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Table Of Content ARTHRITIS-INTRODUCTION ........................................................................................................ 6

What is Arthritis? ................................................................................................................... 6

Broad Symptoms And Causes ................................................................................................ 8

Symptoms .......................................................................................................................... 8

Causes ................................................................................................................................ 9

Common Types - Briefly Explained ...................................................................................... 10

Osteoarthritis ................................................................................................................... 10

Rheumatoid Arthritis ....................................................................................................... 10

Psoriatic Arthritis ............................................................................................................. 10

CHAPTER 01-OSTEOARTHRITIS ................................................................................................ 11

Understanding Osteoarthritis? ............................................................................................ 11

Signs and Symptoms ............................................................................................................ 12

Early signs of Osteoarthritis: ............................................................................................ 12

Pain and Tenderness: ....................................................................................................... 12

Stiff Joints: ........................................................................................................................ 12

Unusual sensations: ......................................................................................................... 12

Less flexibility: .................................................................................................................. 13

Symptoms Of Osteoarthritis ................................................................................................ 13

Hips: ................................................................................................................................. 14

Knees: ............................................................................................................................... 14

Hands: .............................................................................................................................. 14

Spine: ............................................................................................................................... 14

Risk Factors: ......................................................................................................................... 15

Primary ............................................................................................................................. 15

Secondary ......................................................................................................................... 16

Treatment Methods ............................................................................................................. 17

Diagnosis: ......................................................................................................................... 18

X-rays: .............................................................................................................................. 19

Laboratory tests: .............................................................................................................. 19

Joint aspiration:................................................................................................................ 19

Treating Osteoarthritis without Surgery .............................................................................. 20

Exercising: ........................................................................................................................ 20

Stretching: ........................................................................................................................ 21

Maintaining a healthy weight: ......................................................................................... 21

Improving sleep: .............................................................................................................. 21

Eating anti-inflammatory foods: ...................................................................................... 22

Taking Pain and anti-inflammatory medicines: ............................................................... 22

COX-2 inhibitors: .................................................................................................................. 26


Therapy: .......................................................................................................................... 26

Physical Therapy: ............................................................................................................. 26

Occupational therapy: ..................................................................................................... 26

Yoga and Tai Chi: .............................................................................................................. 27

Ice or heat therapies: ....................................................................................................... 27

Massage therapy: ............................................................................................................. 27

Acupuncture:.................................................................................................................... 27

Use the Spa: ..................................................................................................................... 28

Assistive devices:.............................................................................................................. 28

Use Tens: .......................................................................................................................... 29

Treating Osteoarthritis with Surgery ................................................................................... 29

Arthroscopy:..................................................................................................................... 29

Joint Replacement: .......................................................................................................... 30

Complications of Joint replacement ................................................................................ 33

Post-surgery ..................................................................................................................... 35

Rehabilitation and Recovery: ........................................................................................... 36

Making the decision: ........................................................................................................ 37

Alternatives to Joint Replacement: .................................................................................. 38

CHAPTER 02-RHEUMATOID ARTHRITIS ................................................................................... 40

Understanding Rheumatoid Arthritis .................................................................................. 40


Early Signs of Rheumatoid Arthritis ................................................................................. 41

Symptoms of Rheumatoid Arthritis ................................................................................. 43

Disorders with similar or overlapping symptoms: ........................................................... 47

Risk Factors .......................................................................................................................... 50

Primary ............................................................................................................................. 51

Secondary ......................................................................................................................... 52

Treatment Methods: ............................................................................................................ 54

Diagnosis: ......................................................................................................................... 54

Citrulline Antibody Test: .................................................................................................. 55

Sedimentation Rate (Sed Rate): ....................................................................................... 56

Joint X-rays: ...................................................................................................................... 56

Arthrocentesis: ................................................................................................................. 57

Treating Rheumatoid Arthritis without surgery .............................................................. 58

Medications: .................................................................................................................... 62

Biological response modifiers/ Biological DMARDS: ....................................................... 69

Synovectomy: ................................................................................................................... 72

Tenosynovectomy: ........................................................................................................... 73

Tendon Repair: ................................................................................................................. 73

Arthrodesis: ...................................................................................................................... 73

Arthroplasty or Joint Replacement: ................................................................................. 74

Preparing for Rheumatoid arthritis Surgery: ................................................................... 77

CHAPTER 03-PSORIATIC ARTHRITIS ......................................................................................... 78

Understanding Psoriatic Arthritis ........................................................................................ 78


Distal arthritis:.................................................................................................................. 79

Asymmetric oligoarthritis: ............................................................................................... 79

Symmetric polyarthritis: .................................................................................................. 79

Arthritis mutilans: ............................................................................................................ 79

Spondyloarthritis: ............................................................................................................ 79


Early signs of Psoriatic Arthritis ....................................................................................... 80

Symptoms of psoriatic arthritis ........................................................................................... 80

Risk Factors .......................................................................................................................... 81

Primary ............................................................................................................................. 82

Secondary ......................................................................................................................... 82

Treatment Methods: ............................................................................................................ 84

Diagnosis: ......................................................................................................................... 84

Treating psoriatic arthritis ................................................................................................... 85

Maintaining a healthy weight: ......................................................................................... 85

Exercise and Physical therapy: ......................................................................................... 85

Nonsteroidal anti-inflammatory drugs (NSAIDs): ............................................................ 85

Glucocorticoid injections: ................................................................................................ 86

Disease modifying anti-rheumatic drug (DMARD) .......................................................... 86

Gout ................................................................................................................................. 89

Risk factors: ...................................................................................................................... 90

Diagnosis and treatment: ................................................................................................ 90

CHAPTER 04-LATEST DEVELOPMENTS IN ARTHRITIS TREATMENT ......................................... 91

Stem Cell therapies: ......................................................................................................... 92

Tiny electrical implant: ..................................................................................................... 93

Microvessicles: ................................................................................................................. 93

'Self-care Strategies for Coping with Arthritis' .................................................................... 94

Organize yourself: ............................................................................................................ 94

Manage pain and fatigue: ................................................................................................ 94

Eat a healthy balanced diet: ............................................................................................ 94

Rest: ................................................................................................................................. 94

Exercise: ........................................................................................................................... 94

Three exercise goals: ............................................................................................................ 95

Increase range of motion: ................................................................................................ 95

Strengthen your muscles: ................................................................................................ 95

Build endurance: .............................................................................................................. 95

Choosing Shoes: What not to wear ................................................................................. 96

Helpful gadgets: ............................................................................................................... 96

CONCLUSION ............................................................................................................................ 97


ARTHRITIS-INTRODUCTION

What is Arthritis?

Arthritis is among one of the most common and widely prevalent diseases of the joints and

bones. In fact, more than being a disease, it falls under the category of ‘conditions’ that

develop over a period of time.

According to statistics provided by the official ‘Center for Disease Control and Prevention’ of

the government of United States, around 52 million adults, constituting a whopping 27% of

the population, were diagnosed with one form or another of arthritis, between 2010 and

2012. Moreover, 65% of the cases reported happened to adults above the age of 65.

Based on these real time stats, what’s projected for some 25 years down the lane, is the

development of doctor diagnosed arthritis in about 78 million American adults. The

projection suggests that there is a consistent increase in the number of people getting

affected by arthritis.


In order to understand arthritis, let’s take a look at the roots of this word. The word Arthritis

derives from Greek, where ‘Arthro’ translates to joint, and ‘Itis’ means inflammation or

swelling. This should give you an idea that arthritis, at its core, is all about inflammation and

swelling of the joints of any part of the body.

Understanding arthritis in detail requires us to first examine the basic element found around

the bones and joints – cartilage. Cartilage is basically a layer of soft connective tissue that

surrounds the bone joints (where two bones meet), and prevents direct friction between

them as joints move against each other and are stressed due to movements.

Naturally, when you make movements, from something as simple as walking, to something

as elaborate as performing exercises and other household chores, it is your bone joints that

enable those movements by pressing against each other. Cartilage, forming a layer between

hard joints, minimizes the adverse effects of this stress and friction.

It is the central shock absorber of the joints. In terms of flexibility, it is somewhere between

bone and muscle; softer than bones, but stiffer than the muscle.

The protective ability of cartilage is inherent in the substance it is made of. The fibrous

construction of the cartilage (collagen, elastin and proteoglycan fibers) renders it flexible

enough to allow for smooth movement of the joints.

The specific cells that produce these fibers are called chondrocytes. Upon secreting the

substance that results in the formation of these fibers, the cells themselves become part of

the fibrous substance. In other words, chondrocytes become entrenched in their own

secretions.

The onset of Arthritis begins when the cartilage is damaged, thereby directly exposing the

joints. When these exposed joints move, the friction inevitably increases because of

increased stress, and over a period of time, the joints become weaker and begin tearing

down.

There is a variety of reasons why cartilage is damaged, some of which include direct and

impactful injury to any of the joints, extreme obesity that puts unbearable stress on the

joints, and consistent immobility, which sends the joints into kind of a hibernation, where

they become accustomed to non-movement and start getting damaged.


Broad Symptoms And Causes

Symptoms

Although the symptoms and causes of each type of arthritis vary, there are few general

symptoms that can be outlined that occur regardless of the type. The presence of these may

act as an alert to get yourself checked, so that the exact category of arthritis can be

determined. The symptoms can be studied under two spectrums; first are the inflammatory

factors, and second are the viral factors.

Inflammatory Symptoms

The presence of symptoms such as redness, pain and swelling around the joint area is the

primary indication of arthritis. Although swelling is also experienced when the level of urea

in blood is increased, what distinguishes it from arthritis is the presence of the other two;

redness and pain. Also, stiffness in the joints and a resulting inability to move the joints

easily are two major signs of alert for arthritis.

Stiffness is mostly experienced in the morning right after waking up, when you simply

cannot move about without hearing crackling sounds of the joints. It is only after doing

some basic stretches that the joints become accustomed to movement. In extreme cases,

quite visible joint deformation is also experienced; this could result to permanent

movement disability.

Viral symptoms

These symptoms have the propensity to be somewhat deceptive as these could point

towards a number of potential problems. Unlike swelling, redness and pain which are

primarily the signs of arthritis, viral symptoms could be hard to diagnose, unless you get a

detailed checkup done. A few of the major viral symptoms are a persistent fever that keeps

coming back, constant lack of energy to perform daily tasks even after sufficient amount of

sleep, repeated occurrence of chills in the body and immobility of the muscles. Abnormal

headaches can also be experienced.

One thing that’s common in almost all these symptoms is that they are same for flu as well,

specifically tiredness, chills and fever. Because of this similarity, there is a chance that for a

good amount of time they get misdiagnosed as viral flu and infection. If you’ve had a family

history of arthritis, it is advisable that you get yourself checked if you find yourself

experiencing these symptoms persistently.


Causes

The same way that symptoms vary with each type of arthritis, different causes could result

in different types of arthritis. As a general rule, the causes are triggered when the presence

of certain external factors catalyze the internal factors (release of hormones and other

substances) that result in the development of arthritis. Broadly, the causes can be examined

filed under the categories of dietary, hereditary and immune system among others.

The consistent intake of certain types of foods results in bone degenerating substances that

trigger arthritis. Some of these food types and their respective releases are given below;

Sugars: Abnormal intake of food items that have high sugar content can release

cytokines which cause inflammation.

Fast food: These contain trans-fats (solidified oil) that are substances proven to

cause inflammation in the body; primarily in the joints.

Saturated Fats: These fats do not get digested easily, and are rather deposited in the

joints and other body parts; increasing pressure on the joints, as well as causing

obesity. Saturated fats are found in red meat and dairy products made with full fat

content.

Hereditary factors account arthritis being developed from a young age , whereas immune

factors account for a fervid immune system that ends up attacking itself. The details of these

factors will be discussed later in the text, along with their respective types of arthritis.


Common Types - Briefly Explained

Osteoarthritis

Among some 100 types of arthritis, Osteoarthritis is the most common . It is also referred to

as the ‘degenerative joint disease’ or the ‘wear and tear disease’ because of the way it

progresses and gradually tears down the joints, causing complete immobility in extreme

cases. The symptoms primarily include joint stiffness that occurs after prolonged period of

inactivity, as well as prolonged activity or work. As such, it is quite tricky to manage this

condition, as you have to have a balance between working and resting to avoid stiffness.

Rheumatoid Arthritis

Rheumatoid arthritis is mainly to do with the deformation and swelling of joints. This type is

the result of a malfunction in the immune system, wherein it attacks the body rather than

protecting it. Rheumatoid does not tear down or degenerate the joints - that is caused by

damage in cartilage. It rather attacks the formation and structure of joints and cartilage. Like

most other types of arthritis, this is also chronic; meaning that it sustains over a period of

time, unlike acute diseases which happen all of a sudden. It also affects other body parts, in

addition to joints, in the long run.

Psoriatic Arthritis

Psoriatic arthritis affects patients who already have psoriasis; a skin disease that causes

redness and scaling in excessive patches. Although having psoriasis is not a condition; others

with blood relatives having psoriasis can also get affected. Like rheumatoid arthritis,

psoriatic arthritis is also an autoimmune disease. It has various forms, based on what parts

of the body it affects. Some of these are Spondylitis which affects the spine, Distal

Interphalangeal Predominant which affects the toe and finger joint nearest to the nails,

Arthritis Mutilans which affects the smaller joints in the hands and feet. Which part of the

body is affected easily determines the type of psoriatic arthritis a patient is suffering from.

Symptoms and causes also may vary in accordance with the type.

Now that we’ve understood arthritis and its common types, it is time to look at the

aforementioned arthritis types in a bit more detail.


CHAPTER 01-OSTEOARTHRITIS

Understanding Osteoarthritis?

In simple terms, Osteoarthritis refers to inflammation of the joints. A joint disease,

Osteoarthritis mostly affects the cartilage. We’ve already discussed what cartilage is. Known

as wear and tear arthritis, Osteoarthritis is the most common type of arthritis. According to

statistics provided by the official ‘Center for Disease Control and Prevention’ of the

government of United States, approximately 27 million adults, constituting a significant 13%

of the population, were diagnosed with Osteoarthritis in 2005. The statistics further

revealed that Osteoarthritis affects 13.9% of adults aged 25 years and older, as well as

33.6% (12.4 million) of those over 65.

Osteoarthritis can occur in almost any body joint, and is associated with the disintegration

of cartilage in them. Healthy cartilage does two things—it helps absorb shock of movement

and allows bones to glide over one another. Osteoarthritis causes the upper most layer of

cartilage to disintegrate and deteriorate. As a result of this, the bones beneath the cartilage

rub together, which in turn causes swelling, pain, and loss of joint motion. Furthermore, the

joint may lose it shape and spurs may grow on the joint’s edges. Generally, Osteoarthritis


occurs in joints of the spine, knees and hips. However, it can also affect the neck, thumb,

toe, and fingers. So what are the signs and symptoms of Osteoarthritis? Let’s take a look.

Signs and Symptoms

Early signs of Osteoarthritis:

The following are some early signs of Osteoarthritis. If you experience any of these

symptoms, you may be suffering from Osteoarthritis. However, you must visit your doctor

before coming to any conclusion.

Pain and Tenderness:

People suffering from arthritis often experience aching neck, hips, back, and knees. Early

signs of Osteoarthritis include pain and tenderness in the joints. When you move your

affected joint in a certain way, you might feel a sharp pain. For example, opening a jar may

cause pain in the fingers. On the other hand, when you press down on the joint, you’ll get a

feeling of discomfort. This feeling of discomfort is known as tenderness. Early signs of

Osteoarthritis may include one or both types of pain.

Stiff Joints:

Along with pain, stiff joints are an early sign of Osteoarthritis. When you sit at your desk all

day or wake up after a deep slumber, joint stiffness is a normal occurrence. However, this

may also be an early sign of Osteoarthritis. If you often feel sluggish and want to go back to

bed when you first wake up, you may be suffering from early Osteoarthritis. However, it is

important for you to keep in mind that people with Osteoarthritis often start to feel better

once they’ve performed some gentle exercise, or have warmed up their joints through their

daily routines.

Unusual sensations:

A shock absorber, cartilage allows your joints to move smoothly. When cartilage

disintegrates, the bones rubbing together can cause a number of unusual sensations. A

common occurrence in Osteoarthritis patients is the jarring of the joints. The jarring of the

joints is an indication of the bones rubbing together. When you move, you may hear or feel

your joints clicking or cracking.


Joint pain

Tenderness or swelling in joints

Increased pain and stiffness after periods of inactivity such as sitting or sleeping

A clicking or cracking sound or unusual sensations in your joints

Loss of muscle bulk

Joints appearing larger than normal

Inflammation when you move the affected joint

Less flexibility:

The final early sign of Osteoarthritis is the loss of flexibility. You might be suffering from

Osteoarthritis If you notice that moving a particular area of your body isn’t as easy as it once

was. Osteoarthritis causes Joint stiffness and pain. Joint stiffness and pain contributes to

two things—loss of range of motion and loss of flexibility. The extent to which you can move

your joints is known as your range of motion. An example of range of motion is bending and

extending your knee. You might not be able to bend your knee like you normally do if you’re

suffering from Osteoarthritis. On the other hand, loss of flexibility occurs gradually so it

might not be noticeable to you at first.

The early signs of osteoarthritis include joint stiffness, pain, tenderness, and loss of

flexibility. If you’re suffering from early stages of osteoarthritis, you might experience a stiff

back when you first wake up or your hips hurting after a game of basketball. However, as

osteoarthritis progresses you might experience pain and discomfort, even when you’re at

rest. So what are the symptoms of osteoarthritis, regardless of its stage? Let’s take a look.

Symptoms Of Osteoarthritis

Aching joints after exercise or first waking up are early signs of osteoarthritis. However,

more symptoms come to the forefront as the disease progresses. Pain and stiffness in your

joints that affect your ability to do certain activities and move the affected joints, are the

main symptoms of osteoarthritis. The symptoms may come and go, and are related to

factors such as the weather and your activity levels. Following are some common symptoms

of osteoarthritis.

It is important that you talk to your doctor if you experience any of the aforementioned

symptoms. Your doctor will help you to find out if you’re suffering from osteoarthritis. The

most common areas affected by Osteoarthritis are joints in the hands, hips, spine, and

knees. However, it can affect any joint in the body.


Hips:

You’ll find it difficult to move your hip joints if you have osteoarthritis in your hips. For

example, getting in and out of the car, or bending down pick something up, might become

difficult for you if you have hips osteoarthritis. Furthermore, you’ll feel pain outside the hip

or in the groin. When you move the hip joints, osteoarthritis in your hips will worsen.

However, this type of osteoarthritis can affect you even when you’re sleeping or at rest.

Knees:

The knees are most affected by osteoarthritis, simply

because they are primarily weight-bearing joints.

