Arthritis-The Origin Arthritis, a word frequently heard in the current times.
Although, the condition marked its appearance in the historical literature
since mid fifteenth century or even before. It is not until the late
nineteenth century when it has become a rampant disease.
The word arthritis originates from the Greek word arthron meaning
joint and has transitioned through Latin word 'arthritides' to form the
word 'arthritic' in the mid sixteenth century English. Though the roots
of this disease dates back to such an early era, reports of arthritis were
first described by Bannatyne in 1896.
The description of arthritis can be aptly given by three prominent
characteristics associated with it, namely; pain, inflammation and joint
stiffness. Primarily arthritis affects the joints and the tissue surrounding
it, however, depending on the type of arthritis, degree of involvement
and severity greatly varies. Also the onset of disease may be abrupt or
might develop gradually over a period of time. Arthralgia meaning pain
in the joint is a symptom almost always seen to precede and/or accompany
arthritis. inflammation of the areas in and around the joint, redness and
warmth are also some of the common sign that are suggestive of arthritis.
What causes Rheumatoid arthritis (RA)?
Though RA is the most common form of arthritis, the exact causative factor is yet to be completely understood by
the medical community. In RA, the body's immune system mistakenly attacks it's own tissues or cells, instead of
protecting it from foreign invaders. An abnormal immune response produces variety of molecules (antibodies), which
results in severe inflammation and damage to the cartilage and tissues around the joint. Damage to joint is a slow
and gradual process that varies from one person to another. As the disease progresses, it can lead to joint
deformities and development of serious systemic complications.
Triggers like changes in sex hormone levels (especially in females), genetic susceptibility, environmental
factors such as exposure to dust, fibers, etc. are believed to be associated with development of RA. Infections
by certain bacteria and viruses have also shown to be a contributing factor for development of the disease.
Exposure to silica dust, obesity, dietary factors are also considered as potential risk factors.
Who is at risk for arthritis?
As mentioned earlier the exact cause for RA is still not clear. However individuals with the following factors
are deemed to be at an increased risk for RA.
Family history: Some individuals may inherit genes which make them more susceptible for developing RA in
future. Hence, history of RA in the family is one of the major risk factors.
Age:
It is also considered to be a potential risk factor for RA. Although RA can occur at any age, the onset is
mostly seen in the age group of 40 - 60 years.
Gender: Gender-wise classification on susceptibility to RA
has shown that the condition is more common in females than in males.
Smoking: Heavy Smoking is a very strong and significant risk factor for RA
Hormonal changes:
Changes in the levels of female hormones during pregnancy, breastfeeding, etc. can play a role in the
development of RA. Females who have never been pregnant have slightly increased risk for RA. It is also
found that women who breastfeed are less likely to develop RA.
Arthritis Types :
Overlapping horizons of different arthritis forms has blurred the discrete
margins segregating one type from the other. There are over hundreds of
types of this condition depending on the specificity of clinical condition,
organ system involvement and degree of severity Yet keeping in view the
probabilities and frequencies of the types some are tagged to be the most
common ones by the global bodies. Osteoarthritis, Rheumatoid Factor Rf,
Juvenile arthritis, Septic arthritis, Psoriatic arthritis and Gouty arthritis are
found to be most predominant types of the disease. Many other conditions
like Lupus, Fibromyalgia, Ankylosing spondylitis, Hemarthrosis, and so on
can as well be grouped under arthritis.
In the United States alone, within the years 2013 to 2015, around 22.7%
of its population i.e. 5.44 crore individuals are estimated to suffer from
different forms of arthritis. The same report depicts the higher prevalence
of the condition in women (23.5%) than men (18.1%). Indian scenario is
quite similar with a prevalence of around 13% to 15% affecting over 180
million people.
The below tables illustrate the common types of arthritis along with their
prevalence, risk factors, symptoms and diagnosis
1. Osteoarthritis: Commonest form of arthritis that is degenerative in nature,
causing structural and functional failure of synovial joints. It primarily
affects knee and hip joints, with elderly people being more prone to
the condition. The severity and incidence of Osteoarthritis is reported
to be more in women than men.
-Prevalence: Reported to be 5.1 to 10.5% for men and 11.9 to 17.6% for women.
-Signs and Symptoms: Pain, swelling, stiffness, reduces joint function and motion.
-Risk factors: Age, Obesity, diet, occupation, genetic predisposition.
