritis exercise best when their pain is least severe. Start with an adequate warmup and begin exercising slowly. Resting frequently ensures a good workout. It also reduces the risk of injury. A physical therapist can evaluate how a patient’s muscles are working. This information helps the therapist develop a safe, personalized exercise program to increase strength and flexibility

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Knee Arthritis

Osteoarthritis is the most common type of knee arthritis. Also called degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint. Bare bone is exposed within the joint, as the protective cartilage is worn away by knee arthritis.

Knee arthritis normally affects patients over 50 years of age. It is more common in patients who are overweight. Weight loss tends to reduce the symptoms associated with knee arthritis. There is also a genetic predisposition of this condition. Other contributing factors include ligament damage, trauma to the knee, and fractures to the bone around the joint.

Symptoms of knee arthritis tend to progress as the condition worsens. The symptoms do not always progress steadily with time. Quite often, patients report good months and bad months or symptoms that change with weather changes. So comparing the symptoms of arthritis on one particular day may not accurately represent the overall progression of the disease.

The most common symptoms of knee arthritis are:
•    Pain when engaged in various activities
•    Limited range of joint motion
•    Stiffness of the knee joint
•    Joint swelling
•    Tenderness in the joint
•    A feeling general weakness of the joints
•    Knock-knees or bow-legs

Evaluation of a patient with knee arthritis should normally begin with a physical examination and X-Rays. These serve as a baseline to evaluate later examination to determine the progression of the disease.

Treatment of knee arthritis must begin with the most basic steps and progress, possibly including surgery. Not all treatments are appropriate in every patient. A regular checkup with your doctor is required to determine which treatments are appropriate for your knee arthritis.

The following are the common treatments for knee arthritis:
•    Weight loss
•     Swimming
•    Walking
•    Physiotherapy
•    Anti inflammatory medications
•    Steroids like cortisone etc
•    Use of products like glucosamine to supplement joint wear
•    Arthroscopy
•    Osteotomy
•    Knee replacement surgery

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Juvenile Arthritis

Arthritis is an inflammation of the joints that is characterized by pain, swelling and heat. Nearly 300,000 children in the United States have some sort of arthritis. Arthritis can be short-term - lasting for just a few weeks or months, then going away forever. Or it can be chronic and last for months or years. In rare cases, it can last a lifetime.

The most prevalent form of juvenile arthritis is juvenile rheumatoid arthritis, or JRA. It affects approximately 50,000 children in the United States.

What Causes Juvenile Arthritis?

The medical community hasn’t figured exactly what causes rheumatoid arthritis in children. Research shows it as an autoimmune disease. To effectively manage and minimize the effects of arthritis, an early diagnosis is essential. There are many types of JRA. Understanding their symptoms and characteristics can help you help your child maintain an active, productive lifestyle.

Types of Juvenile Rheumatoid Arthritis

Normally, juvenile rheumatoid arthritis appears between the ages of 6 months and 16 years. The first signs are often joint pain or swelling and reddening or warming of the joints. The greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.

There are three major types of juvenile rheumatoid arthritis:

Girls are more affected by Polyarticular arthritis than boys. Symptoms include swelling or pain in five or more joints. The small joints of the hands are affected as well as the weight-bearing joints such as the neck, hips, ankles, feet, and knees. Additionally, a low-grade fever may appear, as well as bumps or nodules on the body on areas subjected to pressure from leaning or sitting.

Pauciarticular JRA affects four or fewer joints. Symptoms include pain, swelling of the joints or stiffness. The knee and wrist joints are commonly affected. An inflammation of the iris might occur with or without active joint symptoms. An ophthalmologist can detect early signs of this inflammation, called iridocyclitis or iritis or uveitis.

Systemic JRA afflicts the whole body. Symptoms include high fevers that often increase in the evenings and then suddenly drop to normal. During the onset, the child may feel very ill, appear pale, or develop a rash. The rash may disappear and then quickly appear again. The spleen and lymph nodes may become enlarged. Sooner or later, many of the body’s joints are affected by swelling, pain, and stiffness.

Signs and Symptoms of Juvenile Rheumatoid Arthritis

The first signs of arthritis can be subtle. Signs may include limping or a sore knee, finger, or wrist. Joints might suddenly swell and remain enlarged. Stiffness in the neck, hips, or other joints can also happen. Rashes may suddenly appear and disappear, developing in one area and another. High fevers tending to spike in the evenings and suddenly disappear are characteristic of systemic juvenile rheumatoid arthritis.

