Let us be optimistic and face this bane as a manageable condition by understanding the significance
of timely diagnosis, treatment, exercise and precautions.
JOURNEY OF JOINT PAIN
Arthritis is the clinical manifestation of inflammation in the musculoskeletal system, specifically involving
one or more joints. Its etymology comes from the greek word arthon meaning joint' and a latin word
'inflammare' which means inflammation. Inflammation is generally accompanied by symptoms such as pain,
swelling, redness, stiffness and warmth. Normally inflammatory responses are generated as a part of
immune defense against infections and foreign substances. But, in certain autoimmune conditions,
inflammatory responses are triggered without any such external factors. Arthritis can occur as a result
of multiple factors like genetics, autoimmunity, lifestyle changes, hormonal imbalance, environmental
factors or due to some infectious agents. It is classified as a long lasting or life time chronic disease.
Apart from joints and connective tissues, some types of arthritis also affect other tissues and organs. Based
on its origin, causes and symptoms, arthritis is clinically a broad family with Rheumatic disorders, and
Osteoarthritis is one of the major types to be detected.
What is a joint?
It serves as movable connections between two bones. Joint comprises of many parts that work together
for movement of bones and actions such as bending, turning, twisting, stretching, etc. Also, joints allows
these movements only in certain directions.
Do you know how your joints work?
Joints consist of different parts which perform action by coordinating with each other. They are covered by
a fibrous and tough sheath called as capsule, responsible for restricted movements of bones. The inner
portion of the capsule is called as synovium. Synovium cavity is filled by synovial fluid which is a thick, slimy
fluid secreted by the capsule and aids in lubrication for bone movements and nourishment of the synovium
cavity. Bone endings are covered by a smooth and slippery, cushioned surface called cartilage. Cartilage helps
in easy bone movements and reduces friction among two bones. It is a shock absorber and majorly aids in
transmission of the pressure on the bones outwards to prevent bone degeneration. Bones are held together
by bundles of connective tissue called ligaments that aid in elastic movement of bones.
In India, approximately 15% people of the total population are suffering from various types of Arthritis,
which is even more than the number of patients suffering from diseases like Hypertension, Diabetes
Mellitus, Coronary Artery Disease and HIV.
Prevalence of Arthritis
Musculoskeletal conditions have pervasive impact on health; due to sedentary lifestyle and lack of hearty
habits, arthritis is becoming the most common cause of physical pain and suffering in society. Osteoarthritis
(OA) is the most common form of arthritis seen to develop in the aged population, with females being more
susceptible than men. According to an article published in the International Journal of Rheumatic Diseases,
the percentage of people above 65 years will be more than double in the next two decades and so will be the
prevalence of Osteoarthritis. Osteoarthritis affects about 4-6% of the adult population and is mentioned as one of the top five chronic
diseases in the country. rheumatoid arthritis (RA) on the other side, is the second most common type of
arthritis in India, Rheumatoid Arthritis affects about 0.92% of adult Indian population. Each year, about 20-40 new cases per one
lakh population are recorded, and occurrence is higher in females than males. Third commonly occurring arthritic
condition in India is Gout. Men are found to develop gout more frequently than females. Around 0.5% to 1% of
Indian male population tend to develop this condition. Psoriatic arthritis is the fourth common condition and
developes mostly in psoriatic patients. Psoriasis is a skin condition, found to affect 1% of the overall population.
Nearly 5-25% patients with psoriasis are prone to develop Psoriatic Arthritis.
Types of Arthritis Osteoarthritis (OA)
Osteoarthritis is also known as degenerative joint disease and is the most common type of arthritis becoming a
major health concern. Initially, it was believed to be a normal clinical condition associated with aging and hence
the name degenerative joint disease was assigned. It was not until 1980s, this disease was considered a natural
occurrence of "wear-and-tear" on joints as a result of aging. Later, studies confirmed its association with multiple
causative factors. It is an inflammatory condition marked by degeneration of cartilage and can occur in different
joints with knees being the most commonly affected part. Osteoarthritis of the wrist can be caused due to fractures of distal
radius or scaphoid and avascular necrosis of carpus or disruption of ligaments. It can also be the result of traumatic
changes in wrist caused by injuries and physical damages.' Occurrence in neck region between joints of the upper
spine can also be seen and the pain can spread to arms and skull base. Other sites include toe, fingers, hips,
lumbar and spine.
