Arthritis

Arthritis literally means "inflammation of a joint". Arthritis can be unpredictable and debilitating; many people with arthritis cannot perform normal daily tasks due to intense pain and restricted movement.

There are many types of arthritis, the common ones are:

• Ankylosing spondylitis
• Gout
• Infectious arthritis
• Juvenile arthritis
• Osteoarthritis
• Polymyalgia rheumatica
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Ankylosing spondylitis

Ankylosing spondylosis (AS) is a chronic form of arthritis that mainly affects the joints in the spine (usually the little joints between the vertebrae of the spine), thus restricting the movements that take place at these joints. AS may also cause inflammation and pain in other parts of your body, such as your hips, shoulders, knees or ankles.
Its effects are usually mild in the majority of sufferers. AS often begins with an ache in the buttocks, in the back of the thighs and down the leg and in the lower part of the back. One side is commonly more painful than the other. Sufferers may experience early morning back stiffness and pain, and increased pain and stiffness after long periods of sitting. There may also be a slow or gradual onset of back pain and stiffness over weeks or months. Some people may occasionally experience chest pain because the joints and ligaments around the ribs are affected.
The exact cause is unknown, but possibly related to a hereditary factor (ie, gene HLA B27). AS is more common in young people aged 20-40 years, and men are 3 times more likely to be affected than women.
Early diagnosis and proper management helps to minimize the pain and stiffness of AS, as well as to prevent disability and major deformity. There is no cure for AS but you can do a lot to minimize the pain and stiffness, so that you can continue to lead a normal working and social life. Physiotherapy, exercise and maintaining the correct posture are the mainstays of treatment.
Anti-inflammatory drugs are useful in reducing pain and inflammation. After a short trial of non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs) may be used. Surgery is used in cases where a hip replacement is required. It is rarely used to correct and restore a straighter posture of the spine and neck.

Gout

Uric acid is made in the body as part of the breakdown process of foods containing purines. Gout is a form of arthritis caused by inflammation due to deposition of uric acid crystals in an affected joint. People with gout usually have an excess of uric acid in their bloodstream either because they are making too much or their body cannot get rid of it properly. Uric acid is eliminated from the body through the kidneys, and those prone to gout may also develop kidney stones.
A single joint is usually affected during a gout attack, the most common being the joint at the base of the big toe. The joint suddenly becomes intensely painful, red, hot and swollen. If untreated, gout can sometimes progress to other joints of the body (eg, ankles, knees and hands).
The typical sufferer of this painful condition is the overweight male who eats a lot of meat and drinks considerable amounts of alcohol. He will often have high blood pressure too. Gout may also be associated with people who have metabolic syndrome (diabetes and dyslipidaemia).
Oestrogen, one of the female sex hormones, seems to protect against gout. This explains why the disease is less common in women. When it does affect them, it is almost always only after menopause. This may also be because of the increased use of diuretic high blood pressure medications by elderly women.
The treatment of gout may be twofold. The acute attack is treated with rest and anti-inflammatory drugs. For those who get repeated (chronic) gout attacks and have a persistently raised uric acid level in their blood, it may be necessary to take medication on a daily basis to lower the uric acid level. Gout sufferers would need to watch their diet and alcohol intake to prevent triggering an attack as much as possible.

Infectious arthritis

Infectious arthritis is a type of joint inflammation caused by an infection. Infections of the joints usually occur following infections in other parts of the body.
Normally only one joint is affected by infectious arthritis, although two or three joints may sometimes become infected. In most cases, infectious arthritis affects the large joints (ie, shoulder, hips and knee); smaller joints in the fingers and ankles may be involved as well.
Anyone in any age group can get infectious arthritis. Some are more predisposed to infectious arthritis than others, such as those whose immune systems are weakened due to an illness or suppressed by certain medicines, those with existing arthritis, and those who are constantly exposed to animals, plants, marine life and soil.
The symptoms of infectious arthritis vary according to the cause. Warning signs that require immediate action by your doctor are when the joints become hot, swollen, red and the patient experiences loss of function.
Your doctor may perform a physical examination, x-rays or other tests (eg, joint aspiration) to ascertain whether or not you have infectious arthritis. Infectious arthritis can be cured if detected and treated early. Without treatment, the affected joints may become severely damaged and the infection may spread to other parts of the body.
Those with infectious arthritis often require treatment at the hospital. Excess fluid that has accumulated in the affected joints has to be drained by using a needle. This process may be repeated if fluid build-up happens again.
Your subsequent treatment depends on the type of infection that you have. Anti-inflammatory medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), are often used to reduce the pain and swelling. Antibiotics are prescribed if bacteria are the cause of your infection.

Juvenile arthritis

Juvenile arthritis (also called juvenile idiopathic arthritis) is an autoimmune disorder that can occur in children of any age. More commonly it first appears between the ages of 1 and 4, and 10 and 13 years.
It is not known why this occurs, but some scientists suspect that an environmental factor, such as a virus, may trigger the condition in genetically susceptible children.
The three main types of juvenile arthritis are pauci-articular arthritis (the most common), polyarticular arthritis (affects about 30% of all children with juvenile arthritis) and systemic arthritis (affects approximately 20% of all children with juvenile arthritis).
Joint swelling or pain must be present for at least 6 weeks for the doctor to consider juvenile idiopathic arthritis as a diagnosis. Along with a detailed medical history, thorough physical examination and symptom evaluation, blood tests and X-rays may be necessary to confirm the diagnosis.
Early diagnosis and treatment are essential. The main aim is to minimise damage by keeping the joints moving, the muscles strong and the limbs in a good position. This may involve a combination of medication, physical therapy and exercise in order to relieve the pain and inflammation and to delay or prevent joint destruction.
Non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs) can relieve the pain for many children. Those with more severe disease may require surgery. While steroids can be very effective, it is important that they are not taken for prolonged periods as they can inhibit growth and cause weak bones (osteoporosis).

