A Simple Guide to Rheumatoid Arthritis

A Simple Guide to Rheumatoid Arthritis
-----------

What is Rheumatoid Arthritis?
-----------

Rheumatoid arthritis is a systemic autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.

Who gets Rheumatoid Arthritis?
--------------------------------------

Rheumatoid Arthritis is one of the most common form of inflammatory arthritis.
It most commonly occurs between the 25 and 50 years.
However it can occur at any age.
Females are 3 times more likely to get Rheumatoid Arthritis than males.

What causes Rheumatoid Arthritis?
-------------------------------------------

Rheumatoid Arthritis is an autoimmune disease..
Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system which consists of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections.
Patients with autoimmune diseases have antibodies in their blood that target their own body tissues .

What are the symptoms of Rheumatoid Arthritis?
-----------------------------------------------------------

Most common symptoms are pain, swelling, stiffness, warmth and sometimes redness of the joints.

Rheumatoid Arthritis is suspected when there are:
1. Swelling in the joints especially those of the hands,elbows,knees,ankles and feet.

2. Stiffness in the joints in the mornings which can last more than an hour or after prolonged rest

3.redness and warmth in one's joints

4.Persistent pain or tenderness in a joint for more than a month

5.Inability to move or use a joint normally

6. Unexplained weight loss and appetite, fatigue, or weakness together with joint pains

What tests are done to confirm Rheumatoid Arthritis?
----------------------------------------------------------------

Abnormal blood antibodies can be found in patients with rheumatoid arthritis.

1.A blood antibody called "rheumatoid factor" can be found in 80% of patients.

2.Another antibody called "the antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.

3.Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein.

4.A blood test called the sedimentation rate (ESR) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of the inflammation of the joints.

The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis

How does the Rheumatoid Arthritis starts?
--------------------------------------------------

Rheumatoid Arthritis may start gradually or with a sudden and severe attack.
It usually attacks many joints at one time.
Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions.

Where does Rheumatoid Arthritis occur?
-------------------------------------------------

In rheumatoid arthritis, multiple joints are usually affected in a symmetrical pattern.
It most commonly affects the hands and feet,often in a systemic pattern(both right and left joints are affected).
Other joints affected are the elbow,knees,and ankles.
Less common are shoulder,hip and spine.

What are the Complications of Rheumatoid Arthritis?
----------------------------------------------------------------

Rheumatoid Arthritis can result in joint deformities and disability especially in untreated severe cases.
Daily activities such as bathing,dressing, walking and even writing may be difficult.
Besides the joints, Rheumatoid Arthritis may sometimes affect other organs such as the eyes,lungs,skin,intestines,nerves and bone marrow.
Mild fever, fatigue, loss of appetite and loss of weight may be present.
Severe Rheumatoid Arthritis is associated with an incresed risk of mortality.

How is Rheumatoid Arthritis treated?
--------------------------------------------

There is no known cure for rheumatoid arthritis.
Therefore the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Rheumatoid Arthritis can be broadly classified into:
1. Non-drug therapy:
Weight loss is an effective way to reduce the stress on the joints and minimise the pain Walking sticks are useful ways to offload the stress on the affected weight bearing joints such as hips or knee.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibilty are useful to minimise the disability of Rheumatoid Arthritis. A range of motion exercises is useful to keep the joints supple and mobile.
Water based exercises are a good alternative form of aerobic workout by patients afflicted by Rheumatoid Arthritis. The warm water especially is a good medium for joint mobility and together with the buoyancy of water it helps to minimse the body weight impact on the joints.
2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions. Examples are Non-steroidal Anti-inflamatory Drugs(NSAIDS) like diclofenac.

2. disease modifying drugs such as steroids, methothrexate, sulphasalazine, redaura, hydroxychloroquine have been shown to slow down the damage caused by Rheumatoid Arthritis. However they cause a lot of side effects such as anemia, abnormal white cells, kidney damage,liver damage, vision loss so the medications must be monitored all the time.
It is important that the disease should be controlled before irreversible joint damage occurs.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira).

3. Surgery

Surgery is used as a last result to correct deformities and reduce disability.

