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Arthritis
| What is Arthritis? |
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Arthritis is
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he name of a broad set of rheumatic diseases causing pain, stiffness
and swelling in or around joints
- A disorder that can be prevented in certain cases by risk-reduction
strategies
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| What are the types of arthritis? |
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Two common types of arthritis are rheumatoid arthritis and osteoarthritis.
These are separate diseases that affect people in different ways.
Rheumatoid arthritis involves inflammation of the joints and results
from the body's abnormal attack on the joints, not from overuse
of joints. It can affect a person's entire body, and often causes
overall symptoms in addition to joint pain. Rheumatoid arthritis
is most commonly diagnosed in people aged 25 to 50, but can affect
people of all ages, including babies.
Osteoarthritis is the most common type of arthritis. It is also
called "degenerative joint disease", and most often involves
the weight-bearing joints. The disorder results from mechanical
joint damage - whether from long-term "wear and tear",
or previous injury. Osteoarthritis is usually diagnosed in people
older than 40. Nearly everyone over 70 has osteoarthritis in at
least one joint, but not all develop symptoms.
There are many other types of rheumatic disorders. Not all of them
are primarily diagnosed in adults. Juvenile arthritis is the name
of a group of arthritis-related conditions that affect children.
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| How can a person prevent arthritis? |
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A person can reduce the risk for developing symptomatic osteoarthritis
by maintaining a normal weight. Being overweight puts more stress
on weight-bearing joints, and increases the risk for knee pain (and
possibly hip pain). If a person is already overweight, losing just
10 or 11 pounds will significantly reduce the risk for developing
osteoarthritis in knees. |
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OSTEOARTHRITIS
| What is osteoarthritis? |
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Osteoarthritis (OA) is an age-related disease involving the breakdown
of the joint cartilage. The loss of joint cartilage causes pain,
stiffness, and decreased mobility in the affected joints. In most
people with OA, joint cartilage becomes damaged through mechanical "wear and tear" - a lifetime of walking or running on
hard surfaces, for example.
Other possible causes of OA include previous joint injury, or heredity.
The disease most often affects the knees, fingers, hips, neck, and
lower back. It is not usually found in the wrists, elbows, shoulders,
ankles, or jaw, unless these joints have been injured or put under
heavy stress.
OA occurs in both men and women, and is most often diagnosed in
middle-aged and older people. It can occur in people who have other
forms of arthritis as well. |
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| How osteoarthritis affects the joints? |
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A joint is the place where two bones meet. Cartilage normally
covers and cushions the ends of the two bones. This prevents the
hard surfaces of the bones from rubbing together and causing damage.
After "wear and tear" or a joint injury damages the cartilage,
it becomes torn and frayed, loses its elasticity, and eventually
wears away altogether. The bones begin to rub together as the joint
is moved. Bony growths, or "spurs," begin to form on the
ends of the bone. The joint becomes painful, is stiff after periods
of inactivity, and its movement may ultimately be limited.
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| Symptoms |
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If persons have OA, the joints will probably hurt most after using
them too much, or after a long period of not using them much at
all. In the morning, patients may get up feeling stiff, but the
stiffness goes away as the person is going about to daily movements.
Pain in the joints may cause to limp, and patients may find it difficult
to go up or down stairs.
The knuckles of the hands may swell and feel painful. Patients may
feel pain and even a "grating" sensation as they move
the knee. Other joints, such as hip or the large joint at the base
of the big toe, may also feel stiff and tender.
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| Diagnosis and treatment |
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Doctors commonly diagnose OA by listening to a patient's history
and performing a physical examination. The doctor may also order
x-rays, to evaluate the condition of the joints, and in some cases
may perform joint aspiration.
A may be treated with medications to control pain and reduce inflammation,
if any. These medications include:
- Non-narcotic pain relievers (paracetamol)
- Narcotics, for short-term pain relief (codeine, and oxycodone)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen,
and naproxen
- Injectable corticosteroids (may be injected into an arthritic
joint after joint aspiration)
- Topical pain relievers (creams, rubs, or sprays applied directly
to the skin)
Other treatment strategies for OA include physical
therapy, aerobic exercise that does not put undue stress on the
joints, and maintaining a normal weight or losing weight. Ultimately,
in some cases, surgery may be needed to remove bone spurs within
a joint, reposition the bones, or otherwise repair bony damage.
