Rheumatoid Arthritis and Osteoarthritis

It can also produce inflammation in the lungs, heart and eyes as well as lesions under the skin. RA can be a disabling and painful condition causing substantial loss of function and mobility.

Early symptoms of RA include fatigue, joint pain, and stiffness. As it progresses, rheumatoid arthritis symptoms may be similiar to flu with muscle aches and loss of appetite. In most people symptoms develop gradually over several years, but in some patients it progresses rapidly or they may have symptoms for a limited period of time and then enter a period of remission. RA is two to three times more common in women than in men, although men tend to be more severely affected when they get it. Symptoms usually begin to develop in middle age although it may also affect young children.

The exact cause of rheumatoid arthritis is unknown, but it is thought to be due to a combination of genetic, environmental and hormonal factors. Something seems to trigger the immune system to attack the joints and sometimes other organs: some theories suggest that a virus or bacteria may be altering the immune system.
Research has been unable to determine exactly what role genetics plays in rheumatoid arthritis, however some people do seem to have a genetic or inherited factor that increases their chance of developing rheumatoid arthritis.

Once the immune system is triggered cells migrate from the blood into the joints and tissue that surrounds them. The immune cells then produce inflammatory substances which cause irritation, wearing down of cartilage (cushioning material at the end of bones) and swelling. This inflammation of the joint lining stimulates it to produce excessive fluid, and as the cartilage wears down the space between the bones narrows. If the condition worsens, the bones can rub against each other and as the joint lining expands it may erode the adjacent bone resulting in irreversible bone damage.

Most people with rheumatoid arthritis have a rheumatoid-factor antibody in their blood that can be detected in a laboratory test. However, the rheumatoid factor may also be present in some people who do not have arthritis and other diseases can also cause it to be produced. Therefore, the diagnosis of rheumatoid arthritis is based on a combination of the joint symptoms and appearance as well as laboratory information. A newer, more specific blood test for rheumatoid arthritis is the citrulline antibody test. When positive, it is very suggestive of rheumatoid arthritis. Citrulline antibody presence also implies a tendency toward a more aggressive form of rheumatoid arthritis.

There are many different treatments for rheumatoid arthritis. Medications are available to decrease joint pain, swelling and inflammation and some of these medications prevent or minimize the progression of the disease. There are also several stronger medications called disease-modifying antirheumatic drugs (DMARDs) that usually work by interfering with or suppressing the immune system attack on the joints.
A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups it is best to rest the joints that are inflamed, sometimes with the temporary use of a cane or joint splints. When joint inflammation is decreased, exercise programs are suggested to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility.

When joint damage from the arthritis has become severe or pain is not controlled with medications, surgery may be an option to help restore function to a damaged joint.

Osteoarthritis is also known as degenerative arthritis. It is the most common arthritis condition, affecting over 20 million people in the United States.

Osteoarthritis occurs more frequently as we age: before age 45 it occurs more frequently in males and after age 55 years it occurs more frequently in females. Osteoarthritis commonly affects the hands, feet, spine, hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.

Primary osteoarthritis is mostly related to aging, although it can occasionally develop in multiple members of the same family implying a genetic basis. As we age the water content of the cartilage increases and the protein makeup degenerates: eventually the cartilage begins to flake and form tiny cracks. Repetitive use of the worn joints over the years also irritates and inflames the cartilage and can also stimulate new bone growths (spurs, also referred to as osteophytes) to form around the joints. In advanced cases there can be a total loss of cartilage in the joints. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility.

Secondary osteoarthritis is caused by another disease or condition:

  • Obesity is the most powerful risk factor for osteoarthritis of the knees due to the increased mechanical stress on the cartilage.
  • Repeated trauma or surgery to joint tissues
  • Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.
  • Congenital abnormalities: some people are born with abnormally formed joints that are vulnerable to mechanical wear
  • Hormone disturbances, such as diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms, others may have remarkably few symptoms in spite of dramatic degeneration of the joints. Symptoms also can be intermittent. It is not unusual for patients with osteoarthritis of the finger joints of the hands and knees to have years of pain-free intervals between symptoms.

There is no blood test for the diagnosis of osteoarthritis, although one may be performed to exclude other diseases or conditions. X-rays are commonly used to detect loss of joint cartilage, narrowing of the joint space between adjacent bones and bone spur formation. Joint fluid analysis (arthrocentesis) is useful in excluding gout, infection, and other causes of arthritis, and injection of corticosteroids into the joints during arthrocentesis can help relieve pain and inflammation. Arthroscopy is a surgical technique used to detect and sometimes repair abnormalities in the cartilage and ligaments. If successful, patients can recover from the arthroscopic surgery much more quickly than from open joint surgery.

There is no specific treatment to halt degeneration or repair damaged cartilage in osteoarthritis. The goal is to reduce joint pain and inflammation while improving and maintaining joint function. Rest, exercise and weight reduction are particularly important. Exercise strengthens the muscular support around the joints and improves and maintains joint mobility. Medications such as acetaminophen can relieve pain in osteoarthritis of the knees. Cortisone injected directly into the inflamed joints can decrease pain and restore function, but repetitive cortisone injections can be harmful to the tissues and bones and are reserved for patients with more pronounced symptoms. Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments. Arthroscopy, discussed above, can be helpful when cartilage tears are suspected. Osteotomy may help realign some of the deformity in selected patients. In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty).

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