Signs and symptoms
1. Stiff joints especially after getting from bed and continuous sitting at one place for longer hours.
2. Swelling, tenderness and pain in one or more joints.
3. Crunching and creaking noise during movements.
4. Weakness in the muscles.
Based on the age, signs and symptoms, Osteoarthritis can be classified as
1. Primary Osteoarthritis: It usually develops in adult age groups. With aging, the protein content of cartilage
decreases and the water content rises. Age related degeneration and damage to cartilage leads to pain and
swelling. In severe cases, bone shows abnormal outgrowths in the form of spur. Rare cases of heredity Osteoarthritis occur
due to defective collagen; an important component in synthesis of cartilage
2. Secondary Osteoarthritis: It is caused by multiple clinical conditions including obesity, injuries, fractures and inflammation
resulting due to various other disorders and hormonal imbalance. obesity is the major key player for development
of secondary Osteoarthritis. When joints bear a heavy body weight, they tend to wear faster. People with congenital abnormalities
in joints are prone to early degeneration of cartilage and hence, develop osteoarthritis. Deformity in hip joints are the
most common type of congenital abnormality.
Arthritis Causes and risk factors
- Obesity and overweight
- Aging
- Injury to joints
- Excessive stress on joint area due to heavy jobs or sports activity.
- Genetic defects and improper formation of cartilage.
- Cigarette Smoking
- Older women are more likely to develop Osteoarthritis than men.
Rheumatoid Arthritis (RA)
It is an autoimmune condition associated with long term pain, inflammation and swelling of the joint.
Rheumatoid Arthritis is a progressive complication of the joints that leads to stiffness and ache. Further, it is not a single
disease but is an array of various clinical conditions. Rheumatoid Arthritis is a systemic disease which affects internal organs
of the body. It usually affects the smaller joints such as joints of hands and fingers, feet and toes, elbows,
wrist, ankles and knees.
Signs and symptoms
Depending upon the stage of severity, different parts may be affected in Rheumatoid Arthritis. Varied symptoms include:
1. Movement of affected joints become difficult.
2. Loss of appetite leading to weight loss.
3.Malaise (general feeling of illness or discomfort).
4. Rheumatoid nodules are the bumps developed underneath the skin and can be predominantly observed near the elbows.
5. Rheumatoid Arthritis can cause inflammation in the lining around the heart.
6. In less than 5% cases, inflammation of eyes can occur which is characterised by redness, swelling and pain.
Causes of Rheumatoid Arthritis and progression of the disease
Rheumatoid Arthritis is one of the most popular autoimmune condition, although, the exact causative factors is still debatable
in the medical community. It develops due to complex interactions between environment and genes. Genes
that play important role in functioning of immune system are believed to be associated with development of
Rheumatoid Arthritis. One among them is the HLA-DRB 1 gene which belongs to the Human Leukocyte Antigen (HLA) family of
super genes. The proteins formed are majorly involved in aiding the immune system to recognise between self
and non-self. Mutant alleles of HLA-DRB 1 code for citrullinated peptides that are not recognised as 'self' and
hence the immune system generates antibodies against them, called as anti-citrullinated protein antibodies(ACCP).
This results in failure of immune tolerance, inflammation of the synovium and destruction of matrix. Severe
inflammation causes damage to the cartilage and erosion. It can affect the bone underneath, making it thinner.
The joint cartilage, capsule, cavity and nearby ligaments along with tissues around the joint can also get damaged.
Damage in the joint is a slow and gradual process and it varies from one person to another. As the damage
progresses over time, it can lead to deformities.
It may begin with a swollen knuckle, a spiking fever, or an unexplained rash. But no matter what symptoms
appear, hearing the word "arthritis" in a diagnosis for the child can be unexpected and confusing.
Juvenile Idiopathic Arthritis (JIA)
Juvenile arthritis is an arthritic condition which develops in children under 16 years of age. It is a chronic
rheumatological condition of childhood. The term arthritis has literal meaning as inflammation of joints but
in juvenile arthritic condition, the affected areas include eyes, skin as well as the gastrointestinal track.
Up till late 1990s, the term Juvenile Arthritis was not used. The condition was instead called as Juvenile
Rheumatoid Arthritis (JRA) or Juvenile Chronic Arthritis (JCA). Later, it was termed as Juvenile Idiopathic
Arthritis (JIA) to better distinguish it from Rheumatoid Arthritis of adults.