Some patients may need to have their damaged joints surgically replaced
with artificial ones.
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| Is osteoarthritis the same as osteoporosis? |
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No, although the two conditions may sound similar. Osteoarthritis
is a type of arthritis involving damage to joints. Osteoporosis
is an unrelated disease in which bones gradually lose their mass
and become weak and brittle. Eventually, people with osteoporosis
may suffer vertebral fractures as the bone fails to support the
weight of the spinal column, or hip fractures after minor falls.
Osteoporosis is best prevented by building strong bone over the
years through an adequate calcium intake, avoiding smoking, and
exercising regularly. In contrast, the calcium intake does not directly
affect the risk for osteoarthritis. |
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| What is the difference between osteoarthritis and rheumatoid
arthritis? |
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Osteoarthritis is usually found in middle-aged to older people,
developing slowly over many years. Inflammation of the joints is
not very common, although pain, stiffness and limitation of motion
may be present. If one joint is affected, the corresponding joint
on the other side of the body may not be. In addition, pain is usually
limited to the affected joint only. Weight-bearing joints like the
knees and hips are most often involved. Patients may get up in the
morning with joint stiffness, but it usually goes away gradually
as the joint is used.
Rheumatoid arthritis is usually first manifested in people between
25 and 50, but can occur in young children and even small babies.
The disorder may develop quickly after the first symptoms appear,
over a period of weeks or months. It typically causes inflammation
of the joints, and usually involves the joints on both sides of
the body. Many joints may be affected. Patients may have a sense
of overall sickness and fatigue, and may experience fever and weight
loss. Morning joint stiffness may be prolonged.
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MANAGING PAIN OF ARTHRITIS
| What is Pain? |
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Pain is the body's warning system, an unpleasant sensation alerting
a person that something is wrong. Specialized nerve cells within
the body transmit pain signals in response to tissue damage or injury.
Most forms of arthritis are associated with two types of pain: acute
and chronic. Acute pain is temporary. It can last a few seconds
or longer, but goes away as healing occurs. Chronic pain ranges
from mild to severe, and may last for months, years or a lifetime.
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| What causes arthritis pain, and why is it so variable? |
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The pain of arthritis may come from different sources, such as inflammation
of joint tissue, tendons, or ligaments; muscle strain; and fatigue.
A combination of these factors contributes to the intensity of the
pain.
Doctors do not yet understand completely why the pain of arthritis
varies so widely from person to person. Factors that contribute
to pain include swelling within the joint, the amount of heat or
redness present, and the extent of damage within the joint. Activities
affect pain differently: some patients note joint pain after first
getting out of bed in the morning, while others develop pain after
prolonged use of the joint.
Each individual has a different threshold and tolerance for pain.
A person's subjective experience of pain is affected by both physical
and emotional factors. These can include depression, anxiety, and
even hypersensitivity at the affected joints due to inflammation
and tissue injury.
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| How do doctors measure arthritis pain? |
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Pain is a private, unique experience that cannot be seen. The most
common way for a doctor to measure pain is to ask about the symptoms.
If patients use terms like aching, burning, stinging, throbbing,
or others as appropriate, they will give the doctor a clearer idea
of what type of pain they're feeling. |
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| Who can treat arthritis pain? |
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Both the patient and his/her physician should be involved in treating
and managing arthritis pain. There is no specific pain treatment
that works for all people with arthritis. However, the doctor or
medical team should develop a pain management plan designed to minimize
the specific pain and improve the joint function.
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| What Treatments are used to provide short-term relief for arthritis
pain? |
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Medications
Because people with osteoarthritis have very little inflammation,
pain relievers like acetaminophen (eg, Napa) may be effective. People
with rheumatoid arthritis generally have pain caused by inflammation,
and often benefit from aspirin or other nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen.
