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Arthritis

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body's natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

There are over 100 different types of rheumatic diseases. The most common are:

Osteoarthritis: Osteoarthritis is also called as degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called bone spurs.

Osteoarthritis causes joint pain and can limit a person's normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees and hips.

Rheumatoid Arthritis: This is an auto-immune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform or change a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.

Rheumatoid arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Post-traumatic arthritis: Arthritis developing following an injury to hand, wrist or elbow is called as post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain or ligament tears.

Psoriatic arthritis: This form of arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.

Causes of arthritis

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Rheumatoid arthritis is often caused when the genes responsible for the disease are triggered by infection or any environmental factors. With this trigger, the body produces antibodies, the defense mechanism of the body, against the joint and may cause rheumatoid arthritis.

Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. It is considered that your body secretes certain hormones following injury which may cause death of the cartilage cells.

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.

Symptoms of arthritis

There are more than 150 different forms of arthritis. Symptoms vary according to the form of arthritis. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

Diagnosis

Doctors diagnose arthritis with a medical history, a physical exam and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.

Treatment Options

There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicine. Your doctor may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. In the elderly, with severe arthritis, joint replacement can give good results.

Initial treatment for arthritis is conservative, consisting of rest, avoidance of vigorous weight-bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms, a cane or braces may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted, offer no relief, and have become disabling, surgery may be recommended. Surgery is usually considered if non-surgical treatment fails to give relief. There are different surgical procedures that can be used and may include:

Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.

Arthroplasty: In this procedure, your surgeon removes the affected joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis. The goal of the surgery is to relieve pain and restore the normal functioning of the joint. Total joint replacement can be performed through an open or minimally invasive approach.

Arthrodesis: A fusion, also called an arthrodesis, involves removal of the joints and fusing the bones of the joint together using metal wires or screws. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and when heavy manual use is expected.

Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.

Steroid

Cortisone is a corticosteroid released by the adrenal gland in response to stress and is a potent anti-inflammatory agent. Artificial preparations containing cortisone are injected directly into the affected joint to relieve pain and reduce inflammation. The effects may last for several weeks and cortisone injections are recommended in injuries that cause pain & inflammation and those don’t require surgical treatment. One such condition frozen shoulder and cortisone injection into shoulder joint relieves pain & inflammation.

Cortisone injections offer significant relief in pain & inflammation however is associated with certain adverse effects. The most common side effect is a “cortisone flare”, a condition where cortisone crystallizes and cause severe pain for a brief period that lasts for a day or two. Cortisone flare can be minimized by applying ice to the injected area. Other adverse effects include whitening of the skin and infection at the injection site, a transient elevation in blood sugar in patients with diabetes.

Viscosupplementation

HA-Viscosupplementation Injection for Arthritis

Hyaluronic acid (HA)-viscosupplementation is recommended in arthritis and to treat knee, hip joints, shoulders, ankle, and other joints problems.

Arthritis is a condition of inflammation of joints causing stiffness, swelling, and severe pain in the affected joints. In arthritis, the cartilage which connects the bones and helps in smooth gliding of bones during movement is damaged. Therefore, the bones rub against each other causing severe pain and inflammation. The risk of arthritis increases with age, family history, injury, over use of the joints, and other factors. There are different types of arthritis such as osteoarthritis, rheumatoid arthritis, infectious arthritis. Treatment includes anti-inflammatory medicines that reduce the pain and surgeries to repair the damaged cartilage.

In patients with osteoarthritis the concentration of HA is reduced and therefore the elasticity and viscosity of the synovial fluid, that acts as lubricant and reduces the friction between cartilages during the movement, is decreased. To treat patients with arthritis viscosupplementation injections are given. This injection relieves pain and brings back the elasticity and stability, and improves the functions of the joints.

Hyaluronic acid is found in higher concentrations in the connective tissues and body fluids, particularly in synovial fluid. It acts as a lubricating agent (help in the movement of joints) and shock absorber (protects the joints by withstanding high energy or high forces that hit the joints).

The HA-viscosupplementation injection is one of the most conventional methods recommended over surgery, that requires longer time to heal, and medications, that offer temporary relief from pain.

Allergic responses and mild pain are reported with the use of HA injection and no major risks are associated.

Contact
Kramer Orthopedics
Suite 307, 1401 Avocado Avenue, Newport Beach, CA 92660

Tel:    |   scheduling@kramerorthopedics.com