Osteoarthritis in your knees is usually caused by

obesity or repeated injury. Your knee joints may feel

painful, stiff or swollen if you have osteoarthritis in

your knees. This in turn will make it difficult for you to

walk, climb stairs, and get in and out of chairs. Finally,

when you move the affected joint you may hear a

soft, jarring sound.

Hands:

The three main areas of your hand that may be affected by Osteoarthritis include:

The joint closest to the fingernail

The base of the thumb

The middle joints of your fingers

You may experience swollen, painful, or stiff fingers. Furthermore, your finger joints may

develop bumps. Although the bumps and swelling may remain, pain in the fingers decreases

and disappears over time. The fingers may bend slightly sideways at the affected joints.

Also, the back of your fingers may develop fluid-filled lumps or painful cysts. In some cases,

a bump may develop where your wrist joins the base of the thumb. As a result of this, you

may find opening jars, turning keys, or writing difficult.

Spine:

You may experience stiffness and pain in the lower back or neck if you have Osteoarthritis of

the spine. Often, changes related to Osteoarthritis can put pressure on the nerves. This

causes numbness or weakness in arms or legs.


Risk Factors:

When there is damage in and around the joints that your body cannot fully repair,

Osteoarthritis occurs. There are several factors that can increase your risk of developing

Osteoarthritis. Although the exact causes of Osteoarthritis are unknown, repetitive

movement could be exacerbate joint damage. Alternatively, Osteoarthritis could be a result

of an injury. Regardless of the reason, there’s erosion of the cartilage with Osteoarthritis.

Risk factors are the things that increase your risk for osteoarthritis. There are two types –

primary and secondary. The primary risk factors are factors that you cannot prevent or

change, such as your age or genetics. On the other hand, secondary risk factors are those

that you can reduce by taking medicine or making lifestyle changes. Some examples are

obesity, injury, and inactivity.

Primary

The following are the primary factors that that may increase your risk of developing

osteoarthritis.

Age:

The strongest risk factor for osteoarthritis is age. Although it isn’t a normal part of ageing,

the risk of developing osteoarthritis increases with age. Adults over 45 are most likely to be

affected by osteoarthritis. In fact, it is a common occurrence in the older population. As

pointed out earlier, 33.6% (12.4 million) of those over 65 in the United States suffer from

osteoarthritis. This percentage increases to 70% when we consider individuals over 70.

The longer you use the joints, the greater your chance of cartilage disintegration. Therefore,

age is a primary risk factor for osteoarthritis. Whether it’s mild or severe, you’re likely to

develop osteoarthritis if you live 'long enough’.

Genetics:

The second primary risk factor for osteoarthritis is genetics. A contributing factor in

developing osteoarthritis may be an inherited defect in one of the genes responsible for

manufacturing cartilage, meaning that it may run in families in some cases. According to

doctors, genes can greatly influence osteoarthritis. Certain joint problems, such as the

tendency towards cartilage wear and tear, are something that we may inherit. Birth

abnormalities may also lead to osteoarthritis. Genes that put you at risk for osteoarthritis


may be something that you carry. In fact, most cases of hand osteoarthritis in women are

said to be genetic. Furthermore, there have been cases where genetic reasons caused

osteoarthritis in the knee and hip.

Secondary

The following are the secondary factors that that may increase your risk of developing

osteoarthritis.

Obesity:

A risk factor that greatly increases your chances of developing osteoarthritis is obesity. As it

puts added stress on your joints, extra weight or obesity can change the normal shape of

your joint.

The extra weight can also cause the joint to deteriorate faster. A primary risk factor for

osteoarthritis, obesity causes excess strain on your joints, especially on those that bear most

of your weight, such as your hips and knees. Therefore, obese people are more likely to

develop osteoarthritis.

We apply a force that is three to six times our body weight on our knees when walking, so

the risk of developing knee osteoarthritis increases.

During weight bearing movements, the force placed over your knees will be dependent on

your body weight. To a lesser extent, body weight can influence osteoarthritis of the hips.

When you’re walking or standing, your hips can carry up to three times the body’s weight.

Any excess body weight will put strain on your joints and may cause osteoarthritis.


Injury:

You will increase your chances of developing osteoarthritis in a joint if that joint sustains a

traumatic injury. Overuse can also have the same effect. Both cases increase the chances of

developing osteoarthritis at a young age.

As it changes the structure of the joint and puts extra stress on it, damage to joint, bone or

ligament can cause osteoarthritis at any age. You will suffer from wear and tear in later life if

you injure your knee, ankle, or hip spine. This wear and tear is the damage in joints that

precedes osteoarthritis.

Joint damage can cause osteoarthritis whether the damage is a result of an injury or

operation. You will also increase your chances of developing osteoarthritis in later life if you

overuse your joint without giving it enough time to heal after an operation or injury.

Over time, cartilage can be damaged by several minor injuries or a single major injury to a

joint. Activities that damage the joint include heavy lifting, kneeling, or squatting.

Inactivity:

Your muscles and joints will get weak and stiff if you don’t exercise ‘enough’. Weight gain is

a byproduct of an inactive lifestyle, and by now you know that weight gain or obesity leads

to osteoarthritis. Furthermore, you will weaken muscles and tendons that surround the joint

by being inactive. You can keep joints properly aligned and stable if you have strong

muscles. You can build strong muscles with low-impact activities such as swimming and

walking.

Other diseases:

Diseases that damage joints and cause inflammation increase your risk of developing

osteoarthritis. Osteoarthritis often occurs in joints severely damaged by an existing or

previous condition. Some of these conditions include rheumatoid arthritis, gout, and

hemochromatosis.

Muscle weaknesses:

Often, people with weak muscles are diagnosed with osteoarthritis. According to research,

people with weak thigh muscles are prone to osteoarthritis, making it a factor that

contributes to the development of osteoarthritis.


Treatment Methods

Diagnosis:

Before you get treatment for osteoarthritis, it is important for you to diagnose the

condition. You should make an appointment to see your doctor if you experience joint pain,

swelling and/or stiffness that won’t go away. Your doctor will be able to determine whether

you have osteoarthritis or not.

Diagnosing osteoarthritis can be challenging, as there can be several reasons for joint

discomfort. This is the why when you visit him/her, your doctor may ask questions about

when and how you started experiencing the symptoms you have. Your doctor will also

probably give you a physical examination.

Your doctor will do so by looking at it, feeling it, and moving it through a range of motions.

Furthermore, they will carry out an examination to assess the health of your lungs, liver,

heart, and kidneys.

The physical examination will look for:

Mild to moderate swelling around the joint

Crunching sound of bone rubbing on bone

Limited range of motion

Tenderness in the joint

Pain with movement of the joint

Mild inflammation over the joint

Weak muscles surrounding the affected joint

Joint deformity

Joint instability

Altered walking gait

Unequal leg lengths

Bone Lumps

In order to reach a conclusive diagnosis, the doctors will go through your medical history

and discuss the symptoms with you. Medical history plays a big part in the diagnosis. It can

provide important clues to whether the arthritis is inflammatory or not. Furthermore, it will

tell your doctor about the onset of osteoarthritis symptoms, a family history of the disease,

past treatments or surgeries, or other significant information related to your condition.


It is important that you prepare yourself in advance for the visit to the doctor. In order to

ensure that you don’t leave out important clues, record or write down the information to

bring with you. When you’re being seen for a specific problem, you must recap all of the

things in your medical record. This includes past surgeries and injuries. You must also note

down any recent injuries so that you can discuss them with your doctor during your

examination.

Apart from the physical examination, other tests may be required to confirm the diagnosis

of osteoarthritis, as well as ascertain the severity and extent of joint damage. Some of these

tests include X-rays, laboratory test, and joint aspiration.

X-rays:

Whether you have osteoarthritis or not is something your doctors can determine with the

help of x-rays. The speed with which joint damage is progressing is something a series of X-

rays obtained over time can show. Bone damage, cartilage loss and extra bone growth that

can develop on the surface of normal bones is what the X-rays of the affected joints can

show.

Laboratory tests:

By ruling out conditions with similar symptoms, laboratory tests help diagnose

osteoarthritis. However, there isn’t any specific blood test for osteoarthritis.

Joint aspiration:

You doctor may perform joint aspiration if he or she suspects you have an infection, or is

uncertain about the diagnosis after performing an X-ray test. Also known as arthrocentesis,

joint aspiration is a procedure in which your doctor uses a needle to extract and inspect

synovial fluid from affected joints. Synovial fluid is the liquid that lubricates the joint.

Using the aforementioned methods, your doctor can confirm a diagnosis of osteoarthritis.

You should see your doctor if:

You experience unexplained and sudden swelling/ inflammation in any joint

Joint pain accompanied by fever or rash

Joint pain that makes it impossible for you to use that joint

Mild joint discomfort that lasts more than six weeks


A person suffering from osteoarthritis will have to get treatment for osteoarthritis once the

diagnosis is confirmed. Currently, there is no way to reverse osteoarthritis. However, you

can effectively manage symptoms with medications, lifestyle changes, therapies, and

surgery. The long-term management of osteoarthritis includes several factors such as:

Getting a good amount of exercise

Maintaining a healthy weight

Improving joint flexibility and mobility

Managing symptoms such as stiffness, pain and swelling

Generally, the most important ways to treat osteoarthritis are exercising and maintaining a

healthy weight. However, your doctor may suggest some other methods of treatment. Let’s

now take a look at the different, non –surgical methods for treating osteoarthritis.

Treating Osteoarthritis without Surgery

Exercising:

Exercise is one the most beneficial ways to manage osteoarthritis. Exercising is considered

an important part of the treatment plan, even though some people may find it difficult to

exercise when their joints hurt.

According to studies, you can reduce pain and maintain/attain a healthy weight by

performing simple exercises, such as walking in the park or around the neighborhood. A

great combination treatment for osteoarthritis is gentle weight training, plus aerobic

exercise. This treatment method can help you to strengthen the muscles around the

affected joint. This will ensure greater support to the joint and will keep it healthy.

In order to keep itself healthy, cartilage needs exercise to bring nutrients into it. It allows

nutrients to flow into the cartilage by compressing and decompressing the cartilage.

According to the U.S. Department of Health and Human Services, everyone, including those

with osteoarthritis, need to get 150 minutes of moderate exercise per week. Performing

certain exercises can help you to effectively manage osteoarthritis.

By performing strengthening exercises, you can ease the burden on the joints affected by

osteoarthritis. This will help you to reduce pain. You can also reduce stiffness and improve

joint flexibility through range-of-motion exercise. Finally, you can reduce excess weight

through aerobic exercise. However, before starting an exercise program you must consult

your doctor.


Stretching:

A form of exercise, stretching is a great way to manage pain. You can lessen stiffness,

improve flexibility, and reduce pain by slowly and gently stretching joints.

Maintaining a healthy weight:

You’ll add additional stress to weight-bearing joints such as knees, hips, back, and feet if you

have excess weight. A great way to reduce the pain associated with osteoarthritis and limit

further joint damage is losing weight. Increasing physical activity and eating fewer calories is

the basic rule for losing weight. In case you’re overweight, one thing that you can do to

improve symptoms, and perhaps even slow progression, is controlling your weight. Most

doctors will recommend this. You will find that even a modest amount of weight loss, such

as 10 to 20 pounds, will prove to be extremely beneficial.

Improving sleep:

If you have joint pain, you may find it hard to

sleep. Trouble falling sleep or staying asleep

throughout the night is something at least

half of the people with osteoarthritis have.

However, research suggests that you can

improve your condition by improving your

sleep. So why is improving you sleep

important?

According to researchers, a lack of sleep may trigger inflammatory pathways that

exacerbate osteoarthritis pain. There are many ways for you to improve your sleep and

reduce pain, including the use of medicine. However, pain medication can have side effects.

Therefore, you should try to improve your sleep by using simple strategies such as:

Avoiding heavy meals before hitting the bed

Avoiding watching TV in the bedroom

Avoid drinking alcohol or caffeinated beverages before bed

Maintain a comfortably cool, dark, and quiet environment in your bedroom

Consult your doctor if you aren’t able to improve your sleep through the aforementioned

ways.


Eating anti-inflammatory foods:

The swelling and inflammation of affected joint is a major cause of the pain associated with

osteoarthritis. According to research, there are a number of foods that reduce inflammation

and swelling.

Particularly beneficial in controlling inflammation and improving joint healing are Omega-3

fatty acids, and in doing so, they slow progression of osteoarthritis. Most doctors advise

people with osteoarthritis to eat plenty of vegetables, fish, whole grains, and healthy fats to

reduce inflammation.

Taking Pain and anti-inflammatory medicines:

Using certain medications, you can treat osteoarthritis symptoms. Medicines for

osteoarthritis are available in many different forms - they can be injected into a joint or are

available as pills, lotions, creams, and syrups. The following are some commonly used

medications for osteoarthritis.

Pain Relievers/Analgesics:

Known as Analgesics, the pain relievers for osteoarthritis include opioids, acetaminophen,

and tramadol. However, they do not affect swelling. They are available by prescription or

over-the-counter.

Acetaminophen

People with osteoarthritis, who have mild to moderate pain, will find acetaminophen quite

effective. However, you could damage your liver if you take more than the recommended

dosage of this medicine.

Opioids

You doctor may recommend an opioid medication if you’re experiencing severe pain.

Opioids are medications that act like opium and are available as Percocet, Vicodin, and

Darvon. By blocking pain receptors in the brain, opioids relieve pain.


Opioids are powerful pain blockers. However, they can be addictive and also have many side

effects. Opioids are usually safe when they’re prescribed for pain relief. However, you must

avoid driving or operating machinery while using Opioids because they cause drowsiness.

The FDA recommends that you take these medications as prescribed, and not in excess.

Pain-Relieving Creams, lotions, sprays:

Also called topical pain relievers, pain-relieving creams are applied to the skin over the

joints. These creams can provide relief from minor arthritis pain. Often used in conjunction

with oral medications, pain-relieving creams, lotions and sprays are available over the

counter. Some examples of these pain relievers include capsaicin, salicin, methyl salicylate,

and methanol. Since the combination can cause too much heat, and even burns, topical

pain-relievers should not be used with other heat treatments.

Corticosteroids:

Powerful anti-inflammatory medicines, Corticosteroids are either taken orally, or injected

directly into a joint by a doctor. The stiffness and joint pain caused by osteoarthritis can

make it difficult for you to play sports, work, or even perform routine activities. However,

anti-inflammatory medications such as Corticosteroids allow you to perform these different

activities by easing your pain.

Hyaluronan injections:

Hyaluronic acid, which these injections comprise of, are a natural component of synovial

fluid, and act as a shock absorber and lubricant. However, hyaluronic acid seems to break

down in people with osteoarthritis. In order to give themtemporary relief, doctors use

hyaluronan injections to help lubricate joints. Generally, hyaluronan injections are used

with people suffering from knee pain that caused by osteoarthritis, and are given once

other treatments have failed.


Nonsteroidal anti-inflammatory drugs (NSAIDs):

Typically, osteoarthritis pain is relieved by over-the-counter Nonsteroidal anti-inflammatory

drugs (NSAIDs), such as naproxen sodium, aspirin, celecoxib, and ibuprofen, taken at the

recommended doses.

Available by prescription, stronger NSAIDs may slightly reduce inflammation along with

relieving pain. Most commonly used drugs for easing inflammation and related pain, NSAIDS

have some side effects. These include liver and kidney damage, bleeding problems,

cardiovascular problems, and stomach upset. NSAIDS are available by prescription or over-

the-counter.

An NSAID is often prescribed at the lowest effective does for people who don’t respond to

acetaminophen, and they help to reduce inflammation and relieve pain. However,

compared to acetaminophen they can trigger more side effects.

Apart from causing bleeding problems and kidney damage, prolonged use of NSAIDs may

also increase the risk of a heart attack or a stroke.

NSAIDs and the risk for heart disease and stroke

When it comes to the major causes of death for both men and women, heart disease is right

there at the top. According to the US Centers for Disease Control and Prevention (CDC),

approximately 735,000 people in the United States suffer from heart attacks each year.

Heart disease accounts for 1 in every 4 deaths, causing the death of approximately 610,000

people every year.

Although they’re less overwhelming, the statistics related to stroke are still alarming.

According to the US Centers for Disease Control and Prevention (CDC), each year about

800,000 cases of stroke are reported in the United Sates. Strokes account for 1 in every

twenty deaths as almost 130,000 people die from them each year. The blockage of blood


flow to the brain is the main cause of most strokes. On occasion, a stroke may lead to long-

term disability instead of death.

For a long time it has been known that high levels of blood cholesterol and triglycerides,

smoking, diabetes, and hypertension add to the risk factors for heart attacks and strokes.

However, in 2015 the U.S. Food and Drug Administration (FDA) made an addition to the list.

On July 9th 2015, the FDA released a statement that said using non-aspirin nonsteroidal anti-

inflammatory drugs (NSAIDs) increased your likelihood of having a stroke or heart attack.

Since aspirin is selective COX-1 inhibitor, it isn’t included in FDA’s warning and kept separate

from other NSAIDs. COX-1 is beneficial from a cardiovascular standpoint, as it helps to

control angiogenesis in endothelial cells. The use of aspirin can help prevent cardiovascular

events.

NSAIDs are linked to heart attack and stroke due to various factors. For example, sodium

excretion and vasoconstriction are affected to varying degrees by all NSAIDs. A byproduct of

vasoconstriction and sodium excretion is hypertension, which is an established a risk factor

for heart attack and stroke.

Compared to someone who takes NSAIDs, but doesn't have heart disease, you may have a

higher risk of having a stroke or heart attack if you take NSAIDs and have heart disease.

However, people without cardiovascular disease who take NSAIDs are also at increased risk

of heart attack or stroke.

It is recommended that you take the lowest possible dose, for the shortest time, if you need

to take an NSAID. However, you must talk to your doctor if you have cardiovascular disease,

or need to take NSAIDs for an extended period of time. Your doctor may discuss which

NSAIDs are appropriate for you, and whether you should take other medications.

The existing label warning in non-aspirin NSAIDs contained information on heart attack and

stroke risk. However, they only stated these drugs ‘may’ cause an increased risk of such

events. The FDA is now changing this warning to a more assertive version.

Today, it is mandatory for drug manufacturers to include warning labels that state that the

risks of heart attack and stoke increase with the length of time you take NSAIDs, as well as

with the strength of the dose. They also need to state that these risks are higher for people

with heart disease, or other risk factors.


COX-2 inhibitors:

Available under the brand name Celebrex, COX-2 inhibitors are NSAIDs designed to produce

less stomach irritation. COX-2 inhibitors may be the best option for you, if you have a low

risk for heart disease and acetaminophen doesn't do enough to relieve your pain.

COX-2 inhibitors have the same risk of kidney damage as other NSAIDs. However, they

cause less stomach upset. The FDA demands that these medications carry the same warning

as over-the-counter NSAIDs. You must take COX-2 inhibitors at the lowest does required to

relieve your pain.

