Common Ilnesses - Arthiritis

Just what is arthritis?

There are many health terms thrown around in the world that are confused and filled with half-truth. Arthritis has to be one of these.

One reason for confusion is that the word arthritis comes from arthro- meaning joint, and itis- meaning inflammation of. If we use the term strictly then we understand arthritis to be restricted to the joint and the conditions that cause it to swell. Commonly known examples of this are osteoarthritis and rheumatoid arthritis.

There are however groups who include the tissues that surround the joint and because of inflammation in them consider these also to be arthritic conditions. Examples of this are bursitis and tendonitis.

For the purposes of this discussion we will restrict ourselves to the causes of joint inflammation (arthritis) that exist primarily within the joint capsule.

Interesting

If you are told by your health professional that you have arthritis you should ask them to be a little more specific… there are over 150 types.

What is a joint?

A joint is where the ends of two or more bones meet. For example, a bone of the lower leg, called the tibia and the thighbone, called the femur, meet to form the knee joint. The hip is a ball and socket joint. It is formed by the top end of the thighbone-the ball-fitting into the socket-part of the pelvis called the acetabulum.

There are many types of joints but most of them share certain characteristics and basic formation.

The boney ends of a joint are covered with a smooth material called articular cartilage. It is the glassy shiny material you may have observed on the end of a bone bought from your butcher. This articular cartilage cushions the bone and allows the joint to move easily without pain. The two opposing surfaces of the joint slide over one another with barely any friction or wearing. If this continues the development of premature OA is unlikely.

The joint is enclosed by a fibrous envelope called the synovium that acts a bit like a plastic bag around the joint keeping it sealed. The synovial membrane produces a fluid that helps to reduce friction and degenerative wear in a joint. This fluid is thick in consistency, a bit like egg. Hence the name “synovial” which refers to the Latin root for egg.

Ligaments connect the bones and keep the joint stable. They connect the bones in certain ways such that the joint will only move through a particular number of degrees in any given direction. For example a healthy elbow will straighten out to 180 degrees and then close up so that your fingers can touch your shoulder. The ligaments however will not allow the joint to bend from side-to-side very much.

Muscles and tendons power the joint and cause the joint to move. For this to occur a muscle will originate on one bone of the joint and insert as a tendon on the other side. When the muscle contracts (gets smaller) the bone on the other side of the joint moves. Some muscles will even span two joints to create quite complex movement patterns.

Interesting

We have more than 200 joints in our body. Some move a lot such as a hip joint. Some have next to none such as the joints (sutures) in your skull.
There are a lot of joints to get arthritic change in.

Inflammation

Inflammation is one of the body’s normal reactions to injury or disease. In an injured or diseased joint we can expect the joint to show signs of inflammation. This is observed as swelling which in turn produces pain and stiffness. The skin itself may be red and hot to touch.

Inflammation is usually temporary and resolves without any long-term consequences. However, in chronically arthritic joints, inflammation may cause long-lasting or permanent disability with significant impacts at many levels from physical to vocational and even social. Arthritis makes choices for some people that are seriously detrimental to their well-being. You may previously have liked to dance or bush walk. Exercise choices become smaller. Your social life can suffer because you don’t want to leave the house or have to walk to far.

What is osteoarthritis?

The most common type of arthritis is osteoarthritis (OA). The hallmark of OA is the gradual breakdown and disintegration of the articular cartilage lining the joint.

It is seen in many people as they age through continued use of a joint although it may begin when they are younger as a result of injury, poor nutrition or overuse. It can be more painful in weightbearing joints such as the knee, hip, and spine than in the wrist, elbow, and shoulder joints.

OA is not common in a non-traumatized joint before the age of 40. However, statistics suggest that around 80% of people will have some joints affected by OA after 50. The bad news for women is that they are more likely to suffer from OA and that OA tends to run in families.

The most common symptoms of OA are pain and stiffness that develop with time and often with periods of no symptoms in the early stages.

As OA progresses the joint becomes inflamed and may display increasing amounts of movement limitation. There may be grating noises or clicks which represents the articular cartilage breakdown having an impact on the normally smooth gliding of the opposing joint surfaces. We change from having two pieces of smooth wet glass sliding over one another to two pieces of sandpaper grating instead.

In many cases, bone growths called “spurs” can develop in osteoarthritic joints. These are called osteophytes. They alter the action of joints and often cause limitation of range which is postulated to be the reason they develop. It may be the body’s way of getting you to use the joint in a different way to the one that caused the osteoarthritic change in the first place.

What are some of the risk factors for OA?

How can we treat OA?

There are many ways people can approach the treatment of OA depending on the cause and severity of their OA.

1. Pharmaceuticals;

There are a number of drugs that have an impact upon the symptoms of OA. Many drugs, both prescription and over-the –counter, can help with the pain and inflammation of OA. T he concern relates to any side effects they may have, particularly since the ability to cure OA is essentially nil once it is in place. The common approach is through non-steroidal anti-inflammatory medication. They have unfortunately had significant associations with gastro-intestinal upsets, ulcer formation and cardiac events.

There is also the concern that with the symptoms of OA temporarily alleviated that the potential for further joint destruction to continue unabated is increased.

2. Weight control;

If the OA is in the weight bearing joints then less is more. Obviously the less force going into a joint, particularly one with osteoarthritic change, the better.

3. Physical Therapy;

Various physical therapies such as physiotherapy, osteopathy and chiropractic can all help with OA changes. Attention can be given to joint mobilization, load sharing, muscle facilitation and soft-tissue release. All things that make OA a little easier to bear.

Other exercise forms might be considered. Water-based exercise can help a great deal.

Speak to your provider.

4. Occupational Therapy;

Typically an underused resource that has many common-sense answers to modifying our environment for the deficiencies caused by OA. For example different taps can be fitted that don’t require thumb strength which often suffers from OA attack.

5. Joint Support;

There are a large number of joint supports available to decrease load and swelling. These range from crutches and frames through to bandages and braces.

Your directory for medical and rehabilitation supplies will help out here.

6. Orthopaedic Surgery;

Not necessarily the option of last resort, in some cases it is definitely the best choice. There are plenty of hip joints which are so deformed and damaged as to be incredibly debilitating to the sufferer. Corrective surgery gives them a chance to move again with much less pain and get back on the road to being healthy again.

Surgery these days is improving not only in the skills and techniques. Arguably the most important improvement has been the selection processes of which person meets the criteria of being appropriate for the surgery. It is no longer a case of “well nothing else has worked so we may as well try some surgery”.