Arthritis is a disorder which causes inflammation of the joints. There are more than 100 different forms of the condition with the most common and widely known being osteoarthritis and rheumatoid arthritis. Robert Mair reports.

Osteoarthritis

About 8.5 million people in the UK have osteoarthritis (OA) and less than 1/8th of these request treatment. 10% of over 65s are disabled by osteoarthritis in some way.

Causes

There is no exact cause of OA but the following factors are widely understood to increase the likelihood of getting the disease:

  • Age – OA becomes more likely as we age, but is less common before the age of 40
  • Gender – OA is more common in women
  • Genetics – a family history of the condition may exist, but it’s not directly inherited
  • Weight – you will be more at risk of the condition if you are overweight or obese
  • Injury – an injury to the bone or ligaments, repeated strain, fracture, surgery or other trauma may put you more at risk of OA later in life

Symptoms and effects

OA develops differently from one person to another. It’s most common in hands, hips, knees and feet. Some experience it in the back and neck.

The symptoms are typically stiff, painful joints whether you’re at rest or moving. Swelling around the joint may be visible and associated tendons may also be affected causing pain which is sometimes felt further down the bone even as far as the next joint.

As the symptoms worsen, muscle power and mobility are affected. Bits of cartilage may break away from the bone causing bone to rub bone and the ligaments (soft tissue that joins bone to bone) become strained.

Diagnosis and treatment

Your GP will be able to identify arthritis, but they will be piecing together their diagnosis from the items of information provided to them during the consultation, their examination and any additional tests.

If the GP suspects arthritis, they’ll likely refer you for either an X-ray, blood test or both.

Once confirmed, you may be referred to other specialists who will design and tailor the best package of care suited to you.

The following are the most common treatments for the condition:

  • Improvements in nutrition/diet or taking regular exercise to manage weight
  • Food supplements such as glucosamine and chondroitin are widely used (although these are unproven by research)
  • Painkillers like Paracetamol or anti-inflammatories like Ibuprofen taken as tablets or creams
  • Heat pads to warm up the joint
  • Steroids taken in tablet or injection form
  • Physiotherapy, occupational therapy or massage
  • Orthotic shoe inserts available at the chemist or via a Podiatrist
  • Walking aids such as sticks or zimmer frames
  • Treatments like hyaluronic acid injections into joints are still unproven in trials
  • Joint replacement or permanent fusing of the joint is an end-point treatment. Although surgery is reasonably routine, it still does carry some risks

Rheumatoid arthritis

Rheumatoid arthritis affects about 1 in 100 people. People of all ages have the condition, but it most commonly starts between the ages of 30 and 50. Three times as many women are affected as men.

Causes

Rheumatoid arthritis is still not fully understood, but in essence it’s a disease where the body's defence mechanisms go into action when there's no threat. The immune system attacks the joints and sometimes other parts of the body.

Although no single gene can be blamed for rheumatoid arthritis it is more common in Pima and Chippewa Indians and less common in Japan and China. Apart from that the condition isn’t more likely for those whose parents or other relatives have experienced it.

Symptoms and effects

Joints become inflamed, particularly the synovial membrane, tendon sheaths (covers) and bursae (bags of fluid that allow tendons and muscles to move smoothly over one another).

Acute inflammation (referred to as a 'flare-up') is accompanied by a stiffness, swelling and pain when the joint gets warm and blood flow to the area increases.

In 80% of cases, the symptoms of rheumatoid arthritis develop over several months. For about 5% people with the disease the cycles of inflammation cause permanent damage to joints. Treating the inflammation quickly is critical because the joint damage is irreversible.

The symptoms of rheumatoid arthritis differ from osteoarthritis because in the latter, the morning stiffness wears off quickly whereas for the former it usually lasts more than 45 minutes. Many people find that the condition gives them flu-like symptoms and makes them tired, irritable or depressed.

Diagnosis and treatment

As for osteoarthritis, your first port of call would be your GP and once diagnosed, the course of treatment will similarly be one or more of the same treatments.

Other forms of arthritis

Other arthritis forms include:

  • Lupus – a reasonably rare disease affecting mostly women causing inflammation of joints, skin and often other organs such as kidneys and lungs. It can be controlled with medication.
  • Gout – caused by uric acid crystals forming in the joints, particularly the big toe, ankles, hands and wrists. It is controlled with medication and improvements to diet.
  • Reactive arthritis – temporary inflammation of one or more joints as a secondary reaction to infection elsewhere in the body. This normally clears up by itself in a few days.
  • Ankylosing spondylitis – inflammation of the spine and pelvis causing joints to stiffen and become immobile affects men more than women. Often includes neck, shoulders and eyes.

Further information

The Arthritis Foundation http://www.arthritis.org/

Arthritis Care http://www.arthritiscare.org.uk/Home