Therapy:

Physical and occupational therapy can also help alleviate osteoarthritis symptoms. A range

of treatment options for pain management is what physical and occupational therapists can

provide you. Some of the treatment options include:

Heat and cold therapies

Range of motion and flexibility exercises

Ways to properly use joints

Assistive device

Physical Therapy:

Physical therapy may include individualized exercise programs that reduce pain, increase

your range of motion, and strengthen the muscles around your joint. Equally effective are

regular gentle exercise that you do on your own, such as walking or swimming.

Occupational therapy:

Occupational therapy provides you with ways that allow you to do your everyday tasks,

without putting extra stress on your painful joint. For example, if you have finger

osteoarthritis, a toothbrush with a large grip could make brushing your teeth easier, or if

you have knee osteoarthritis, a bench in your shower could help relieve the pain of standing.


Yoga and Tai Chi:

Gentle exercises and stretches, along with deep breathing, are involved in movement

therapies, such as yoga and Tai Chi. In order to reduce the stress in their lives, many people

use these. According to research, yoga and tai chi may improve movement and reduce

osteoarthritis pain. These are safe when performed under the supervision of a

knowledgeable instructor. However, you should avoid moves that cause pain in your joints.

Ice or heat therapies:

Many people use hot or cold to relieve osteoarthritis pain. This form of osteoarthritis

treatment is known as thermotherapy. Icing may help when acute pain occurs. However,

you should use moist heat to relieve pain when you’re suffering from chronic pain. You

should ask your doctor when and how to best use these two different remedies.

Massage therapy:

You can improve arthritis pain, stiffness and mobility

by getting an hour-long massage each week, for at

least two months. Using massage therapy, you can

soothe the muscles that spasm around the joints.

Blood flow is stimulated as the massage therapist

kneads or lightly strokes the sore muscles. This can

cause a stressed area to become more warm and

relaxed. Since arthritic joints are very sensitive and need to be handled with care, you must

ensure that your massage therapist has experience treating people with osteoarthritis. You

can ask your doctor for a referral.

Acupuncture:

In order to relieve pain, inserting thin needles into specific points on the body is involved in

the ancient Chinese practice of acupuncture. The research related to acupuncture for

osteoarthritis is still ongoing. However, acupuncture is known to relieve the pain associated

with osteoarthritis to some extent. There is a consensus now that acupuncture may be of

value, even though it’s been difficult to evaluate it for osteoarthritis.


Use the Spa:

According to research, an effective osteoarthritis treatment is going to the spa. Known as

hydrotherapy, using the spa can help relive joint pain, as it involves soaking in very warm

water or water containing minerals. A natural remedy for arthritis symptoms are sulfur-rich

mud baths. However, researchers and other people are yet to identify the mechanisms by

which spa therapy relieves the pain caused by osteoarthritis.

Assistive devices:

Function and mobility are the two areas where assistive devices can help. Some examples

are splints, walkers, shoe orthotics, canes, scooters, or helpful equipment such as steering

wheel grips, long-handled shoehorns, or jar openers. You’ll find most of these at medical

supply stores and pharmacies. However, some items are typically fitted by a physical or

occupational therapist, and prescribed by a doctor. Shoe wedges and custom knee braces

are examples of such devices.

You can support and protect arthritic joints, and relieve osteoarthritis pain, with the help of

mechanical devices known as orthotics. By supporting the joint and relieving some of the

stress caused by body weight or daily use, a brace placed on an inflamed joint provides pain

relief. The braces also assist in realigning joints that have been distorted by arthritis.

Another beneficial device is shoe orthotics. Shoe orthotics are soles that absorb some of the

shock of walking. One of the most common orthotics is a cane. However, most people use it

incorrectly. In order to get the maximum benefit out of the cane, you must get the correct

length of cane for your height and learn how to use it. You can relieve pressure on sore

knees, hips, ankles, and feet with the correct cane.


Use Tens:

The final non-surgical way for you to treat osteoarthritis is using TENS. In order to disrupt

pain signals, TENS (Transcutaneous Electrical Nerve Stimulation) sends electrical charges

through patches placed on your skin, with the help of a handheld device. According to

studies, TENS can improve function in arthritic joints and help reduce pain. In order to find

out whether it will help your pain and how to properly use it, you should consult your

doctor. However, you need to keep in mind that it isn’t for everyone. If the cause of your

pain is yet to be diagnosed or if you have an implanted defibrillator, using it is not an option

for you.

The aforementioned treatment methods were the non-surgical ways of treating

osteoarthritis. On most occasions, these treatment methods are sufficient for effectively

managing the symptoms. However, there are times when these non-surgical treatment

methods don’t work and surgery becomes necessary. There are various surgical treatments

for osteoarthritis. The following section lists and explains them.

Treating Osteoarthritis with Surgery

The following are some surgical treatments for Osteoarthritis:

Arthroscopy:

A minor surgery, arthroscopy can moderately improve Osteoarthritis for a few months or

years. Cleaning out the bone and cartilage fragments that cause pain and inflammation is

the purpose of performing arthroscopy. At times, it is used to diagnose osteoarthritis. The

surgeon inserts the arthroscope after making a small incision in this procedure. Containing a

light and magnifying lens, it is a pencil-width fiber-optic instrument. Then, a miniature

camera attached to the arthroscope allows the surgeon to see the inside of the joint.

Whether arthroscopy really benefits those with osteoarthritis is debatable. It is unclear

which patients are likely to benefit from it the most. However, there some studies suggest

that people with mild-to- moderate osteoarthritis, and bone and cartilage fragments in the

joint, are most likely to benefit from arthroscopy. It may also be beneficial for patients

whose joints catch or lock with movement.


Joint Replacement:

The surgeon removes damaged joint surfaces and

replaces them with plastic and metal parts in joint

replacement surgery. Infections and blood clots are

some of the surgical risks involved in joint

replacement. You may eventually need to replace

artificial joints, as they can become loose and wear

out over time. You may be considered for joint

replacement if you fail conservative and comprehensive care. The main reasons to consider

joint replacement include limitation of motion, severe osteoarthritis, and intractable pain.

The functional capacity to rise from a chair is limited by the inability to flex the knee more

than 90 degrees. Due to the risk of future loosening or implant failure and duration of the

joint plant, life expectancy is also an important consideration. However, some people with

osteoarthritis get prosthesis that lasts more than 20 years. You need to keep in mind that

more complications are involved in a second surgery. Many people become candidates for

artificial joint implants when osteoarthritis becomes so severe that immobility and pain

makes normal functioning impossible. The procedure involved in getting these artificial joint

implants is known as arthroplasty. The most established and successful replacement

procedure is hip replacement, while knee replacement is a close second. Some less common

joint surgeries include shoulders, elbows, wrist, and fingers. A method is yet to be devised

for joint replacement of the spine. When two joints need to be replaced, fewer

complications will arise if operations are done sequentially, rather than at the same time.

Surgical procedures, such as joint replacement, are considered as the “last resort” for

people with osteoarthritis. People with osteoarthritis are often advised by doctors to wait

for as long as possible before going for joint replacement. However, you should not delay

the procedure too long if you want to get the best results. So how do you know it’s time to

seek joint replacement surgery? Pain and significant limitations of movement, that cannot

be treated with medications and therapies, are primary indications for surgery. In order to

determine whether you need joint replacement or not, ask yourself the following questions:

Do I still enjoy shopping, playing tennis or golf, or jogging in the park?

Do the medications I take and the therapies I use alleviate the pain reasonably well?

Is it possible for me to sleep at night without waking multiple times?

Am I still able to perform routine daily activities such as getting in and out of the car,

using the toilet, going up and down stairs, and getting out of a chair without much

difficulty?


You probably don’t need to consider joint replacement surgery yet if you answered yes to all

of the aforementioned questions. On the other hand, you should discuss joint replacement

surgery with your doctor as a possible option if you answered ‘no’ to most of them. Keep in

mind, joint replacement surgery may not be suitable for certain individuals.

Joint replacement may not be suitable for the following people:

Obese individuals

People with other chronic medical conditions

People with severe osteoporosis

People with emotional, neurologic, and mental disorders

Since implants wear out, and the patient will need at least one revision procedure later on,

surgeons often prefer to delay joint implantation in young people with osteoarthritis.

However, the rate of revision operations can be reduced by using newer, longer lasting

materials.

After joint replacement surgery, elderly patients with poorly controlled osteoarthritis

usually do very well. Compared to younger people, it takes older patients longer to fully

recover. However, there are many long-term benefits of surgery for older patients, such as

significant improvements in pain and quality of life. The following are the different types of

joint replacement.

Minimally Invasive Joint replacement:

A variety of new techniques for “minimally invasive” approach to knee and hip joint

replacement are being explored by surgeons. These techniques involve smaller specialized

instruments and a smaller incision. Giving the patient a shorter recovery time and less pain

is the goal of this surgery. However, we’re still in the early stages of minimally invasive joint

replacement, or arthroplasty. As of now, there is no consensus on whether minimally

invasive joint replacement achieves any additional benefits, beyond the recovery period or

which minimally invasive technique works best.

Unicondylar Knee joint replacement:

Also known as unicompartmental knee arthroplasty, unicondylar knee joint replacement or

arthroplasty may be useful for limited knee damage. Relatively sedentary patients, who are

not obese and are older than 60, are advised to opt for this surgery. This type of joint

replacement offers two benefits—it may delay the need for a total knee replacement, and

relieve pain. The insertion of small implants and a small incision is involved in this

procedure. Important knee ligaments, which ensure more movement than a total knee

replacement, are retained in this procedure.


Hip Resurfacing:

A surgical alternative to total hip replacement, hip resurfacing involves placing a metal cap

over the dome, and scraping the surfaces of the hip joint and femur. In order to ensure that

a standard hip replacement can be performed down the line, the procedure preserves much

of the bone. This procedure is a potentially good option for young, physically active

individuals as it provides a faster recovery, more stability, and a greater range of motion.

Revision Arthroplasty or Joint replacement:

In cases where the original transplant fails, a repair or revision procedure known as

arthroplasty revision may be used. Whether the bone defects that occurred

are contained or uncontained, determines the specific procedure. Contained defects are

those defects that can be repaired with the help of oversized cementless implants, the use

of cement or small bone grafts. On the other hand, the more severe defects that require

specially constructed implants, or a large bone graft to restore bone, are known as

uncontained defects.

The potential for complications increases in case a second arthroplasty is required. This

means that the operation takes longer, more blood is lost and more bone is cut in

arthroplasty revision. Also, people that undergo this surgery are generally older individuals

and more prone to complications.


Complications of Joint replacement

Although they are common, complications can occur in the surgery. Some of these

complications are life threatening. Serious potential complications include deep blood clots

in the legs, as well as blood loss and infection. The blood clots pose a risk of death as they

can travel to the lungs. Individuals that are at a higher risk for blood clots include

overweight or obese osteoarthritis patients.

Some other complications are the risks associated with the use of general anesthesia. The

following are some complications that you and your doctor need to watch out for:

Blood Clots:

The most common complication associated with joint replacement is blood clots. After joint

replacement surgery, blood clots can occur in the large veins of the leg and pelvis. Following

the surgery, your doctor will prescribe you blood thinning medication. In order to reduce

the risk of developing blood clots, you’ll have to take this medication for several weeks after

the surgery.

In order to keep the blood in the legs circulating, the doctor will give you compression

stockings. Also, you’ll be able to prevent blood clots from forming if you perform early

movement,. such as standing, sitting, and walking, as recommended by your physician or

physical therapist.

In case it develops, the blood clot could travel to the lungs. This can be potentially fatal. In

order to ensure that you know what to look out for, you’ll be given instructions on what

symptoms might indicate the clot has traveled to your lungs. In case you develop these

symptoms, get medical help as soon as possible.

Lung Congestion:

Following a major surgery, pneumonia or lung congestion is always a risk. You’ll be asked to

regularly perform deep- breathing exercises while you are in the hospital, in order to

overcome lung congestion or minimize its threat.


Infections:

After the surgery, one of two things may happen—your joint may become infected or the

surgical wound may become infected. This could occur either right after you return home,

or years after your surgery. After the surgery, your doctor will prescribe antibiotics in order

to reduce the risk of infection. You’ll be asked to take antibiotics prior to certain medical

procedures, even if several years have passed after the surgery.

You may need to remove your artificial joint in case it becomes infected. At times, the

infection is cleared through surgery and does not require the removal of the joint. However,

there are also times when antibiotic treatment and removal of the implants becomes

necessary to clear the infection. Once the infection is completely cleared, a new joint may

be considered.

Scaring and Stiffness:

Making scar tissue is your body’s natural response after surgery. The scar tissue develops

both deep inside the joint, and on the surface of your skin. Your joint may become stiff and

difficult to move as the scar develops. Therefore, beginning activity as soon as possible after

surgery is important. Following the surgery, you must continue regular physical therapy as

prescribed by your doctor.

A manipulation under anesthesia may be required, in case physical therapy doesn’t improve

stiffness. The manipulation will break up scar tissue. However, following this you will need

to be careful about performing your prescribed physical therapy.

Loosening or failure of implant:

Implants wear out and may loosen over time. Today, they last longer due to newer

materials. The average lifetime of most knee and hip replacements is approximately 20

years. However, there are some implants that last less than ten years, while others lasts

more than thirty.

In spite of the fact that some they all have different life spans, one thing is true for all of

them—they eventually wear out. This is something that concerns younger patients more, as

they live longer with the implant and put more stress on the artificial joint. A revision

surgery may be performed if the joint wears out.


Hip Dislocation:

When the ball comes free from the socket, this is called dislocation of the hip replacement.

Generally, this occurs after a fall. However, there are other things that could cause it. Even

simple activities, such as sitting down on a low seat could cause dislocation. As a result of

this, you will have to follow certain precautions, especially during the early part of your

recovery process. The following are the precautions you may be required to take after hip

replacement:

Avoiding turning your foot inward

Using elevated seats

Sleeping with a pillow between your legs

Avoiding behind your hip more than 90 degrees

Avoiding crossing your legs

Post-surgery

Following surgery, a normal part of the recovery process is postoperative pain, swelling and

bruising. Fortunately, there are ways for you to manage the pain, and make your recovery

process easier.

A lot of hard work is involved in getting the most function out of your new joint after the

surgery. After the surgery, you’ll probably be in the hospital for several days. In order to

restore movement in the affected joints, physical therapists will teach you the appropriate

exercises during your time at the hospital. However, once you go home the healing and

recovery of the joint will be up to you.

Joint replacement takes a significant toll on the body. This is the reason expecting to resume

your routine activities only a week or so after the surgery is something you shouldn’t do.

Let’s put it this way—the damage caused to joints happened over time.

Therefore, it’s only natural that the healing and recovery of the joint will also happen over

time. Bruising, swelling and pain are all-related. Therefore, they all have the same

antidote—rest.

People with osteoarthritis need time to adjust to the artificial joint, even though the joint

replacement eventually restores some mobility and provides pain relief. The following are

the limitations after hip surgery:

Patient with new hips cannot run. However, they can walk a few miles and climb stairs

Osteoarthritis patients must learn new ways to perform activities that require bending

down, as artificial hips should not be flexed more than 90 degrees.


Limitations after knee surgery include:

Osteoarthritis patients cannot run after knee replacement surgery. However, there is

improvement when walking.

It may be difficult to climb stairs with artificial knee joints as they have a limited range of

motion.

You will need to prepare for what comes afterward before you consider joint replacement

surgery. You will also need to have realistic expectations of how much work is required for

the best outcome, and how much of an improvement to expect.

Most people who undergo joint replacement experience major improvements in their ability

to perform routine activities such as cleaning house, engaging in low-intensity exercise and

stair climbing, as well as dramatic reductions in pain.

However, you need to keep in mind that a joint replacement is an artificial joint, and you will

have to limit some of your activities with them. These include high impact activities. The

following are some of the activities that you should avoid after joint replacement, or

perform only after talking to your doctor:

A high-impact aerobics class

Skipping

Karate or other martial arts

Playing soccer, basketball, football or other high-impact sports

Skiing, running or jogging

Rehabilitation and Recovery:

Depending on the condition of the patient at that particular time, he or she is sent home, or

to a rehabilitation facility, after knee replacement surgery. The average rehabilitation stay is

approximately a week to ten days, in case the osteoarthritis patient is sent to a facility. A

physical therapist, recommended by your doctor, will visit your home to treat you, in case

you’re sent directly home from the hospital.

As the final stage of the rehabilitation process, your doctor may ask you to go to an

outpatient physical therapy facility. Depending on your progress, outpatient therapy mat

last from one to two months. Because every person is different, your doctor and physical

therapist will help you to determine the course of rehabilitation on an individual basis. This

is something you must keep in mind.


If you treat it well, your new hip or knee can last 20 years or longer. However, it will wear

out or become loose sooner than expected, if you put stress and strain on the joint. After

the surgery, you should perform activities that put less strain on your joints, such as cycling

and swimming. Without overstressing it, these exercises can help the new joint significantly.

A surgeon can put in the new hip or knee. However, only you have the ability to exercise it.

Therefore, you should commit to an exercise program before pursuing joint replacement

surgery. The exercise program should include:

In order to gradually and safely increase your mobility, regular walking, first at home and

then outdoors for longer distances

Resuming routine activities, such as getting up and down from a chair, climbing stairs,

and standing, gradually

In order to strengthen the muscles around your joint, performing the exercises advised

by your physical therapist regularly at home

Provided you choose joint replacement surgery, you’re likely to have an excellent outcome,

if you do all of the aforementioned things. So is joint replacement surgery good for you?

According to a 2008 study, compared to people who did not have surgery, people with

osteoarthritis, especially older individuals, that underwent joint replacement surgery

significantly improved their osteoarthritis symptoms. Whether joint replacement is right for

you is something we’ll briefly discuss in the next section.

Making the decision:

One of the most successful operations in medicine, that has improved the lives of millions of

people, is joint replacement. People with osteoarthritis often ask when they should consider

joint replacement surgery. Unfortunately, there isn’t a straightforward answer to this.

However, you may require joint replacement surgery if you feel a loss of function in your

knee or hip, and are suffering from extreme pain.

Osteoarthritis can affect your every move including sitting, walking, lying down or climbing

stairs. One thing that can bring relief is surgery.

However, doctors advise people with osteoarthritis to try other treatments before turning

to joint replacement surgery. When non-surgical treatments such as the use of assistive

devices, physical therapy, and medication do not work, joint replacement may become

necessary to treat osteoarthritis.


Other signs indicating the need of joint replacement surgery include loss of mobility, aching

in the joint followed by periods of relative relief, pain that increases in humid weather, stiff

joints after periods of rest or inactivity, and/or pain after extensive use. Anti-inflammatory

and pain relieving medications, physical therapy, and assistive devices may help, but most of

the times surgery is required to treat symptoms.