Children with JIA can experience non inflammatory diseases such as chronic pain associated with injury and
unknown causes that can also be hereditary in nature. It is an umbrella term under which many other forms
of juvenile arthritis can be classified. Based on clinical manifestations, therapy and causative factors, JIA is
classified into following major categories:
Polyarticular JIA:
Condition marked by arthritis of five or more joints during the first six months of disease.
Children with this condition are further classified as RF factor positive and RF factor negative.
Enthesitis Related Arthritis(ERA):
It is commonly found in male children of more than 8 years of age.
Affected areas include sacroiliac joints, lower back, joints of legs, feet and ankle.
Children with positive (HLA-B27) genetic marker tend to develop psoriasis, Inflammatory Bowel Diseases,
inflammation of pelvic joints, ankylosing spondylitis and arthritis.
Systemic onset JIA SOJIA) :
It was first recognised by a British doctor, George F. Still in ill children during
late 1800s and hence called as Still's disease.
Exact cause of onset is unknown, but believed to be due to faulty immune response, stress or microbial infections.
Recent research suggest that it is not an autoimmune disease but it is an auto-inflammatory condition.
Oligoarticular JIA:
It is defined as an arthritic condition that affects four or fewer joints during first six months of disease
which is seen in 50% to 60% of children and teenagers with JIA.
the two types of oligoarticular arthritis are oligoarticular-persistent arthritis and oligoarticular-extended arthritis.
It is more prevalent in the age group between 2-4 yeaes of age and affect girls more than the boys.
Usually, it is associated with high risk of eye disease called uveitis and is found in un to 20% of
children and teenagers.
Signs and symptoms of Juvenile Idiopathic Arthritis
- Spiking fever, pale pink colored rashes on chest and thighs.
- Inflammation in the lining of lungs and heart, enlarged spleen and liver,and swelling of lymph nodes.
- Pain in muscles after strenuous activity and early morning pain,
- Stiffness in joint and difficulty to perform day to day functions.
- Weight loss, finicky about eating and rashes on the skin.
Infectious / Septic Arthritis
When arthritis is caused due to infection by microorganisms, it is termed as infectious arthritis or septic
arthritis. Bacteria, viruses, or fungi can be the causative factor. They can enter the system, either through
the bloodstream or an infection that can occur during surgical procedures and injuries. Arthritis caused by
gonococcal infections is termed as Gonococcal arthritis. Other causative organisms include Haemophilus
influenza, Staphylococcus, Mycobacteria and Streptococcus. Viruses which have been documented to cause
arthritis include Hepatitis A, B, and C, Parvovirus B19, Herpes viruses, HIV, HTLV-1, Adenovirus, Coxsackie
viruses, Mumps etc. Fungi that cause arthritis include Coccidiomyces, Histoplasma and Blastomyces.
Types of infectious arthritis include
- Acute septic arthritis : Acute septic arthritis is mostly caused due to bacteria such as Staphylococcus or
Streptococcus.
- Chronic septic arthritis : It occurs less commonly than that of acute arthritis. It is generally caused by
Mycobacterium Tuberculosis and Candida albicans.
Signs and symptoms
- Tenderness and pain in the joint.
- Inability to move joints.
- Fever and chills
- Redness and warmth in the joint due to increase in blood circulation to the infected area.
- Fatigue and generalised weak ness
Causes and risk factors for infectious /septic arthritis
1. Recent arthroscopy of joints or other surgery.
2. Intake of immunosuppressants.
3. Microbial infection in the blood.
4. Artificial joint implants.
5. Chronic illness such as Diabetes, anemia, sickle cell diseases, rheumatoid arthritis, etc.
6. Use of intravenous drugs and injections.
7. People with immune deficiency disorders.
8. History of sexually transmitted disease.
Psoriatic Arthritis
Psoriatic arthritis is an inflammatory condition of joints. Its prevalence is more common in patients with
psoriasis. Psoriasis is a chronic autoimmune skin disease marked by skin lesions, scaly patches, rashes,
papules and itching on the skin. Around 10-30% of the patients suffering from psoriasis tend to develop
psoriatic arthritis. It can occur at any age group but 30 to 50 is the more prone group and both the genders
are equally Psoriatic Arthritis affected. Patients of psoriatic arthritis can develop inflammation around
cartilage and tendons. Inflammation of tendons is termed as tendinitis.
