Arthritis

Over 100 different disorders can be classified as arthritis. Some can affect one or more joints, whereas others have their most significant effects on other parts of the body.

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Listed here are some of the most common arthritic conditions that physical therapists evaluate and diagnose movement dysfunction when using various interventions to treat their patients:(click each title for a brief description.)

This condition primarily affects the spine, but it may also cause arthritis in the hips, shoulders, and knees. The tendons and ligaments around the bones and joints in the spine become inflamed and the symptoms include pain and stiffness, especially in the lower back. Ankylosing spondylitis tends to develop during late adolescence or early adulthood.

Bursitis involves inflammation of the bursae (small, fluid-filled sacs that help reduce friction between bones and other moving structures in joints). The inflammation may result from arthritis in the joint, or from injury or infection of the bursae. Symptoms include pain, tenderness and limited movement of the involved joint.

This chronic syndrome is associated with pain and stiffness throughout the tissues that support and move the bones and joints. Pain and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders and hips. Other common symptoms include widespread pain, fatigue and sleep disturbances.

Gout results from deposits of needle-like crystals of uric acid in the connective tissue near joints and/or in the joint space. Symptoms include inflammation, swelling and pain in the affected joint, often the big toe. Although rest of the affected joint is often prescribed physical therapy management can assist in a quicker recovery time.

Osteoarthritis (OA) is the most common form of arthritis in the United States, affecting an estimated 21 million adults and is most common in women as women become especially susceptible to OA after menopause

OA begins with the breakdown of joint cartilage, resulting in pain and stiffness. It commonly affects the joints of the fingers, knees, hips and spine. Other joints affected less frequently include the wrists, elbows, shoulders and ankles. When OA is found in a less-frequently affected joint, there is usually a history of injury or unusual stress to that joint.

Work-related repetitive injury and physical trauma may contribute to the development of OA. For example, if you have a strenuous job that requires repetitive bending, kneeling, or squatting, you may be at high risk for OA of the knee.

What are the symptoms of osteoarthritis?

  • Steady or intermittent pain in a joint.
  • Stiffness after periods of inactivity, such as sleeping or sitting.
  • Swelling or tenderness in one or more joints.
  • Crunching feeling or sound of bone rubbing on bone (called crepitus) when the joint is used.

OA usually comes on slowly and in the early stages of the disease, joints may ache after physical work or exercise. If you are experiencing symptoms such as joint pain and stiffness, see a physician to find out if you have OA. Physical therapy care will increase mobility and strength in the joints and restore your quality of life.

Where do symptoms of osteoarthritis typically appear?

Although OA can occur in any joint, most often it occurs in the following areas:

  • Fingers. OA of the fingers is often hereditary, meaning it runs in families. Fingers may ache or be stiff and numb. The base of the thumb joint is commonly affected. Fingers can become enlarged and gnarled. Small, bony knobs (called Heberden’s nodes) may also appear on the end joints of the fingers. Similar knobs (called Bouchard’s nodes) can appear on the middle joints of the fingers. More women than men have OA of their fingers as women become especially susceptible to OA after menopause.
  • Knees. Because knees are primary weight-bearing joints, they are very commonly affected by OA. They may be stiff, swollen, and painful, making it hard to walk, climb and get in and out of chairs and bathtubs.
  • Hip. OA in the hip can cause pain, stiffness and severe disability. In addition to your hip, you may feel the pain in your groin, inner thigh, or knees. This can lead to difficulty moving, bending and walking.
  • Spine. OA of the spine can cause stiffness and pain in the neck or in the lower back, as well as weakness or numbness in your arms or legs.

What causes osteoarthritis?

Although the exact cause of OA is not known, some scientists believe that joint damage begins in response to physical stress, such as an injury or repetitive movement. Also known as “wear and tear” this stress can erode the cartilage that normally encases the ends of the bones in a joint. Cartilage serves to cushion the bones and to help the joint move smoothly and easily.

As cartilage breaks down, the ends of the bones thicken and the joint may lose its normal shape. With further cartilage breakdown, the ends of the bones may begin to rub together causing pain. In addition, damaged joint tissue can cause the release of certain substances called prostaglandins, which can also contribute to the pain and swelling characteristic of the disease.

How is osteoarthritis diagnosed? What can be done to ease the pain?

If you are experiencing joint pain, stiffness and/or swelling for more than 2 weeks, it is important to find out if you have this type of arthritis as early diagnosis and physical therapy care can help minimize pain and disability.

A very painful condition that can affect many different joints and, in some people, other parts of the body as well, including the blood, the lungs and the heart besides the quality of life. Inflammation of the joint lining, called the synovium, can cause pain, stiffness, swelling, warmth and redness. The affected joint may also lose its shape, resulting in loss of normal movement. RA can last a long time and can be a disease of flares (active symptoms) and remissions (few to no symptoms).

What are the symptoms of rheumatoid arthritis?

Symptoms of RA differ from person to person but generally include:

  • Joint tenderness, warmth and swelling. Both sides of the body are usually affected at the same time. This is also called a “symmetrical pattern” of inflammation. For example, if one knee is affected, the other one is also. This is in contrast to osteoarthritis, where it is possible for only one knee to be affected.
  • Pain and stiffness lasting for more than 1 hour in the morning or after a long rest.
  • Joint inflammation in the wrist and finger joints closest to the hand (although joints of the neck, shoulders, elbows, hips, knees, ankles and feet can be affected as well).
  • Fatigue, an occasional fever and a general sense of not feeling well (called malaise).
  • Symptoms that last for an extended period of time.
  • Symptoms in other parts of the body, not just in the joints.

