A joint is formed by two bones moving together. To reduce friction, the ends of the bones are
lined with cartilage, which is normally quite smooth. There is also a joint fluid secreted by the
lining of the joint that acts as a lubricant and a cushion. To stabilise and strengthen the joint,
muscles are attached to it via ligaments. Tendons link the bones involved together.
Arthritis is inflammation (irritation) of a joint. This inflammation causes changes within the joint that
may be acute (days to weeks) or chronic. Acute changes (such as excess fluid being produced by the
lining of the joint to cushion the movement of the bones) are easily reversible. Excess fluid may be
seen as swelling of the joint and sometimes a doctor may suggest removing some of it for diagnosis
or for comfort.
Chronic changes are more serious, as they indicate joint damage. They cause pain and the bones
around the joints may become overgrown and deformed. Usually there is also swelling in the joint,
but, surprisingly, pain is not necessarily present.
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Types of arthritis
Osteoarthritis is “wear and tear” arthritis which is associated with ageing and with injuries to the joints. It is by far the most common form of arthritis and is usually diagnosed clinically or by x-ray, as there is no blood test that will show its presence.
Rheumatoid arthritis is an auto-immune disease that occurs when the body makes antibodies (proteins) which attack the lining of the joint. Symptoms include painful, stiff joints which appear to be deformed. Other symptoms include the development of painless, small nodules around the joints which can flare up and become inflamed during an episode that can last for a few weeks or even months. In most cases the smaller joints of the body such as those of the fingers are predominantly affected.
Other Autoimmune arthritic conditions include, S.L.E. (or Lupus) and polymyositis. These conditions are uncommon and the arthritis resulting from them may wax and wane over time.
Sero-negative forms of arthritis include most commonly ankylosing spondylitis, psoriatic arthritis and reactive arthritis (for example, the short lived arthritis patients may get with viral illnesses, such as rubella). These forms of arthritis do not show autoimmune antibodies on blood testing.
Metabolic arthritis is where crystals deposit in the joint fluid, irritating it. The most common example occurs when there is a build up of uric acid causing gout. |
Causes of arthritis
Osteorarthritis can be caused by a number of factors including:
1. Genetic inheritance.
2. The stresses a joint has been under over time may quite obviously contribute to the development of osteoarthritis. Those that suffer injuries to a joint (such as the knee joint in professional footballers)
find that osteoarthritis comes much earlier to the damaged joint than it does to the other non-injured
joint.
3. Rheumatoid arthritis is often inherited and affects women three times more than it affects men.
4. Considered an autoimmune disease.
Other
There are some specific conditions that increase the risk of arthritis developing in joints. A good
example is obesity. It is easy to see how the extra weight carried puts a larger load on the knees and
ankles of people who are overweight. Osteoporosis contributes to arthritis because certain bones
(e.g. those in the back) become weaker and may crush under the pressure of the weight above them.
The joints may change their alignment over time and the surfaces may no longer
rub together smoothly.
Bacterial infection of joints is a serious health condition and the damage done may predispose a
person to arthritis later.
Prevention of arthritis
There are many things one can do to reduce the risk of developing or worsening arthritis.
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Exercise – strong muscles help to reduce the load on a joint that is prone to irritation. Those
who have arthritis or who are unfit should begin an exercise regime very slowly and gently,
preferably with medical advice first. Even if one has painful arthritis, complete joint rest is not
advised for more than a couple of days. Gentle movements should be encouraged and
swimming is an excellent exercise for arthritis as the water shares the body’s weight and
relieves it of the forces of other body weight bearing exercises.
– Avoid alcohol (especially red wine)
– Avoid offal meats (such as liver, kidneys and brains)
– Restrict or avoid shellfish and anchovies
– Drink plenty of water and avoid dehydration
– Don’t overeat on a regular basis.
There is some theoretical evidence that fish oil might help arthritis.
Treating symptoms of arthritis
Glucosamine
Glucosamine is a natural substance found in joint cartilage and fluid. When given orally, some studies have shown that it can help with pain. There are some differences in the effectiveness of the different preparations of glucosamine. Glucosamine has a very good safety profile with very little side effects being reported.
Anti-inflammatory and analgesic medications
Anti-inflammatory medications help to reduce inflammation in a joint and hence can help with symptoms such as pain associated with the condition.
They are available both with and without prescription, but should not be used by people who have had asthma, oesophageal reflux or stomach ulcers. Ideally, anti-inflammatories should be used for less than a week at a time, but many people have symptoms for much longer than that. There are also over-the-counter anti-inflammatory gels and creams that may be used by those who can’t take the tablet equivalent. Some find the mild irritant properties of capsicum lotions and similar help with the symptoms of arthritis.
Paracetamol or paracetamol and codeine combinations (maximum eight tablets a day and after medical review) are suitable medium or long term management options. |
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© Australian Pharmaceutical Industries Limited 2006
Produced by API, 11 Grand Avenue, Camellia NSW 2142 ABN 57 000 004 320
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information contained in this booklet, to the extent permitted by API, their agents and employees:
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