You'll only feel pain when walking long distances in the early stages of osteoarthritis.

However, you’ll feel pain even when performing routine activities such as dressing, putting

on shoes, or taking short walks, as osteoarthritis progresses. In many ways, osteoarthritis of

the hip and knee can negatively affect your life.

However, the good news is that there is a solution, and it is joint replacement surgery. Most

people return to an active and pain free life after the surgery, even though the joint requires

time to heal afterwards. The surgery also improves walking ability and overall health.

Your primary care doctor will probably recommend an orthopedic surgeon to you who’ll

help you determine when and if you need joint replacement surgery. He or she will also

inform you about the type of surgery you require. The orthopedic surgeon may advise you

against getting a in certain cases, such as if your bone isn’t strong enough, you don’t have

enough of a bond or you have an infection.

In favor of less invasive treatments, doctors generally try to delay total knee replacement

for as long as possible. However, joint replacement may offer you an opportunity to relieve

pain and return to normal activities if you have advanced joint disease.

Alternatives to Joint Replacement:

There are several other options if you feel a joint replacement isn’t right for you. They

include realignment, fusion, and synovectomy. Let’s take a brief look at these alternatives to

joint replacement.

Osteotomy (bones realignment):

Cutting and removing bone or adding a wedge of bone near a damaged joint is involved in

the procedure known as osteotomy. For example, osteotomy transfers weight from an area

affected by osteoarthritis to an undamaged area.

On many occasions, osteotomy is used to correct misalignment of the hip, or hip dysplasia

that occurs early in life. Individuals who are too young for total joint replacement, such as

people with osteoarthritis in their 30s and younger, are the best candidates for osteotomy.


The biggest benefit of this surgery is that it can stop damage and delay the need for a joint

replacement. However, only specialized surgeons can perform osteotomy, as it is a complex

and highly specialized surgery.

Synovectomy:

The lining of the joints or the synovium can grow too much, or become inflamed in people

with inflammatory osteoarthritis. As a result of this, the surrounding cartilage and joints are

damaged. Using either traditional open surgery or arthroscopy, surgeons remove most or all

of the affected synovium in synovectomy.

The best candidates for synovectomy are people with osteoarthritis, that have limited

cartilage damage in the affected area, and have tried anti-inflammatory medications, but

continue to have overgrowth or inflammation of the synovium around the hips, fingers,

wrist, elbow, and knee.

People that undergo synovectomy may be able to reduce their intake of anti-inflammatory

medications. This surgery improves function and relieves pain. However, it is possible that

this procedure may provide only temporary relief of symptoms, and limit range of motion.

Fusion or Arthrodesis:

In order to join two or more bones and make one continuous joint in the spine, fingers,

thumbs, wrists or ankles, surgeons use rods, plates, pins or other tools, in the procedure

known as Arthrodesis or fusion. The bones grow together and lock in place over time. The

most suitable candidates for this type of joint replacement are people with severe damage

from osteoarthritis. The results of Arthrodesis should last a lifetime, as it is an extremely

durable process. People that have this surgery can safely take part in high-impact physical

activity. However, this surgery may reduce flexibility as merging joints inhibits their motion.

It also puts stress on surrounding joints, as it changes the normal biomechanics of the joint.


CHAPTER 02-RHEUMATOID ARTHRITIS

Understanding Rheumatoid Arthritis

An autoimmune disease, Rheumatoid arthritis is a condition in which the body’s immune

system responsible for protecting its health by attacking foreign substances like viruses and

bacteria mistakenly attacks the joints. Basically, the body attacks itself. As a result of this,

inflammation occurs, and this causes the tissue that lines the inside of the joints (the

synovium) to thicken, causing pain and swelling in and around the joint. Joints on both sides

of the body such as both hands, both knees, and both wrists are affected by Rheumatoid

Arthritis. According to statistics provided by the official ‘Center for Disease Control and

Prevention’ of the government of United States, approximately 1.5 million adults,

constituting a noticeable 1.3 %population, were diagnosed with Rheumatoid Arthritis in

2005. The statistics further revealed that people aged over 85 and 65-77, were much more

likely to get Rheumatoid Arthritis than people aged 18-34.

The cartilage can be damaged if the inflammation caused by Rheumatoid arthritis goes

unchecked. This can cause damage to the elastic tissue that covers the ends of a joint’s

bones and the bones themselves. Over time, the joint spacing between bones can become


smaller, as there’s a loss of cartilage. Rheumatoid arthritis causes joints to lose their

mobility and become painful, loose, and unstable. It can also cause joint deformity. Doctors

recommend early diagnosis and aggressive treatment to control Rheumatoid arthritis, as it

occurs early on and cannot be reversed.

The cartilage can be damaged if the inflammation caused by Rheumatoid arthritis goes

unchecked. This can cause damage to the elastic tissue that covers the ends of a joint’s

bones and the bones themselves. Over time, the joint spacing between bones can become

smaller, as there’s a loss of cartilage. Rheumatoid arthritis causes joints to lose their

mobility and become painful, loose, and unstable. It can also cause joint deformity. Doctors

recommend early diagnosis and aggressive treatment to control Rheumatoid arthritis, as it

occurs early on and cannot be reversed.

The joints commonly affected by Rheumatoid arthritis include the knees, elbows, hands,

feet, ankles and wrists. Usually, the joint effect is symmetrical. This means that if one hand

or knee is affected, usually the other is too. Rheumatoid arthritis is also referred to as a

systemic disease, because it can affect body systems such as respiratory or cardiovascular

systems. So what are the signs and symptoms of Osteoarthritis? Let’s take a look.

Signs and Symptoms

Early Signs of Rheumatoid Arthritis

The early signs of Rheumatoid arthritis include minor symptoms that appear and disappear

all of a sudden, on both sides of the body. The progression of these symptoms usually

happens over weeks or months. Symptoms of Rheumatoid arthritis can change each day,

and are unique for every person. However, there are some signs that may be an early

indication of this condition. The following are some early signs of Rheumatoid arthritis. If

you experience any of these symptoms, you may be suffering from Osteoarthritis. However,

you must visit your doctor before coming to any conclusions.

Fatigue:

The first indication of Rheumatoid arthritis is fatigue. Prior to any other symptoms becoming

prominent, you may find yourself feeling unusually fatigued. It often comes before the

emergence of other symptoms, and it can fluctuate from day to day, or week to week. It

may even accompany depression and feelings of illness.


Stiffness in the morning:

An early indication of all forms of arthritis, including Rheumatoid arthritis, is morning

stiffness. Usually, stiffness that lasts for some time indicates degenerative form of arthritis.

On the other hand, if the arthritis lasts for several hours, it may indicate inflammatory

arthritis. 0Stiffness that occurs after prolonged sleeping or sitting can also be an indication.

Stiffness in the Joint:

A common early sign of Rheumatoid arthritis is stiffness of the smaller joints. Whether

you’re active or not, this can take place at any given time. The joints of the hands are usually

the first to become stiff.

Pain and Tenderness:

Regardless of whether the joint is moving or at rest, joint tenderness or pain follows joint

stiffness. Joint tenderness or pain equally affects the right and left hand side of the body.

The wrists and fingers are usually where the pain occurs in early Rheumatoid arthritis.

However, shoulders, ankles, feet, or knees may also be affected.

Minor Swelling:

Minor swelling of the joints is an early indication of Rheumatoid arthritis. This means that

your joints may seem bigger than what they normally look like. Your joints may also be

warm to touch because of this swelling, and it lasts anywhere from a few days to a few

months.

Fever:

A low-grade fever may indicate that you have Rheumatoid arthritis, if it’s accompanied by

other symptoms, such as inflammation and joint pain. However, you’re probably suffering

from an infection or some other illness if the fever is higher than 100°F.

Numbness and tingling:

Tingling, numbness, or a burning feeling in your hands is also an indication of Rheumatoid

arthritis.


Decrease in range of motion:

Ligaments and tendons can lose stability and deform due to inflammation in your joints. You

may not be able to straighten and bend joints as the disease progresses. In short, the pain

caused by Rheumatoid arthritis may affect your range of motion.

If you’re suffering from early stages of osteoarthritis, see your doctor to get a proper

diagnosis. The early signs of Rheumatoid arthritis include joint stiffness, pain, tenderness,

minor swelling, and decrease in range of motion. However, as Rheumatoid arthritis

progresses the symptoms also change/increase. So what are the symptoms of Rheumatoid

arthritis, regardless of its stage? Let’s take a look.

Symptoms of Rheumatoid Arthritis

A serious autoimmune disease, Rheumatoid arthritis attacks the joints and other body parts.

However, diagnosing this condition can be a tough task. Often, symptoms of Rheumatoid

arthritis mimic other illnesses. Furthermore, lab tests aren’t perfect—you could have

Rheumatoid arthritis, even if your test results are negative. However, there are some

symptoms that are related only to Rheumatoid arthritis, and these indicate this condition,

regardless of its stage. Let’s now look at these symptoms.

Hard to heal injuries:

When the symptoms are due to Rheumatoid arthritis, you may have an injury such as a

sprained ankle that seems to be refusing to heal, or healing at a slower rate than normal.

This symptom is more evident in younger people. If you have Rheumatoid arthritis, you may

have a swollen knee a day after you play soccer or some other sport.

Inflammation in the forefoot:

The forefoot is one area in which people with Rheumatoid arthritis have pain or

inflammation. Often, women stop wearing heels due to the pain. As a result of plantar

fasciitis, some people with Rheumatoid arthritis may develop pain in the heel. Caused by

swelling of the tissue near the heel, plantar fasciitis is a common foot disorder.


Dryness of the eyes, mouth, nose, throat, or skin:

An autoimmune disease, Sjogrens syndrome can cause dryness of the eyes, mouth, nose,

throat, or skin in people with Rheumatoid arthritis. The dryness is due to inflammation that

prevents glands from unhitching moisture. This symptom may occur even in the early stages

of Rheumatoid arthritis. However, your doctor will confirm Rheumatoid arthritis in you only

if this symptom is accompanied by some other symptoms of RA. Your doctor may rule out

Rheumatoid arthritis in you, if dryness of the eyes, mouth, nose, throat, or skin, in isn’t

accompanied by other symptoms of RA.

Achy Joints:

Aching in the joints is one of the most overriding symptoms of Rheumatoid arthritis. Often,

people think that their pain is a result of overexertion or osteoarthritis. However,

osteoarthritis usually occurs in old age. At times, this aching in the joints is misdiagnosed as

chronic fatigue syndrome or fibromyalgia. As pointed out earlier, fatigue is a symptom of

Rheumatoid arthritis. Rheumatoid arthritis joint pain isn’t brief, rather it lasts more than a

week. Furthermore, this pain can be symmetrical—you will feel pain in both hands, ankles,

knees or feet, at the same time.

Locked Joints:

Locked joints are what people with Rheumatoid arthritis can experience at times. Usually,

they occur in the knees or elbows. Why?

They happen because there’s significant swelling of the tendons around the joint, which

prevents it from bending. This can lead to painful cysts behind the knee. Often, people

mistake the symptom for meniscus tear. A condition that also leads to cysts, meniscus tears

are a knee joint injury that usually occurs in sportsmen.

Nodules:

Nodules grow under the skin near the affected joints and manifest as small, firm lumps.

Often, they appear at the back of the elbows, while on other occasions they’re found in the

eyes of people with RA. Nodules may show up in the early stages of Rheumatoid arthritis.

However, they’re also common in people with advanced Rheumatoid arthritis. At times,

nodules mimic another form of arthritis, known as gout.


Digestive Problems or Stomach Pain:

You’re more likely to develop stomach bleeding, ulcers and conditions such as diverticulitis

and colitis, if you have Rheumatoid arthritis. Inflammation from Rheumatoid arthritis or side

effects from medications such as corticosteroids or nonsteroidal anti-inflammatory drugs

(NSAIDs) can cause this. Also, you’re highly likely to have diarrhea or constipation, which

indicates and warns that the amount of good and bad bacteria in your intestine is out of

balance.

Weight loss:

You may experience flu-like symptoms when you have Rheumatoid arthritis. At times, this

includes loss of appetite, which may lead to muscle or simple weight loss. If you have

Rheumatoid arthritis, you may even become malnourished. This means that you need to be

watchful about what and how much you eat. In order to get the right nutrition and calories

every day, work with your doctor.

Inflammation of lungs lining:

If you have Rheumatoid arthritis, the lining of your lungs may become inflamed. Known as

pleurisy, this is an inflammation of the lining of the lungs. The feeling of pain when you try

to take a deep breath is the most noticeable symptom of pleurisy. The inflammation can

lead to scaring in the lungs and shortness of breath over time. However, you can treat this

with anti-inflammatory medications. There is a possibility that your lung symptoms are due

to Rheumatoid arthritis medications. If you have any trouble breathing, you should tell your

doctor about it.

Breathing Problem:

You’re at a higher risk for scarring of the tissues in the lungs if you have Rheumatoid

arthritis. Therefore, you should visit your doctor if you’re short of breath during routine

activities, or have a cough that won’t go away.


Broken bones:

Bone loss that raises your risk of fractures, can be triggered by some Rheumatoid arthritis.If

you avoid exercise and physical activity your bones may become weaker. A broken bone

may indicate that you’re developing osteoporosis. A disease that causes your bones to get

thinner is known as osteoporosis. Once you’re tested and diagnosed, you can treat

osteoporosis.

Depression or anxiety:

At times, depression or anxiety is an indication of

Rheumatoid arthritis. According to a CDC study,

depression or anxiety is seen in about one-third

of people with arthritis. If you notice changes in

your mood, talk to your doctor. In order to help

treat this symptom, your doctor will suggest

therapy or medicine to you.

Swollen Lymph Nodes:

Along with the appendix, spleen, tonsils, and certain areas of the small intestine, Lymph

nodes are a part of the immune system. By producing antibodies that directly attacks

infectious bacteria, the immune system protects us from diseases and infections. On the

other hand, an over-active immune system can occur, due to unknown triggers. This over

activity produces auto-antibodies, which are directed against body components. This causes

autoimmune diseases, such as lupus or Rheumatoid arthritis, to develop.

This symptom occurs when there is lymph node swelling, or enlargement of lymph nodes.

The term used for this is called lymphadenopathy. The infected areas are where painful

lymph nodes are commonly found. In Rheumatoid arthritis, the enragement or swelling of

the lymph nodes is limited to the nodes voiding the infected area. For example, one or more

lymph nodes in the armpit of the same side may swell and become painful if a finger is

infected, or lymph nodes in the groin are likely to swell and hurt if a toe is infected.

Rheumatoid arthritis is a systemic illness, that primarily results in inflamed joints. However,

it can affect several systems of the body. Overactive lymph nodes that produce auto

antibodies are what patients with Rheumatoid arthritis have. Examples of such anti bodies

are anti- CCP anti bodies and Rheumatoid factor. At times, lymph nodes in Rheumatoid

arthritis do not cause pain, even though they become enlarged. Lymph nodes caused by

Rheumatoid arthritis affect many areas throughout the body.


Anemia:

An autoimmune disorder, Rheumatoid arthritis causes chronic inflammation of the joints.

One of the most common symptoms of Rheumatoid arthritis is anemia. In fact, about 60

percent of the people with Rheumatoid arthritis have anemia. This may occur due to the

failure of the bone marrow to produce enough new red cells. It is especially important for

you to recognize and treat anemia, because anemia-related fatigue contributes to the

wearing nature of Rheumatoid arthritis.

Chest Pains:

According to a 2015 study, people with Rheumatoid arthritis are more likely to die from

heart-related problems than those without RA. About 40% of people with Rheumatoid

arthritis have symptoms in areas on their body, apart from joints. The areas include the skin,

lungs, eyes, and muscles.

Disorders with similar or overlapping symptoms:

Because, many other conditions have similar symptoms, Rheumatoid arthritis can be

difficult to diagnose. There are several disorders with symptoms that overlap with

rheumatoid arthritis. The following are some of these disorders.

Lupus:

A potentially fatal autoimmune disease, Lupus

affects many parts of the body, including

internal organs, blood vessels, skin, and

joints. Because they share many symptoms,

distinguishing between Rheumatoid arthritis

and Lupus is hard. Joint pain is the most

obvious similarity between the two. Other

shared symptoms include swelling,

inflammation, fatigue, a periodic fever, and

decrease in energy levels. Fortunately, there

is a way to tell them apart. Unlike

Rheumatoid arthritis, Lupus does not cause

erosive, deforming arthritis. Furthermore, the

joint symptoms in Lupus tend to be mild.


Gout:

When excess levels of uric acid form needle-like crystals in a joint, gout occurs. The primary

symptoms of gout are swelling and severe pain. Gout is an extremely painful type of

arthritis, and its symptoms begin in the big toe. The symptoms of gout that mimic

Rheumatoid arthritis include redness, warmth, swelling, and pain. While it typically attacks

the toe, gout can extend to any part of the body including the fingers, elbows, wrists, knees,

ankle, and foot. Gout can cause erosive, deforming arthritis if it goes untreated.

The best way to know whether you have Rheumatoid arthritis or gout is to make an

appointment with your doctor for a diagnosis. However, there are few things that can help

differentiate the diseases. The following are some of them:

Usually, gout occurs in the foot. To be precise, it occurs at the base of the big toe

Even though it can affect any joint on either side of the body, Rheumatoid arthritis

usually occurs in the small joints of the feet, wrists, and hands

Intense swelling and agonizing pain accompanies gout

Even though it can be painful, a joint affected by Rheumatoid arthritis is not always

swollen or red

Rheumatoid arthritis pain varies in intensity and quality. Sometimes it’s excruciating

while on other occasions it’s mild

Pseudogout (CCPD):

A form of arthritis, Pseudogout is triggered by deposits of calcium crystals in the joints.

Spontaneous, painful swelling is what Pseudogout causes. It also causes inflammation joint

pain and fluid buildup around the joint.

Scleroderma:

An autoimmune disease, Scleroderma attacks the skin and tissues. Scleroderma is a form of

degenerative arthritis. Both Rheumatoid arthritis and Scleroderma attack connective tissues

and cause pain, swelling and immune system responses. However, there are a few

differences between the two. First and foremost, Scleroderma hardens the skin and causes

inflammation inside, and outside, the body. On the other hand, Rheumatoid arthritis causes

inflammation, but it does not spread to the skin.A less common form of arthritis,

Scleroderma hardens the skin and causes random swelling and scarring to occur. Due to

chronic inflammation within the blood vessels, Scleroderma causes blood vessel disease. On

the other hand, Rheumatoid arthritis causes joint pain and swelling.


Osteoarthritis:

We’ve already covered Osteoarthritis.

