Arthritis

 Arthritis is an inflammation of the joints. It can affect one joint or multiple joints.

 There are more than 100 different types of arthritis, with different causes and treatment
methods.

 Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).

 The symptoms of arthritis usually develop over time, but they may also appear suddenly.

 Arthritis is most commonly seen in adults over the age of 65, but it can also develop in
children, teens, and younger adults.

 Arthritis is more common in women than men and in people who are overweight.

Signs and Symptoms

 Joint pain, stiffness, and swelling are the most common symptoms of arthritis.

 Your range of motion may also decrease, and you may experience redness of the skin
around the joint.

 Many people with arthritis notice their symptoms are worse in the morning.

 In the case of RA, you may feel tired or experience a loss of appetite due to the
inflammation the immune system’s activity causes.

 You may also become anemic — meaning your red blood cell count decreases — or have
a slight fever. Severe RA can cause joint deformity if left untreated.

Etiology
  Cartilage is a firm but flexible connective tissue in your joints. It protects the joints by
absorbing the pressure and shock created when you move and put stress on them.

 A reduction in the normal amount of this cartilage tissue cause some forms of arthritis.

 Normal wear and tear causes OA, one of the most common forms of arthritis.

 An infection or injury to the joints can exacerbate this natural breakdown of cartilage
tissue.

 Your risk of developing OA may be higher if you have a family history of the disease.

 Another common form of arthritis, RA, is an autoimmune disorder. It occurs when your

body’s immune system attacks the tissues of the body.

 These attacks affect the synovium, a soft tissue in your joints that produces a fluid that
nourishes the cartilage and lubricates the joints.

 RA is a disease of the synovium that will invade and destroy a joint. It can eventually
lead to the destruction of both bone and cartilage inside the joint.

 The exact cause of the immune system’s attacks is unknown. But scientists have
discovered genetic markers that increase your risk of developing RA fivefold.

Differential Diagnosis

The initial diagnostic goal is to differentiate osteoarthritis from other arthritides, such as
rheumatoid arthritis. The history and physical examination findings are usually sufficient to
diagnose osteoarthritis. Radiographic findings confirm the initial impression (see Workup), and
laboratory values are typically within the reference range.

The following disorders should also be considered in the differential diagnosis:

  Crystalline arthropathies (ie, gout and pseudogout)

 Inflammatory arthritis (eg, rheumatoid arthritis)

 Seronegative spondyloarthropathies (eg, psoriatic arthritis and reactive arthritis)

Diagnostic Studies

 A diagnosis of arthritis is the first step toward successful treatment.

 To diagnose arthritis, your doctor will consider your symptoms, perform a physical exam to
check for swollen joints or loss of motion, and use blood tests and X-rays to confirm the
diagnosis.

 X-rays and blood tests also help distinguish the type of arthritis you have.

 For example, most people with rheumatoid arthritis have antibodies called rheumatoid

factors (RF) in their blood, although RF may also be present in other disorders.
 X-rays are used to diagnose osteoarthritis, typically revealing a loss of cartilage, bone
spurs, and in extreme cases, bone rubbing against bone.
 Sometimes, joint aspiration (using a needle to draw a small sample of fluid from the joint
for testing) is used to rule out other types of arthritis.
 If your doctor suspects infectious arthritis as a complication of some other disease,
testing a sample of fluid from the affected joint will usually confirm the diagnosis and
determine how it will be treated.
Management (Non-Pharmacologic and Pharmacologic)
 Optimal care of patients with rheumatoid arthritis (RA) consists of an integrated approach
that includes both pharmacologic and nonpharmacologic therapies.
 Many nonpharmacologic treatments are available for this disease, including exercise,
diet, massage, counseling, stress reduction, physical therapy, and surgery.
 Active participation of the patient and family in the design and implementation of the
therapeutic program helps boost morale and ensure compliance, as does explaining the
rationale for the therapies used.
 Medication-based therapies comprise several classes of agents, including nonsteroidal
anti-inflammatory drugs (NSAIDs), nonbiologic and biologic disease-modifying
antirheumatic drugs (DMARDs), immunosuppressants, and corticosteroids.
  Early therapy with DMARDs has become the standard of care, because it can both retard
disease progression more efficiently than later treatment and, potentially, induce more
remissions.
 In pregnant patients with RA, no special obstetric monitoring is indicated beyond what is
performed for usual obstetric care.
 However, some of the medications used in treating RA can have adverse effects on the
fetus and may have to be discontinued several months before conception is planned.

Surgical procedures used in the treatment of RA include the following:

 Synovectomy
 Tenosynovectomy
 Tendon realignment
 Reconstructive surgery or arthroplasty
 Arthrodesis

Principals Differences on Infants, Children, Pregnant Women, and Old Adults

Infants and Children

Children can get a kind of arthritis called juvenile idiopathic arthritis or JIA (it's also called
juvenile rheumatoid arthritis, or JRA). Juvenile means young, so this means that JIA is different
from the arthritis that adults get. Children can have many different types of arthritis, but JIA is
the most common.

Children with juvenile arthritis can have no symptoms at all. Symptoms may also vary depending on
the type of arthritis. Symptoms of juvenile arthritis may include:

 Joint stiffness, especially in the morning

 Pain, swelling, and tenderness in the joints
 Limping (In younger children, it may appear that the child is not able to perform motor skills
he or she recently learned.)
 Persistent fever
 Rash
 Weight loss
 Fatigue
 Irritability
 Eye redness or eye pain
 Blurred vision

Pregnant Women
  Women who have uncontrolled rheumatoid arthritis may be at increased risk of
complications such as preterm birth and babies that are small for their gestational age.
 This may increase the likelihood that the baby requires more medical care early in life.
 Research suggests that some women with RA have more difficulty conceiving than
women without the disease, yet you always assume you are fertile until you have been
evaluated.
 Having arthritis won’t affect your ability to get pregnant. However, if you take
medications for arthritis consult your doctor before you conceive.
 Certain medications can affect your unborn child, and some can stay in your system for a
time after you stop taking them.
Symptoms During Pregnancy
 Since arthritis affects joints throughout the body, the added weight of pregnancy can
increase pain and discomfort.
 This may be particularly noticeable in the knees.
 Added pressure on the spine can cause muscle spasms or numbness in the legs.
 Water weight may cause carpal tunnel syndrome, or stiffness of the hips, knees, ankles,
and feet.
 These symptoms generally go away after the baby is born.
 Women who have the autoimmune disease rheumatoid arthritis (RA) may experience
increased fatigue.

Old Adults

The elderly are more likely than other segments of the population to suffer from
rheumatoid arthritis (RA) and osteoarthritis (OA). Arthritis can result in chronic pain (common
in older people) and can lead to depression and sleep disturbances, as well as increased health
care costs.

Carpal Tunnel