What is Arthritis and What Can You Do to Prevent It?

Arthritis is a painful condition that affects our joints and the tissues surrounding them. Pain, immobility, restricted movement and difficulty in doing day-to-day activities make it a huge challenge. Arthritis has a worldwide prevalence. In the US, arthritis is a leading cause of disability. Arthritis-related consultations made up 11.4% of  doctor office visits in 2018.  A little understanding of this condition can go a long way in evolving a plan to manage it successfully.

Let us decode the basics.

Causes | Types | Diagnosis | Treatment | Prevention

What causes Arthritis?

Inflamed or damaged joints and the tissues around them cause arthritis. This damage may be due to age, wear and tear, inflammation, infection or metabolic causes such as obesity. Depending upon the cause, diverse types of arthritis occur. Stiffness, aches, swollen and tender joints are its telltale signs. 

Types of arthritis

You may have heard about osteoarthritis, rheumatoid arthritis, and gout arthritis, but did you know that there are more than 100 distinct types? 

Osteoarthritis

Osteoarthritis is also called  “wear and tear arthritis” and mostly occurs due to degeneration of the cartilage underlying bones. Cartilages are the connective tissue around our bones. They act as cushions, and when there is movement they function as shock absorbers to help the bones move smoothly. With time, cartilage may wear down and ultimately get thin or break down. This exposes the bones to rub against each other. Such friction causes the bones to get damaged, inflamed and even deformed. This results in pain and osteoarthritis. The creaks and cracks that you hear as you move are due to this friction between the bones.

Osteoarthritis sets in gradually and the initial signs might be joint pain, swollen bones and pain during movement. You may also experience stiffness after a prolonged period of inactivity like sitting or sleeping. Though osteoarthritis may affect any part of the body, the parts that bear weight like hips and knees are more prone to it. Managing weight is crucial to prevent and manage osteoarthritis. An extra body weight of 10lbs, puts a pressure of 20 to 30lbs on the knees. Such pressure naturally wears down the cartilage and bones. Though this is a disease of aging, accidents or some predisposed genetic conditions may also result in osteoarthritis. Pain management medications, physical therapy and surgical interventions are helpful.

Rheumatoid Arthritis 

This is an autoimmune disease. In autoimmune diseases, for reasons that are not too clear, our body’s immune system goes awry and attacks healthy organs. When our own immune system attacks the joint lining, it causes inflammation and damage to cartilages and bones, resulting in rheumatoid arthritis. Besides joints, rheumatoid arthritis can also affect the eyes, heart and lungs. Though it may strike at any time, people seem to be more prone to it  after their 40s.   Women are three times more likely to develop rheumatoid arthritis than men. Reduction in the hormone estrogen levels after menopause, may predispose women to it. Although rheumatoid arthritis is a chronic condition, there may be periods when the disease flares up when the immune activity is more and may slow down when the immune activity is low. Usually. rheumatoid arthritis starts in the joints of fingers and toes and gradually spreads to wrists, knees, elbows, hips and shoulders. The same joints on both sides of the body are usually affected. Apart from pain, occasional fever and discomfort can also occur in rheumatoid arthritis. Usually, this condition is managed with disease modifying antirheumatic medications and lifestyle modifications. There is no cure as such but there are many helpful ways to combat it and lead an active life.

Gout

This is a type of metabolic arthritis since it involves uric acid, which is a metabolic waste in our blood stream.  Your kidneys expel this waste through urine. If this does not happen, uric acid builds up in our body and triggers gout.

Gout is characterized by a sudden onset of severe pain that mostly starts in the big toes, but it can happen in other joints as well. Uric acid produces a specific kind of pain with a hot, swollen reddish patch over the site of gout. It takes a couple of weeks to subside without treatment, but it may become a chronic condition if the underlying cause is not addressed. Men are more prone to gout as they have higher levels of uric acid throughout their life. Women have higher levels of estrogen than men. This helps women excrete uric acid, so they tend to have lower levels until menopause. Uric acid goes up with increasing purine and fructose metabolism. This means that fatty and sugary foods tend to increase uric acid levels. A vegetarian diet is associated with lower uric acid and a lower risk of gout.

Infectious Arthritis

Infectious arthritis mostly develops when an infection in some part of the body travels through the bloodstream and lands in any joint.The immune system in the body naturally attacks the pathogen and inflammation happens. Symptoms usually come on rapidly and include intense swelling, pain, fever and chills. Infectious arthritis typically strikes the knee, but hips, ankles and wrists may also be affected. Doctors treat this condition with antibiotics and by draining the infected synovial fluids in the joint. Resting the joint and gradually resuming activity after the infection is controlled is advised.

