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Arthritis - That pain in my joints

We commonly hear the word “arthritis” pop up when we experience ongoing pain in our joints, especially as we get older, but what does this mean?


There are many different types of arthritis but the 3 main classifications that we will focus on here are Osteoarthritis (OA), Rheumatoid arthritis (RA) and Gout. The underlying cause of the 3 different types are quite different. We have outlined it below in the table to help make sense of them and help to differentiate them from each other:


Osteoarthritis

Osteoarthritis (OA) is characterised by the degeneration of bone and cartilage. It is believed this occurs due to overload in mechanical forces on weight bearing joints. OA of a joint occurs when the joint is subjected to higher loads over an extended period of time resulting in wear-and-tear of the cartilage and bone in the joint. Due to the inflammation caused by this in the area other structures such as ligaments, joint capsules and the synovium may be affected too. In some instances, small bone projections called osteophytes develop which further contribute to the degeneration of the joint.


Causes

Trauma, weight gain, overexertion, repetitive movements. Mechanical wear and tea.

Symptoms

Pain, swelling, stiffness. Typically affects large joints and is worse first thing in the morning or after periods of rest.

Diagnosis

Clinical history and evaluation, xrays.

Treatment

Weight management, activity modification, strengthening to correct biomechanics, pain management with medication, surgery.



Rheumatoid arthritis

Causes

An autoimmune disease where the body starts attacking its own joints. There have been links shown to genetics, hormones and environmental factors but their full role is not fully understood yet.


Symptoms

Pain, fatigues, loss of appetite and a low grade fever. Typically affects small joints, more than one at a time and often both sides of the body are affected concurrently. Symptoms tend to come and go, depending on the level of inflammation present in the body at the time.


Diagnosis

Clinical history and evaluation, blood tests, xrays.


Treatment

There are different drugs used for the management of RA and it is very patient dependent. The primary aim is to reduce inflammation, and control the process of the disease through DMARDS (disease-modifying antirheumatic drugs), biologics, JAK inhibitors. Joint replacements are a last resort in severe cases to improve pain and restore function.


Gout

Causes

An inflammatory arthritis that occurs due to high levels of uric acid in the blood that deposits in the joints, forming crystals that affect the mechanics and cause pain. The uric acid is produced when the body breaks down purines (a chemical compound found in certain foods).

Symptoms

It typically presents with sudden onsets of pain, warmth, swelling and redness in the area affected.

Diagnosis

Clinical history and evaluation, xrays, blood tests, joint fluid test.

Treatment

Lifestyle modification to avoid food and drinks that trigger attacks. Anti-inflammatories, icing, and staying hydrated during acute attacks to reduce the duration. Chronic gout is often treated with drugs known as colchicine.




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