ARTHRITIS

Osteoarthritis is one of the types of arthritis that is caused due to degeneration and eventually loss of the cartilage of joints. Cartilage is a tissue that covers the inside of the joints and acts as a cushion between the two bones forming a joint. When the cartilage starts undergoing degeneration, the bone becomes inflamed as its protective covering is lost. This causes pain during weight bearing activities such as standing, walking, etc.

Osteoarthritis occurs commonly as a person ages and it is frequently seen in persons above the age of 55 years though it can also occur earlier than this. Before the age of 45 years, it is more common in males. Genetic predisposition also is one common cause for osteoarthritis. This condition usually affects the weight bearing joints such as the knees and hips; it can also affect other joints such as those of the hands, feet and the spine.

When the osteoarthritis is due to ageing process it is known as primary osteoarthritis; when there are other conditions in the background that have triggered this disorder, it is known as Secondary osteoarthritis. Secondary osteoarthritis can be caused by any of the following:

• Trauma
• Joint surgery
• Obesity
• Congenital anomalies of the joint
• Gout
• Diabetes
• Hormonal disorders (especially Growth hormone disorders)

The common symptoms of Osteoarthritis:

• and stiffness of the affected joint
• Swelling and warmth of the joint
• Creaking of the joint
• Pain is usually worse after repetitive use of the joint
• Stiffness is usually worse after a long period of inactivity
• Pain may occur at rest too (in severe cases)
• Limited mobility of joints
• Inability to squat
• Bony enlargement of small joints of fingers (called Heberden’s nodules)

• Neck pain and stiffness
• Backache
• Tingling numbness of extremities

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. This condition can also affect the tissues surrounding the joints (muscles, tendons, ligaments) as well as other organs of the body (skin, blood vessels, heart, lungs and muscles).

RA is a chronic condition and it tends to last for many years though there are periods in between when the patient is without any symptom. RA is a progressive condition and over a period of time, it causes joint destruction and functional disability.

Scientists largely believe that the tendency to develop rheumatoid arthritis may be genetically inherited. It is also suspected that certain infections or factors in the environment might trigger the immune system to attack the body's own tissues (Autoimmune response), resulting in inflammation. In any case, the autoimmune response causes chronic inflammation of the joints, that later progresses to joint destruction. Stress can act a predisposing factor as well as a trigger to induce acute episodes of the condition. The disease is three times more common in women as compared to men. It afflicts people of all races equally. The disease can begin at any age, but peak incidence is seen between 40 to 60 years of age.

The course of RA varies from patient to patient. There are stages when the disease is active and this is called a ‘Flare-up’. In between the flare-ups are episodes when the patient is absolutely free from symptoms, such periods are called ‘Remissions’.

Common symptoms during the active stage of RA are as follows:

• Joint swelling, redness and tenderness
• Joint stiffness
• Limited range of motion of joints
• Deformities of hands and feet (at later stages)
• Muscular pains
• Fever
• Loss of appetite
• Usually multiple joints are affected at one time (polyarthritis)
• Small joints of hands and feet; elbows, ankles are commonly involved
• Skin redness or inflammation
• Round, painless nodules under the skin
• Inflammation of the lung (pleurisy)
• Swollen glands
• Anemia

Following are the common tests done to diagnose RA:

• RA (Rheumatoid Arthritis) factor
• X-ray of the joint
• ESR (Erythrocyte Sedimentation Rate)
• C-Reactive proteins (CRP)
• CBC (Complete blood count)

GOUT

Gout is a form of arthritis which is caused by the accumulation of uric acid crystals in joints. In this condition, due to a metabolic dysfunction, there is deposition of uric acid in and around the joints causing severe painfulness, swelling and restricted mobility of the affected joint.

The underlying cause of gout is a disturbance in Purine metabolism of the body. Purine is a substance found plenty in the living cells as well as in many food articles. Uric acid is a body waste product, which is produced in the body after the breakdown of Purine. Underexcretion of uric acid through the kidneys and large intestines or excess formation of uric acid due to certain factors (such as alcohol, lack of physical activity, crash diet, meat, etc.) leads to accumulation of excess uric acid in the blood, eventually leading to Gout. The exact cause for the underexcretion remains unknown in many cases, and it is believed to be more genetically determined.

Gout is an intensely painful condition, which mostly affects only one joint (monoarthritis) at a time, most commonly the big toe. However, Gout may also affect elbows, knees, ankles, wrists or small joints of the hands and feet. The classic history in a patient suffering from Gout is of excruciating and sudden pain, swelling, redness, warmth and stiffness of the joint. Low-grade fever may also be present. The skin overlying the joint can also be swollen, tender and sore if it is touched even lightly. Patients with longstanding hyperuricemia (high levels of uric acid in blood) can have uric acid crystal deposits called tophi in other tissues as well, e.g. the helix of the ear.

• Asymptomatic: High levels of Uric acid in blood but no joint complaints
• Acute phase: Acute complaints described above occur for a brief period
• Intercritical phase: There is no pain or swelling of joints in this phase, the patient is     relatively symptom-free.
• Chronic: Gout attacks may become frequent during this phase and the condition may affect many joints at a time (polyarticular). Tophi formation may also be seen.