Disease of the joints

ARTHRITIS is a commonly encountered problem in the world. Patients with arthritis have innumerable doubts with respect to the occurence, the causes and the treatment. This article will highlight these aspects.

What is arthritis?

It is a disease of the joint or structures related to the joints.

Does arthritis affect only adults?

No. Arthritis occurs in all age groups.

How many arthritic diseases are there?

There are nearly 150 varieties.

What are the common arthritic disorders seen in children?

Rheumatic fever, juvenile rheumatoid arthiritis and hypermobility of joints.

What is rheumatic fever? What are its effects?

It is a disease mostly among children of five to 15 years. This disease follows an episode of upper respiratory tract infection caused by a bacteria called beta - hemolytic streptococcus. The child has fever with throat pain and this is followed in a few days with pain and swelling of the joints. The swelling keeps changing from one joint to another and is called migratory arthritis. Fortunately, the arthritis becomes completely alright without any residual deformity but rheumatic fever can affect the valves of the heart. In medicine it is said that "rheumatic fever licks the joint and bites the heart". Once these are affected, there is permanent damage and these children have to be on prolonged medical treatment and may even have to be taken up for heart surgery. Children with rheumatic fever are advised to take antibiotics like pencillin either as a tablet or an injection. Rheumatic fever can be prevented by improving nutrition, preventing overcrowding and prompt treatment of upper respiratory infection with antibiotics.

What arthritic disease is common in the younger age group?

It is commonly seen in the younger age group - between 24 and 40 years.

What is rheumatoid arthritis? How it is treated?

Rheumatoid arthritis is an inflammatory arthritis predominantly seen in the age group of 25 to 40. It is more common in women than men. The symptoms are pain, swelling and warmth of the smaller joints of the hands, feet, ankles, knees and elbows. These patients experience severe stiffness in the joints, especially in the morning. Research is being done to find out the cause. Basically the body has a defence system called the immune system that recognises its own joints as an enemy and starts a civil war. The joint gets inflammed and ultimately destroyed. Anti-inflammatory drugs like aspirin and ibuprofen are used to relieve pain and extinguish the fire of inflammation. These do not have any effect on the basic disease process. Gold, antimalarials, D-Penicillamine, Sulfasalazine and Methotrexate are the disease modifying drugs used in the management of rheumatoid arthiritis. These drugs have the potential to control the disease process and their administration is associated with side-effects. Patients ought to take the disease modifying drugs only under medical supervision. It is good to avoid steroids, since long term intake of steroids results in diabetes, hypertension, cataract and osteoporosis (bones become fragile).

What arthritic diseases are common in the elderly?

Osteoarthritis is the most commonly encountered disorder.

What is Osteoarthritis? How is it treated?

It is a disease where there is wear and tear of a joint. To reduce the friction and facilitate better movement in a joint, there is a structure called cartilage which covers the opposing ends of the bones which meet to form a joint. Due to repeated trauma and aging, this cartilage becomes thinner and there is friction between the bones within the joint. The patient experiences pain. The knees and hips are commonly affected. If left the knee gets affected. It is treated by administering pain killers and anti-inflammatory drugs to give symptomatic relief. These drugs should be used with utmost caution in the elderly since they are associated with side-effects like gastric ulcers and even damage to the kidney.

Patients with osteoarthritis should avoid self medication. Other suggestions are weight reduction, usage of walking aids and joint protection (viz., usage of knee cap, using a dining table and sleeping on a cot). Patient education regarding chronic nature of disease and the need for prolonged treatment and an exercise programme go a long way in preventing these patients doing doctor shopping.

Is there any special diet for patients with arthritis?

There is no special diet. Patients have to have a well balanced diet and maintain normal body weight. The only arthritic condition in which dietary restriction is imposed is a condition called gout in which these patients have to avoid high quality protein foods (non-vegetarian) and soya beans.

What is the role of physiotherapy in arthritis?

Physiotherapy does form a sheet anchor in the management of patients with arthritis. These patients are prescribed a regular exercise programme which helps to maintain joint motion and prevent deformities. Other modalities of treatment in physiotherapy include application of heat or cold, traction and assisted exercises.

Is arthritis curable?

The minority are curable and the majority are controllable depending upon the type of arthritis which is encountered. Patients have to understand the chronic nature of the disease so that they are compliant with treatment and modify their lifestyle.

Is the pain in arthritis due to involvement of the nervous system?

It is a myth that patients assume that arthritis is a neurological disorder which will result in paralysis. Arthiritic diseases are rheumatological disorders whose origin is from the joints.

DR. S. RAMAKRISHNAN

The writer is consultant rheumatologist, Sundaram Medical Foundation, Dr. Rangarajan Memorial Hospital, Chennai.

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