By Josephat Chiripanyanga
ARTHRITIS is inflammation of the joint surfaces. To simplify it, inflammation simply means the presence of either one or a combination of or all of the following: pain, swelling, redness, heat and loss of function. A joint is simple an articulation or connection between two or more bones. So when inflammation occurs on any one or more joints we call it arthritis.
There are more than a hundred types of arthritis with different possible causes. The commonest forms of arthritis are osteoarthritis, rheumatoid arthritis, gout and septic arthritis. Osteoarthritis normally affects the elderly and it’s of gradual onset. It mainly causes joint pain and stiffness as it progresses. The main joints affected are the fingers, hip and knee joints. It’s also notorious for affecting the vertebrae (back bones) resulting in kyphosis (bending of the back that we see in the elderly).
Rheumatoid arthritis is an autoimmune condition. An autoimmune disease is where your body sends soldiers (antibodies) to fight its own cells. And in this case the soldiers are sent to fight the joint surfaces resulting in arthritis. The main features of rheumatoid arthritis are pain, swelling, heat production and stiffness only sets in later on in the course of the disease. Rheumatoid arthritis is not limited to the elderly unlike osteoarthritis. It can affect young children and we call it juvenile rheumatoid arthritis.
Gout is a form of arthritis that mainly affects the joint at the base of the big toe. But it can also affect other joints and other organs like the kidney. The main symptoms of gout are pain, redness and swelling. Gout is mainly caused by elevated uric acid levels in the bloodstream. Uric acid is a product of protein metabolism, particularly red meat. That is why most gout cases are triggered by eating red meat, especially if it’s under done.
Septic arthritis like the name implies is a form of arthritis that occurs due to the presence of an infection in the joint space. Sepsis is a medical term for infection. The main symptoms of septic arthritis are pain, swelling, redness and limited mobility. Usually it affects a single joint. It can also be accompanied by a fever, headache and generalized body malaise. The onset is usually sudden and it has no respect for age. It normally affects a joint that was previously injured either from an accident or simple trauma in childhood.
Arthritis is generally a disease of the elderly and it affects women more than men. About four percent of the world population is affected by arthritis and most of the cases are due to osteoarthritis. It affects all races in a similar manner. Arthritis is a common reason why people miss work and if not well managed can significantly affect the quality of one’s life. The mortality rate of arthritis is fairly low, as of 2015 studies it caused only about 30 000 deaths globally per year.
The causes of arthritis are wide and generally depend on the type of arthritis. Age is a risk factor for osteoarthritis. People who are obese have a higher propensity to develop arthritis. A history of joint injury increases your risk of developing arthritis later in life. Postmenopausal women are also at a higher risk of developing arthritis. Hip and knee arthritis has been seen to be more prevalent in certain occupations. For instance someone who spends the better part of their day lifting heavy stuff, people who spend most of their time bent or kneeling, people who squat for most of their time at work. There are certain conditions like diabetes that can also predispose you to arthritis.
To minimize your chances of developing arthritis we encourage that people exercise at least twice a week, eat less junk food, eat more fruits and vegetables, cut on red meat intake especially under cooked and braaid beef. Drinking at least 2L of water a day also helps with flushing the uric acid out of your system and hence minimize your chances of developing gout. If you have an underlying condition like diabetes, make sure it’s well managed to minimize your chances of developing secondary arthritis.
To make a diagnosis of arthritis we mainly base on a good history, a thorough physical examination and a clear radiograph of the affected joint. Normally a simple Xray is enough to make the diagnosis of arthritis as it will show the basic changes of arthritis. The only disadvantage is at times especially in the early stages of arthritis the X-ray films maybe normal or the extent of the pain the patient is feeling may not correlate directly to the X-ray changes. Rarely do we need to do more complex imaging tests like a CT scan or MRI scan to make a diagnosis of arthritis. If the joint is swollen at times we may need to aspirate (drain) the fluid in the joint space to help us make a diagnosis of the type of arthritis and this can also serve as a therapeutic procedure. In septic arthritis you can aspirate pus from the joint space. In cases of trauma you can aspirate blood or a blood stained fluid from the joint.
The management of arthritis is mainly through pain medications like paracetamol or celecoxib, lifestyle changes like cutting on fattening foods and eating more fruits and vegetables and exercising more regularly. The goal of treatment is to maintain function and avoid disability. So what we try to do when managing arthritis is to take away the pain and swelling and make sure the joint is fully functioning. There are also drugs we call disease modifying drugs. These drugs change the course of the condition by minimizing recurrence. We can also use steroids that are longer acting and can protect the patient for weeks or even months. If push comes to shove surgery is instituted. Surgery could be a simple aspiration all the way to replacing the whole joint with an artificial one.
Remember a healthy you, a healthy me to a healthy world.
Josephat Chiripanyanga is a Harare-based medical doctor. He can be reached on email@example.com