However, we’ll do a quick recap. In simple

terms, Osteoarthritis refers to inflammation

of the joints. A joint disease, Osteoarthritis

mostly affects the cartilage. Known as wear

and tear arthritis, Osteoarthritis is the most

common type of arthritis.

Osteoarthritis can occur in almost any body

joint and is associated with the

disintegration of cartilage in joints. Healthy cartilage does two things—it helps absorb shock

of movement and allows bones to glide over one another. Osteoarthritis causes the upper

most layer of cartilage to disintegrate and deteriorate. As a result of this, the bones beneath

the cartilage rub together, which in turn causes swelling, pain, and loss of joint motion. The

joint may lose it shape and spurs may grow on the joint’s edges. Generally, Osteoarthritis

occurs in the spine, knees and hips. However, it can also affect the neck, thumb, toe, and

fingers.

They are differences between Rheumatoid arthritis and Osteoarthritis, even though they

share a lot of symptoms. The first difference is the cause behind the symptoms themselves.

While mechanical wear and tear on joints causes Osteoarthritis, Rheumatoid arthritis is

caused by an autoimmune disease which causes the body’s own immune system to attack

the body’s joints.

Rheumatoid arthritis tends to affect the middle joints of the fingers, while Osteoarthritis

affects the joints at the ends of the fingers. Morning stiffness in joints caused by

Osteoarthritis doesn’t last more than 20 minutes after you wake up. On the other hand,

morning stiffness in joints caused by Rheumatoid arthritis lasts for more than 45 minutes.

Apart from the aforementioned diseases, there are some other diseases that resemble

Rheumatoid arthritis, such as drug-induced lupus and Sjorgen’s syndrome. Finding the

difference between these diseases and RA is important.


Risk Factors

Rheumatoid arthritis affects about 1.5 million people in the U.S. and can affect adults at any

age. However, this form of arthritis appears in women between the ages 30 and 60 while

symptoms of RA start appearing in men after they cross 50. Women are two or three times

more likely to develop Rheumatoid arthritis than men.

An autoimmune disease, Rheumatoid arthritis is a condition in which your immune system

starts attacking your body’s own tissues instead of viruses and bacteria. This causes

inflammation. Normally, inflammation dies down fairly quickly. However, inflammation

becomes a long-term (chronic) process in Rheumatoid arthritis. What sets off the

inflammation in Rheumatoid arthritis is not clear. However, there’s some evidence that

lifestyle factors affect your risk of developing RA. You

are at a risk if you:

Drink a lot of coffee

Eat a lot of red meat

Smoke

Apart from the aforementioned things, another thing

that may increase your chances of developing

rheumatoid arthritis is the genes that you inherit from

your parents. However, it is important for you to keep in mind that genetics alone cannot

cause Rheumatoid arthritis. Even if your father had Rheumatoid arthritis, and you have the

same genetic material as him, your chances of developing RA are 1 in 5.The severity of

Rheumatoid arthritis varies from person to person.

Apart from genetics, there are many risk factors for developing Rheumatoid arthritis,

including temperature and weather. There are two types of risk factors, namely primary and

secondary risk factors. Primary risk factors are factors that you cannot prevent, such asyour

age and genetics, while secondary risk factors are ones that you can control or prevent

through medications or lifestyle changes. The following are some risk factors for developing

Rheumatoid arthritis.


Primary

The following are the primary factors that that may increase your risk of developing

Rheumatoid arthritis:

Genetics:

You may have an increased risk of Rheumatoid arthritis if a member of your family has the

disease. The chances of developing Rheumatoid arthritis are greater in people who have a

close family member with RA. According to experts, you do not inherit the disease itself,

rather you inherit the genes that give you the chance to develop Rheumatoid arthritis.

Your chances of having Rheumatoid arthritis are increased by certain genetic material that is

inherited from your family members. For example, you’re about twice as likely as others to

carry a gene linked to Rheumatoid arthritis, if your ancestors came from Europe, and your

chances of having RA are greater if you have a twin with the disease. On the other hand, if

you have a parent with RA, your risk goes up, but only slightly. However, the genes alone

aren’t enough to cause Rheumatoid arthritis. According to experts, these genes will only

become active when other risk factors of RA trigger them.

Age:

Rheumatoid arthritis can occur at any age. However, it usually appears in women between

the ages 30 and 60, and in men after they cross 50.

Gender:

Women are two or three times more likely to develop Rheumatoid arthritis than men. In

fact, of all the people living with Rheumatoid arthritis, only 25 % belong to the male gender.

The remaining 75% are women. The major reason for this is probably the female hormone

estrogen. Usually, the first symptoms of RA in women appear after age 40. This is the same

time when their estrogen levels are changing due to the onset of menopause.


Secondary

The following are the secondary factors that that may increase your risk of developing

Rheumatoid arthritis.

Smoking:

One of the most likely Rheumatoid arthritis triggers is smoking, especially if you have a

genetic inclination for developing the disease. Studies reveal that smoking doubles your

chances of developing RA and can cause problems even after you develop it. Smoking

interferes with the treatment process by making your body less responsive to it.

Environmental factors:

You may be at a higher risk of developing Rheumatoid arthritis if you’re constantly exposed

to silica or asbestos. However, this cause is uncertain and there isn't any solid research

behind it.

Obesity:

Most people don’t consider obesity as a risk factor for Rheumatoid arthritis. However, a

study that compared the weight of people with Rheumatoid arthritis with the weight of

people without RA, found that obesity was associated with about a 25% higher risk of

developing the disease. The best diet for reducing arthritis is one that’s high in beans,

grains, vegetables, and fruits. People who appear obese or are overweight seem to have a

higher risk of developing RA. This is especially true in women 55 or younger.

Lack of Omega-3s:

Omega-3 fatty acids reduce inflammation and therefore, also the risk of diseases like

Rheumatoid arthritis. Omega-3s are present in nuts and oily fish such as sardines, mackerel,

salmon, and tuna. Alternatively, you can take omega-3s pills. According to a few studies,

people that consume omega-3s suffer from fewer RA symptoms. It was also noted that

people that consumed omega-3s required fewer over-the-counter medications to reduce

the pain and swelling caused by Rheumatoid arthritis.


Vitamin D deficiency:

A study that examined the link between Rheumatoid arthritis and vitamin D found that the

risk of RA was higher in people with low levels of Vitamin D and that people with high levels

of vitamin D were 25% less likely to develop Rheumatoid arthritis. The ways of increasing

your vitamin D levels include taking vitamin D supplement, eating foods rich in vitamin D

and getting out in the sunlight. You can measure your vitamin D levels through a blood test.

Testosterone:

Low testosterone in men may be an indication of Rheumatoid arthritis. Also known as low T,

low testosterone indicates low levels of male sex hormone testosterone.

Drinking Coffee or Tea:

A strong connection between the risk of developing Rheumatoid arthritis and drinking

decaffeinated coffee is suggested by some studies. Others show that women that drank

large amounts of tea had a higher risk of developing the disease. However, what remains

unclear is whether the risk is in the tea itself, or the method of preparation.


Eating excessive amounts of red meat:

Over-indulging in red meat is something you

should avoid, since there are many dangers

associated with it. One of them is the

development of Rheumatoid arthritis.

However, recent studies have found that

people consuming high levels of red meat

were two to three times more likely to

develop the disease than people who

consumed less than an ounce of red meat each day. Some people with Rheumatoid arthritis

claim that their symptoms improve when they stop consuming red meat. However, it is

important for you to keep in mind that lean cuts of red meat provide sufferers with

important nutrients and protein.

Avoiding Breastfeeding:

Almost all recent studies indicate that Rheumatoid arthritis is less common among women

who breastfeed. Breastfeeding seems to offer a certain degree of protection against

Rheumatoid arthritis. Women who didn’t breastfeed were two times more likely to get RA

than those who do. Women that never gave birth had a higher Rheumatoid arthritis risk

than women who had children.

Treatment Methods:

Diagnosis:

Before getting treatment for Rheumatoid arthritis, you must first diagnose the condition.

You should make an appointment to see your doctor if you experience any of the signs and

symptom. There is no single diagnosis method. Instead, the doctor will perform a physical

examination, while also consulting the patient's medical history. In order to determine if

there’s inflammation and tenderness, an examination of the joints will be carried out, while

the skin may be examined to look for rheumatoid nodules. In order to help diagnose the

condition, the doctor may order X-rays or blood tests. The doctor will also rule out diseases

that resemble RA, such as gout, lupus, and fibromyalgia. The physical examination is a key

part of the diagnostic process. Your doctor will evaluate your joints, as well as check your

general health, such as the heart and lung function, pulse rate and blood pressure.


Your doctor will examine how your joints function and ask whether the joints are painful

when used. In order to find out if there’s any inflammation, your doctor will assess your

joints for warmth and swelling. They will then examine you for signs of the disease outside

of the joints, and will record the number of swollen and tender joints, as well their severity.

Basically, the physical examination will look for:

Affected Joints

Swelling, tenderness, and warmth

Reduced Range of motion

Reduced mobility

Symptoms in other areas of the body such

as skin, lungs, and eyes

Presence of bumps or rheumatoid nodules

over pressure points in the body

Presence of fluid on the joint

Pain or soreness during movement

Unusual positioning of the joints

Redness

Any abnormalities or growths in the joint

In order to reach a conclusive diagnosis, the doctor will go through your medical history and

discuss the symptoms with you. Medical history plays a big part here It will tell your doctor

when the onset of symptoms occurred, whether or not you have a family history of the

disease, your past treatments or surgeries, and any other significant information related to

your condition. Apart from the physical examination, other tests may be required to confirm

the diagnosis and ascertain its . Some of the tests include blood tests, Joint X-rays and

Arthrocentesis. Often, people mistake diseases such as lupus, fibromyalgia, and gout for

Rheumatoid arthritis because these diseases closely resemble RA, as we mentioned before.

Citrulline Antibody Test:

In order to reach a diagnosis, doctors usually run blood tests. Certain anti-bodies present in

a majority of Rheumatoid arthritis patients are what these tests look for. The anti-bodies

include antinuclear bodies (ANA), Rheumatoid factor (RF), and anti-cyclic citrullinated

peptide antibodies (ACPA).


Present in about 75% to 80% of Rheumatoid arthritis patients, Rheumatoid factor (RF)

indicates the severity of the disease. For example, a high RF may be an indication of a more

aggressive Rheumatoid arthritis. Detecting Rheumatoid arthritis earlier on is an advantage

of anti-cyclic citrullinated peptide antibody (ACPA) tests. This helps patients treatment

sooner, and better manage the disease. Although it isn’t a definitive diagnosis for

Rheumatoid arthritis, the presence of antinuclear bodies (ANA) can indicate the presence of

an autoimmune disorder.

Sedimentation Rate (Sed Rate):

There are some blood tests that your doctor may run to determine the extent of the

inflammation in the joints, and in other parts of the body. Also known as erythrocyte

sedimentation rate or ESR, the sedimentation rate test measures the speed with which red

blood cells make their way to the bottom of a test tube. Usually, if the sedimentation rate or

ESR is high, it means that there is a good amount of inflammation in the body. C-reactive

protein (CRP) test is another blood test that measures inflammation. A high CRP usually

indicates high inflammation levels.

Joint X-rays:

An X-ray is another test that helps diagnose Rheumatoid arthritis. Since they don’t show soft

tissue damage, X-rays aren’t helpful early in the disease. However, because they show

erosion, doctors can use x-rays in later stages to monitor the progression of the disease over

time. Some other tests for diagnosing Rheumatoid arthritis may include magnetic resonance

imaging (MRI), ultrasound and bone density scans.


Arthrocentesis:

In order to obtain joint fluid to test in the laboratory, your doctor may perform a joint

aspiration procedure known as arthrocentesis. Using a syringe and a sterile needle, fluid is

drained from the joint. After being drained, the fluid is analyzed to detect the causes of joint

swelling. The removal of the fluid may relieve joint pain. For more immediate pain relief,

doctors may inject cortisone into the joint during the aspiration procedure.

Once the diagnosis is confirmed, a person suffering from Rheumatoid arthritis will have to

get treatment for it. Currently, there isn’t any cure for Rheumatoid arthritis. However, there

are number of ways through which you can ease symptoms.

When the patient has few to no symptoms, the treatments are aimed at remission. Early on

in the disease process, treatments are used to minimize or slow joint damage and improve

the patient’s quality of life. They usually involve managing symptoms with medications,

rest, exercise, and therapies. I In some cases surgery may be required.

Usually, maintaining a healthy weight and exercising are good enough to treat the

symptoms of Rheumatoid arthritis. However, your doctor may suggest a few other ways.

Let’s now take a look at the different non-surgical methods for treating Rheumatoid

arthritis.


Treating Rheumatoid Arthritis without surgery

Rest:

Getting enough sleep is important for you to maintain optimal health and it becomes even

more important if you have Rheumatoid arthritis. If you’re suffering from the disease, you

must ensure that you get at least eight hours of sleep. If you cannot enough sleep during the

night, take a nap in the afternoon. Muscle relaxation exercises, deep breathing exercises

and guided imagery can help you relax if stress is preventing you from getting enough sleep.

Other things that may help ease stress and tension include massage, meditation, and

hypnosis. Talk your doctor if you’re suffering from insomnia. They will suggest appropriate

treatment plans which will help you get a better night’s sleep.

Exercise:

A great way to increase range of motion, strengthen muscles, and fight fatigue is regular

exercise. Good low-impact choices include walking, swimming, gentle stretching, and water

aerobics. Gentle exercises have been proven to help fight pain. It is important that you avoid

high-impact sports when your joints are tender or severely inflamed. Apart from those

mentioned above, another good option to reduce Rheumatoid arthritis pain is Yoga.

Exercise is the only way people with RA can maintain strength and flexibility.

It is important that you choose an activity that you enjoy, and you should avoid overdoing it.

There are many benefits to exercising. For example, weight-bearing exercises keep your

bones strong. Being cautious is always a wise thing to do when it comes to exercise. Consult

your doctor for a list of activities that will be safe for you to do. Consulting a physical

therapist is also a good idea, as they can tutor you on the proper ways to perform various

exercises.

Tai Chi:

A Chinese martial art, Tai Chi combines slow, gentle movements with awareness and deep

breathing, exercising the body, mind, and spirit. Studies show that Tai Chi may improve

function in those with Rheumatoid arthritis. It is important that you don’t perform moves

that make your pain worse, and take lessons from a professional.



You can better manage pain by maintaining a healthy weight. According to a 2013 study,

people who are obese or overweight need an increased amount of medication to control

inflammation. This in turn decreases their chances of symptom relief. Therefore,

maintaining a healthy weight is important to overcome the symptoms of Rheumatoid

arthritis.

Cream, Gels and Lotions:

A good way to ease painful joints is topical creams, gels, and lotions that you can rub

directly onto the skin. You may experience temporary joint pain relief as the skin absorbs

the ingredients. You’ll find topical creams in spray form as well. If you want to get the best

results, look for products that contain menthol, camphor, salicylates, and capsaicin.

Fish oil:

According to a few studies, fish oil may help reduce the pain and stiffness caused by

Rheumatoid arthritis. However, fish oil supplements can increase the likelihood of bleeding

or bruising, and can interfere with certain medications.

There are many benefits of using fish oil for people with Rheumatoid arthritis, including

reduced pain and inflammation. In fact, some researchers suggest that there are as effective

as nonsteroidal inflammatory drugs. The recommended dose for people with RA is one or

two fish oil capsules per day. However, make sure that you talk to your doctor before using

fish oil supplements.

Physical Therapy:

In order to help heal and strengthen a body part or area that is giving you problems, your

doctor may prescribe physical therapy. In order to help ease pain and get you back into

shape, the physical therapist will use gentle strengthening exercises, range of-motion

exercise, transcutaneous electrical stimulation, and ice and heat therapy. Typically a short-

term option, physical therapy is performed few times a week for several weeks, until you’re

feeling better. A terrific bridge to an exercise program, physical therapy is recommended for

early treatment of Rheumatoid arthritis.


Occupational Therapy:

Apart from physical therapy, another good bridge to a regular exercise plan is occupational

therapy. Helping a person live as independently as possible, regardless of age or condition,

is what occupational therapy looks to do. In order to identify problem areas in your daily

life, and find out the ways to eliminate them, an occupational therapist will work with you.

For example, typing on a keyboard all day long may cause your hands and wrists to be

painful and swollen. In order to ensure that you avoid overuse injuries and use the

computer more comfortably, the therapist will help you modify your work area., They will

also identify the assistive devices you require to help make your routine tasks easier.

Heat and Cold Therapy:

Heat therapy is one of the simplest ways to treat Rheumatoid arthritis. You can soothe

painful joints and aching muscles by taking a relaxing 15-minute hot bath or shower.

Alternatively, you can use a heating pad or hot towel to apply heat to an affected area. This

will help you to relax tense muscles and relive pain and stiffness. Alternating hot packs with

cold ones can also provide relief. In order to ease swelling and pain, apply an ice pack to

inflamed joints. Relaxing muscles spasms and numbing pain are the two things cold therapy

can help you to do.It is important that you don’t overdo hot or cold therapy. In order to find

out how to use heat and cold therapy safely, talk to your doctor or a physical therapist.

Acupuncture:

With the help of fine needles, gently placed near nerve endings, the ancient Chinese

practice of acupuncture stimulates the body’s natural painkillers to provide relief from

Rheumatoid arthritis. Some studies suggest that acupuncture can provide temporary relief

from joint pain caused. However, it isn’t a viable long-term option and there has only been

minimal research done on it.


Massage:

Massages can be wonderful, or agonizing, depending on how your body is feeling. They can

be extremely beneficial in helping you relax, and ease the muscle tension caused by joint

stress, if your joints and muscles aren’t feeling too tender. Whether massage can help you

or not on a particular day is something you’ll have to decide for yourself. If you think it

might help your body feel better, give it a try. However, you must ensure that your massage

therapist has previously treated people with Rheumatoid arthritis.

According to a 2013 study that involved 42 people with Rheumatoid arthritis, light or

medium massages from a therapist once a month can provide relief from pain, and a greater

range of motion.

Orthotics:

A form of mechanical aids, orthotics can help support and protect your joints. Braces that

keep your joints properly aligned or padded insoles for your shoes and splints are examples

of orthotics. Furthermore, special gloves for hand and finger Rheumatoid arthritis are also

available. In order to determine the best orthotics options for yourself, take help from a

physical therapist.

Smoking Cessation:

Many people don’t consider Rheumatoid arthritis as a reason to

quit smoking since they aren’t aware of the effect smoking has on

their condition. If you’re one of them, you need to know that

smoking makes Rheumatoid arthritis worse. Often, people with

RA don’t quit smoking because they see it as a way to cope with

the pain, feelings of isolation and lack of support. Apart from

worsening Rheumatoid arthritis, it causes lung cancer,

Osteoporosis, cardiovascular disease and stroke. . You should quit

if you’re a smoker and want to decrease your chances of

developing Rheumatoid arthritis or improve your RA symptoms.

