A few fact about Arthritis

Arthritis is an insidious disease that starts and continues at a slow rate of progress over many years developing into something that can only be described in general terms as pain, stiffness and often inflammation (heat and swelling) in one or more joints (Gout- Crystal arthritis) or muscles of the body.

There are more than 100 forms of arthritis.
Osteoarthritis and rheumatoid arthritis are two common forms of this condition.

There are many techniques that can help you to manage your condition. These include medication, physiotherapy, exercise and self-education.

Symptoms of arthritis
Arthritis can affect a person at any age. Arthritis is more common in middle-aged and older people.

The symptoms may include:

• Persistent joint pain made worse by movement
• Inflammation that shows up as joint swelling, stiffness, redness and/or warmth
• Loss of flexibility or range of motion in a joint
• Loss of strength in the muscles supporting a joint
• Joint deformity
• Fatigue
• Fever
• Crepitus – the cracking noise arthritic joints make with movement.

Sometimes these symptoms are called ‘rheumatism’. Rheumatism isn’t a disorder in itself, but the word is often used to describe any sort of joint or muscle pain.

The workings of the joint
A joint like the knee or elbow is the meeting point between bones that allows movement. The workings of a joint include:

• Muscle – muscle tissue contracts and relaxes, usually in opposite working pairs, to move a joint.
• Tendon – a tough cord that anchors muscle to the bone.
• Ligament – tough cords, like bunches of rubber bands, that bind the bones of the joint together.
• Cartilage – smooth material found between the bones to stop them from grating against each other. Cartilage also acts as a shock absorber.
• Joint capsule – thick tissue that surrounds the ends of the bone of the joint.
• Synovial membrane – a membrane that lines the inside of the joint capsule. This membrane produces lubricating fluid to keep the joint moving smoothly and provide the cartilage with nutrients.
• Bursa – a pouch of lubricating fluid that reduces the friction between moving joint structures such as tendons and bones.

Eight categories of arthritis
Eight categories of arthritis and associated conditions have been identified. These categories are:

• Inflammatory – for example, rheumatoid arthritis. The membrane of the joint becomes inflamed. Other parts of the body can also be affected.
• Attachment arthritis – for example, ankylosing spondylitis. The ligament or tendon attached to the bone becomes inflamed, commonly in the heels and lower back.
• Crystal arthritis – for example, gout. Deposits of microscopic crystals of sodium urate are found in the joint, usually in the big toe.
• Joint infection – for example, staphylococcus. Bacteria infect the fluid inside the joint. This is commonly found in the hip, shoulder and knee.
• Cartilage degeneration – for example, osteoarthritis. The cartilage of the joint breaks down. This is commonly found in the knees, neck, lower back, hips and fingers.
• Muscle inflammation – for example, polymyalgia rheumatica. Muscle tissue becomes inflamed.
• Local conditions – for example, tendinitis. A local injury causes pain, such as tennis elbow.
• General conditions – for example, fibromyalgia. A condition characterised by non-specific muscle pain and sleep disturbance.

The importance of a correct diagnosis

As there are so many different types of arthritis, it is important that you seek a diagnosis if you suspect you have the condition. Treatment, especially medication, can differ greatly between different forms of arthritis. A correct diagnosis can ensure you get the most appropriate care.To know exactly what you are suffering from is the most important step you can take towards a better quality of life

Speak to your local doctor about your symptoms. They will take your history, examine your joints and may order an x-ray. If appropriate, your doctor will refer you to a specialist, often a rheumatologist, for diagnosis and specialised management of your condition.

Managing arthritis
Experiences of living with arthritis can be different from person to person. For each individual, symptoms can vary from day to day. Treatment and management options vary with the type of arthritis, its severity and the parts of the body that are affected.

Some tools you can use to help you manage arthritis include:

• Exercise – physical activity is the key to maintaining muscle strength and joint flexibility and managing your pain.
• Medication – different types of arthritis are treated by different medications which aim to reduce pain and inflammation.
• Aids and equipment – walking aids and specially designed cutlery, kitchen equipment and garden tools reduce joint strain and save physical energy. An occupational therapist can give you advice on aids.
• Education programs – self-management education programs can help people with rheumatoid arthritis and other chronic (ongoing) conditions to build their skills and confidence to live with the condition. Arthritis Victoria can provide more information on these courses.
• Support and self-help groups – dealing with a chronic condition can be isolating. Being able to speak with others who understand your condition can be a great relief. Support and self-help groups exist are around  for people with all different forms of arthritis.

Exercise keeps joints mobile

Physical activity plays a major role in managing pain and keeping joints mobile and flexible. It also offers many other health benefits including weight control. A person with arthritis can choose from many different types of exercise.

A physiotherapist can help design an individual program for you.

Some physical activity options   include:

• Warm water exercises
• Tai chi
• Strength training.

It is important to balance rest and exercise to avoid injury and fatigue.

Medication types
Arthritis medications aim to reduce pain and inflammation. Different types of arthritis are treated by different medications. These include:

• Paracetamol – for pain management, particularly for osteoarthritis.
• Non-steroidal anti-inflammatory drugs (NSAIDs) – may be prescribed for osteoarthritis and rheumatoid arthritis. These drugs aim to reduce inflammation and assist with pain management.
• Disease-modifying anti-rheumatic drugs (DMARDs) – for inflammatory forms of arthritis such as rheumatoid and attachment arthritis. These medications reduce inflammation and slow the progress of joint damage.

It is important to discuss any medication or treatment for arthritis with your doctor or rheumatologist so they can monitor your treatment. They will take into account the illness being treated, any other health issues and identifiable risk factors.

Supportive therapies
A variety of approaches to treatment can be helpful. These may be used in conjunction with medical management and, for some people, management by medical specialists known as rheumatologists.

Health professions and therapies that may be able to help you in managing your arthritis include:

• Exercise physiology
• Physiotherapy
• Occupational therapy
• Chiropractics
• Acupuncture
• Osteopathy.

A note about Cox-2 inhibitors (coxibs)
Drugs described as Cox-2 inhibitors, also known as coxibs, are a newer group of NSAIDs. In 2005 the Therapeutic Goods Administration (TGA) in Australia advised doctors to take care when prescribing Cox-2 inhibitor drugs.

The medications in this group that may have been, or currently are, prescribed for people with arthritis are known by these brand names:

• Celebrex (celecoxib) – one study of Celebrex has suggested patients taking high doses of the drug (800mg per day) may have a higher risk of heart disease. However, two other studies have found no increased risk of heart disease. In Australia, the recommended and most commonly prescribed dosage of Celebrex is 200mg per day.
• Mobic (meloxicam) – the TGA recommends patients avoid taking more than 15mg of Mobic daily.
• Prexige (lumiracoxib) – the TGA withdrew registration for Prexige in August 2007, after reports of serious liver damage in some people taking this medication. All patients taking Prexige were advised to stop taking this medication and see their doctors for an assessment of their liver function.
• Vioxx (rofecoxib) – this was withdrawn from sale in Australia in 2004, after research demonstrated a higher risk of heart attacks and strokes.

As with all medicines your own reaction to any particular dosage and type should be monitored very closely.

Where to get help

• Your doctor
• Rheumatologist

Things to remember

• Arthritis is a general term that describes problems of the joints and muscles.
• There are more than 100 different forms of arthritis.
• In most forms of arthritis, it is important to keep active to prevent joints from becoming stiffer and prevent muscles from wasting.