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis, affecting around half of Malaysians aged over 60 years, and virtually all of those over 80 years of age. OA is caused by wear and tear of the cartilage that cushions the joints. It most commonly occurs in the large weight-bearing joints (eg, knees, hips and spine), as well as in the hands.

OA symptoms can differ greatly from person to person. In many cases, the symptoms are mild even though x-rays show joint changes. In other cases, sufferers have periods of severe pain interspersed with long periods of relative stability. Some of the typical symptoms are joint pain and stiffness.

Changes that have already taken place in the joints cannot by reversed with medication, but disease progression can be slowed and the symptoms controlled. It is important to see your doctor so that the most disabling effects of the disease can be avoided.

Your doctor will design a treatment that best suits the severity of disease, the joints affected, your age and your symptoms. Options include weight loss, physiotherapy, muscle strengthening exercise, joint protection, pain-relieving and anti-inflammatory drugs, viscosupplementation, glucosamine and diacerein. Surgery may be indicated for severe cases.

Polymyalgia rheumatica
Polymyalgia rheumatica (PMR) is a condition in which the muscles of the shoulders, neck, spine, buttocks and thighs are in severe stiffness and pain. The forearms, hand, calves and feet are usually spared The name 'polymyalgia rheumatica' simply means rheumatic-type pains in many muscles.

PMR almost always affects people over 50 years of age. It is more common in women and is said to be more frequent in Caucasians.

The muscle pain and stiffness is most often worse in the morning and tends to wear off as the day goes by.. People with PMR usually experience other symptoms: weariness and loss of energy, poor appetite, night sweats and fevers, weight loss and depression. These complaints are usually present at the beginning of the illness and, in some cases, are worse than the actual muscle pain. Unlike other forms of arthritis, PMR does not cause deformity of the joints.

Presently the cause of PMR is not known. The muscles do not show any obvious abnormality when examined microscopically. The incidence of weight loss, fevers and fatigue with abnormal blood tests indicates a disease of the whole body rather than just muscles. Some cases appear to start after a flu-like illness. It may be that a virus triggers off an alteration in the way the body's defence mechanism works and this is responsible for the continuing complaints.

PMR is treated with long-term, low-dose steroid tablets (usually prednisolone). Other treatment options include non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs) and physiotherapy during the active phase of illness. Rest may also be an appropriate option.

Rheumatoid arthritis
An autoimmune disease is a condition where the body's immune system attacks its own organs and tissues. Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and swelling of joints. If left untreated, bone and cartilage of the affected joint may become damaged and the joint becomes deformed.

RA affects up to two people out of 100 and is three times more common in women than men. Although RA may begin at any age, it occurs most commonly between the ages of 35 and 45. It is not hereditary.

People with RA usually experience pain, swelling and stiffness in the small joints of the hands or feet; other joints may also be involved – elbow, shoulder, and knee joints. The affected joints may be painful and stiff in the morning. For the majority of sufferers, RA is a long-term disease characterised by recurring flare-ups and remissions.

Although there is no way to prevent RA, you can reduce the effects by early diagnosis and treatment. Diagnosis is usually made on an evaluation of the symptoms and tests, including a physical examination of the joints. It may be difficult to distinguish RA from other forms of arthritis in the beginning because it takes several months before blood or x-ray changes occur. These help your doctor to make a definite diagnosis.

Treatment of A can be a combination of different approaches:

Medication – Painkillers to provide pain relief and disease modifying anti-rheumatic drugs (DMARDs) to modify the disease.
Physiotherapy and exercise – to help maintain normal joint movement and muscle strength as well as prevent deformities.
Occupational therapy – to teach you more efficient ways of using your joints, and how to cope with arthritis in daily living.
Surgery – reserved for people who have severely damaged joints.
Rest - Only indicated for short periods of time during acute flareups.
Apart from physiotherapists and occupational therapists, other health professionals such as podiatrists, nurses and dieticians may be involved in your treatment program.

Systemic lupus erythematosus
Systemic lupus erythematosus (SLE), or simply lupus, is an autoimmune disease where the body's immune system attacks its own organs and tissues. It is thought to affect about one person in 1,000. Females are 9 times more likely to be affected than males. Although it can occur at any age, lupus usually appears during childbearing age (from 15 to 45 years old).

Just about all parts of the body may be affected by lupus. The joints, skin, kidneys, heart and lungs are most often involved. Symptoms vary greatly depending on the severity of disease at the affected body part.

Mild kidney damage is quite common. The effect on the lungs and heart are often not too serious, although narrowing of the coronary arteries means a higher-than-expected rate of heart attacks.

Nearly all lupus sufferers will develop arthritis at some point of time. The joints of the fingers are the most commonly affected, followed by knees, wrists, hands, ankles, elbows and shoulders. Joints on both sides of the body are usually affected together. However, the symptoms of arthritis can ‘jump' from place to place, sometimes lasting only a day or shorter in any particular joint.

Skin rashes are also very common. A malar rash affects the bridge of the nose and upper cheeks in a butterfly-shaped pattern. Some people may get a more widespread generalised rash. Exposure to sunlight often triggers the appearance of these rashes. Generalised hair loss is also a very common feature of this illness.

While fertility is not affected by lupus, female sufferers seem to have an increased rate of miscarriages and stillbirths.

Lupus is a complex disease that affects people in many ways. A greater understanding of the disease and the use of newer drugs help those affected lead much longer and better lives than before. Lupus is often treated with hydroxychloroquine (a drug also used for treating malaria). Steroids may be necessary. Other drugs that also suppress the body's immune system may be used.