Psoriatic Arthritis

Psoriatic arthritis is a chronic, autoimmune form of arthritis that affects around 20% of people with the skin condition psoriasis. It causes joint inflammation and can affect large or small joints.

Genes and environmental triggers, such as  trauma or viruses, are believed to play a role in developing psoriatic arthritis.  Symptoms may be mild or severe, affect just a few or many joints, and symptoms may occur sporadically. Usually, a primary care doctor refers you to a dermatologist or rheumatologist based on your chief condition to manage this condition.

Arthritis diagnosis

Your physician would do a few physical checks to assess your joints for swelling, warmth, mobility and redness. They may also order a few imaging tests.

 X- Rays are usually the first step in the process to detect any cartilage loss, bone damage and bone spurs. 

CT or MRI scans help your doctor get more detailed images. 

Depending on the findings, your doctor may order further fluid tests including blood, urine or joint fluid tests to determine the type of arthritis you have. 

Your doctor may also refer you to a rheumatologist or orthopedist for further opinion and management.

Treatment options for arthritis

Treatment options focus on reducing the impact of the disease and slowing down its progress. You many need medications, therapeutic interventions, lifestyle changes, and, in some cases, surgery. 

Here are some therapeutic methods that may help you:

Physical therapy 

Physical therapy is useful to manage arthritis. Therapy focuses on improving range of motion, movement and strengthening the muscles surrounding the joints. In some cases, you may need splints or braces. Resistance training is effective in managing arthritis.

Resistance training increases tendon stiffness and strengthens connective tissue. Cyclic loading (e.g., walking, cycling, strength endurance exercises) enhances cartilage integrity and joint lubrication. Mobility exercises increase range of motion (Cooney et al., 2011).

Aquatic Therapy

Exercise in water has been found to be effective. It is a safe, low-cost method to improve pain and quality of life. Water’s natural buoyancy reduces the stress on the joints. Water has greater density than air, hence walking and working out in water requires more effort. This develops muscle power and burns calories. Exercise in warm pools improves circulation of blood and soothes pain.

Exercise in water has many advantages, due to the properties of water in creating resistance, lightening and reducing the pressure on the affected joints, exercise is done with less damage and easier learning (Silva et al., 2008).

What can you do to prevent arthritis?

While the above involve care by professionals, as individuals, we can plan , prepare and practice certain techniques to avoid or postpone the progression of  arthritis. The most crucial factor is lifestyle modification. Lifestyle factors such as cigarette smoking, excess weight, dietary intake, physical activity, and dental hygiene may play important roles in the development of arthritis.

 

Inflammation control is key to managing arthritis. Research shows that foods high in saturated fat, omega-6 fats, sugar, and salt could intensify arthritis symptoms. A diet rich in fruits and vegetables, omega 3s, whole grains help in combating inflammation.

In my capacity as a  health communicator, I work with people to help them decipher the complex instructions that come with medical advice and make them easy to follow. Here is an acronym I use to help people manage their pain. I call it MANAGE mode.

The MANAGE mode to prevent and/or manage arthritis

Move 

Pain puts you in agony and inactivity, but inactivity makes pain worse. Avoid long periods of both activity and inactivity. Get moving, start slowly and gradually increase your activity. Pace yourself with short bouts. .. Mild to moderate exercise helps strengthen muscles, improve your mood and sleep, and increase blood flow which reduces inflammation .

Adapt

Prepare yourself mentally to the challenges of pain and inability to be as active as you normally could. Focus on your activities of daily living and make suitable adaptations in terms of supports, placing things at a convenient height and distance, making  safeguards against falls. Ask for help!

Normalize 

Normalize your weight to an ideal BMI. Being overweight will increase stress on your joints and cause more damage. 

Acknowledge 

Acknowledge the fact this condition affects you and do not try to ignore when the disease is at its beginning stage. Get medical guidance. Being a part of support groups is a wonderful way to engage yourself and learn from people with similar challenges.

Gauge 

Depending on your condition, weather and other environmental factors could cause flares and remissions of pain. Maintain a diary to know what causes your flares, understand the pattern and guide yourself through such periods by either avoiding the causes or by taking precautions to manage them.

Eat

Eat a balanced diet that is low in sugary fats, carbs and increase your consumption of anti-inflammatory foods like nuts, legumes. Olive oil, olive leaf extract, curcumin and sanguinarine have been studied as supplements with anti-inflammatory properties. These natural dietary supplements help in maintaining our homeostatic balance  and in slowing down the progression of Arthritis.

Arthritis though chronic,painful and disabling can be handled easily and you hold the key to it!