What is Arthritis? Information on types, symptoms, causes and treatment of Arthritis. Where Arthritis attacks?
Arthritis; is a general term used to denote an affliction, which may be inflammatory, of one or more joints. The symptoms of arthritis vary with the cause, but they usually include pain on motion, tenderness, swelling, warmth, and stiffness of the involved joints.
Types of Arthritis: Osteoarthritis, the most common form of arthritis, is frequently associated with aging (primary type) or trauma (secondary).
Rheumatoid arthritis, the second most common type, affects one percent of the U.S. population. It is twice as common in women as in men and may occur at any age. This chronic inflammatory disease may attack any moveable joint but most frequently affects small joints, especially the middle knuckles and the wrists. There may be stiffness about the joints lasting for more than half an hour after arising; muscle aching, particularly around the shoulders; fatigue; weight loss; and occasionally slight fever.
In this type of arthritis there is an overgrowth of inflammatory or scar tissue inside the joints (see Joint). Irreparable destruction of the cartilage lining the joint space and the bone beneath the cartilage occurs and can be seen on X-ray. With prolonged disease there may be destruction of the joint capsule and the tendons that control the motion of the joint; partial dislocation of the joint; or fusion of the joint by scar tissue and new bone. Neighboring muscles tend to shrink from disuse.
Approximately 25 percent of all patients with rheumatoid arthritis develop painless nodules under the skin, especially on the elbows. Anemia, which often does not respond to iron therapy, also is found in about 25 percent of the patients. Occasionally, rheumatoid arthritis is associated with inflammation of the eyes, arteries, or nerves. Juvenile rheumatoid arthritis, which starts before puberty, may begin with a rash and fever and be associated with abnormal bone growth.
An abnormal protein called rheumatoid factor is present in the blood of 75 percent of adults with rheumatoid arthritis and 5 percent of adults without it. Those with the factor but without rheumatoid arthritis include healthy, often elderly, individuals and patients with liver disease, chronic infections, and other disorders. The erythrocyte sedimentation rate (ESR), a blood test that measures disease severity, is usually abnormally increased in rheumatoid arthritis, as it is in most other inflammatory diseases.
Rheumatoid arthritis often fluctuates in severity, and in 10 percent of the patients it may disappear permanently within one year. Many patients are no worse after 10 years of the disease than they were at its onset. Factors that predict severity are: onset of the disease early in adult life, persistent pain, nodules, and rheumatoid factor. Rheumatoid arthritis does not shorten life appreciably, except when it is complicated Dy vasculitis (inflammation of blood vessels), amyloidosis (a disease in which the protein amyloid is deposited in body tissues and organs), or misguided treatment.
Ankylosing spondylitis is a chronic inflammatory arthritis predominantly of the joints of the spine and pelvis, but in 15 percent of patients it also affects the joints of the hands and feet. It is five times more common in men than in women and usually begins in adolescence or young adulthood.
Early in the disease, patients may suffer stiffness on arising, malaise, and loss of weight. Later, the back and rib cage may become rigid because of calcification at edges of vertebrae, in intravertebral discs, and in adjacent supporting ligaments. In 25 percent of these patients there is inflammation of the eyes. Occasionally, disease of the aortic heart valve or amyloidosis, is present. The erythrocyte sedimentation rate is increased, and there may be anemia. Nodules under the skin and rheumatoid factor usually are absent. Life is not shortened by this type of arthritis, and most patients continue to lead a productive existence.
Arthritic symptoms are present in 80 percent of patients with systemic lupus erythematosus, a disease that may have many of the features of rheumatoid arthritis. This disease occurs mainly in women of child-bearing age. The disease may affect many organs and be associated with a falsely positive test for syphilis. Lupus erythematosus (LE) cells may be found in blood samples. (An LE cell is a white blood cell that has engulfed the nucleus of another white cell because of the presence of antinuclear antibodies in the patient’s blood.) The disease, especially of the kidney and heart, may shorten life.
Two other types of arthritis, gout and rheumatic fever, are discussed in separate articles. Arthritis of any joint may result from bacterial infection in the joint (gonococcus, staphylococcus, or tuberculosis). Arthritis also is found in association with other diseases and conditions.