Diagnosing Juvenile Rheumatoid Arthritis

Determining if your child has JRA starts with your doctor taking a detailed medical history and conducting a thorough physical examination of the child. Your child’s doctor may take X-rays or perform blood tests to exclude other conditions that can cause symptoms similar to those of JRA. Additionally, some of the tests the doctor may perform while evaluating your child’s symptoms include:

•    Culture of the blood
•    ANA (antinuclear antibody)
•    Bone marrow examination
•    A complete blood count
•    Bone scan

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Inflammatory Arthritis

The most common form of inflammatory arthritis is rheumatoid arthritis. Osteoarthritis along with this particular type are the ones most common. Inflammatory arthritis causes inflammation of the lining of the joints. Rheumatoid Arthritis attacks healthy joint tissue for an unknown reason. This form of arthritis is known to affect both sides of the body at once.

Rheumatoid arthritis is one of the most debilitating forms of arthritis, and causes extreme pain in the joints, which eventually become deformed. These symptoms can lead to even the simplest of movements to be extremely painful and difficult to manage.  Unlike osteoarthritis, which results from wear and tear on the joints, rheumatoid arthritis is an inflammatory condition. The exact cause is not really understood. It is three times more common among women than in men and generally strikes between the ages of 20 and 50.

Inflammatory arthritis of the hip is characterized by a dull, aching pain in the groin, outer thigh, or buttocks. Pain usually worsens in the morning and lessens with activity. However, vigorous activity can result in increased pain and stiffness. The pain may limit your movements and make walking difficult.

There is practically no cure for rheumatoid arthritis. But with proper treatment, a strategy for prevention and control of conditions of inflammatory arthritis can be worked out. However treatment procedures are definitely followed depending on the type and location of the condition.

Infection of the joints can be eliminated, either through the use of medications or through surgical draining. Non invasive procedures may provide some relief with relatively few side effects or complications. Anti-inflammatory medications, such as aspirin, ibuprofen, and various cortisteroids in the form of creams, injections or oral intake are effective.

There are also prescriptions which can help in the control of inflammatory arthritis such as Methotrexate and Sulfasalazine.These medications are part of a drug category called DMARDs, or disease-modifying antirheumatic drugs. Physical therapy may be of tremendous help to the patient to increase the range of motion and also in strengthening muscles through various exercises. Swimming is a preferred exercise.

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Gout Arthritis

Diagnosis and treatment

Since time immemorial, gout has caused much human suffering and has been researched extensively by physicians.  Once known as the disease of kings and also the king of diseases, gout was seen as one of the leading causes of painful, disabling arthritis.  With scientific advances in medicinal research, gout has been all but conquered.  People who continue to suffer with gout often are found to be ignorant about new and effective treatments.

Excess uric acid in the body is recognized as the cause of gout.  The excess can be caused by:
•    Increased production of uric acid by the body.
•    Insufficient discharge of uric acid by the kidneys.
•    Increased intake of foods containing purines which are metabolized to form uric acid.

Certain seafood, meats, beans, and dried peas are very high in purines.  Alcohol can also increase uric acid levels and lead to attacks of gout.

Increased levels of uric acid in the blood may result in deposits around the joints.  Uric acid also can collect under the skin as tophi or in the urinary tract as kidney stones.

The sure and definitive diagnosis of gout depends on finding uric acid crystals in joint fluid during an acute gout attack.  Uric acid levels in blood alone can mislead, as they can be transiently normal or low.  Uric acid levels often are elevated in people who do not have gout.

Gout usually strikes a single joint rather suddenly and violently.  The episode begins with redness, heat, swelling, and pain – all the classic signs of inflammation.  Sometimes, gout can develop more slowly, involving multiple joints, resembling rheumatoid arthritis.  The big toe is normally affected first with distinct pain, called podagra. Since 1800s, colchicine has been the standard treatment for acute gout.  Common side effects of colchicine include nausea, vomiting, and diarrhoea.

When administered intravenously the side effects are less common.  Because side effects of colchicine are sometimes problematic, for the treatment of acute attacks of gout NSAIDS are commonly used.  Indomethacin is the most commonly prescribed NSAID for gout, but it must be watched for toxic side effects.  Aspirin and aspirin-containing products are not recommended during acute gout attacks.

For patients who have had multiple gout attacks or developed tophi or kidney stones, stabilising uric acid levels should be considered.  Probenecid helps the kidneys eliminate uric acid, and allopurinol blocks production of uric acid by the body.  The medicine of choice is found out by the amount of uric acid in the urine.

•    Gout affects about 840 out of 100,000 people.
•    Gout occurs commonly and at a younger age in men.
•    Gout is associated with diabetes, hypertension, hyperlipidemia, and obesity.
In almost all cases, gout should be well-controlled, with proper treatment.  Gout is seen as one of modern medicine’s success stories.

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