The following are reasons for you to quit and improve your overall

health.

Talk to your doctor: The first way to quit smoking is talking to your doctor. They will inform you about the

different options available to you. This includes focus groups related to smoking cessation,

medications, and physical or mental therapies.


Choose a plan to follow: After talking to your doctor, choose the smoking cessation plan you want to follow.

Pick a day for quitting smoking: Pick the day you plan to quit smoking. By doing so, you will motivate yourself to quit and

start working towards your goal.

Inform your friends and family: In order to ensure that they don’t offer you cigarettes, making it harder for you to quit,

inform your friends and family as their help will make it easier. At times, you’ll be tempted

to smoke, but the right support from friends and family will ensure that you stay clear of

cigarettes.

Find activities to distract yourself: If you want to quit smoking, you’ll need to find activities to distract yourself. For example,

you should keep gum with you to chew when the urge hits you. Alternatively, you can keep

yourself busy by listening to music.

Know what to expect: When you’re trying to quit smoking, there are certain things that you should expect. Your

body will go through withdrawal because nicotine is a drug. As a result of this, you’ll feel

angry, frustrated, anxious, cranky, unable to sleep, restless and depressed. You may also

gain weight. Since you’ll know what to expect, you’ll be better able to cope with the

withdrawal affects.

Don’t give up: In case you relapse, avoid giving up. Before you can kick the habit, you may require several

tries.

Medications:

The sooner the treatment begins, the better the outcome will be if you’re diagnosed with

Rheumatoid arthritis. You can alleviate symptoms by using many different medications. All

of these medications have the same goal—bringing a patient into remission. The following

are the main types of Rheumatoid arthritis medications:

Disease- modifying

antirhenatic drugs

(DMARDs)

Biological response

modifiers/ Biological

DMARDs

Nonsteroidal anti-

inflammatory drugs

(NSAIDs)

Kinase inhibitor

Corticosteroids

COX-2 inhibitors

Analgesics


As they are fast acting and relieve symptoms quickly, drugs that reduce pain and

inflammation such as analgesics and NSAIDs are considered as ‘first-line’ drugs. On the other

hand, medications such as DMARDs and biological response modifiers take longer to have

an effect, but help prevent joint damage and inflammation.

Analgesics (pain relievers):

For minor pain, analgesics such as acetaminophen are useful. Analgesics play a role both in

the early stages of Rheumatoid arthritis, and even in the later stages of the disease. Until

DMARDs become effective, analgesics help relieve pain.

As long as they don’t exceed the recommended dose, most people can take acetaminophen

without any problems. The recommended dose is doses of 1 gram every 4 to 6 hours.

Acetaminophen can reduce mild pain. However, it does not help with swelling or

inflammation.

Over the counter medicines include acetaminophen with caffeine or aspirin. Prescription

medicines are acetaminophen with narcotics, propoxyphene, or codeine.

Used to treat moderate to severe pain, another prescription analgesic is tramadol. Typically,

tramadol is taken every 4 to 6 hours, and it may be taken with or without food. It is

important for you to keep in mind that there are many side effects of tramadol, including

gastrointestinal symptoms, muscle tightness, nervousness, headache, sleepiness, weakness,

and dizziness.

Given to manage Rheumatoid arthritis related pain, neuromodulators are another pain

reliever. There is little evidence to show that neuromodulators are effective analgesics.

However, because neuromodulators such as capsaicin have minimal side effects, they may

be considered as an add-on analgesic with NSAIDs for people with RA who have persistent

pain, and have failed to respond to other pain medications.

The final analgesics for Rheumatoid arthritis are muscle relaxants, such as drugs that reduce

muscles spasm such as valium, benzodiazepines, and Zopiclone. Muscles relaxants provide

short-term relief. However, there are many side effects associated with them, such as

dizziness and drowsiness.


Anti-Inflammatory Medicines:

Used to treat Rheumatoid arthritis, anti-inflammatory drugs include (NSAIDs) and COX-2

inhibitors.


Temporary relief of pain and inflammation is what over-the-counter nonsteroidal anti-

inflammatory drugs (NSAIDs) can provide. Examples of NSAIDs are naproxen and ibuprofen.

If necessary, your doctor may prescribe a more potent dose. The NSAIDs your doctor may

prescribe include:

Anaprox

Celebrex

Clinoril

Daypro

Feldene

Lodine

Relafen

Toradol

NSAIDs don’t change the course of Rheumatoid arthritis, instead they ease the pain and

discomfort .

All NSAIDs have the same analgesic, anti-inflammatory and antipyretic properties, even

though they differ in structure. However, individual patient response and tolerance to

different NSAIDs can vary. In order to work, NSAIDs inhibit arachidonate cyclo-oxygenase

(COX enzyme), and in doing so, inhibit the production of thromboxanes and prostaglandins.

COX-1 and COX-2 are the two types of COX enzymes. In most tissue, COX-1 is expressed. This

includes platelets. Induced in primary inflammatory cytokine and inflammatory cells when

they are activated, the COX-2 enzyme is responsible for producing inflammation mediators.

Most NSAIDS inhibit both isoenzymes.

The inhibition of COX-2 is the major cause of the anti-inflammatory action of NSAIDs. On the

other hand, the inhibition of COX-1 causes their unwanted side effects. Gastrointestinal

irritation is the most common side effect of NSAIDs. At times, gastrointestinal irritation can

lead to stomach bleeding or ulcers.


In order to prevent or minimize the side effects, NSAIDS must be taken with food. However,

this will not decrease the risk of bleeding. You will also increase the risk if you take a

combination of NSAIDs or NSAIDs and aspirin together. It should also be noted that long-

term use of NSAIDs may cause heart problems. NSAIDs may lead to impaired renal function

in some patients, since prostaglandins regulate blood flow in the kidneys. This may cause

salt and water retention, as well as increased blood pressure.

A warning that the medications may increase the chance of having a stroke, heart attack, or

stomach bleeding is what all prescription NSAIDs come with. You may decrease

gastrointestinal irritation, ulceration, or bleeding caused by anti-inflammatory agents if you

take NSAIDs together with gastroprotective agents such as proton pump inhibitors.

COX-2 inhibitors:

In order to lessen the effect on the stomach, another type of NSAID called COX-2 inhibitor

was designed. COX-2 inhibitors achieve their objective by blocking an inflammation-

promoting agent called COX-2. Initially, it was thought that COX-2 inhibitors worked as well

as traditional NSAIDs. However, the FDA re-evaluated the risks and benefits of COX-2

inhibitors after they received reports of heart attacks and strokes. Following reports of heart

attacks and stroke in some patients, two COX-2 inhibitors (rofecoxib and valdecoxib) were

taken off the market.

COX-2 inhibitors are now available with strong warning and a recommendation that these

medications should be prescribed for the shortest duration possible, and at the lowest

possible dose. Like other NSAIDS, COX-2 inhibitors don’t delay the progression of the

disease. Instead, they provide relief from symptoms.

Celecoxib is the only COX-2 inhibitor available for short-term use. Using the medication for

one to two weeks is considered safe. Side effects of long-term use include:

Increased risk of heart attack and stroke

Impaired kidney function

Fluid retention

High blood pressure

Gastrointestinal bleeding and ulcers

Talk to your doctor if you need to take NSAIDs for longer period of time. In order to prevent

stomach bleeding and gastrointestinal ulcers, your doctor may prescribe treatments such as

an H2 inhibitor, a proton pump inhibitor, or misoprostol.


Corticosteroids:

Often known as steroids,

Corticosteroids are powerful

drugs that reduce

inflammation. Quick relief

from pain and inflammation is

what corticosteroids can

provide Rheumatoid arthritis

patients. In order to curb RA

symptoms, corticosteroids

suppress the overactive

immune system.

Corticosteroids are not the anabolic steroids that build up muscles. Corticosteroids act

throughout the body and their impact isn’t limited to the immune system. Using these drugs

for a short period of time to control flares is recommended. Following the recommended

dosage will help you to avoid the side effects. You may need to take steroids for a long time

if you have severe Rheumatoid arthritis.

Corticosteroids have both short-term and long-term side effects. The short-term side effects

include irritability, acne and weight gain, while long-term effects include osteoporosis,

psychological problems, diabetes, glaucoma, cataracts, bone thinning and high blood

pressure.

In order to quickly reduce inflammation at the start of the treatment, you may use high

doses of corticosteroids in combination with disease- modifying antirheumatic drug

(DMARDs). However, steroids may be discontinued entirely, or tapered down to very low

doses, when DMARDs begin to take effect.

At times, corticosteroids are injected directly into joints affected by Rheumatoid arthritis.

This is a good way to get the benefits of the drug with limited side effects. However,

injections should be limited to no more than a few per year for safety reasons.


Disease Modifying Anti-Rheumatic Drugs (DMARDs):

As far as Rheumatoid arthritis is concerned, the topmost pain relief strategy to control

inflammation is using disease modifying antirheumatic dugs (DMARDs). All other pain relief

strategies to control inflammation are secondary to DMARDs.

Even though they are slow acting, DMARDs are the most effective medications for

controlling Rheumatoid arthritis. All DMARDs appear to slow or stop the changes in the

joints. However, different DMARDs have different structures, and the mechanisms of action

for most of these agents are unknown. DMARDS can delay the progression of bone damage

and alter laboratory characteristics of disease activity. Within eight to ten weeks, patients

taking DMARDs show some response. However, this variable depends on the drug and

patient. The doses of DMARDs depends on its side effects. When the maximum dose is

reached, an additional DMARD is added, or the initial DMARD is stopped and switched to

another.

Since most DMARDs can cause bone marrow toxicity and some can cause liver toxicity, they

require monitoring to ensure safety. Monitoring includes urea and electrolyte level test,

liver function tests and a full blood count. In order to determine how well medications are

working, regular blood or urine tests should also be performed. Methotrexate is the most

commonly used DMARD.

Methotrexate:

The most commonly used DMARD, methotrexate slows down the damage to the joint and is

effective in reducing signs and symptoms of Rheumatoid arthritis. You’ll see results from

this drug within six to eight weeks. Other DMARDs that you can use in conjunction with

methotrexate include hydroxychloroquine, sulfazine. Methotrexate has some side effects,

including bleeding, bruising, liver problems, anemia, diarrhea and mouth sores.

Hydroxychloroquine:

An anti-malarial drug, hydroxychloroquine is effective in the treatment of Rheumatoid

arthritis. For added benefits, hydroxychloroquine is used in conjunction with methotrexate

and sulfasalazine. Before using this drug, you must keep its side effects in mind. The side

effects include experiencing dizziness, headache, stomach pain, weight loss, loss of appetite,

mood changes, itching, and hair loss.


Sulfasalazine:

Another effective DMARD, Sulfasalazine reduces symptoms and slows down the joint

damage. The side effects of sulfasalazine include vomiting, nausea, headache, itching, rash,

stomach upset, and pain, decreased appetite and decreased sperm count.

Leflunomide:

Used in patients who cannot take methotrexate, leflunomide shows similar effectiveness to

that. The side effects of leflunomide include skin rash, itching, cold symptoms, numbness or

tingling, back pain, headache, weight loss, dizziness, diarrhea and mild stomach pain.


Biological response modifiers/ Biological DMARDS:

The newest class of drugs used to treat Rheumatoid arthritis is biological response

modifiers. For many people with Rheumatoid arthritis, these modern biologics have greatly

improved treatment. Since they’re made with the help of biotechnology, biological DMARDs

are different from traditional disease DMARDs. In order to make them act like natural

proteins in your immune system, biological DMARDs are genetically engineered.

In order to help combat joint damage, your doctor may suggest that you start drug therapy

immediately after your diagnosis. Often, the first drug prescribed is methotrexate. However,

if methotrexate doesn’t work well, your doctor will prescribe you a biologic drug. Biological

DMARDs slow the progression of Rheumatoid arthritis. However, they don’t cure it.

Compared to other drugs, biologics have fewer side effects.

A biologic may benefit people who don’t respond to Rheumatoid arthritis drugs such as

methotrexate. At times, biologics are given alone. However, there are also occasions when

they’re given in combination with another type of drug. For most people with Rheumatoid

arthritis, taking a biologic drug with methotrexate is effective.

Unlike traditional DMARDs, biologics target the molecules that cause inflammation in

Rheumatoid arthritis. Here is a simple explanation of this. The development of Rheumatoid

arthritis itself involves inflammatory cells in the joints. The inflammatory process that

ultimately causes the joint damage seen in rheumatoid arthritis is what biological DMARDs

cut down. On the other hand, traditional DMARDs work by modifying the body’s own

immune response to the inflammation.

Biological DMARDs are considered to be more effective and more specifically targeted than

traditional DMARDs, because they attack the cells at a more specific level of inflammation.

Theyinclude rituximab, abatacept, etanercept, tofacitinib, tocilizumab, infliximab,

golimumab, adalimumab, pegol, anakinra, and certolizumab.

Anti- TNF agents:

Some biological DMARDs are known as anti-TNF drugs. A protein known as tumor necrosis

factor increases inflammation. Anti-TNF agents target this protein when excess amounts of

it are present in the blood or joints.

Also known as tumor Necrosis factor (TNF)-inhibitors, anti-TNF agents is the largest group of

biological DMARDS available today to treat Rheumatoid arthritis. Anti-TNF agents include

etanercept, golimumab, certolizumab, infliximab, and adalimumab.


Adalimumab:

An injectable drug, adalimumab reduces inflammation caused by Rheumatoid arthritis.

However, there are some side effects of using the medicine, including weakening of the

immune system, bacterial or viral infections, cold, headaches, and injection site reactions.

Adalimumab blocks a substance in your body that causes inflammation and makes your

immune system react. The recommended dose is taking 40 mg once every two weeks, or 40

mg every week. People who aren’t taking methotrexate may use the dose of 40 mg.

Etanercept:

An injected drug, Etanercept is used to treat Rheumatoid arthritis, as well as other types of

arthritis. Etanercept works to lower the levels of TNF in your body, which helps to control

excess inflammation. There are some serious side effects of etanercept, including

weakening of the immune system, serious infections, upper respiratory infections, injection

site reactions, loss of body fat and muscle, severe rash, bleeding, bruising, stomach pain,

vomiting, dizziness and headaches. Rheumatoid arthritis patients should take etanercept as

a single-use pre-filled syringe of 50 mg once per week.

Infliximab:

An injected drug, infliximab is used to treat Rheumatoid arthritis and a number of other

diseases. Infliximab works by blocking the action of a protein in your body called tumor

necrosis factor-alpha (TNF-alpha). In order to treat Rheumatoid arthritis, infliximab may be

combined with methotrexate. The side effects of infliximab include stomach pain,

headaches, coughing and respiratory infections. If you have an infection, avoid using

infliximab. Your body’s ability to fight infections is what infliximab may decrease. Your dose

may depend on your general health. Therefore, before taking this drug tell your doctor

about all your health conditions.

Golimumab:

An injectable drug, golimumab is used to treat Rheumatoid arthritis and other conditions.

Golimumab works just like other anti-TNF agents. There are many side effects of golimumab

including weakening of the immune system, viral infections such as cold or flu, upper

respiratory infections, injection skin reactions, redness, swelling, and dizziness. The

recommended dose is 50 mg, to be injected under your skin once per month. Golimumab

may be given with or without methotrexate, or other non-biologic disease modifying

antirheumatic drugs (DMARDs).


Non-TNF biologic agents:

Non-TNG agents include abatacept, anakinra, rituximab, and tofacitinib. Even though they

are also biological DMARDs, non-TNF agents work a bit differently from TNF inhibitors.

Rituximab:

By destroying another category of immune cells called b-cells, rituximab help control

Rheumatoid arthritis. The activity of the drug in the body is complex, and its actions are yet

to be fully understood. However, rituximab seems to slow down the joint destruction and

reduce the signs and symptoms of Rheumatoid arthritis. The side effects of rituximab

include headache, fever, chills, stomach pain, nausea, diarrhea, heartburn, flushing, night

sweats, weakness, muscle or joint pain, back pain, or dizziness.

Abatacept:

Inhibiting the production of the cytokines tumor necrosis factor (TNF) alpha, interferon-γ,

and interleukin-2 and decreasing T cell proliferation is what abatacept does. Side effects of

abatacept include headache, nausea, diarrhea, stomach pain, indigestion, dizziness, flushing,

back pain, or cold symptoms.

Anakinra:

The action of an immune system protein called interleukin-1 (IL-1) is what anakinra blocks.

This protein is often known as master cytokine. By blocking the action of master cytokine,

anakinra controls local and systemic inflammation in the body. The side effects of anakinra

are nausea, diarrhea, stomach pain, headache, and cold symptoms such as stuffy nose,

sneezing, sore throat.


Tofacitinib:

Also known as a Kinase inhibitor, tofacitinib is a new class by itself. Tofacitinib works by

blocking a cellular signaling pathway inside cells. This prevents the production of the

components that cause inflammation. Traditional biologics block inflammation from the

outside of the cells. However, Kinase inhibitors work from within. The only biological

DMARD that isn’t injected, tofacitinib comes as a pill, which is taken twice per day. Side

effects of tofacitinib include:

Infection caused by

Bacteria

Pneumonia

Shingles

Acute Infection of the

Nose, Throat, or Sinus

Diarrhea

Head Pain

High Amount of Fats

in the Blood

Here, we tell you exactly what to expect and why you don't have a thing to be nervous

about. The following are the different surgeries for Rheumatoid arthritis.

Synovectomy:

Inflamed joint tissue known as synovium limits your range of motion or ability to function,

and causes a great amount of pain. Removing synovium is what Synovectomy is used for. In

order to access and remove inflamed joint lining, ligaments, and other structures may be

moved aside. An effective filter, synovium clears spoilage and viral infections, or even

potential bacteria, from the joint. However, inflammatory cells and inflammatory debris clog

the filter in Rheumatoid arthritis. This causes the promotion of inflammation in, and of

synovium. Preventing or stopping further damage to the joint is the goal of synovectomy. If

drug treatment fails to resolve persistent pain and swelling in 3 to 6 months then you may

consider this procedure for alleviating these symptoms. In order to ensure that it can still

perform its function of releasing synovial fluid, part of the synovium is left intact during

synovectomy. The synovial fluid acts as joint lubricant. There are two different ways of

performing synovectomy—using arthroscopic methods or making a large incision that

exposes the entire joint. The extent of repair required and the joint involved determine the

choice of approach.

If medications such as DMARDs or corticosteroid injections aren’t able to improve early

rheumatoid arthritis, then synovectomy is a useful treatment option. However, it is

important for you to keep in mind that synovectomy is a temporary fix, even though it

provides relief of pain and swelling. The synovium will continue to become overgrown, as

long as rheumatoid inflammation continues. Bleeding within the joint and a slight risk of

infection are the risks involved in synovectomy.


