arthritis Images (Click to view larger image)
rheumatism, joint inflammation
Arthritis is the name for irritation in a joint, which often becomes swollen, painful, and stiff.
Arthritis can occur for many reasons. Osteoarthritis is a degenerative process, and is also called wear and tear arthritis. Many other kinds of arthritis are inflammatory. These include rheumatoid arthritis, psoriatic arthritis and some connective tissue disorders. Disorders of metabolism cause gout and pseudogout. Infections cause septic arthritis and viral arthritis (such as Ross River disease). Mechanical problems can also lead to arthritis. This may happen when joints are not aligned properly, or as the result of a fracture or dislocation.
Often the lining of the joint, the synovium, becomes inflamed. It reacts by producing extra synovial fluid, resulting in a swollen joint. The smooth white surface of the joint, the hyaline cartilage, can become thin, worn, and rough. Any joint in the body can be affected by one or another form of arthritis. Sometimes one joint is affected, other times many. Sometimes the pattern of affected joints is symmetric, other times it is not.
What are the signs and symptoms of the condition?
The affected joint is usually painful, stiff, and swollen. Weight bearing, walking, and motion can be difficult. Weakness and deformity of the joint may occur.
What are the causes and risks of the condition?
Risk factors for arthritis include old age, injury to the joints, infections, and diabetes mellitus. There may be a genetic or hereditary tendency to arthritis.
What can be done to prevent the condition?
Trauma to the joints should be avoided as much as possible. If there is an injury or infection, it should be treated promptly. For example, a severe ankle sprain that is not properly splinted may lead to osteoarthritis. Inflammatory arthritis (such as rheumatoid) should be treated as early as possible to minimise long term damage.
How is the condition diagnosed?
Diagnosis is based on symptoms of pain, swelling, stiffness and limited function of the joint. Signs of arthritis include tenderness, restricted motion, swelling, and weakness. Limping in the legs and rubbing or grinding of the joint are other signs. X-rays can be normal at first, perhaps showing some swelling. Later the X-rays may show narrowing of the joint space, roughness of the joint surface, or malalignment of the joint. Bone spurs, which are calcium deposits at the edge of the joint, may also be seen. Blood tests can help determine certain types of arthritis. Aspiration, which involves removing joint fluid with a needle under local anaesthesia, can sometimes provide useful information. Rarely, a magnetic resonance imaging (MRI) is needed to determine the cause or extent of the arthritis.
What are the long-term effects of the condition?
The function of the joint may continue to decline, with more pain, stiffness, and swelling. The amount and rate of decline depend on the type of arthritis and the effectiveness of the treatments that are available.
What are the risks to others?
Arthritis is not contagious, so others are not at risk.
What are the treatments for the condition?
Treatment varies quite a bit, depending on the type of arthritis and its severity. The age, health, and activity level of the person also help decide on treatment options. Reducing the level of activity, using non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or celecoxib, ice or heat, and careful exercises can help to relieve symptoms. Some form of support, such as a cane, crutches, or a brace, may also help.
For some forms of arthritis, orals corticosteroids, such as prednisone, can work very well. They can be taken by mouth or injected into the joint. A change in diet can help certain forms of arthritis. Losing excess weight can help, especially when the legs are affected by arthritis. If there is a bacterial infection of the joint, antibiotics are critical. In this case, the joint is drained by repeated aspiration or by open surgical drainage.
Several types of surgery may be done:
What are the side effects of the treatments?
- Arthroscopy is done with a small scope and instruments to get inside the joint without opening it up
- Arthrotomy means opening the joint through a larger incision
- Synovectomy is the removal of the lining of the joint
- Osteotomy refers to the realignment of the bone next to the joint
- Arthroplasty is the partial or total replacement of the joint
Side effects depend in part on which drugs are used. Surgery is usually effective, although some problems may continue. The person may still have some pain, stiffness, deformity, and instability. Possible complications of surgery include infection, bleeding, and blood clots. Nearby bones, ligaments, tendons, nerves, or blood vessels can also be accidentally injured.
What happens after treatment for the condition?
Exercises to maintain the range of motion and strength of the surrounding muscles are very important.
How is the condition monitored?
A doctor will monitor the person's level of comfort and function of the joint.
Author: John A.K. Davies, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request