Arthritis: Symptoms, Types, Causes, Risk Factors, Management.

The word “arthritis” literally translates to “joint inflammation. Arthritis, a term encompassing over 100 conditions, affects millions globally, causing pain, stiffness, and inflammation in the joints. While it’s commonly associated with aging, arthritis can strike at any age.

Prevalence:

Around 53.2 million adults, or 21.2%, have doctor-diagnosed arthritis. Prevalence increases with age, with nearly half (47.3%) of adults over 65 reporting arthritis. Women are more susceptible than men, with 20.9% affected compared to 16.3%.

Risk Factors:

The risk factors might differ based on the type of arthritis condition. The common risk factors for arthritis include:

Age: Most people gain fat and lose muscle mass as they get older, which could modify the amount of pressure placed on joints and increase the progression of arthritis. 

Obesity: Studies have shown that excess weight overloads the joints and destroys the articular cartilage. 

Gender: Women get changes in oestrogen levels after menopause; these hormones affect cushioning cartilage, which allows joint movements. In addition to this, hormonal changes lead to low mineral density and cause arthritis conditions. 

Heredity or genes: Studies have shown that HLA-B27 causes ankylosing spondylitis (spondylitis arthritis), whereas HLA-DRB1 causes rheumatoid arthritis. Thus, human leukocyte antigen (HLA) plays a significant role in developing arthritis conditions.

Environmental factors: Factors such as sporting activities, job roles, and exercises that require frequent use of joints play a significant role in developing arthritis conditions. These activities are associated with the overuse or repetitive use of joints.

Autoimmune disorders: In some cases, the person’s immune system attacks their own cells or tissues because it mistakenly assumes they are foreign cells. This condition leads to autoimmune arthritis conditions such as rheumatoid arthritis, lupus, etc.

Injuries: Injuries due to accidents, sporting activities, etc., may lead to the damage to joints, which in turn develops inflammation and causes arthritis conditions.

Infections: When an infection spreads to one or more of the joints and causes inflammation, infectious arthritis results. The synovial fluid that lubricate the joints and the surface of the cartilage is inflamed. The infection, which typically originates from another area of the body and spreads to the joint through the bloodstream, may be caused by bacteria, a virus, or a fungus.

Causes of Arthritis:

While the exact cause of arthritis can vary depending on the specific type, several factors can contribute to its development. Here’s a breakdown of the common causes:

➡️Wear and Tear: The most common form of arthritis, osteoarthritis is caused by the gradual breakdown of cartilage, the protective tissue cushioning the ends of bones within a joint. This degeneration happens naturally with age, as repetitive stress and strain take their toll over time.

➡️Autoimmune Dysfunction: In rheumatoid arthritis, the immune system mistakenly attacks the body’s healthy tissues, including the synovial membrane lining the joints. This attack triggers inflammation, leading to pain, swelling, and stiffness.

➡️Uric Acid Crystals: Uric acid is a waste product formed during the breakdown of purines, naturally found in certain foods and produced by the body. When uric acid levels become too high or the body is unable to eliminate it effectively, urate crystals can form and deposit in joints, leading to sudden and severe pain and inflammation.

➡️Other Causes:  Injuries due to accidents or sporting activities, Infections , Degeneration of joints , Jobs with repeated stress on the joints , Muscle weakness , Being overweight.

Signs and Symptoms:

The signs and symptoms of arthritis include:

➡️Pain: Arthritis pain may be intermittent (come and go) or persistent (constant)

➡️Swelling: Usually, in arthritis conditions, joints become swollen and feel warm or tender to the touch

➡️Tenderness (pain upon touch)

➡️Loss of function (decreased range of motion)

➡️Stiffness: Stiffness is seen in the morning or else upon sitting or performing exercises

➡️Deformity (joints become deformed) 

➡️Weakness

➡️Instability 

➡️Erythema (redness)

➡️Warmth 

➡️Sleep disturbances, fatigue, emotional liability, and systemic illnesses may accompany the above symptoms. These symptoms are usually seen in one or more joints.

➡️Morning stiffness, swelling, tenderness, warmth, effusion, and erythema are seen in inflammatory and osteoarthritic conditions.

➡️ Morning stiffness and overall body pain are seen in patients with fibromyalgia.

Types of Arthritis:

There are more than 100 types of arthritis conditions with specific causes and different treatments. Out of those, some of the common arthritis types include:

Osteoarthritis: Osteoarthritis is the most common form of arthritis that develops slowly and most frequently during the middle and older ages. In this condition, the cartilage that cushions and shields the ends of the bones gradually wears away, causing osteoarthritis. Osteoarthritis (OA) is also called as wear and tear arthritis. This condition results in discomfort and stiffness that gets worse over time, making it challenging to do daily tasks. 

Rheumatoid arthritis: Rheumatoid arthritis (RA) is a long-lasting autoimmune disease that initially affects the joints in the body. It is the second-most common form of the arthritis condition. Rheumatoid arthritis arises if the person’s immune system cannot protect the body from diseases and infections. In this condition, the immune system attacks its tissues, finally resulting in symptoms such as swelling, pain, loss of joint function, and stiffness. 

Gouty arthritis: Gout is an inflammatory arthritis characterised by swelling and joint pain that lasts one to two weeks and then resolves. Gout flares commonly occur in the big toe or lower limb. Gouty arthritis is caused by high levels of serum uric acid deposits in the body (hyperuricemia). This serum uric acid deposits as needle-shaped crystals around the joint, resulting in inflammation and arthritis. Usually, this happens when the body produces too much uric acid. 