-Diagnosis: Clinical examination, radiography and imaging techniques (CT scan, MRI).
2. Rheumatoid arthritis: An autoimmune disorder that mostly affects the shoulder,
elbow, wrist,finger, hip, knee, ankle and toe joints. It is the second most common form of
arthritis after osteoarthritis. Elderly people and females are seen to be more affected
by rheumatoid arthritis.
-Prevalence: Affects 1% of the population worldwide.
-Signs and Symptoms: Pain, warmth, swelling, stiffness and also rheumatoid nodules
(normally seen).
-Risk factors: Environmental or genetic factors and associated comorbidities.
-Diagnosis: Serological tests.synovial fluid analysis, radiography, ultrasonography
and imaging techniques (CT scan, MRI).
3. Septic arthritis: The condition generally results from microbial colonization in
the affected joints impairing its functions. People of all age groups can develop
this form of arthritis and the source of infection might be through wounds, joint
surgery, trauma or intravascular devices.
-Prevalence: Around 4-10 out of 1,00,000 cases per year.
-Signs and Symptoms: Redness, warmth, swelling, limited motion and fever.
-Risk factors: Prosthetic joints, surgeries, blood sugar, immuno suppressed conditions.
-Diagnosis: health, synovial fluid analysis, PCR, radiography and imaging
techniques (CT scan, MRI)
4. Juvenile arthritis: It is idiopathic in nature and usually affects children under
the age of 16 years. Further based on the presentation in the initial six months
of the disease, it can be categorized into Systemic arthritis, Oligoarthritis
(persistent or extended), Polyarthritis (RFnegative or RF- positive), Psoriatic arthritis,
Enthesitis-related arthritis and Undifferentiated arthritis.
Prevalence: Seen in 0.07 to 4.01 per 1000 children.
-signs and symptoms: fever, arthralgia, rash on trunk and proximal extremities,
lymphadenopathy, hepatosplenomegaly and serotitis.
-Risk factors: Idiopathic, lack of breastfeeding, antenatal exposure to tobacco,
early life infections with Juvenile arthritis.
-Diagnosis: Clinical examination, serological tests, radiography and
imaging techniques (CT scan, MRI).
5. Gouty arthritis: A painful condition affecting the joints, owing to raised serum kidneys
levels along with the deposition of monosodium urate crystals in soft tissues and joints.
Men are found to be more affected than women and also, women who have attained
menopause are more prone to develop gouty arthritis. It can be further classified
based on its severity into Acute gout, Chronic tophaceous gout and Intercritical gout.
-Prevalence: A general prevalence of 1% to 4% is seen. Prevalence of gout varies
from country to country as food habits have a significant role in its occurrence.
-Signs and Symptoms: Pain, redness, tenderness and inflammation of the joint
with or without accompanying fever and chills.
-Risk factors: Family history of gout, alcohol consumption, Obesity, high blood pressure and
high purine diet like red meat, fish and lentils.
-Diagnosis: Serological tests and clinical examination .
Diagnosis of RA
No single test can confirm whether you have RA. Diagnosis is made on the basis of physical examination,
family history and patient's signs and symptoms. laboratory testing and X-ray can be recommended in
combination for accurate diagnosis. rheumatoid factor (RF) and anti-cyclic citrullinated peptide (ACCP test)
antibody are the blood tests that are often recommended for RA diagnosis along with other tests.
How to Manage Arthritis?
First step towards managing arthritis, a disease afflicting humans more and
more over the years, is lifestyle chance. Advances in medical sciences has
brought in several ways to manage the symptoms and decrease the intensity
of pain. However, the first step towards tackling arthritis is identifying it in
the early stages by screening for it. Thereafter educating oneself about the
condition and options to effectively live a life by self-management can be
of great benefit. Dietary control by avoiding certain food and increased
intake of recommended eatables, routine exercise and keeping a check
on excess weight gain improves the quality of life of the affected individuals.
Musculoskeletal disorders have now become the second most global health
issue if measured in terms of years lived with disability. Also by 2040, an
estimated 34.6 million adults (43.2% of adults with arthritis or 11.4% of
all US adults) will report arthritis attributable activity limitations. Although
treatment with various drugs, physio therapies and surgeries are used to
combat arthritis, delaying or avoiding its onset through lifestyle changes
is the best possible approach.
