Arthritis
Arthritis is a medical term that means inflammation of a joint.
Arthritis Symptoms
The most common symptoms of arthritis are joint pain, stiffness, and swelling. Over time, the symptoms may become more and more severe, leading to loss of range of motion and/or inability of the joint to support weight.
Types of Arthritis
Osteoarthritis is the most common form of arthritis and is due to the normal “wear-and-tear” of the joint due to our daily activities. Over time, normal use of our joints causes the cartilage at the end of the bone to wear down (like the wearing down of the tread on your tires). Cartilage is a hard, slick coating at the end of our bones which allows the bones to move smoothly at our joints. As the cartilage wears away, there is more friction, which leads to inflammation. Eventually, the cartilage can completely wear away, leading to “bone-on-bone” conditions, which can be extremely painful.
Rheumatoid arthritis is a form of arthritis where the body’s own immune system attacks the capsule around the joint. This results in severe inflammation of the joint, with the joint often becoming swollen, warm, stiff, and painful. Unlike osteoarthritis, gentle movement often improves the pain in mild cases of rheumatoid arthritis.
Gout is a recurrent inflammatory arthritis that is most common in the big toe (metatarsal-phalangeal joint). Gout is caused by high levels of uric acid in the blood, leading to the deposition of uric acid crystals into the joint.
Septic arthritis is caused by an infection within the joint and is always a medical emergency! Untreated infections within a joint can destroy the joint very rapidly and then spread to the rest of the body resulting in sepsis.
Ankylosing spondylitis is inflammatory (auto-immume) arthritis of the spine and the sacroiliac joints. It often starts as a dull pain in the lower back or buttocks that is improved with activity. As the disease progresses, patients lose range of motion in the spine, leading to more severe stiffness and pain. Ankylosing spondylitis has a very strong genetic component (90+% have the HLA-B27 genotype) and is more common in men than women.
Tests for arthritis
Appropriately diagnosing the type of arthritis a patient in experiencing is the single, most important part of an effective treatment plan. Therefore, your pain management doctor at FAST MD 4 You may order many different types of diagnostic tests to determine the specific cause of your arthritis.
X-rays are a low-cost, low radiation method of visualizing your bones and joints. X-rays are able to see cartilage loss, bone damage (such as erosion of bone or fractures), and bone spurs. X-rays are unable to see soft-tissues such as tendons, ligaments, muscles, or intervertebral discs.
Computerized tomography (CT or CAT scan) is an advanced X-ray technique that takes X-rays from multiple angles and then uses computer processing to generate advanced 2D and 3D images. CT scans are more effective than X-rays in visualizing certain structures and are very effective in diagnosing fractures, hemorrhages, and tumors.
Magnetic Resonance Imaging (MRI) is a radiological technique that uses radio waves and magnetic fields to produce 2D and 3D images. MRI is more effective in seeing soft tissues such as muscle, tendons, ligaments, and discs than CT or X-rays, and therefore is very useful in pain management, orthopaedics, and sports medicine in helping to diagnose painful conditions. With respect to joint pains, MRI can help distinguish arthritis from other conditions that can cause joint pain (such as ligament or tendon tears).
Ultrasound uses sound waves to generate 2D (and now 3D) images. Ultrasound is very effective in visualizing soft tissues such as muscle, tendons, ligaments, and bursae. Ultrasound also offers the ability to see these structures in real-time, allowing your doctor to see the structure with movement. Ultrasound is also used for needle guidance during joint injections.
Laboratory tests are very useful in differentiating among different types of arthritis. These may be blood tests looking for an indication of rheumatoid arthritis or tests of fluid removed from the joint to look for crystals that may be seen in gout or signs of infection that might indicate septic arthritis.
Arthroscopy is a surgical technique where a tiny camera is inserted into the joint to visually inspect the joint. Arthroscopy allows the surgeon to actually see the joint and also may allow them to repair any problems that they see without having to perform an open surgical procedure.
Arthritis Treatments
The specific treatment chosen by your doctor will depend on the type of arthritis that you have, the severity of your symptoms, and any other medical issues that you are currently experiencing. Your specific treatment plan may include one or many of these options.
Non-steroidal Anti-inflammatory drugs (NSAIDs) reduce inflammation and therefore reduce pain from arthritis. NSAIDs may be administered orally or topically and many are available over-the-counter. NSAIDs are typically the first line of treatment for many forms of arthritis.
Analgesics reduce pain but do not help reduce inflammation and therefore are usually reserved for more advanced cases of arthritis where NSAIDs alone are not able to relieve the pain.
Oral Corticosteroids are very powerful anti-inflammatories and also suppress the immune system. They are very effective in reducing the arthritis pain and inflammation, but they also may have very significant side effects.
Disease modifying antirhematic drugs (DMARD) are medications that reduce the body’s immune response, thus reducing the immune system’s ability to attack the joint capsule. Unlike other medications that only treat the symptoms of rheumatoid arthritis, the DMARDs actually slow down or stop the progression of the disease itself. This reduces the destruction of the joints and limits disability later in life.
Biologics are genetically engineered “designer” medications that specifically target and inhibit proteins (such as tumor-necrosis factor alpha) that are involved in the immune response. Like the DMARDs, biologics can slow down or stop the progression of the disease rather than just treating the symptoms.
Injected corticosteroids are powerful anti-inflammatories which can also temporarily depress the central nervous system. The side effects from injected corticosteroids are typically less than the oral corticosteroids due to the lower doses that are necessary.
Platelet Rich Plasma (PRP) therapy is an advanced regenerative medicine therapy which uses your own platelets to help your body heal itself. PRP contains 3 specific growth factors [platelet derived growth factor (PDGF),transforming growth factor beta 1 (TGF-b1) and transforming growth factor beta 2 (TGF-b2)], all of which have been shown in studies to enhance the regrowth of normal bone, ligament, and tendons.
Physical therapy can be very effective in certain types of arthritis by improving range of motion and strengthening supporting muscle groups.
Braces may be an effective option for reducing or eliminating arthritic pain, especially during weight bearing activities.
Joint replacement is an option when the arthritis pain is severe and conservative options have been ineffective in controlling the pain. The most common joint replacement surgery is for the knee, hip, and shoulder.
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