Juvenile arthritis (JA), or Juvenile idiopathic arthritis (JIA), or Juvenile rheumatoid arthritis (JRA): Juvenile arthritis is a chronic type of arthritis that is commonly developed in children. Juvenile arthritis is associated with inflammation, resulting in joint pain, warmth, swelling, stiffness, and loss of motion. There are various forms of juvenile arthritis involving different patterns or features with inflammation of other parts besides the joints. It lasts for a limited time, usually a few months or years. However, in some cases, it may require lifelong treatment. 

Ankylosing spondylitis: Ankylosing spondylitis is an arthritis condition accompanied by inflammation of the joints and ligaments in the spine. Ankylosing spondylitis may also affect the peripheral joints, such as the knees, hips, and ankles. Usually, the joints and ligaments of the spine play a key role in moving and bending. Individuals affected by ankylosing spondylitis might develop stiffness in joints and tissues. This condition might lead to vertebrae fusing in some complicated cases, resulting in a rigid and inflexible spine. 

Lupus (systemic lupus erythematosus): Lupus is a long-lasting disease affecting numerous body parts. This condition arises if the person’s immune system cannot protect the body from diseases and infections. In these circumstances, the immune system attacks its own tissues, resulting in inflammation and permanent tissue damage (in rare cases). This condition can also be widespread in the skin, joints, lungs, kidneys, heart, circulation, and brain. 

Psoriatic arthritis (PsA): It is an inflammatory condition that affects the joints, especially at the sites where the tendons and ligaments adhere to the bones. It is caused by an overactive immune system, which leads to pain and swelling. Psoriatic arthritis is usually developed in patients who already have psoriasis. 

Fibromyalgia: Fibromyalgia is a long-lasting disorder that primarily causes pain and tenderness all over the body. In addition to this, it also causes fatigue and trouble sleeping. There needs to be a clear understanding regarding this condition among researchers and scientists. There is no cure for fibromyalgia, but arthritis doctors might suggest a combination of exercises, movement therapies, psychological therapies, behavioural therapies, and arthritis medicines to treat this condition’s symptoms. 

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Reactive arthritis (ReA): As mentioned, the name reactive arthritis indicates that an infectious reaction usually causes the condition. This condition progresses due to a bacterial infection in the urinary, genital, or digestive tract. The symptoms of this condition include inflammation in the eyes, urinary tract, or genitals. Every individual might not get these three symptoms simultaneously or combined. 

Septic arthritis (SA): Septic arthritis is a serious bacterial joint inflammation caused primarily by bacterial pathogens but occasionally by fungal, mycobacterial, viral, or other uncommon pathogens. This condition is usually monoarticular, involving one large joint, such as the hip or knee. However, this might be polyarticular, involving multiple joints in some cases. Septic arthritis is an orthopaedic emergency requiring immediate treatment to reduce morbidity and mortality. 

Arthritis in knee: Knee arthritis is a condition characterised by swelling, pain, and joint stiffness. It is commonly seen in the knees; knee arthritis affects the largest joints. Knee arthritis can be serious and debilitating. The knee joint is where the thigh-bone, shin-bone, and patella meet. 

Seronegative arthritis: It is especially indicated for rheumatoid arthritis. A serology test usually gives results regarding the rheumatoid factor (RF) and citrullinated peptides (CCP). The significance of seronegative arthritis means that people with symptoms of rheumatoid arthritis test negative for RF and CCP in their blood. 

Diagnosis:

Usually, a diagnosis is required to confirm the condition. Doctors might suggest various diagnostic approaches to the patient based on the medical history and symptoms. The diagnostic approaches for arthritis are as follows:

-Physical examination

-Blood tests – Blood test for arthritis include:

-Complete blood count

-Serum creatinine

-Haematocrit

-Anti-nuclear antibody (ANA) test

-Uric acid 

-Rheumatoid factor (RF) and CCP (cyclic citrullinated peptide) antibody test

-White blood cell (WBC) count etc. 

-Joint aspiration (arthrocentesis)

-HLA tissue typing 

-Urine test

-Muscle and skin biopsies 

-Bone X-ray (radiography)

-Synovial fluid analysis

-C- reactive protein (CRP) test

-Musculoskeletal MRI (magnetic resonance imaging scan)

-Direct arthrography 

-Ultrasound 

-CT (computed tomography) scan

Management of Arthritis:

The Unani system of medicine offers a holistic approach to managing arthritis, focusing on addressing the root cause and promoting overall well-being. Here’s a breakdown of their strategies

1. Ilaj Bil Ghiza (Dietary Therapy):

Emphasizes consuming foods that reduce inflammation and promote joint health. Includes fruits, vegetables, whole grains, and lean proteins. Spices like ginger, turmeric, and garlic are recommended for their anti-inflammatory properties. Limiting processed foods, sugary drinks, and unhealthy fats is advised.

2. Ilaj Bit Tadbeer (Regimenal Therapy):

Recommends exercise and physical activity tailored to the individual’s condition and capacity. Gentle exercises like yoga, swimming, and walking can improve flexibility, strength, and range of motion. Maintaining a healthy weight is crucial to reduce stress on joints. Rest and proper sleep are essential for promoting healing and reducing inflammation.

3. Ilaj Bid Dawa (Pharmacotherapy):

Unani medicine uses herbal formulations and natural remedies to manage arthritis symptoms. Commonly used herbs include:

Suranjan: Possesses analgesic and anti-inflammatory properties.

Guggul: May help reduce inflammation and stiffness.

Ashwagandha: Supports overall well-being and reduces pain.

4. Other Modalities:

Massage therapy: Using oils and specific techniques can improve circulation, reduce pain, and promote relaxation.

Hijama (cupping therapy): Hijama Therapy helps to reduce inflammation and improve blood flow.

By: Dr. Waseem Qadir (MO JKHME)