The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.

Early treatment of rheumatoid arthritis results in better outcomes.

A Simple Guide to Ankylosing Spondylosis

A Simple Guide to Ankylosing Spondylosis

What is

----------

Anklyosing

-------------

Spondylosis?

----------------


Ankylosing Spondylosis is a chronic inflammatory disease of the joints of the spine. manifested by fusion(ankylosing) and inflammation(spondylosis) of some or all of the joints and bones of the spine.

It is a painful progressive disease affecting mainly the spine. It can also affect other joints, tendons,ligaments, also other areas such as eyes,lungs,bowels and heart.

Who get Ankylosing Spondylosis?
---------------------------------------

Every one can get Ankylosing Spondylosis.The age of onset is usually in the late teens or early 20's.

It is also more common in men than women about 5:1.
In men the spine and pelvis are most affected.
In women the pelvis,hips,knees,wrists and ankles are more common.

How does Ankylosing Spondylosis occur?
------------------------------------------------

Inflammation occurs at the attachment of the ligaments and tendons to the bone.
Erosion of the bones occur at the site.

When the inflammation subside, new bone develop and replaces the elastic tissues of the ligaments or tendons.

Fusion of bones occur leading to restriction of movement. This usually starts in the vertebra of the spine followed by the pelvis, then upwards to the chest wall and neck.


What are the Symptoms?
-----------------------------

The onset is usually gradual with occasional back pain over weeks or months.
Early morning stiffness and pain occurs,then wears off during the day.

It gradually becomes worse ,affecting the lower back first then upwards to to the neck, resulting in stiffening of the whole back.

Chest expansion can become limited because of the the stiffness of the bones.
Sometimes peripheral joints such as shoulders and hips are affected.

Weight loss and fatigue may occur in the early stages.

The blood Erythrocyte Sedimentation Rate is raised in most cases.
The blood Rheumatoid Arthritis factor is not present.

Does Ankylosing Spondylosis occur in other organs?
-------------------------------------------------------------

It can sometimes affect the eyes, heart and lungs.
These effects are not life-threatening and they can be treated with relative ease.

Inflammation of the iris of the eye(Uveitis) occur in 5% of cases with blurring of vision. Occasionally it may affect the heart causing the aortic valve to leak.

The rib joints and muscles are also affected resulting tightness of the chest making breathing painful.

How is Ankylosing Spondylosis diagnosed?
--------------------------------------------------

Classical features of symptoms with stiffening of spine and back pain usually suggest the diagnosis.
Confirmation is usually by an x-ray of the spine and pelvis.

How to treat Ankylosing Spondylosis?
--------------------------------------------

Not every patient suffer the same degree of symptoms. Some may be very mild requiring only exercises or mild pain killers.

Others may be more severe requiring strong NSAIDSor anti-rheumatoid drugs such as sulphasalazine .

ANTI-TNF drugs( a new therapy) has also been found to help improve the Rheumatoid Arthritis patients and also Ankylosing Spondylosing patients.

What is the prognosis of Ankylosing Spondylosis?
----------------------------------------------------------

Symptoms comes and go.

With exercise and NSAIDSpain is reduced considerably and flexibility of the spine is improved especially with regular exercise and proper posture.

Ankylosing Spondylosis is never life threatening and can be controlled but not cured.

A Simple Guide to Osteoarthritis

A Simple Guide to Osteoarthritis

Osteoarthritis
------------------
What is Osteoarthritis ?
----------------------------
Osteoarthritis
is a degenerative condition of the joints in the human body.
It is the most common form of arthritis.
The cartilage lining of the joint are worn down such that the underlying bone come in contact with each other.
In addition bone spurs may form and joint fluid is reduced.

This causes mechanical and chemical reactions giving rise to the symptoms of Osteoarthritis.

What causes Osteoarthritis ?
----------------------------------
1. Genetics
has found to have role in the predisposition of Osteoarthritis.
Genes on chromosome 2q,4 & 16 have been linked with Osteoarthritis.

