Arthritis is a combination of two word ARTHROS and ITIS. The word ARTHROS means of the joint of the body and the word ITIS signifies swelling or what we call medically as Inflammation. So ARTHRITIS means swelling or inflammation of the joints. This in turn leads to pain, limitation or loss of motion, loss of flexibility and deformities of the joint. All these complex of symptoms in turn lead to poor quality of life by decreasing the confidence levels of the patient as he/she modifies his/her lifestyle to accommodate the disability of the disease. About 20% of the population suffers from arthritis and it is the leading cause of disability in adults.
A joint is the place in the body where two or more bones meet. Joints are formed to facilitate controlled movement of the body in different directions. A joint on which a person has no control and moves randomly is called NEUROPATHIC joint.
There are three types of joints – Synovial, Cartilaginous and Fibrous. Synovial joints are the commonest variety of joints in the body examples are – Hip, Knee, Shoulder, etc. These joints have maximum mobility. Cartilaginous joints are the joints of ribs to the body and have limited mobility. Fibrous joints are tough joints like joints of skull bones and have negligible mobility.
The diagram shows a typical synovial joint. It is made up of the two bones which form a joint. The ends of the bones are covered by CARTILAGE which is a tough elastic tissue which can take the shocks of movements and is also very smooth so that there is almost no friction on movement. The bones are surrounded by a JOINT CAPSULE which contains SYNOVIAL MEMBRANE which secretes SYNOVIAL FLUID and has the function of maintaining lubrication to facilitate frictionless movement.
Inflammation or swelling in any of the parts of the joint is called ARTHRITIS. There are various factors which can cause inflammation –
Whatever may be the underlying cause the end result is destruction of the smooth CARTILAGE which leads to pain (which arises from the exposed underlying bone), swelling due to increased production of Synovial fluid and also thickening of the Synovial membrane (which is natures response to buffer the shock on the exposed bone). The supporting structures like the ligaments, muscle become loose and this leads to deformities which are reversible initially but later when the bones that form the joint change shape to adapt to arthritis the deformities becomes irreversible and sometimes fixed ( stiff joints).
Infective arthritis as the name suggests is due to infective process. The infection could be bacterial, viral or fungal. Many a times due to immunologic response to an infection elsewhere in the body there could be picture of inflammation of the joint. A common presentation in such forms is the Chikunguniya or other similar viral infections. A variety of bacterial infection that is special to our country is the Tuberculous infection of the joint (Joint TB). Whatever may be the cause the process of infection of a joint goes through four phases – inflammatory synovitis with free fluid in the joint (Stage I), necrosis of cartilage due to hampered blood supply which leads to cracks and fissure formation (Stage II), loosening and breakdown of cartilage with loose body formation leading to severe pain, noise on movement, locking and loss of motion (Stage III) and this leads to the last stage – that of development of deformities with or without ankylosis (fused joints) (Stage IV). Stage I is mainly a clinical diagnosis which is supported by blood tests with or without testing of the joint fluid removed specially for testing. X-rays at this stage are not very informative. The damage is seen in X – rays only from late Stage II onwards and gets progressively prominent as Stage IV is approached. Viral infections resultonly in joint swelling – synovitis and rarely if ever cause bone destruction.
A high index of suspicion is needed to diagnose early as the sooner the treatment starts the better is the outcome. Proper diagnosis by studying the joint fluid is necessary to define the organism responsible. Initially rest along with specific medications is necessary. Usually majority of the patients respond well to this line of treatment. If the response is not satisfactory then a surgery to clean the joint (like cleaning any part with pus – abscess) is performed. The material thus obtained is tested for detecting the organism and appropriate medications given. Cleaning of the joint may also be necessary when the dead tissue in the joint hampers movements. Rarely do we see Stage IV – neglected cases due to various reasons like poor socio-economic status, non availability of proper medical aid, etc. In such cases appropriate surgery to overcome the deformity and provide maximum function is performed to treat the condition. Hence any joint pains especially if it appears after a bout of infection which does not settle with regular medicines for 5 to 10 days should not be neglected and appropriate medical aid should be solicited. It is commonly seen in children, people with compromised immunity, and poor health due to uncontrolled diabetes, liver disease and kidney disease.
GOUT is a hereditary condition of disturbed uric acid metabolism in which urate salts are deposited in the joint and surrounding soft tissues. There is intermittent pain with periods of normal periods of freedom from pain when the patient feels he/ she is absolutely normal. Untreated or improper treatment can lead to crippling deformities which would need surgical intervention. A lot of people when screened show high levels of Uric acid in blood without any symptoms of arthritis. It can be triggered by trauma(long walks included), high fat diet, drugs especially in people with deranged liver function, red meat and organ meat in diet, exposure to cold, stress – all forms including post surgery stress. There is sudden onset of pain and joint swelling mostly starting in night or early morning and disturbing sleep. The joint are swollen and very painful and it can mimic infection and cellulitis. Movements are generally extremely painful and often there is low grade fever with a feeling of being unwell. The diagnosis is mainly clinical and often the inciting factor can be pointed out clearly. The blood shows high levels of Uric acid, white blood cells. It responds very well to treatment with uricosuric drugs and regular anti inflammatory drugs. At times a combination of multiple drugs is used in high numbers and patients often wonder why they are taking so many medications. However, multiple drugs are used only for short durations like 10 to 14 days.
Foods to be avoided or taken in moderation in gout are - i.e