Tenosynovectomy:

Removing the inflamed synovial lining of the extensor tendons is the purpose of

tenosynovectomy. The extensor tendons help the fingers extend. Swelling over the back of

the hand and the wrist occur due to the inflammation of the synovial lining. In case it

continues, this swelling and inflammation can eventually cause fissures in the tendons.

Tenosynovectomy is used to treat the restricted or painful motion of a tendon that is caused

by thickening and adhesions within the tendon covering.

The operation is usually performed under a local anesthetic that lasts about half an hour. In

tenosynovectomy, the surgeon divides the pulley, which restricts the excursion of the

tendon. For this purpose, the surgeon uses a tourniquet. For the five to ten minutes after its

inflation, the tourniquet can be uncomfortable. It is possible that the surgeon may remove

only the lining of the joint and preserve the pulley in Rheumatoid arthritis patients. The

reason for this is simple— People with Rheumatoid arthritis have a number of weak pulleys.

Therefore, entirely removing the valuable remaining pulleys might not be such a good thing

to do.

In order to use tenosynovectomy as an affective prophylactic procedure for Rheumatoid

arthritis, it has to be performed before there’s significant tendon damage. Preventing

recurrent tenosynovitis and subsequent tendon rupture is what tenosynovectomy is usually

considered for.

Tendon Repair:

Tendon rupture can often result from swelling and inflammation

of joints or the related changes to bones and other structures that

happens in Rheumatoid arthritis. Tendons located in the wrist and

hands are particularly prone to ruptures. The use of tendons from

other areas in the body is involved in surgical repairs, including

end-to-end and end-to-side reconstructions.

Arthrodesis:

In order to achieve permanent immobilization of a joint, a surgical procedure that involves

fusion of bones is used. This procedure is known as arthrodesis. By fusing the bones

together, arthrodesis eliminates pain. Arthrodesis or joint fusion is performed when

replacing the affected joint isn’t possible. However, fusing the bones prevents the

movement of the joint. The small joints of the hand and feet and the spine are where bone

fusion is mostly done.


The surface layer of bone and cartilage is removed from the ends of the bones that are to be

fused together during the arthrodesis procedure. After this, using rods and screws, the

joints are locked into place once it is positioned in the most functional alignment. In cases

where there’s no joint stability and joint movement causes pain, arthrodesis is the most

useful procedure. Typically preferred for certain joints such as wrist, thumb, ankle, hindfoot,

and first toe, arthrodesis provide relief of pain and even allows the patient to maintain some

limited joint function. Several months may be required to recover from this procedure.

Arthroplasty or Joint Replacement:

Rheumatoid arthritis may eventually progress to the point that normal functioning is

impossible even after using the aforementioned procedures. Under such circumstances, you

may consider artificial (prosthetic) replacement joint implants for wrists and hands, ankles,

hips, knees, shoulders or other joints. People who are over 50, or have rapidly progressing

joint damage, are best suited for arthroplasty. The lifetime of the joint replacement is

usually about twenty years.

Joint replacement can both relieve pain and restore joint function. Arthroplasty has a high

success rate. Joint replacement surgery is successful in nine out of ten cases. There are

several different types of joint replacement. Depending on joint location, and the nature of

damage to joints and related structures, arthroplasty can involve the use of different

artificial (prosthetic) and natural components.

An orthopedic surgeon performs this procedure under general anesthesia. After opening the

joints, the surgeon will disengage tendons and ligaments from the bone. After this, he or she

will dislocate the joints and remove the damaged parts of the bone. The surgeon will

preserve the bone as much as they possibly can. In arthroplasty, the stability of the

replacement joint depends on how much bone remains. The prosthetic joint is cemented

into place once the bones are reshaped. Then, tendons and ligaments are reattached.

There are risks associated with joint replacement surgery, even though great advances have

been made since its inception. One of the major concerns with joint replacement is the risk

of infection at the site of surgery. Such an infection may require removal of the prosthetic

joint. Nerve damage and formation of blood clots in the area of the surgery are some of the

other complications. There is also a chance that the replacement joint may loosen or

dislocate. Prosthetic joints can wear out over time. There are several different types of joint

replacement. The following are some of them:


Minimally invasive Joint Replacement:

For RA of the hip and knee, total hip replacement and total knee replacement are very

successful surgical treatments. Over the past few years, hip and knee replacement surgery is

now performed as with minimally invasive techniques. There are many benefits of minimally

invasive joint replacement including less tissue trauma, as the muscles and tendons aren’t

cut, instead they’re avoided or separated. The rehabilitation is also faster and less painful,

there’s less scarring and smaller incisions, the hospital stay is shorter and there’s reduced

blood loss, and less need for pre-surgery blood transfusions. Finally, returning to routine

activity after the surgery is faster.

Revision Arthroplasty or Joint replacement:

In cases where the original transplant fails, a repair or revision procedure known as

arthroplasty revision may be used. Whether the bone defects that occurred

are contained or uncontained determines the specific procedure. Contained defects are

those defects that can be repaired with the help of oversized cementless implants, the use

of cement or small bone grafts. On the other hand, the more severe defects that require

specially constructed implants or large bone graft to restore bone are known as

uncontained defects.

The potential for complications increases if a second arthroplasty is required. This means

that the operation takes longer, more blood is lost and more bone is cut. People that

undergo this surgery are generally older individuals and more prone to complications.

Total knee replacement:

A surgical procedure, total knee replacement involves the replacement of the diseased

cartilage and bone of the knee joint with artificial materials. After removing them, a surgeon

replaces the damaged sections of your knee joint with parts that are usually constructed of

metal and very hard plastic. Reducing pain and improving function is what the artificial joint

(prosthesis) does. If more conservative treatments haven’t helped, and hip pain caused by

RA interferes with daily activities, then knee replacement surgery may be an option for you.


Total Elbow Replacement:

One of the procedures used to restore the function and relieve the pain in elbows affected

by Rheumatoid arthritis is total elbow replacement. The outcomes of surgeries are what the

advent of arthroplasty procedure has improved. In total elbow replacement surgery, the

damaged elbow joint will be replaced with the new artificial joint after the scar tissue is

removed and elbow muscles are balanced.The artificial joint will be fixed to the outside of

ulna and the inside of the humerus. In order to ensure joint stability and connect the limb

with other bones, hinge pins may be used.

Total Wrist joint replacement:

Also known as total wrist arthroplasty, total wrist joint replacement is used to treat the

symptoms of Rheumatoid arthritis that haven’t responded to non-surgical treatments, such

as medication or therapy. Eliminating your pain and increasing the mobility of your wrist

joint is the goal of wrist joint replacement. Wrist joint replacement is performed under

general or regional anesthesia.

In total wrist joint replacement, your surgeon will perform an incision over the back of the

wrist. To expose the wrist joint, the surgeon will then move away the tendons. In order to

ensure smooth surface for implants attachment, the surgeon will remove the damaged

surfaces of the arm bone with the help of a surgical saw, and they may also remove the first

row of carpal bones. In order to insert the radial components of the prosthesis, a special

instrument is used to hollow out the inside of the radius bone.

The surgeon will prepare for the insertion of the carpal components of the prosthesis once a

proper fit is established. A plastic spacer is fit between the metal components, and cement

is inserted into the components. Using its range of motion, the wrist joint is tested once the

new prosthesis is in place. After testing the wrist, the surgeon stitches together the joint

capsule, repairs the muscles and tendons, and closes the skin.


Preparing for Rheumatoid arthritis Surgery:

If you want to see great results then it is important that you prepare yourself for

Rheumatoid arthritis surgery. In order to prepare you for the surgery, your doctor may ask

you to do several things. In order to help avoid infection, they may ask you to temporarily

stop some of your medication. You may also be required to take aspirin, or other blood

thinning drugs a week or so before the operation. Your doctor may also ask you to give

blood in advance, in case you need it during the surgery. The following are some of the

things you can do to improve your recovery and lower the risks of complications during

surgery:

Before the surgery, treat any tooth or gum disease that you may have. This will help you

to prevent infection from mouth bacteria.

Before the surgery, treating urinary tract infection is important. Therefore, tell your

doctor if it hurts to pee.

If you want to heal faster after the surgery then eat a healthy and balanced diet. It will

provide you to the energy you need to heal.

After surgery, people who are fitter do better. Therefore, exercising is important.

Quit smoking if you’re a smoker. Smoking cessation reduces the risks of complications

after the surgery.

If you’re going to get joint replacement surgery, try to lose any extra weight. Less weight

means less stress on the artificial joint, which in turn will help it to last longer.

It is important that you prepare your home before the surgery. This means finding

someone to help you with routine activities such as cleaning, cooking, shopping etc.

Tape down electrical cords or loose carpets to reduce the likelihood of falls.


CHAPTER 03-PSORIATIC ARTHRITIS

Understanding Psoriatic Arthritis

Psoriatic arthritis causes your immune system to be over reactive, which in turn causes

inflammation in your joints. It generally affects people who have psoriasis. A skin disease

related to your immune system, psoriasis causes red patches of skin topped with silvery

scales.

Most people are diagnosed with psoriatic arthritis after developing psoriasis. However, the

appearance of skin lesions is not always a prerequisite for joint problems. Often, doctors

misdiagnose Psoriatic arthritis as gout, osteoarthritis, or Rheumatoid arthritis. A chronic

disease, psoriatic arthritis causes the inflammation of the skin and joints as well as stiffness

and swelling in people with psoriasis.

Men and women are equally affected by psoriatic arthritis. Before developing arthritis

symptoms, most people with psoriatic arthritis develop symptoms of psoriasis. However,

symptoms of arthritis are noticed before the appearance of psoriasis in about 15 percent of

cases.


Certain groups of joints are what psoriatic arthritis tends to affect. The following are the

different types of psoriatic arthritis:

Distal arthritis:

The end joints of the fingers and toes are what this type of psoriatic arthritis affects.

Asymmetric oligoarthritis:

Fewer than five small or large joints in the body are what this type of psoriatic arthritis

affects. However, it does not necessarily occur on both sides of the body.

Symmetric polyarthritis:

Five or more joints on both sides of the body are what this type of Psoriatic arthritis affects.

The symptoms of symmetric polyarthritis are similar to those of Rheumatoid arthritis.

Arthritis mutilans:

The joints are destroyed and deformed by this type of psoriatic arthritis. A shortening of the

affected fingers or toes often accompany arthritis mutilans.

Spondyloarthritis:

The joints of the spine are what this type of psoriatic arthritis affects.

The most common type of psoriatic arthritis is polyarthritis. A close second is oligoarthritis.

However, less than twenty percent of patients get distal arthritis, arthritis mutilans, or

spondyloarthritis. The main symptoms of psoriatic arthritis include joint pain, swelling, and

stiffness. These symptoms can affect any part of your body, including your fingertips and

spine. The symptoms of psoriatic arthritis range from relatively mild to severe. So what are

the signs and symptoms of psoriatic arthritis? Let’s take a look.


Signs and Symptoms

Early signs of Psoriatic Arthritis

Psoriatic arthritis can either develop quickly and be severe, or can develop slowly with mild

symptoms. Extensive joint damage that occurs in later of the disease can be prevented by

early recognition, diagnosis, and treatment of psoriatic arthritis. Psoriatic arthritis may seem

like cartilage tear, and can develop in a joint after an injury. The following are some early

signs of psoriatic arthritis:

Redness and pain of the eye

A reduced range of motion

Fatigue

Morning stiffness and tiredness

Pain, throbbing, swelling, and

tenderness in one or more joints

Nail changes

Tenderness, pain, and swelling over

tendons

Psoriatic arthritis usually affects the

distal joints in fingers or toes.

Symptoms of psoriatic arthritis Apart from the distal joints in fingers or toes, you may experience symptoms of psoriatic

arthritis in your knees, ankle, or lower back. Psoriasis occurs before the joint disease in 85

percent of patients. It is important to tell your doctor about any aches and pains if you’ve

been diagnosed with psoriasis.

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time.

However, you may have periods when your symptoms improve as well, as periods when

symptoms become worse. Joints on just one or both sides of your body can be affected by

psoriatic arthritis. Just like Rheumatoid arthritis, psoriatic arthritis causes joints to become

warm to touch, swollen and painful. However, there are some symptoms related solely to

psoriatic arthritis. The following are those symptoms:

Swollen fingers and toes:

it can cause painful swelling of your fingers and toes. Before having significant joint

symptoms, you may develop swelling and deformities in your hands and feet.


Foot Pain:

People with psoriatic arthritis may feel pain at the points where ligaments and tendons

attach to their bones. This is especially true for the sole of the foot or the back of the heel.

Lower back pain:

As a result of psoriatic arthritis, some people may develop a condition called spondylitis.

This cauases inflammation of the joints between your spine’s vertebrae and in the joints

between your spine and pelvis This leads to lower back pain.

Any of the 78 joints in the body can be affected by psoriatic arthritis. However, some joints

are more prone to this disease than others. Approximately one in four people with psoriatic

arthritis will experience pain and stiffness in their back or neck.

Unlike other forms of arthritis, psoriatic arthritis doesn’t usually affect major organs, such as

the lungs or liver. However, you may develop a painful red eye. A condition called uveitis

causes this. If untreated, the painful red eye may lead to permanent eyesight damage.

Finally, people with psoriatic arthritis have a slightly greater risk of developing heart disease

than people without the condition. Therefore, you should address anything that could

aggravate this risk, such as:

Obesity

Blood pressure problems

Excessive alcohol intake

Smoking

Risk Factors

Researchers are yet to identify the exact cause of psoriatic arthritis. However, they believe

that the disease develops due to a combination of primary and secondary risk factors. Risk

factors are the things that increase your risk for psoriatic arthritis. There are two types of

risk factors –primary and secondary. The primary risk factors are factors that you cannot

prevent or change, such asyour age, genetics, or immunologic factors. On the other hand,

secondary risk factors are those risk factors that you can reduce by taking medicine or

making lifestyle changes. Some examples of secondary risk factors are obesity,

environmental factors, and having psoriasis. There are several factors that increase your risk

of psoriatic arthritis. The following are some of them:


Primary

Genetics:

Approximately forty percent of people with

psoriatic arthritis have a parent or sibling with the

disease. Therefore, a person whose close relative

is a psoriatic arthritis patient is about fifty times

more likely to develop the disease than a person

who isn’t related to anyone with PA. A person is

also highly likely to have, or develop PA, if his or

her identical twin has the condition. According to

genetic researchers, certain chromosomes

increase the risk of developing PA while some

genetic factors contribute towards its severity.

Age:

Anyone can develop psoriatic arthritis. However, the people most affected by it are adults

between the ages of 30 and 50.

Immunologic factors:

Researchers have noted a variety of immune system abnormalities in people with psoriatic

arthritis. This is a birth condition and cannot be prevented. Therefore, it’s a primary risk

factor.

Secondary

Having Psoriasis:

The single greatest risk factor for developing

psoriatic arthritis is having psoriasis. People who are

most likely to develop psoriatic arthritis include

individuals who have psoriasis lesions on their nails.

Obesity:

About forty percent of people with psoriatic arthritis are obese. This clearly shows that

obesity is a major risk factor for psoriatic arthritis. Therefore, you can reduce your risk of

developing psoriatic arthritis by maintaining a healthy weight.


Environmental factors:

Another risk factor for psoriatic arthritis is exposure to certain infections. The development

of psoriatic arthritis is what exposure to certain infections may lead to. According to some

experts, there is a link between the development of psoriatic arthritis and streptococcal

infection. However, this link is yet to be proven. People infected with the human

immunodeficiency virus (HIV) are more likely to develop psoriatic arthritis than the general

population.

Having an injury:

Although it isn’t proven yet, a joint injury may cause psoriatic arthritis in some people. After

an injury, an inflammatory reaction is thought to set off the psoriatic arthritis. Therefore,

you should take extra care to protect your joints.

Injury to the skin:

Most people who have psoriasis are likely to develop psoriatic arthritis. According to

studies, injury to the same causes plaque psoriasis. For example, psoriasis may be triggered

by a skin inflammation, skin infection, or even excessive scratching.

Emotional stress:

An increase in emotional stress has led to the development of psoriatic arthritis in many

people. Therefore, emotional stress is a risk factor for PA.

Alcohol:

Many people consider alcohol a risk for psoriasis. Young to middle-aged men are most

prone to this risk.


Treatment Methods:

Diagnosis:

Before you get treatment for psoriatic arthritis, it is important for you to perform a

diagnosis of the condition. You should make an appointment to see your doctor if you

experience joint pain, swelling and/or stiffness that won’t go away. Your doctor will be able

to determine whether you have psoriatic arthritis or

not.

In order to diagnose psoriatic arthritis, your doctor

will:

Obtain your medical history

Perform a physical examination

Check inflammation by taking x-rays of the joints

Apart from the aforementioned things, your doctor may perform blood tests or joint fluid

tests to rule out other diseases, such as gout or Rheumatoid arthritis. In order to detect joint

and soft-tissue inflammation that is not visible on x-rays, a magnetic resonance imaging test

(MRI) may be used in some cases. A loss in bone mineral density may cause psoriatic

arthritis. Therefore, tests are also done to determine if you have an increased risk of bone

fractures, or are at risk for osteoporosis.

Often, psoriatic arthritis is confused with other forms of arthritis, such as osteoarthritis and

Rheumatoid arthritis. However, psoriatic arthritis can be differentiated from other forms of

arthritis through conditions specific to it, such as nail problems, skin lesions, and specific

patterns of inflammation.


Treating psoriatic arthritis Psoriatic arthritis can affect you inside and out. Therefore, treating it is important. The first rule of treating psoriatic arthritis is controlling the inflammation that causes your joints to ache and swell. You can relieve joint pain and swelling, as well as other symptoms of psoriatic arthritis, by getting treatment for it. Your doctor will recommend treatment based on the severity of the condition and your reaction to it. The following are the treatment methods for psoriatic arthritis.


As pointed out earlier, approximately forty percent of all people with psoriatic arthritis are

obese. This clearly indicates the importance of maintaining a healthy weight to avoid

psoriatic arthritis.Researchers have proven that by losing weight psoriatic arthritis patients

can improve their response to medical treatments.

Exercise and Physical therapy:

Exercising is a great treatment method for psoriatic arthritis. Exercise can help you to relieve

the pain and stress associated with psoriatic arthritis. You can also relieve the symptoms of

psoriatic arthritis with the help physical and ice and cold therapy. The exercises and physical

therapy methods involved in the treatment of psoriatic arthritis are pretty much the same

as that of osteoarthritis and Rheumatoid arthritis.


