The word arthritis derives from the Latin ‘arthro’ meaning joint and ‘ritis’ meaning inflammation.
There are broadly two main types of arthritis although one can classify 100 different types. The two main types are the degenerative (wear and tear) and the inflammatory types of arthritis.
Arthritis can affect any age group, not just the elderly. Juvenile inflammatory arthritis can be a disabling illness in young children.
In the vast majority of cases, degenerative arthritis is primary i.e. with no preceding cause. In rare cases, however, degenerative arthritis may be secondary to a fracture of the joint, infection or inflammation.
Arthritis can affect any joint; but those most commonly affected by degenerative arthritis are the hip, knee, neck and back.
The patient suffers from a variety of symptoms which may develop and progress over time into degenerative arthritis.
In contrast, in inflammatory arthritis, these symptoms may develop suddenly. The symptoms include pain which usually worsens with activity and stiffness mostly in the morning and following inactivity which might be accompanied by swelling. In advanced cases, there will be deformity and muscle-wasting. The symptoms cause lack of function of the joint and disability.
Diagnosis is aided by radiological investigations which, in degenerative disease, show loss of joint space, sclerosis ‒ which is whitening of the bones ‒ and bony projections called osteophytes. Interestingly, there is not always a direct correlation between the severity of radiological findings and the symptoms described.
Diagnosis is aided by radiological investigations which, in degenerative disease, show loss of joint space, sclerosis ‒ which is whitening of the bones ‒ and bony projections called osteophytes
Treatment of arthritis broadly falls into four categories:
1. Weight loss for lower limb arthritis, routine and regular exercise and physiotherapy helps build muscle, decrease stiffness, decrease pain and also improve psychological well-being. Cycling, swimming and the cross-trainer are ideal for hip, knee and foot arthritis.
2. Medications include cartilage-nutrient supplements such as glucosamine and chondroitin. Medications including anti-inflammatories shouldn’t be prescribed on a long-term basis due to side effects. They should be used to allow the patient to exercise and undertake regular physiotherapy.
3. Other options for treatment include injections. There are principally three types of injections I use. These are not all necessarily adapted for each arthritic joint.
While steroid injections are a mixture of a local anaesthetic and steroid injected directly into the joint, viscosupplementation involves injecting a thick viscous fluid in the joint which is thought to act as a shock absorber.
On the other hand, PrP or platelet rich plasma involves extracting about 15ml of blood from the patient, centrifuging it and injecting the fluid left without the cells into the joint. This plasma contains nutrients and other factors that help regenerate cartilage, prevent its breakdown and decrease inflammation.
4. Surgery remains the best option for those patients who fail to improve with the other options. Different surgical techniques are adapted for different joints but broadly, these may include washout of the joints by keyhole or arthroscopic techniques. Examples of these techniques include excision of the joint (excision arthroplasty) such as the collar bone joint; fusion of the joint (arthrodesis) such as the foot big-toe joint and replacement (arthoplasty).
In the latter, the arthritic joint is excised and replaced by a metal and plastic artificial joint. In fact, most joints in the body may be replaced including the small joints of the hand, wrist, elbow, shoulder and, of course, hip and knee. Although these are fairly major procedures, the benefit they provide to the patients’ quality of life is tremendous.
Alistair Pace is a consultant orthopaedic surgeon and senior lecturer at the University of Malta.