Osteoarthritis

In osteoarthritis (OA), the protective cartilage and fluid inside the joint begin breaking down due to years
of use or injuries. This makes the movement of affected joints more difficult and painful. In time, bones
may rub directly against one another inside the joint, causing severe pain. Inflammation can also result
from this constant, painful friction. OA most often affects knees, hips, hands, and the spine. In most
cases, OA does not affect the same joint on both sides of the body, such as both knees.
The intensity of pain varies from person to person. It can range from mild to moderate and may be
manageable with drugs and regular physical activity. But for some it can be debilitating, making any
movement of the affected joint almost impossible.
To ease pain and reduce inflammation, regular doses of nonsteroidal anti-inflammatory drugs (NSAIDs)
are needed. To only relieve pain, acetaminophen may be effective with fewer gastrointestinal side effects.
If pain is severe, an analgesic combined with an opioid, such as codeine or hydrocodone, is prescribed. In
severe cases, surgery to replace the damaged joint may be the only effective treatment.
Non-medicinal pain relief has proven very beneficial for people with OA. These treatments include hot &
cold therapy, topical rubs, exercise, physical therapy, and others.
Rheumatoid Arthritis
In rheumatoid arthritis (RA), the joints are attacked by the bodys own immune system. The immune
system normally protects a person from viruses, bacteria and other invaders. In people with autoimmune
conditions (like RA), it becomes overactive and attacks healthy tissue. In the case of RA, the immune
system goes after the lining of the joints, called the synovium. This causes a severe, chronic inflammation
in the affected joints as well as low-grade inflammation throughout the whole body. Over time, the
persistent inflammation breaks down the joint and damages it permanently. RA typically affects the joints
on both sides of the body, such as both knees or both hands. Besides joints, RA can also affect internal
organs like the liver, heart, spleen, and eyes.
People with RA often have flares of pain caused by sudden onsets of severe inflammation. The flares
may last for days or weeks.
The pain caused by RA is usually treated by medications to control the disease by calming down the
malfunctioning immune system. These include disease-modifying antirheumatic drugs (DMARDs) and
biologic response modifiers (biologics). In addition, NSAIDs or analgesics may be taken.
In children, this type of inflammatory arthritis is called juvenile idiopathic arthritis (JIA).
Psoriatic Arthritis
Like in RA, in psoriatic arthritis (PsA) the immune system attacks the joints and causes inflammation and
pain. It typically appears in people who have psoriasis. PsA can affect any joint in the body.
Besides swollen joints, PsA often causes tenderness or pain in the connective tissue where tendons or
ligaments attach to bones (called the enthesis), such as at the heel or bottom of the foot. Lower back pain
is also common.
The pain and inflammation in PsA is managed similarly to RA.
Fibromyalgia
In fibromyalgia, chemicals that transmit signals between nerve cells (called neurons) are out of balance.
This may cause the brain to sense pain more intensely. The imbalance can also disrupt the persons
ability to sleep deeply, which can lead to an increased sensitivity to pain. Fibromyalgia pain affects the
bodys soft tissues, including muscles, rather than the bones and joints.
Unlike in other arthritis-related diseases, in fibromyalgia there are no visible signs of the disease or injury
in the affected areas. Fibromyalgia is characterized by widespread musculoskeletal pain. Areas of pain
are often near joints, and are usually very sensitive to touch and prone to intense pain. The pain may
come and go or it may be constant. It can also migrate from one area of the body to the next (from the
neck to shoulders and elbows). Besides pain, fibromyalgia is associated with other symptoms, such as
fatigue, concentration problems, and mood disturbance.
To relieve fibromyalgia pain, doctors often prescribe drugs that fix the balance in the neurochemicals.
These include antidepressants like selective serotonin re-uptake inhibitors (SSRIs) and anticonvulsant
drugs like pregabalin (Lyrica). Among non-pharmacologic treatments, they also prescribe exercise, and
acupuncture is helpful too.
Gout
In gout, high levels of uric acid is the problem. Uric acid forms when the body breaks down purines,
substances that are found in the body as well as in some foods. When body the is unable to remove the
uric acid quickly enough or if the body produces too much, it can build up in the blood (called
 hyperuricemia). Excess uric acid can form crystals in the joint. This results in painful joint swelling and
inflammation. If gout goes untreated, these crystals can form lumps (tophi) in the affected joints or even
surrounding tissues. Gout usually strikes in the large joint of the big toe, but can also affect other joints.
Most forms of arthritis pain develop and intensify slowly over time. With a gout flare, however, you can go
to bed feeling fine and wake up with excruciating pain and tenderness.
First, the pain and inflammation of the initial attack is treated with NSAIDs, corticosteroids, or a drug
called colchicine (Colcrys). Once the gout attack subsides, usually within days, several medications
designed to control uric acid levels are available. You and your doctor will decide which one is best for
you. Lifestyle changes, such as drinking more water and avoiding alcohol and purine-rich foods can also
help prevent future gout attacks.
Other Arthritis-Related Diseases
Other forms of arthritis that cause joint pain include:
Ankylosing Spondylitistypically affects the spine and the joints of the pelvis;
Polymyalgia Rheumaticatypically affects upper arms, neck, buttocks and thighs, and the
aches and stiffness are most severe in the morning; the disease affects people over 50 years old and
responds quickly to treatment with corticosteroids;
Tendinitis and Bursitissoft-tissue rheumatic conditions, in which the connective tissues and
cushioning joint components become inflamed and painful.

Boutonniere deformity: This describes a condition where the PIP joint will not straightened under its own
power (actively) but can be straightened by the other hand (passively). In addition the end joint of the
finger (DIP joint) over straightens and will not bend (flex) fully. Patients typically present in young
adulthood following an injury or later (40yo and onwards) due to some joint arthritis. With enough MP joint
(first joint of the finger) excess straightening the patient can often place their hand flat on a surface. In
time the correctible deformity may become stiff and more disabling and lead to further joint damage.
Swan-neck deformity: This describes a condition where the PIP joint over straightens due to laxity of the
restraining ligament on the palmar side of the joint. This is present in many normal people especially in
young ladies and in Asians due to greaterligament laxity. Normally it is not a problem, but if it is sufficiently
marked the patient may be unable to initiate bending of the PIP joint with their own finger muscle and
need help from the other hand which is a nuisance. The finger can gradually become stiffer and fixed in
an over straightened position which is very disabling. Swan-neck deformity is not usually painful.