Arthritis is an inflammation of the joints (the junctures where the ends of two or more bones meet).

Types

Inflammation develops in various ways. With osteoarthritis, there is gradual wearing away of cartilage in the joints. Healthy cartilage is the elastic tissue that lines and cushions the joints and allows bones to move smoothly against one another. When this cartilage deteriorates, the bones rub together, causing pain and swelling.

Osteoarthritis can cause permanent damage, stiffness, and deformity of the joints. Although osteoarthritis can result from direct injury to the joint, it commonly occurs in adults over age 55 because of long-term wear and tear.

Osteoarthritis can cause permanent damage, stiffness, and deformity to the joints.

In osteoarthritis, the cushioning cartilage at the ends of bones wears away or
erodes, allowing the bone ends to rub together. This causes swelling and pain.

Rheumatoid arthritis can attack individuals of any age. This form of arthritis affects all the connective tissues, as well as other organs. The precise cause of rheumatoid arthritis is unknown. Some researchers believe that a virus triggers the disease, causing an autoimmune response whereby the body attacks its own tissues. (Evidence for this theory is inconclusive, however.)

In rheumatoid arthritis, the synovium (the thin membrane lining and lubricating the joint) becomes inflamed. The inflammation eventually destroys the cartilage. As scar tissue gradually replaces the damaged cartilage, the joint becomes misshapen and rigid. Rheumatoid arthritis may damage the heart, lungs, nerves, and eyes.

Those at Risk

Arthritis is not an inherited disease. Nonetheless, people who have a family history of arthritis are more likely to develop the disease. Women are at greater risk than men, although the reason for this is unclear.

Excess body weight may promote osteoarthritis because of the increased pressure on the joints. While inactivity can also aggravate the problem, constant sports- or job-related abuse to joints may also encourage arthritis.

Symptoms

Symptoms of osteoarthritis include swelling, tenderness, pain, stiffness, and redness in one or more joints. For many patients, pain is greatest in the morning and subsides as the day progresses. Damp weather and emotional stress can make symptoms worse.

With rheumatoid arthritis, these symptoms may be accompanied by more generalized feelings of fatigue and fever. This form of arthritis may go into periods of remission, when symptoms disappear. When symptoms return, however, they are often more severe.

Diagnosis

To diagnose arthritis, a physician observes the patient's symptoms and administers a standard physical examination. X-ray studies and laboratory tests may be recommended to confirm joint swelling and to determine the extent of damage the arthritis has caused.

Treatment

The most effective treatment program for arthritis consists of drug therapy, exercise, and rest. Treatment should begin early after diagnosis to prevent permanent damage.

High-dose aspirin was once the most frequently prescribed drug for the relief of symptoms. Although effective, side effects such as stomach ulceration or bleeding and ringing in the ears have curtailed its use.

Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen may also be used to treat the symptoms of arthritis. These medications can cause side effects similar to those caused by aspirin, however, particularly bleeding from gastritis or stomach ulcers. Long-term use of these medications should be supervised by a physician.

In osteoarthritis, joints are sometimes injected with corticosteroids to relieve inflammation and pain. Though these drugs are quite effective, they do have side effects. They should be used only under close and continuous medical supervision.

Oral or injectable gold may prove helpful in treating rheumatoid arthritis. Drugs usually used for cancer chemotherapy, such as methotrexate, may also be helpful as may newer drugs, such as etanercept and infliximab, that modulate the immune system.

Moderate daily exercise, such as swimming, walking, or physical therapy, is critical to maintaining mobility in arthritic joints. A supervised exercise program interspersed with rest periods helps to reduce joint inflammation. To lessen pain while increasing movement, moist heat often helps. In addition, maintaining correct posture and body weight reduces extra burden on sore joints.

Severe cases of rheumatoid arthritis may require surgery to remove inflamed synovial tissue. With either form of arthritis, artificial joints may be implanted to replace those damaged beyond repair.



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