Based on the extent of severity, inflammation and affected body parts they are classified into 5 types
1. Symmetric psoriatic arthritis:
This arthritis affects body parts in a symmetrical pattern i.e. it affects similar sites on both the sides of the body.
2. Asymmetric psoriatic arthritis:
When arthritis occurs in any of the joints in the body, it is called as asymmetric arthritis. Affected joints
may be tender, warm, enlarged and red. While generally mild, some people with asymmetric arthritis may
develop disabling symptoms.
3. Distal interphalangeal predominant (DIP): It majorly affects the small joints in the toes and fingers
closest to the nail. This clinical condition is sometimes confused with bone spurs and osteoarthritis.
4. Spondylitis : It is an inflammation of the spinal column found in about 5% of psoriatic arthritis patients.
Most of the individuals suffer from stiffness of the neck, pelvic area, lower back or spinal vertebrae.
This makes motion difficult and painful.
5. Arthritis mutilans : This category includes < 5% of the affected type of total psoriatic conditions. Arthritis
mutilans mostly affects joints of hands, feet, fingers and toes.
Signs and symptoms of Psoriatic Arthritis
- Noticeable swelling on toes and fingers.
- Stiffness in movement.
- Pain in lower back.
- Pitted and separated nails from nail bed.
Causes and risk factors
40% of the people with family history of psoriasis or psoriatic arthritis have chances of developing this condition.
It can arise from infections that activates immune system.
In cases of identical twins, if one develops Psoriatic Arthritis, there is a 7% risk factor for development of the
condition in the other twin.
Psoriasis and Psoriatic Arthritis: What's the connection?
- Both are autoimmune conditions.
- Around 40% of people suffering from psoriasis can develop psoriatic arthritis.
- Not all the patients with psoriasis will develop psoriatic arthritis and vice versa.
- There is no connection between site/location of psoriatic patches and affected joints in psoriatic arthritis.
e.g. both ankle and toe region is affected by psoriasis but ankle joint can be unaffected by arthritis.
- Psoriasis does not cause severe damage but psoriatic arthritis causes deformities and damage if not treated on time.
Gouty Arthritis
Gouty Arthritis A very painful and disabling form of arthritis, known since ancient times. Also termed as
'disease of kings' since it was mis conceptualised to be associated with indulgence in food and wine that
is affordable only to the rich people. It is a Metabolic disease caused due to deposition of monosodium
urate (MSU), crystals and hyperuricemia in soft tissues and joints. Gout is most common among men than
women, with women being more commonly affected after menopause. Clinically, men tends to have higher
uric acid content than females. In normal process of filtration, uric acid is removed from the body through
urine and some amount via stool. People with gout are marked by increased uric acid levels and is mostly
due to kidney diseases or disorder of purine and pyrimidine metabolisms. Accumulation of the uric acid forms
tiny grit like crystals which get collected in the joints or tissues. When these crystals start to accumulate in
the joints it causes recurring attacks of joint inflammation. Uric acid is a breakdown product of purines, that
are part of many foods we eat. Chronic gout can also lead to deposition of hard lumps of uric acid in and around
the joints. It may cause joint destruction and may as well indicate decreased kidney function.
Based on severity it is further classified in following types
1. Acute gout: It is a self limited episodic inflammatory condition. Intensity of pain is so high that, patients
can not touch and perform routine tasks with affected limb. Factors that can trigger acute gout includes rise
in uric acid, concentrations, infections, acidosis, acute illness, alcoholism, etc.
- Chronic tophaceous gout: Patients with untreated hyperuricemia, develop this type of gout. Solid crystals
of uric acid are deposited in a variety of regions including tendons, joints and helix of ear. Aggregates of uric
acid crystals deposited in various regions are called as tophi. Hence, the term tophaceous gout was given.
If untreated, this type of gout can result in permanent joint damage and impairment.
Intercritical gout: This is an asymptomatic condition that occurs before acute onset of gout. There is a silent
increase in deposition of uric acid crystals.
