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Arthritis

Arthritis is a general term used to describe a condition where a joint is damaged, inflamed or painful.

 The ends of our bones are covered by a glistening, shiny white coating as they form into the joints. This substance, known as the cartilage, is a specialized tissue that provides a very smooth slippery surface allowing the bones within the joint to move against each other with very little friction or effort.  However this surface is very thin and can be damaged easily.  When this thin coat of cartilage is damaged or worn through, ones gets to the bones underneath which are not at all smooth and slippery.  When the arthritic joint moves, cartilage loss causes "bone on bone" grating against one another.  This is often perceived by the patient as a sensation of crackling or slippage as the irregular surfaces move.

A normal knee joint

An arthritic knee joint

Aside from the bone and cartilage, a joint consists of soft tissue surrounding the entire structure.  This is known as the joint capsule.  Within this substance, lies the synovium, which is a specialized tissue structure producing fluids and enzymes to nourish and "lubricate" the cartilage.  When the bones and cartilage first become arthritic, the synovial tissue reacts by enlarging, and produces additional joint fluid.  This condition causes a joint effusion (water on the knee) and thickening of soft tissue (synovitis).

As mentioned, arthritis is a general term.  Many conditions can lead to the situation described above.  The two most common of the several types of arthritis are osteoarthritis andrheumatoid arthritis.

When your physician informs you that you have "arthritis", this usually implies osteoarthritis.  This form of arthritis, affecting an estimated 2.7 million people, is commonly caused by the "wear and tear" of the joint surfaces as we age.  This is an ongoing mechanical process that often progresses with time, especially in the weight-bearing joints of the spine, hips, knees, ankles or feet.  If a previous fracture or injury occurred in the joint, the conditions leading to arthritis are often intensified, thus causing post-traumatic arthritis.

Rheumatoid arthritis is an inflammatory disease affecting the synovial tissue.  The synovium of the joint becomes enlarged and inflamed.  This swelling of the tissue can actually erode the surrounding bone, ligaments and joint cartilage.  The end result is similar to osteoarthritis in that the joint surfaces are destroyed and painful, although rheumatoid arthritis starts differently and has additional problems both in the joint and elsewhere in the body.

Although there is no cure and little prevention for osteoarthritis, there are ways to help relieve the pain and keep active and productive.  Treatment recommendations include the following:

  • Medication
  • Non-prescription acetaminophen (Tylenol), aspirin, ibuprofen (Motrin) or naproxen (Aleve).
    Prescription medications, particularly nonsteroidal  anti-inflammatory drugs (NSAIDs).
    Cortisone injection.

  • Heat/Cold
  • Heat helps relax aching muscles and relieve joint pain and soreness, and cold (ice pack) helps numb the area and reduce swelling.

  • Exercise
  • Moderate stretching to help keep joint and soft tissues flexible and strong.  
    Low-impact exercises (such as aerobics) may reduce pain

  • Joint Protection 
  • Avoid long, repetitive tasks; take frequent breaks
    Use assistive devices; canes, special seats, grab bars, etc.

  • Weight Control
  • Losing weight may lessen pain by reducing joint stress.

  • Viscosupplementation
  • A relatively new treatment for osteoarthritis of the knee.  A clear gel-like substance is injected into the knee that helps the joint fluid regain its ability to lubricate the cartilage.
    Viscosupplementation restores joint movement, thus reducing pain and allowing greater mobility.

  • Surgery
  • Arthroscopy, joint fusion, bone reconstruction (osteotomy) or joint replacement are various kinds of surgical procedures which benefit patients with arthritis.  Some kinds of surgery repair bone deformity, fuse joints, or rebuild part of a joint.
    Other kinds of surgery replace your own joint with an artificial joint.

 

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