ARTHRITIS (Rheumatic Disease)



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Arthritis is the basic medical term for any disease that produces inflammation, pain, and stiffness in one or more joints. There are more than 100 different types, all of which are classified as rheumatic diseases. Arthritis commonly develops when cartilage, the somewhat tough, slippery material covering the ends of bones, is destroyed faster than the body can repair it. Aging, excessive wear & tear, infection and inflammation all contribute to the process. As the cartilage roughens & wears out with the passage of time, the ends of the bones become increasingly exposed and eventually damaged. Osteoarthritis, or the degenerative joint disease, is in fact the most common type. It has been attributed to the natural deterioration from aging and overuse of joints, but researchers now believe that it is indeed a biochemical problem that causes a breakdown of the cartilage in the first instance.

Rheumatoid arthritis is one of the most serious forms. It is systemic and can affect the blood vessels, heart, and other organs in addition to joints. Though the precise cause is unknown, most researchers consider it an autoimmune disorder, in which the immune system attacks one's body itself. Its course is unpredictable, but most people experience remissions in which the disease is quiescent, interrupted by flare-ups that cause progressive, irreversible damage. Some types of arthritis are caused by infection, including such sexually transmitted diseases as gonorrhea and Reiter's syndrome. Autoimmune diseases such as lupus often involve an immune-system attack on joints. Still other types, such as gout, are due to metabolic defects, which may often be hereditary.

A proper diagnosis of osteoarthritis is based on symptoms, X-ray results, and the extent of pain and loss of mobility found in studies of joint movements. In about 80% of patients, rheumatoid arthritis can be confirmed by tests finding rheumatoid factor, an abnormal antibody in the blood and joint (synovial) fluid. Infectious forms of arthritis can be diagnosed by the presence of bacteria or other organisms in joint fluid.

The medical treatment involves approaches that combine medication, exercise, and rest are basic to treating most types of arthritis, with physical or rehabilitative medicine and alternative therapies as important adjuncts. For more serious types, such as rheumatoid arthritis and lupus, treatment should be coordinated by a rheumatologist - a specialist in such disorders.

Arthritis medications suppress inflammation and alleviate pain, but several drugs & dosages combinations may have to be tried to achieve optimum results with possibly a minimum of side-effects. The two main category of drugs are Non-steroidal Anti-inflammatory Drugs (NSAIDs) and corticosteroids. For most cases, if the patient's medical history seems compatible with NSAIDs, these are preferred. To minimise pain even paracetamol (acetaminophane) with Tramdol (an opioid medication) may be suggested, especially in cases where pain is much more of a concern over inflammation - though invariably pain & inflammation almost always coexist. All these NSAIDS act by inhibiting the body's production of prostaglandins, and are thus, over a period of time, quite capable of affecting the integrity of the gastro-intestinal mucosa and renal function as well, as both of these are mediated by prostaglandins only.

Two relatively new drugs for osteoarthritis of the knees are Hyalgin & Synvisc. These drugs, which are based on hyaluronic acid, a normal component of joint fluid, a normal component of joint fluid, are injected into the knee joint weekly for three to five weeks, and may well result in a pain-free period of about half a year or so.

The corticosteroids are synthetic versions of cortisone, one of the normally-secreted hormones of the adrenal or the suprarenal gland. These are fairly potent drugs intended for short-term use, and are usually reserved for cases that cannot be controlled adequately by NSAIDs. Cortisone injected directly into the affected joints reduces systemic adverse reactions significantly. Still, any overuse of this hormone therapy can compromise immunity, weaken bones (osteoporosis), and cause multiple other serious side-effect.

Drugs prescribed for severe rheumatoid arthritis (that is not helped by other medications listed above) include Chloroquin (Aralen), usually administered for malaria, and Cyclophosphamide (Cytoxan) and methotrexate. These drugs are agents that suppress the immune system. Penicillamine (Cuprimine and Depen), a chelating agent normally used to remove copper and other metal ions from the body, appears to remove rheumatoid factor as well; the possible result is a remission of arthritis. Compounds of injected gold salts can produce remission of rheumatoid arthritis as well, but the precise nature of their action isn't known. However, patients receiving all such non-traditional drug therapies must be closely monitored for any adverse effects.

PAIN-control devices : The use of TENS (transcutaneous electrical nerve stimulation) sometimes reduces the need for painkillers. TENS electrodes are placed on the skin at specific trigger points, where they apparently stimulate nerves than block pain signals.

Surgical Treatments : With surgical advances in arthroplasty - the repair or replacement of joints - mobility can now be restores to many severely disabled arthritis patients. It is indeed now possible to restructure certain joints, such as those of the feet and wrists, using grafted cartilage and other tissue, and to replace badly diseased hips, knees, shoulders, and even fingers with artificial ones made of special plastics and metal.

Microsurgery involving arthroscopy : A tube with fiberoptic visualizing & magnifying devices, has further revolutionized joint surgery. Following application of local anesthesia, an arthroscope is inserted into the joint through a small incision, and a magnified view of the damaged interior tissues is projected onto a television screen. While viewing the screen, the surgeon manipulates tiny instruments inside the arthroscope to repair the joint. 

Other remedial surgical procedures include osteotomy, in which the bone is cut and then reset to improve to improve alignment, and synovectomy, in which portions of the diseased synovial membrane - the membranous sac surrounding the joint - are removed.