Causes and risk factors
Buildup of uric acid crystals lead to gout, but not all people with raised blood levels of uric acid tend to develop
gout. Uric acid is synthesised by breakdown of purines. It is a waste product and is eliminated out of the body
through kidneys. When kidneys fail to filter uric acid, its level in blood increases, leading to deposition in tissues.
Risk factors for gout includes family history of gout, alcohol, excess intake of purine rich diet such as red meat
and sea food, obesity, Hypertension and lead toxicity.
Signs and symptoms
- Severe pain with red, tender and inflamed skin.
- Frequent attacks of acute inflammatory arthritis.
- Fever with chills or without chills.
- Intense pain at the first metatarsophalangeal joint (podagra) at the base of the big toe.
- Affects other joints like knees, wrists, fingers, ankles, elbows and heels.
- Deposition of urate crystals forming nodules called tophi on or under the skin surface (ears, knees, elbows, hands).
Hemorrhagic Arthritis/ Hemarthrosis
It is an arthritic condition characterised by bleeding inside the joints. Bleeding is caused mainly due to injury
to the areas affected by arthritis i.e joints. Injury leads to breakage of cartilage, and synovium membrane leading
to bleeding. Individuals with inherited bleeding disorders like hemophilia A, hemophilia B and sickle cell disorders
are more prone to develop the condition of hemorrhagic arthritis.
Hemarthrosis is also called articular bleeding. Inflammation of the joint in hemorrhagic arthritis usually occurs
due to autoimmune disease, traumatic conditions in bone and viral or bacterial infections.
- Chronic hemarthrosis: It is a recurrent bleeding condition that can arise as a complication of an anticoagulant
therapy or injury to a normal joint. Patients with hemophilia suffer from joint bleeding since childhood even during
mild injuries. Commonly affected joints include ankles, elbows and knees.
- Acute hemarthrosis: In acute hemarthrosis, the hemorrhage is not associated to previous inflammatory condition
but rather to injury of healthy joints.
Signs and symptoms
- Inflammation and swelling in joints due to repeated episodes of bleeding.
- Untreated condition can lead to destruction of joints and chronic pain.
- Tingling sensation and warmth in the joint during initial stages of hemarthrosis.
Causes and risk factors
- Injury/trauma to joints.
- Hemophilia in arthritic patient.
- Disorders related to blood clotting.
Ankylosing Spondylitis (AS)
Ankylosing spondylitis (AS) is a form of arthritis that specifically affects spine. Joints of spine cause severe pain
and discomfort. This clinical condition is marked by fusion of vertebrae, rigidity in spine and stooped posture. It
can be systemic and affect other tissues and joints in the body. Also seen to be more common in men than in women.
Signs and symptoms
- Stiffness and pain in lower back and buttocks.
- Ache in hip, ankle, elbow, knee, heel or shoulder
- Bowel inflammation associated with ulcerative colitis or Crohn's disease.
- Inflammation of eye in one third of patients with AS.
Causes and risk factors
- Presence of inherited antigenic cell marker HLA-B27.
- Patients with AS and inflammatory bowel disease, indicates that intestinal bacteria plays a role in development of disease.
Conditions Related to Arthritis
1. Chikungunya Arthritis
Chikungunya is caused by Chikungunya virus (CHIKV) and is transmitted by Aedes aegypti mosquito bite. Its
endemic occurred during 2006, majorly in Maharashtra and some other states of India. The word Chikungunya
means 'a disease which bends up' in Makonde language. About 74% of the affected patients show persistent
joint pain and arthritis in the late phase of infection. Rheumatic symptoms vary from mild to severe. Severe and
unusual forms of arthralgias have also been observed followed by early infection. Some patients are found to
show persistence of arthritis for 15-20 months or even up to 3-5 years. Erosive arthritis and triggering of rheumatoid
arthritis have also been reported.
2. Fibromyalgia
Fibromyalgia is a disorder of the central nervous system caused due to abnormalities associated with
neurobiological conditions. Its origin comes from the Greek word meaning pain in muscles and connective tissues.
Causes and risk factors
- Exact cause is not yet known.
- It's a clinical condition associated with inflammatory arthritis such as RA.
- Trauma and injury
- Illness caused due to viral or bacterial infections.
- Depression and emotional stress
Signs and symptoms
- Pain and stiffness in muscles and joints.
- Tiredness that can hamper routine tasks.
- Difficulty in concentration and loss of memory
- Stomach pain and irritation of bowel due to diarrhea.