You can control inflammation and relieve the pain of psoriatic arthritis with the help of

nonsteroidal ant-inflammatory drugs (NSAIDs). As it stops your body from making the

chemicals that cause inflammation, your doctor may recommend you a nonsteroidal anti-

inflammatory drug if your arthritis is mild. In order to ensure an anti-inflammatory effect,

NSAIDs must be taken in sufficient doses and continuously. Before NSAIDs can become fully

effective as an anti-inflammatory drug, they need to be taken for several weeks. Your doctor

may recommend increasing the dose gradually, or switching to another NSAID if the initial

NSAID does doesn’t improve symptoms.

You can get NSAIDs by prescription, or over the counter. The most common NSAIDs include

naproxen, ibuprofen, and aspirin. There are many side effects of NSAIDs, including bleeding,

ulcers, stomach pain, strokes, and heart attacks. The side effects are more likely to occur if

you take NSAIDs for an extended period of time. If you have stomach problems, your doctor

may suggest celecoxib (Celebrex). Celecoxib is a selective NSAID. Selective NSAIDs i.e. COX-

2 inhibitors are as effective as non-selective NSAIDS and are less likely to cause

gastrointestinal injury and side effects.


Glucocorticoid injections:

Also called steroids, glucocorticoids can relive pain and suppress inflammation when

injected into joints affected by psoriatic arthritis. Because they may cause severe skin

psoriasis, psoriatic patients aren’t recommended oral glucocorticoids. There are only a few

side effects, including a brief flare of pain after an injection.

Disease modifying anti-rheumatic drug (DMARD)

Your doctor may prescribe a disease-modifying anti rheumatic drug (DMARD) if your disease

doesn’t respond well to NSAIDs, or is severe. DMARDs can help slow or stop swelling, pain

and joint and tissue damage. Although they may take longer to work, DMARDS are stronger

than NSAIDs. The most commonly used DMARDs for psoriatic arthritis include:

Leflunomide

Methotrexate

Sulfasalazine

Cyclosporine

Leflunomide:

Sold under the brand name Arava, leflunomide improves the symptoms of both skin and

joint disease. Leflunomide is usually prescribed for Rheumatoid arthritis. However, recent

medical studies state that leflunomide, which comes in a pill, is beneficial to some people

with psoriatic arthritis.

Methotrexate:

An immunosuppressive drug, methotrexate is approved by FDA as a treatment method for

psoriasis. It is widely and successfully used for treating psoriatic arthritis. Methotrexate

effectively relives the symptoms of psoriatic arthritis and helps prevent joint destruction.

The production of skin cells is what methotrexate reduces. It may also suppress the

immune system. People with swollen joints caused by psoriatic arthritis are often

recommended methotrexate.

Usually taken as a pill or by injection once per week, methotrexate is well tolerated in low

doses. However, the long-term use of this drug can cause several side effects, such as liver

damage. When using methotrexate for psoriatic arthritis, it is important for you to follow

your doctor’s instructions carefully.


Sulfasalazine:

A DMARD, sulfasalazine may be effective for skin lesions and joint pain caused by psoriatic

arthritis. Of all psoriatic patients, about one-third respond rapidly to sulfasalazine. However,

not all psoriatic patients benefit from this treatment, because many patients cannot tolerate

side effects such as gastrointestinal effects. You also shouldn’t use sulfasalazine if you’re

allergic to sulfa drugs. Given in doses of four tables twice a day, sulfasalazine may cause

dizziness, vomiting, headaches, rash, nausea or abdominal pain in some psoriatic patients.

Cyclosporine:

A drug that suppresses the immune system, cyclosporine is used to treat severe psoriasis

and psoriatic arthritis. Before the availability of TNF inhibitors, cyclosporine was in high

demand. However, it still may be helpful for some people with psoriatic arthritis, although

you may not see a response until three to four months after you have started the course. A

more effective way of using cyclosporine than taking the treatment alone is adding

methotrexate to it. High blood pressure and impaired kidney function are side effects of

cyclosporine.

Biological Response modifiers:

Given by injection or intravenous (IV) infusion, biological response modifiers or biologics,

are protein-based drugs used for treating psoriatic arthritis. Biologics treat psoriatic arthritis

by either blocking proteins in the immune system, or blocking the action of a specific type of

immune cell called T-cell. The proteins in the immune system include tumor necrosis factor-

alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23. These cells and proteins play

a major role in the development of psoriasis and psoriatic arthritis. Unlike traditional

systemic drugs that impact the entire immune system, biologics target specific parts of the

immune system.

Tumor necrosis factor inhibitors:

Part of biologic DMARDs or biologic response modifiers, tumor necrosis factor (TNF)-alpha

inhibitors interfere with the immune response and inflammation. Drugs in this class are

proteins that interfere with the actions of TNF. Some biologic agents or TNF inhibitors

include etanercept, adalimumab, golimumab, and infliximab. Often, doctors recommend

biologic agents when a traditional DMARD such as methotrexate has been ineffective.

TNF inhibitors work rapidly and they may be used alone or in combination with other

DMARDs, NSAIDs, and/or glucocorticoid injections. People with psoriatic arthritis who

cannot tolerate DMARDs, or haven’t fully responded to DMARDs, are given biologics.

Depending on the medication, TNF inhibitors must be either given intravenously or injected

under the skin.


Ustekiumab:

By selectively targeting the proteins or cytokines, interleukins 12 and 23, ustekinumab treats

psoriatic arthritis. Psoriatic inflammation is what interleukins 12 and 23 are associated with.

Secukinumab:

Also known as Cosentyx, secukinumab binds to and inhibits a protein or cytokine called

interleukin 17-A. It is involved in inflammatory and immune responses. People with psoriatic

arthritis have elevated levels of interleukin 17-A. Secukinumab interrupts the inflammatory

cycle of psoriasis by inhibiting cytokines that trigger inflammation. By doing so, it improves

the symptoms of psoriatic arthritis in many people.

Apremilast:

Sold under the brand name otezla, apremilast is used for treatment of long-term

inflammation diseases such as psoriatic arthritis. Apremilast works by blocking a specific

enzyme called PDE-4. By blocking P,DE-4, apremilast slows other reactions that lead to

inflammation. This improves flexibility in joints. There are some side effects of apremilast,

including sudden weight loss, depression, headache, nausea, vomiting, and diarrhea.

Surgery:

Surgery is something most people with psoriatic arthritis will never need. However, if

nothing else has worked (which rarely happens) then surgery can relieve pain, make an

affected joint work and allow you to perform your routine activities. The diseased lining of a

joint is removed by synovectomy. You may need arthroplasty if the damage is really bad.

You may use joint fusion to make your joint stronger, more stable, and less painful in case it

cannot be replaced.


Gout

Apart from osteoarthritis, Rheumatoid arthritis, and psoriatic arthritis, another common

form of arthritis is gout. One of the most painful forms of arthritis, gout causes pain and

swelling in one or more joints. When too much uric acid builds up in the body, gout occurs.

Uric acid buildup can lead to:

Deposits of uric acid that look like lumps under the skin

Deposits of sharp uric acid crystal in joints, usually in the big toe

Kidney stones in the kidneys caused by uric acid crystals

You can reduce the risk of having gout by improving your lifestyle. This includes losing

weight, eating a healthy diet, and avoiding excessive intake of alcohol or sugar-sweetened

soft drinks. There are several symptoms of gout, including attack in the big toe which causes

it to become sore, red, warm, and swollen. Other symptoms include:

Stiffness in joints

Heat

Redness

Swelling

Pain

Apart from the big, gout can affect the elbows, wrists, fingers, knees, heels, ankles, and

insteps. There are many causes of gout, including another illness, alcohol or drugs, or

stressful events. So what are the things that cause gout? Let’s take a look.


Risk factors:

The buildup of too much uric acid in the body is what primarily causes gout. The breakdown

of substances called purines is where uric acid comes from. You’ll find purines in all of your

body’s tissues as well in foods, such as anchovies, dried beans and peas and liver. Under

normal circumstances, uric acid would dissolve in the blood, passing through the kidneys

and out of the body in urine. However, uric acid may build up in the blood if:

The body increases the amount of uric acid it makes

The kidneys are unable to get rid of enough uric acid

A person eats foods high in purines

Hyperruricemia is the name given to the condition in which high levels of uric acid are

present the blood. The majority of people with hyperuricemia don’t develop gout. However,

you may develop gout if excess uric acid crystals form in your body. You’re likely to develop

gout if you:

Are a man

Are obese

Have family members with disease

Eat foods high in purines

Drink too much alcohol

Use medicines such as aspirin,

levodopa or cyclosporine

Are exposed to environmental factors

such as lead

Have an enzyme defect that makes it

hard for your body to break down

purines

Have had an organ transplant

Diagnosis and treatment:

In order to diagnose gout, your doctor will ask about your symptoms, medical history, and

family history of the condition. Your doctor may draw a sample of fluid from an inflamed

joint to look for crystals associated with gout in order to reach a diagnosis. They may also

perform the diagnosis through x-rays or MRI.

In order to treat gout, doctors prescribe the use of:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids, such as prednisone

Colchicine

Apart from the aforementioned medications, your doctor may prescribe medicines that

lower the level of uric acid in the blood.


CHAPTER 04-LATEST DEVELOPMENTS

IN ARTHRITIS TREATMENT Although no cures for arthritis have been discovered, there is a lot of research being done.

Arthritis isn’t the name of one disease, rather it’s a broad term that encompasses over

hundred varying disorders. Chronic pain, limited mobility, and decreased range of motion

characterize all of these disorders and the joints are involved in all of them.

Arthritis has no known cure. However, advances in science are helping us to identify ways to

improve the diagnosis and treatment of arthritis. Over the past five decades, research has

brought about major advances in finding causes, as well as better ways to treat arthritis.

New developments have helped reduce pain, restore movement, correct deformities, and

reduce deaths. There was a time when the only way to get around was crutches or cranes in

case you destroyed a hip or knee joint. However, in the past three decades researchers have

created artificial joints for people with arthritis. Today, people with arthritis can move freely

by replacing worn-out joints with artificial ones. New treatments are being developed every

day, and by the time you read this there might be an even better way of treating this

condition. The following are some of the latest developments in arthritis treatment.


Stem Cell therapies:

Currently, there are no FDA approved stem cell therapies for treating arthritis. You may come across companies with web sites that offer stem cell treatments. However, most of these claims aren’t supported by scientific evidence. Therefore, you must talk you doctor before going for any stem cell treatment. To date, no one has been able to determine the

long-term effectiveness of current treatments.

Therefore, the door to explore other potential therapies like stem cell therapies is still open.

There is some way to go before stem cell therapies are used to cure arthritis. However,

there’s good reason to think that they could be beneficial. Stem cells have nti-inflammatory

and regenerative capacities For example, some stem cells have proven to stimulate blood

vessel formation, inhibit inflammation, dampen the immune system response, repair tissue,

and evem stem cells can make cartilage.

Today, a number of research teams around the globe are working to develop stem cell

therapies for arthritis. The researchers are trying to find out how stem cells work, which are

the most anti-inflammatory and best suited to making chondrocytes. Chondrocytes are the

cells found in healthy cartilage. They are also trying to determine the best ways to safely

administer stem cells and scale up cell numbers for larger trails.

Stem cell therapy has demonstrated a profound healing activity in animals with various

forms of arthritis For example, a company that provides treatment services to animal

owners and veterinarians routinely utilizes stem cells in horses with various joint

deformities to accelerate healing.

Apart from healing damaged tissues, stem cells can modulate the immune system.

According to many researchers, stem cell treatments have the potential to alleviate

suffering and change the face of human disease. Stem cells offer significant potential for

generation of tissues that can potentially replace diseased and damaged areas in the body,

and with minimal risk of side effects. The complications of Rheumatoid arthritis include

tissue damage and inflammation. Therefore, adult stem cells may be able to cure

Rheumatoid arthritis by targeting inflamed areas of the body and producing anti-

inflammatory agents.


Tiny electrical implant:

Latest developments in arthritis treatments provide Rheumatoid arthritis patients with a

great new way to end the crippling pain caused by the disease. The breakthrough treatment

is a tiny electrical implant. A rheumatologist at the Academic Medical Centre in Amsterdam,

Professor Paul-Peter Tak, tested 20 rheumatoid arthritis patients to check the effectiveness

of a tiny electrical implant in treating RA. In one of the patients, massive improvements

were seen after the breakthrough medical trials of the electronic device.

The condition of test patient Monique Robroek’s was so bad she couldn’t even walk across

the room. Even the strongest medications for Rheumatoid arthritis couldn’t ease the

excruciating discomfort that she endured each day. However, the new electronic implant

somehow cured her pain. Today, Monique has her normal life back—she’s biking, driving,

and walking the dog. Professor Paul-Peter Tak and other researchers at Academic Medical

Centre in Amsterdam hope to cure millions of people of rheumatoid arthritis patients

around the globe with this new discovery. They believe that within a decade this incredible

discovery could pave the way for RA patients to be effectively cured.

In order to hack a patient’s nervous system, doctors embed the electronic implant into the

neck. The size of a cent piece, the tiny device sends electrical impulses into a major nerve,

which sends brain signals to the body’s major organs. Researchers were able to reduce the

activity of the spleen, a key immune system organ, by firing impulses for just three minutes

a day. Patients’ spleens were producing fewer chemicals that cause the abnormal

inflammation in the joints of people with Rheumatoid arthritis within days of the tests.

Microvessicles:

British scientists are developing a bubble-based treatment that could cut the need for hip

replacement and relieve the pain of arthritis. This treatment involves the use of

microvessicles—the tiny particles naturally made by the body to protect and repair

damaged joints. By doing so, it treats arthritis better as it reduces pain and improves

movement significantly. This may cut the need for complicated, painful, and expensive hip

and knee replacements. According to researchers at Queen Mary University of London,

microvessicles is rich in protein Annexin A1. It protects the cartilage that lines and cushions

the joints from the havoc of arthritis. In an experiment involving mice affected by arthritis, a

microvessicles injection was injected into the affected joints of the mice. The result of this

was reduced cartilage damage. Arthritis was so severe in mice, that it made unusually low

levels of microvessicles. It was further observed that microvessicles may even repair

damage. This is surely a great discovery because even though existing treatments can stop

further cartilage damage, they cannot reverse the damage already done.


'Self-care Strategies for Coping with Arthritis'

You’ll probably have several healthcare professionals involved in your care if you’ve been

diagnosed with arthritis. However, self-management of arthritis is the most important part

of your healthcare. Therefore, you must know the self-care strategies for coping with

arthritis. Following are the some ways you can cope with arthritis:

Organize yourself:

In order to determine what works best for you and take charge of your treatment plan, keep

track of symptoms, pain levels, medications and possible side effects.

Manage pain and fatigue:

Allowing pain and fatigue to become overwhelming is something you need to avoid. In order

to do so, combine your medication regimen with non-medical pain relieving techniques. The

key to living well with arthritis is learning and using natural therapies to manage fatigue.

Eat a healthy balanced diet:

When combined with exercise, a healthy diet can help you achieve and maintain a healthy

weight. By now, we already know the importance of maintaining a healthy weight. Look to

add foods that are rich in antioxidants and have anti-inflammatory properties into your diet.

Rest:

A great way to relieve the symptoms of arthritis and cope with the disease is rest. Rest is

especially beneficial when joints feel painful, swollen, or stiff.

Exercise:

Exercise is probably the last thing you’d want to do when you’re in pain. However, exercise

is beneficial for managing arthritis, and your overall health. Exercise can help you to lose

weight, boost your mood, improve sleep quality, preserve and increase joint range of

motion, and strengthen muscles that support your painful joints.


Three exercise goals:

Following are exercise goals that most structured exercise programs target. Therefore, you

should also have the same exercise goals.

Increase range of motion:

The first exercise goal that you should have is increasing your range of motion. There are

certain exercises that can increase your joints’ flexibility and mobility. Move a joint as far as

it can go , then try to push a little farther in order to increase your range of motion.

Strengthen your muscles:

Strengthening the muscles surrounding the aching joints is an excellent way to provide

them with more support. In order to build muscles, strengthening exercises use resistance.

You can use your own body weight as resistance.

Build endurance:

The final exercise goal that you should have is building endurance. You can build your heart

and lung function through activities such as walking, swimming and bicycling. This in turn

can help you to increase endurance and overall health.


Choosing Shoes: What not to wear

It is important for arthritis patients to choose comfortable shoes because most types of

arthritis affect the feet. You will only make your arthritis pain worse if you try to squeeze

your feet into tight-fitting or uncomfortable shoes. On the other hand, you will be able to

reduce foot pain and walk around more easily if you wear the right shoes.

The shoes you need to avoid include high heels and tight flats. Even though they may look

good, soaring heels aren’t good for your feet. You will squeeze you toes and thrust your foot

into an uncomfortable position if you wear pointy high heels. Therefore, you should avoid

them if you have arthritis. Apart from high heels, you should avoid tight flats. In case they’re

rigid and have a pointy toe, flats can be rough on your feet. You may even develop

hammertoes if you wear flats.

The ideal shoes for arthritis patients include low, comfortable heels, and stability shoes. It is

important that the height of your shoes puts your foot in a comfortable, natural angle.

Ensure that your shoes have rubber soles. Rubber soles prevent you from slipping, and act

as shock absorbers. Finally, make sure that your shoes have a wide toe box. This would

ensure that your feet have plenty of room to move around.

Helpful gadgets:

The Faculty University of Harvard recommends some useful gadgets for arthritis patients.

You can click here to find out the different gadgets meant for different areas of the house.

http://healthguides.healthgrades.com/living-life-to-the-fullest-with-ra/helpful-gadgets-for-arthritis-sufferers


CONCLUSION Arthritis is counted among one of the most common and widely prevalent diseases of the

joints and bones. In fact, more than being a disease, it falls under the category of

‘conditions’ that develop over a period of time. According to statistics provided by the

official ‘Center for Disease Control and Prevention’ of the government of United States,

around 52 million adults, constituting a whopping 27% population, were diagnosed with one

for or another of arthritis between 2010 and 2012.

Although the symptoms and causes of each type of arthritis vary, there are few general

symptoms that can be outlined regardless of the type. The presence of these may act as an

alert to get yourself checked so that the exact category of arthritis can be determined. The

symptoms can be studied under two spectrums; first are the inflammatory factors and

second are the viral factors.

The common types of arthritis include osteoarthritis, rheumatoid arthritis, and psoriatic

arthritis. These are the arthritis types that we discussed in detail in the book. We also

briefly discussed another form of arthritis: gout.


This book detailed the early signs and symptoms, risk factors, diagnosis methods and

treatments methods of osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. It also

provided you with latest developments in arthritis treatment, self-care strategies for coping

with arthritis, and list of helpful gadgets to manage arthritis. If you see signs of arthritis, you

must immediately seek medical attention and you must always listen to your doctor’s

advice.

I hope that you’re now ready to conquer the pain and inconvenience caused by arthritis!

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