Health

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HEALTH When the joints age and wear out… arthritis

Dr Rod Pearce

Arthritis is usually split into two main types. One occurs when some diseases, such as rheumatoid arthritis or psoriatic arthritis, actively destroy the joints. These are usually known as erosive forms of arthritis because the disease process erodes the joints and bones.

Gout is an erosive arthritis caused by the urate crystals damaging the joint. With these diseases comes active inflammation. Joints might be hot and tender.

The other type of arthritis is more common and not always caused by inflammation but more so wear and tear associated with age. It is commonly known as degenerative arthritis or osteoarthritis.

Despite one in six of us having this type of arthritis, there is not any real agreement about exactly what it is, other than something wrong with our joints.

In medical terms, it is thought of as primarily a degenerative disorder with inflammatory components arising from the biochemical breakdown of articular (hyaline) cartilage in the synovial joints.

As the joint wears down with age and activity it triggers irritation and inflammation and includes not only the joint but also the cartilage, the lining of the joint (synovium) and the surrounding bone.

Symptoms of arthritis include deep, achy joint pain – made worse by extensive use – with reduced range of motion and crepitus (grinding noise). Joints typically have increased stiffness after rest. As the joint wears down with age and activity it triggers irritation and inflammation and includes not only the joint but also the cartilage, the lining of the joint (synovium) and the surrounding bone.

Arthritis of the hand usually involves the last joints of the fingers, the base of the thumb and sometimes disfigurement of the hand with lumps and bony protuberances.

There are thought to be many reasons the joints are painful.

The presumption is that the pain arises from a combination of mechanisms. Sometimes the bones form spikes which push against the ligaments (osteophytes). Rubbing of bone on bone might cause vascular congestion of subchondral (under the cartilage) bone, leading to increased “bruising” or internal pressure.

The lining of the joint (synovium) might swell and become inflamed and cause irritation to the nerves in the joint. The muscles that cross the joint might become fatigued. The joint itself might become scarred and contract. Fluid might cause swelling. The cartilage might tear or the tissue around the joint might become injured through overuse.

Psychological factors. Sometimes crepitus (a rough or crunchy sensation) might alter the way you walk. Other times it is just the chronic nature of the problem that can become depressing.

The goals of osteoarthritis treatment include pain alleviation and improvement of functional status. It is also important to do no harm with medicines, as the condition is chronic, and to handle the pain and stiffness but not always inflammation.

Sometimes heat packs and other times cold packs are useful. Exercising is important to help the muscles protect the joint. Think of the joints like opening a door. If you thrust the door open it can hit the wall and make a hole. If you slam it shut the whole frame can shudder. So too a joint.

Over-exercising can stir up pain but if the muscles control the movement there is less disruption of the joint.

To reduce the stress on the joint you need to reduce the weight on it. That’s why muscle training, such as strengthening the quadriceps for the knees, becomes important.

The issue of whole-body weight loss is about more than just helping joints like the knee and ankle. It appears that the weight reduction decreases the risk of active inflammation in all joints. So, less shoulder pain if you lose weight, but also less knee pain because there is less for the joint to carry.

If drugs are needed, the first suggested are those other than nonsteroidal anti-inflammatory drugs (NSAIDs). This is partly because there is not always inflammation, but also because of the long-term side effects on blood pressure, the heart and kidneys, and the creation of stomach ulcers.