Lupus
Lupus is a collective term given to autoimmune conditions that attacks healthy tissues of different organs,
skin and joints. There are several forms of lupus such as systematic lupus erythematosus (SLE), discoid lupus,
drug induced lupus and neonatal lupus. Among these forms, SLE is very common and is a closely related
condition to rheumatoid arthritis.
Signs and symptoms
- Photosensitivity
- Pain in chest while breathing deep
- Swollen lymph nodes
- Butterfly shaped rashes on skin
- fever and hair loss
Causes and risk factors
- Genetic factors
- People with younger age group are more prone
- Ethnicity
- Hormonal factors
DIAGNOSING ARTHRITIS
We offer omprehensive range of preventive and Diagnostic tests for arthritis. Some are
generalised tests for autoimmune and inflammatory conditions, whereas, others include specific tests
for arthritis biomarkers.
Generalised tests
Complete Blood Count (CBC)
A complete blood count test measures all the components of blood including red blood cells(RBCs),
white blood cells(WBC) and platelets. Abnormal levels of any of the cells and its components such as
hemoglobin can be inferred to detect conditions related to arthritis.
- Low RBC count gives indication of anemia, autoimmune conditions such as lupus erythematous and RA.
- Raised levels of WBC is found in arthritic patients due to inflammation and infection.
- Abnormal levels of differential blood count gives information about inflammatory conditions.
- Increased Erythrocyte Sedimentation Rate (ESR) is observed in inflammatory conditions, hence it can
be used to check onset of arthritis in the body.
- Lower WBC count gives indication for conditions of autoimmunity.
- Patients who are under medica tions for RA have reduced platelet counts.
Diabetes Profile
People with diabetes are two times more likely to develop arthritis. Lack of insulin and increased blood
glucose levels trigger problems of musculoskeletal system and diabetic arthropathy. Type 1 diabetes and
RA are autoimmune conditions and hence markers of inflammation are common for both. HbAlc tells about
glycosylated hemoglobin levels over
a period of three months. Increased HbAlc in diabetic patients may leads to developing other compli-cations.
The average blood glucose test, fasting and post prandial glucose assessment, and insulin levels may help in
overall assessment.
- Creatinine and Blood Urea Nitrogen (BUN)
These give indication about kidney functions. Patients on long term use of arthritic drugs have chances of
developing kidney impairment. Hence BUN and creatinine levels gives idea about dysfunctions induced by
arthritis drugs.
- Anti Nuclear Antibody (ANA)
Evaluation of autoimmune disease is done by detecting the presence as well as the quantity of ANA. As the
name suggests, these are autoantibodies generated against nuclear content of a cell.
- Thyroid stimulating hormone (TSH)
People with autoimmune thyroid disorders are prone to develop rheumatological conditions such as muscle pain,
joint defects and inflammation of joints.
- vitamin D
Vitamin D plays a significant role in maintaining bone health. Low levels of vitamin D are found to
increase the risk of arthritis.
- Complement 3 (C3)
It plays an important role in host defence against infectious agents and in the inflammatory process.
Specialised blood tests
Uric acid
- Uric acid Uric acid is a breakdown product of RNA. It is slightly soluble in water and has a tendency to
precipitate. It may form needle like crystals in one or more joints and is responsible for developing a condition
called as Gouty arthritis. Arthritic conditions like gout occurs due to deposition of uric acid crystals in the joints
and tissues leading to inflammation. Diagnosis of gout is possible by measuring uric acid levels in the blood.
- C-reactive protein (CRP)
CRP is one of the first acute phase proteins to be elevated in inflammatory disease. CRP is synthesised primarily
by the liver and functions by binding a variety of polysaccharides, phospha tidylcholines and polycations in the
presence of calcium. High levels of CRP gives idea about inflammatory conditions.
Rheumatoid Factor (RF)
RF forms an important part for both diagnostic as well as a prognostic RA marker. RA is a systemic autoimmune
disorder that is responsible for chronic symmetric arthritis of peripheral joints, commonly seen in adults. RF is
basically autoantibodies against the Fc fragments of immunoglobulin G and is produced by neutrophils in the
joints of 80% patients with RA. RF may result in the formation of immune complexes that activate the complement
cascade and release leukocyte enzymes from neutrophils, causing tissue injury.