Treatment: The safest and most useful drug in the treatment of rheumatoid arthritis is aspirin (acetylsalicylic acid). Many patients take up to 15 five-grain aspirin tablets each day (see Aspirin). Indomethacin, introduced in 1962, seems to be an effective anti-inflammatory and analgesic drug, the toxicity of which is still under study. Phenylbutazone may cause peptic ulceration or blood disease and therefore is seldom used for long periods of time. Gold compounds and chloroquine exert their effects only after months of use and are not always of lasting benefit. In severe rheumatoid arthritis, antiinflammatory steroids may be needed. These drugs may produce temporary improvement but may be harmful and are not curative. Steroids may be given by mouth or injected directly into a joint. Narcotics are to be avoided.
Physical therapy is especially valuable in severe disease and should include range of motion exercises, warm moist heat, and rarely, night splints. Orthopedic surgery occasionally is useful to relieve pain or to improve joint function. Exhausting or unusually painful activity should be avoided. No special foods or vitamins, aside from an adequate diet, are of any benefit.
In ankylosing spondylitis, back exercises, a bed board, and elimination of a head pillow prevent fusion of the spine in a bent position while aspirin, phenylbutazone, or indomethacin provide relief of pain and suppress inflammation. Antiinflammatory steroids, gold, and chloroquine rarely are useful in ankylosing spondylitis, and X-ray therapy is to be discouraged.
The treatment of systemic lupus erythematosus includes aspirin and often large doses of antiinflammatory steroids when vital organs, such as the kidney or heart, have been attacked. Chloroquine and drugs thought to suppress immunological reactions in the body may be of value.
Causes of Arthritis: The cause of rheumatoid arthritis is not known. However, it is thought to be, at least in part, an aberration of the body’s immune defense mechanism. The primary reason for this belief is the presence of rheumatoid factor (a gamma globulin). It has an antibodylike affinity for smaller denatured gamma globulin molecules, and it may be identified by its ability to agglutinate (collect into clumps) gamma globulin-coated latex particles or gamma globulincoated red blood cells of sheep. Sometimes other such autoantibodies are present.
A popular theory supported by experiment holds that rheumatoid factor is an antibody to other antibodies that have become altered by interaction with their specific antigen so as to form an antigen-antibody complex. Animals, and probably humans, will make rheumatoid factor when subjected to any prolonged antigenic stimulus. Research suggests that white blood cells may cause damage in a joint by releasing enzymes from tiny intracellular packets (lysosomes) in response to the white blood cells’ ingestion of rheumatoid factor. A vicious circle thus may be established, since the antigens produced by the action of the released enzymes theoretically could stimulate the formation of more rheumatoid factor. Transfusion of rheumatoid factor into individuals with no symptoms of arthritis does not produce arthritis. Conversely, replacing the blood of a patient with unaffected blood does not have a beneficial effect.
The finding of lymphocytes (a type of white blood cell) and plasma cells in the joints of patients with rheumatoid arthritis also points to an immune mechanism, since lymphocytes normally are known to play an active role in the body’s immune defense system. Although no unique antigen has been found, the blood of patients with rheumatoid arthritis often contains large amounts of gamma globulin antibody.
An infectious cause of rheumatoid arthritis is suggested by the following observations. Viral diseases (such as German measles) occasionally cause an arthritis, and rheumatoid arthritis sometimes starts with a grippelike illness. An arthritis may be induced in swine by erysipelothrix (a bacterium) and in several other domestic animals by mycoplasma (microorganisms without a complete cell wall). Also, Bedsonia microorganisms have been isolated from some patients with Reiter’s syndrome of arthritis, urethritis, and conjunctivitis. However, no causative organism has been found in rheumatoid arthritis, and the disease cannot be transmitted from person to person or to animals. It no longer is believed that foci of infection (such as bad teeth) contribute to rheumatoid arthritis.
It is not known whether rheumatoid arthritis can be inherited, and there is no evidence for a psychological, nutritional, endocrine, nervous, or occupational cause of this disease. Some research workers have suggested that rheumatoid arthritis is a metabolic disease, because the majority of patients excrete in their urine increased amounts of 3-hydroxyanthranilic acid, kynurenine, and histadine, with less histadine in the blood.
Except for the possible role of heredity, little is known about the cause of ankylosing spondylitis. The cause of systemic lupus erythematosus is not known but is thought to be similar to that of rheumatoid arthritis.
***This article is for informational purposes only. It is not a doctor warning or recommendation.