RA causes inflammation of the joint lining, which can lead to pain, swelling, stiffness and loss of function. RA can also cause inflammation of tear glands, salivary glands, the lining of your heart and lungs, and the lungs themselves.

As RA progresses, about 25% of people with the disease develop small lumps of tissue under the skin, called rheumatoid nodules. These rheumatoid nodules usually aren’t painful. The nodules may form under the skin of the elbow, hands, the back of the scalp, over the knee, or on the feet and heels. They can be as small as a pea or large as a walnut.

Although RA is often a chronic disease, the severity and duration of the symptoms may unpredictably come and go. For people with a severe case of RA, the disease is generally active, lasts for many years and leads to serious joint damage and disability. Periods of increased disease activity, or worsening of symptoms, are called flare-ups or flares. Periods of remission are when the symptoms fade or disappear.

If you are experiencing any of the symptoms described above, it is important to find out from a doctor if you have RA as early diagnosis and physical therapy care can reduce the pain, joint damage, and disability that occur in some RA patients.

What causes rheumatoid arthritis?

RA is an autoimmune disease. This means the body’s natural immune system does not operate as it should; it attacks healthy joint tissue, initiating a process of inflammation and joint damage. The exact cause of RA is not yet known. Although scientists do know that many factors may contribute to the development of RA – genetic, hereditary, and environmental factors may contribute to the cause of the disease. Researchers have found that RA can be triggered by an infection, possibly a virus or bacterium in people who have an inherited tendency for the disease. However, RA is not contagious; you cannot “catch it” from anyone.

How is rheumatoid arthritis diagnosed and what you can do?

If you have persistent discomfort and swelling in multiple joints or on both sides of your body, it is important to see your physician for diagnosis. Early intervention of physical therapy care will help you keep joints mobile, your body flexible and will return the quality of your life.

SLE is an autoimmune disease in which the immune system harms the body’s cells and tissues. This can result in inflammation and damage to the joints, skin, kidneys, heart, lungs, blood vessels or brain.

This condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or arthritis-producing conditions. Symptoms include pain, tenderness and restricted movement of nearby joints.

During my daily work routine, I see many patients not only in the age group of 40-60 yrs but also in their 20s, 30s, and 40s. They are an active population with many physical demands. Arthritis, or more appropriately called osteoarthritis (not to be confused with osteoporosis), might be thought of as an older person’s disease. However, I see it nearly everyday on the x-rays of these younger generations.

Osteoarthritis is a degeneration of the cartilage in the joints. It is one of the most common causes of disability in the United States. It usually affects weight-bearing joints such as the hip, knee, hands, and spine. Other areas that can be affected are the ankle, wrist and shoulder. Occasionally, inflammation and swelling are present. Risk factors for developing osteoarthritis are increased age, obesity, and high impact or prolonged weight-bearing activities which can cause cartilage breakdown. Other risk factors include low levels of vitamin D, vitamin C, estrogen deficiency, trauma, other forms of arthritis or joint disease, and malformed joints. Although the exact mechanism of breakdown is unknown, once the arthritic process begins to occur, there is steady progression of disease. The most common symptoms are joint stiffness and activity-related pain. Stiffness is usually worse in the morning or when the joint has been inactive for a period of time. With advanced disease, the joint may grind or buckle. Pain may also alter mechanics, for example, a limp may lead to pain in other areas such as the back. X-rays may show a narrowing of the joint space, bone spurs called osteophytes, or abnormal calcium deposition such as sclerosis or cyst formation. Other studies or lab tests are usually not needed.

The main goals in the treatment of osteoarthritis are to minimize progression and control pain symptoms. However, there is no intervention that has been shown to halt or reverse osteoarthritis. Oral pain medications such as tylenol or non-steroidal anti-inflammatories, ie. ibuprofen, naprosyn, provide temporary relief and the latter can help reduce swelling. Herbal over the counter remedies have had mixed resulats. Short-term studies on glucosamine and chondroitin showed promise in regards to pain-relief, however, there has been no data to support a decrease in disease progression. With exceptionally painful or advanced cases, braces or splints may be needed, cortisone shots or shots of synthetic fluid may provide some relief and treatment by a physical therapist is recommended before any joint replacement surgery is considered.

A functional approach to living with osteoarthritis uses education about the disease, stretching, adaptive exercise and the use of energy modalities such as heat and cold. Stretching can ease stiffness and prevent or reduce joint contracture. Prior to exercise, the use of a heating pad or heat packs can further loosen tight joint structures and reduce stiffness. Exercise should avoid jumping, sudden or jarring motions, exertion when a joint is at its end range, or exertion to the point of fatigue. There are many activities that safely promote general conditioning including bellydancing, yoga, tai chi, walking, swimming, riding a bike, or using an elliptical trainer. Afterwards, the use of ice packs can reduce joint swelling and the needs for oral pain medications.

Arthritis is not just an older person’s disease and once a joint has been significantly damaged, it would be extremely hard to correct there is currently, no medical cure to halt progression without physical therapy treatment or possibly surgery. Exercise safely and you will exercise smartly.