Anti Cyclic Citrullinated Peptide (ACCP)
Accp is a blood test to confirm the diagnosis of RA. These autoantibodies are the anti-citrullinated protein
antibodies directed to citrulline containing epitopes and have much clinical importance for the diagnosis of RA.
Citrullinated proteins are present both intra and extracellularly in synovial membranes of patients with various
forms of arthritic conditions. Inflammatory cells release enzymes that bring deamination of proteins. These
deaminated proteins are called as citrullinated proteins.
Anti Streptolysin O (ASO)
ASO is used for diagnosis and monitoring of human streptococcal infections such as tonsillitis, otitis, erysipelas,
scarlet fever, as well connective tissue diseases like rheumatic fever, glomerulonephritis. This test is a sensitive
test for diagnosis of recent streptococcal infection.
Calcium
Monitoring the levels of calcium is important because, people with arthritis are at high risk for developing
osteoporosis. Bone loss and calcium depletion is common since, arthritic patients are prescribed glucocorticoid medica tions.
Phosphorous
It is a major structural component of bone and cell membranes. It is present in the bone in the form of
calcium phosphate salt called hydroxyapatite. It also helps to maintain normal acid-base balance (pH) by
acting as one of the body's most important buffers.
HLA-B27
HLA-B27 is an antigenic cellular marker tested to confirm the presence of Ankylosing spondylitis (AS). It
can also be a helpful test for diagnosis of reactive arthritis and Juvenile arthritis. This molecule is present
on T cell surface which presents microbial antigens to T cells. It is strongly implicated in a set of autoimmune
disease referred as seronegative spondyloarthropathies.
Other Diagnostic Techniques
Microbiological examinations
Some forms of arthritis such as infectious and septic arthritis needs microbiological examination. A procedure
called arthrocentesis is performed to make an accurate diagnosis of septic arthritis. Surgical puncture of the joint
is done to draw a sample of synovial fluid. Microbial culture of the joint fluid can help to identify the specific
microbial infection and determine its susceptibility to a variety of antibiotics.
Polymerase Chain Reaction (PCR)
PCR can be performed in cases of reactive arthritis caused due to B. burgdorferi, Yersinia spp, Neisseria
gonorrhoeae, Chlamydia spp, and Ureaplasma spp.
Radiological techniques
X rays : X rays cannot be used for detecting early stages of arthritis but it can be used to check its progression.
It can also be used to check bone damage, cartilage loss, etc.
MRI: Magnetic Resonance Imaging (MRI) has its own importance in diagnosing disorders of musculoskeletal
system. It allows the visualization of 3D image. MRI scanner produces a magnetic field around the body. With
the help of energy produced from an oscillating magnetic field, radiofrequency signals are emitted by excited
hydrogen atoms from the water content of the body. These signals are detected in order to create an image.
MRI has advantages over X ray and CT scan because it produces detailed and clear images of bones, cartilage, muscles, discs, tendons, ligaments
and blood vessels.
Nuclear Imaging Techniques
FDG-PET CT : Positron emission tomography (PET) is emerging as a promising approach for diagnosis of
inflammatory disorders. FDG (Fluro Dextro Glucose) PET is not only restricted to cancer detection but can
also be used in detection of synovitis, inflammation of joints and arthritis. Apart from cancer, FDG is also
found to be very well distributed in inflammatory tissues such as fibroblasts, macrophages, capillaries, etc.
It acts as a tracer of glucose metabolism in the body. FDG intake by diseased joints reflects the disease
stage and progression.
Effectiveness of arthritis therapy can be monitored by checking for its progression. Advantage of FDG PET
over all other radiological techniques is its detailed evaluation of arthritis in large joints throughout the body.
Hence FDG-PET/CT gives an accurate and clear picture of inflammatory activity in large joints in patients,
with great sensitivity. It can also be helpful for early evaluations of the extent of RA throughout the whole
body including high risk lesion of atlanto-axial joint.
Advantage of FDG
PET over other radiological techniques is its detailed evaluation of arthritis in large joints throughout the body.
Educate yourself & Motivate yourself...
Self-management can be life-changing and makes survival with arthritis easier. It is all about control
of living with your condition. Also, is the most crucial step for your physical and emotional well being.
Since arthritis occurs in a variety of forms; trying to learn more about the disease and managing its
symptoms is beneficial.
