Arthritis

Arthritis is the medical term for any disease that produces inflammation, pain, and stiffness in one or more joints. There are more than 100 different types, all of which are classified as rheumatic diseases. Arthritis develops when cartilage, the tough, slippery material covering the ends of bones, is destroyed faster than the body can repair it. Aging, excessive wear and tear, infection, and inflammation contribute to the process. As the cartilage roughens and wears down, the ends of the bones become increasingly exposed and eventually damaged. Osteoarthritis, also called degenerative joint disease, is the most common type. It is caused by natural deterioration from aging, as well as injuries to and overuse of joints in sports or work. Other contributing factors include an inherited predisposition, excessive weight, and skeletal abnormalities, Rheumatoid arthritis is one of the most serious forms. It is systemic and can affect the blood vessels, heart, and other organs in addition to joints. Though the cause is unknown, most researchers consider it an autoimmune disorder, in which the immune system attacks the body. Its course is unpredictable, but most people experience remissions in which the disease is quiescent, interrupted by flare ups that cause progressive, irreversible damage. Some types of arthritis are caused by infection, including such sexually transmitted diseases as gonorrhea and Reiter's syndrome. Auto immune diseases such as lupus often involve an immune system attack on joints. Still other types, such as gout, are due to metabolic defects, which are often hereditary.

Diagnostic Studies and Procedures

A diagnosis of osteoarthritis is based on symptoms, X-ray results, and the extent of pain and loss of mobility found in studies of joint movements. Rheumatoid arthritis is confirmed by an additional finding of the rheumatoid factor, an abnormal antibody,in the blood and joint fluid. Rheumatoid factor shows up in about 80 percent of patients with this condition, although several tests, taken at different times, may be needed to detect it. Infectious forms of arthritis usually can be diagnosed by the presence of bacteria or other organisms in joint fluid.

Medical Treatments

An approach that combines medication, exercise, and rest is basic to treating most forms of arthritis, with physical or rehabilitative medicine and alternative therapies as important adjuncts. For more serious types, such as rheumatoid arthritis and lupus, treatment should be coordinated by a rheumatologist, a specialist in these disorders.

Drug Therapy

Arthritis medications suppress inflammation and alleviate pain, but several drugs and dosages may have to be tried to achieve the best results with the least adverse side effects. The two main categories are nonsteroidal anti inflammatory drugs (known as NSAIDs) and corticosteroids. Of the NSAIDs, aspirin remains the drug of choice for those who can tolerate it in large therapeutic doses of 16 or more tablets a day. Other NSAIDs include: ibuprofen, which is sold in both non prescription and prescription dosages; and stronger prescription drugs, such as indomethacin (Indocin), ketoprofen (Orudis), naproxen (Naprosyn), piroxicam (Feldene), and sulindac (Clinoril).Osteoarthritis that is free of inflammation can be treated with the nonpre scription painkiller acetaminophen. Otherwise, the NSAIDs used for rheumatoid arthritis are prescribed. The corticosteroids are synthetic ver sions of cortisone, one of the adrenal hormones. These are powerful drugs .intended for short term use and are reserved for cases that cannot be controlled adequately by NSAIDs. Cortisone injected directly into the affected joints reduces adverse reactions, but even so, overuse can reduce resistance to infections, weaken bones, and cause other serious side effects. Drugs prescribed for severe rheumatoid arthritis that is not helped by other medications include chloroquine , usually employed for malaria, and cyclophosphamide (Cytoxan) and methotrexate, agents that suppress the immune system. Penicillamine (Cuprimine and Depen), a chelating agent normally used to remove copper and other metals from the body, appears to remove rheumatoid factor also; the possible result is a remission of arthritis. Compounds of gold salts, usually injected, can produce remission of rheumatoid arthritis also, but how or why they work is unknown. Patients receiving all such medications must be closely monitored for adverse effects.