Heat and cold
The effectiveness of either heat or cold for joint pain depends
on the type of arthritis. Moist heat, such as a warm bath or shower,
or dry heat, such as a heating pad, may relieve pain if placed on
the painful area of the joint for about 15 minutes. An ice pack
or bag of frozen vegetables wrapped in a towel and placed on the
sore area for about 15 minutes may help to reduce swelling and stop
pain. If patients have poor circulation or suffer from Reynaud's
phenomenon, they should not use cold for pain.
Joint protection
Using a splint or brace to allow joints to rest and protect them
from injury can be helpful.
Massage
A therapist lightly strokes and/or kneads the painful muscle, to
increase blood flow and bring warmth to a stressed body area. However,
arthritis-stressed joints are very sensitive, so the therapist must
be very familiar with arthritis. |
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| What treatments are used to provide long-term relief for arthritis pain? |
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These drugs, which include aspirin and ibuprofen, reduce pain and
inflammation and may be used for both short- and long-term pain
reliefs for people with osteoarthritis or rheumatoid arthritis.
Disease-modifying anti-rheumatic drugs (DMARDs)
These drugs are thought to influence and correct the abnormalities
of the immune system that are responsible for diseases like rheumatoid
arthritis. They include drugs like methotrexate, hydroxychloroquine,
penicillamine, gold injections, and newer, recently-approved drugs.
Treatment with these medications requires careful monitoring by
a physician, because of possible side effects.
Corticosteroids
These drugs reduce inflammation, and can be very effective in treating
arthritis, although they may also have significant side effects.
Patients with rheumatoid arthritis may take prednisone by mouth,
while patients with either osteoarthritis or rheumatoid arthritis
may receive injections of corticosteroids directly into the affected
joint. Since frequent injections may cause damage to the joint cartilage,
this procedure should be done only once or twice a year.
Weight reduction
Being overweight puts extra stress on weight-bearing joints such
as the knees or hips. Studies show that losing only 11 pounds can
substantially reduce the risk of developing osteoarthritis in the
knees - and even if a person already has osteoarthritis in one knee,
weight reduction will reduce the risk of it occurring in the other
knee.
Exercise
Swimming, walking, low-impact aerobic exercise, and range-of-motion
exercises may reduce joint pain and stiffness. In addition, stretching
exercises are helpful.
Surgery
In certain patients with arthritis, surgery may be necessary. Surgeons
can perform operations to remove inflamed joint tissue, or replace
very damaged joints with artificial devices. These devices are not
without disadvantages, but in appropriate cases can provide not
only pain relief but also improvement in motion for the involved
joint.
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| What alternative therapies may relieve arthritis pain? |
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Many people look for other ways of treating their arthritis, such
as special diets or supplements. Although these methods are not
necessarily harmful, there is also no real proof that they help.
Because the pain of arthritis may come and go, a person taking an
alternative treatment may mistakenly think that the remedy worked.
It's also true that pain is a very subjective experience, and people
with pain sometimes feel better simply because of their strong faith
in a particular treatment. This is why researchers rely on clinical
trials involving hundreds or thousands of people, in which patients
and doctors are not told what medications are being tested until
the end of the trial, before they claim that a new method for relieving
pain works.
If the doctor agrees that an alternative treatment helps to cope
without doing any harm, then it can be incorporated into the treatment
plan. However, patients should not let themselves be taken advantage
of by unscrupulous people who would promise quick and easy answers
to the pain of arthritis, then sell "remedies" that may
be ineffective or even harmful. It should be considered carefully
about whether the claims of an alternative treatment are reasonable
or likely, and the doctor should be asked before taking such a treatment. |
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| How can a person cope with arthritis pain? |
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Osteoarthritis and rheumatoid arthritis are chronic diseases that
may last a lifetime. Learning how to manage the pain is important
in controlling the disease and maintaining a good quality of life.
A positive attitude should always be maintained. The patients should
not dwell on negative thoughts, and should use distraction or relaxation
techniques to reduce stress and focus thoughts outside of the body,
on the things they enjoy. Studies show that depression, stress and
anxiety actually increase perception of pain. If the patient can
improve sense of control and mental well-being, perception of pain
will be lessened and they will feel better.
Patients should try to eat a healthy diet and get enough sleep at
night, again to lessen perception of pain and increase ability to
cope with it. |
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