2. Aging
is a risk factor of Osteoarthritis.
More than 80% of those above 65 years suffer from Osteoarthritis.

3. Excessive physical activity is a potentially correctable cause of Osteoarthritis.
Activities like long distance running and other high endurance sports may place
the joints under high stress for prolonged periods resulting in overuse injuries and
accelerated wear and tear.

4. Gender plays a role in Osteoarthritis. Osteoarthritis is more common in men for a
cohort of under 50 years and more common in women in the cohort of 50-80 years.

5.Trauma is a common cause of Osteoarthritis in the younger age groups.

What are the symptoms of Osteoarthritis?
-------------------------------------------------
Most common symptom are pain and swelling:

Stiff,painful and swollen joints after a workout

Stiffness in the joints in the mornings which can last about half an hour

Loss of flexibility in one's joints

Bony lumps at the base of the thumb or on the middle of the end joints of the fingers

Pain in the joints after repeated use

Osteoarthritis is often associated with joint surgery or related injury

What are the complications of Osteoarthritis ?
-------------------------------------------------------
Osteoarthritis is the top cause of disability in older women and ranks second in older men.

Besides pain and swelling, quality of life suffers in patients with Osteoarthritis due to their loss of mobility and depression.

The loss of mobility is progressive with age.


Where does Osteoarthritis occur ?
----------------------------------------
It can affect the any joint of the body although the most commonly affected joints are the weight bearing joints:
knee
hip
ankle
spine.
Other non-weight bearing joints such as
shoulder ,
elbow,
fingers
can also be affected.

How do you treat Osteoarthritis ?
----------------------------------------
Osteoarthritis is not curable and the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Osteoarthritis can be broadly classified into:
1. Non-interventional

a. non-pharmaceutical

Weight loss is an effective way to reduce the stress on the joints and minimise the pain
Walking sticks are useful ways to offload the stress on the affected weight bearing
joints such as hips or knee. The walking aids should be used on the opposite side.
It can be in the form of a sturdy umbrella instead of a crutch.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces
and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibility are useful to minimise
the disability of Osteoarthritis.
A range of motion exercises is useful to keep the joints supple and mobile .
Water based exercises are a good alternative form of aerobic workout by patients afflicted
by Osteoarthritis. The warm water especially is a good medium for joint mobility and
together with the buoyancy of water it helps to minimise the body weight impact
on the joints.

b. pharmaceutical
There are 2 main types of drugs:

1. symptom modifying drugs help to alleviate the symptoms but do not change the
natural history of the conditions.
Examples are Non-steroidal Anti-inflammatory Drugs(NSAIDs) like diclofenac.

2. disease modifying drugs such as glucosamine has been shown to slow down the
wear and tear of the cartilage but it does have the ability to grow new cartilage.
It has also being found to work better with chondroitin.

2. Interventional:

a. non-surgical

Joint aspiration is a procedure where fluid from the swollen joint is removed,
helping to decompress the tension and bring relief for a while .

Vasosupplementation is a procedure whereby a lubricant is injected into the affected
joint thus reducing the the frictional wear of the joint surfaces.
In addition the lubricant has anti inflammatory properties to reduce the inflammation in the
lining of the joints and may ease the pain for months in early osteoarthritic cases .

b.surgical

Surgical intervention is usually the last resort when all other above treatment fail and in
advanced cases:

Debridement is an arthroscopic (keyhole) procedure to clean the joint of torn cartilages,
loose pieces of bones, etc.
Its main use is to remove the worn out debris which may cause pain and can mechanically
cause friction.

High tibial Osteotomy is a procedure to correct the alignment of deformed legs which
then reduce the stress on the joint.

Prosthetic joint replacement is a procedure to replace the diseased portion of the joint
with a prosthesis or artificial joint allowing painless good range of movement.
It is more suitable for older patient because there is a shelf life to these implants.

Unicondylar joint replacement can now be performed in which part of one of
the bone of the diseased joint is removed instead of a total joint replacement which
involved removal of part of both bones of a joint.

The choice of treatment depends on the stage of the disease and whether there are associated complication.

In general non-interventional methods are more suitable at the early stage of the illness and interventional modalities are more suitable for the later stage of Osteoarthritis.