Doing the tough things sets winners apart from losers
-Stephen Richards
Battling arthritis with healthy food...
Let food be thy medicine and medicine be thy food'
-Hippocrates
Above quote by Hippocrates, the great ancient Greek physician reveals the importance of healthy food
and its association with healthy body Healthy food can help prevent developing or worsening of arthritis
in high risk patients. Food rich in vitamin E and calcium can also help prevent arthritis. Consumption of
fruits, green leafy vegetables and milk products are essential. Fish is also a good source of cod liver oil,
which helps fight arthritis. Intake of plenty of water is necessary for joint lubrication and aids in weight
management. Abstinence from eating unhealthy and junk food which leads to obesity is essential. Some
food are believed to increase inflammatory signals, whereas, some are enriched with anti-inflammatory
properties.
Foods to be avoided
1. Avoid food containing omega-6 fatty acids as they are believed to trigger inflammation.
2. Corn and corn oils
3. Salts and preservatives
4. Dairy products are believed to enhance pain due to certain proteins present in them.
5. Processed food, sugars, baked food and sodas
Food to be eaten
1. Food rich in omega-3 fatty acids.
2. Olives, nuts and flax seeds.
3. Cruciferous vegetables such as cauliflower and broccoli are found to protect against the occurrence and
development of arthritis.
5. Food rich in Vitamin D and vitamin C.
6. Food with dark reddish colored pigments such as blackberries, raspberries, strawberries, eggplants are
rich in anthocyanins. Anthocyanins are antioxidants, with capacity to lower the levels of C-reactive
protein; a marker of inflammation.
Exercise and Yoga...
Practicing yoga will not only give physical benefits but also add psychological strength. Yoga includes
set of exercise that involve integral parts of body and mind, also termed as holistic movements. Its
gemmological origin comes from a sanskrit word meaning 'to yoke' or unite. Scientific studies done on
patients with arthritis practicing yoga have shown promising results with improvement in joint health.
It also generates a positive feeling of wellbeing.
Yoga teaches us to cure what need not be endured and endure what cannot be cured
Physiotherapy & Massage...
Regular massage by a trained practitioner or therapist can give significant alleviation from pain and
cause relaxation. Massage of joints and muscles can show a significant improvement in stiffness,
swelling, pain and also, improves the joint health. Physiotherapy practices involves combinational
therapies such as hydrotherapy, thermal therapy, electrotherapy and physical therapy.
Drug recommendations from Indian Rheumatology Association...
Before 2008 pharmaceutical treatment of RA in India involved use of non steroidal anti-inflammatory
drugs (NSAIDs) and corticosteroids that act as palliative agent. Since the year 2008, Indian Rheumatology
Association (IRA) recommends the use of biological agents and traditional disease-modifying antirheumatic
drugs (DMARDs).
Medicines heal doubts as well as diseases.
Joint replacement surgery (Osteoplasty)...
If untreated, severe cases of arthritis, becomes difficult to manage. It results in unbearable pain and
hampered join movements. Joint replacement surgery is suggested based on arthroscopic and radiological
studies. Severity of inflammation can also be checked by biopsy studies and based on this, a decision for
joint replacement can be taken. During joint replacement, the affected joint is replaced by an artificial joint
also termed as prosthesis. Prosthesis can be made up of plastic or metal. Joint replacement is commonly
done for hip and knee but, it can also be done for other joints such as shoulders, ankles, elbows and fingers.
You are very powerful, provided you know, how powerful you are.
Managing Arthritis while at work...
1. Talk with the manager frankly about your condition.
2. Work on a supportive chair, a desk of proper height and a user friendly keyboard.
3. Take small breaks at suitable intervals and maintain movements.
4. Plan your work tasks properly to reduce the stress.
Myths and Facts about Arthritis
Myth No.1
Arthritis is an old persons disease.
Fact
It can affect any age group.
Myth No.2
Cold and humid conditions can be a causative factor for Arthritis.
Fact
Cold conditions might exacerbate the painful condition but is not a causative factor.
Myth No.3
Arthritis is treatable.
Fact
There is no complete solution to cure this ailment but can be managed when diagnosed.
Myth No.4
Cracking your knuckles can cause arthritis.
Fact
No, There are not enough evidences regarding cracking knuckles leads to inflammation or arthritis.
