Conditions and treatments
- ARTHRITIS: The word means inflammation of the joints, but it is used as a general term which acknowledges that something is wrong with the body’s musculoskeletal system. The kind of arthritis which we associate mainly with older people is called osteoarthritis, a degenerative arthritis disease. Others are caused by a malfunction of the immune system for reasons still unclear, and are classified as auto-immune arthritis diseases. Diagnosis of the exact disease among the over 200 or so different types of arthritis is often difficult and may take some time. Below is a selection of different arthritis diseases, although there are many others.
- BASAL JOINT ARTHRITIS: This type of arthritis occurs in the base of the thumb that allows swiveling and pivoting. It tends to wear out from everyday use, causing pain, stiffness and arthritic symptoms. It can affect both hands and is common amongst women over forty and men who have worked with their hands for many years. Degenerative basal joint arthritis can develop as a result of normal use and the natural ageing process.
- BEHCET'S DISEASE: This autoimmune disease results in damage to blood vessels throughout the the body. The disease causes blood vessels to become inflamed. Behcet's disease affects each person differently. Symptoms include mouth sores, genital sores, inflammation inside of the eye and skin problems. Other symptoms may include blood clots, arthritis, and inflammation in the central nervous system and digestive system. Treatment typically focuses on reducing discomfort and preventing serious complications.
- COSTOCHONDRITIS, Also known as Fibrositis or Tietze’s syndrome: A soft- tissue form of arthritis that causes inflammation of the rib cage near the breastbone, which is a common cause of chest wall pain. The key symptom is pain along the edges of the breastbone and not in the center portion of the chest under the breastbone. Many patients and doctors can occasionally be thrown off a correct diagnosis as the pain can radiate into the arms, shoulders or the entire chest area.
- DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS or DISH: A degenerative form of arthritis which causes calcification along the sides of the vertebrae. Once known as Forestier Disease. Causing widespread calcification and ossification of the anterolateral ligaments of the spine, it can lead to ankylosis. However strict criteria distinguishes it from degenerative disc and joint disease and ankylosing spondylitis. It can also cause inflammation and growth where tendons and ligaments attach to bone eg; the elbow, knee and heel of the foot.
- FIBROMYALGIA SYNDROME: A chronic form of arthritis where the primary symptom is widespread aching in addition to pain on applying pressure to a range of identified tender points in the body. Its origin is unknown, although there are psychological factors involved.
- FUNGAL ARTHRITIS OR MYCOTIC ARTHRITIS: A type of arthritis caused by an infection from a fungus. Fungal arthritis is the rarest type of arthritis and is caused by any invasive fungi. These fungi may affect bone or joint tissue. Fungal infections are caused by microscopic organisms. They live on the dead tissues of the hair, nails and outer skin layers.
- GIANT CELL ARTHRITIS or GCA: This is a type of vasculitis which occurs due to necrosis (death) of one or more arteries. GCA can exist independently or coexist with or follow Polymyalgia Rheumatica. Also known as temporal arteritis and cranial arteritis. GCA occurs mostly in the head especially in the temporal arteries that branch from the carotid artery of the neck. However it can be systemic, affecting multiple medium-to-large sized arteries anywhere in the body. Symptoms include persistent headaches, accompanied by flu-like symptoms or weight loss.
- GONOCOCCAL ARTHRITIS: An infectious (septic) form of arthritis which occurs in those who are affected with gonorrhea. Two forms are found, one with skin rashes and multiple joint involvement and a second form in which disseminated gonococcemia leads to infection of one joint. Gonococcal arthritis is the most common acute septic form of arthritis found in young adults.
- GOUT: A very specific form of arthritis due to uric acid crystal deposits in joints and in soft tissues. It is eminently treatable in this day and age.
- HENOCH-SCHONLEIN PURPURA: Polyarthralgia and a non-deforming arthritis, most frequently affecting knees and ankles, are common manifestations of this disorder. Other features include nonthrombocytopenic purpura, abdominal pain, and glomerulonephritis. The syndrome is rare in adults.
- LEGG-CALVE PERTHES DISEASE: A disease that affects the femoral epiphysis or the top of the long leg bone inside the socket. It’s caused by an interruption of the blood supply so the bone tissue dies and collapses. The bone breaks across the top, blood supply comes back and the bone regrows. However there are long term problems. Symptoms include stiffness, and pain in the thigh and knee. The thigh muscles on the affected side are smaller than the healthy side. This disease is also found among children. The older the child, the more serious the disease becomes. Treatment includes bed rest, stretching exercises, and regular check-ups. Some children might need a cast or brace. In severe cases surgery is needed to fix the deformity.
- LYME DISEASE: An illness caused by ticks. Ticks are known as vectors for the pirochete Borrelia Burgdoferi which causes the disease. Characteristics include skin rash, joint inflammation and flu-like symptoms. Borrelia burgdoferi is transmitted through the bite of a deer tick. If not treated then the disease can progress to a second and third stage. Joint problems usually occur in the last stage.
- MIXED CONNECTIVE TISSUE DISEASE OR (MCTD): MCTD is caused by an overlap of clinical conditions such as lupus, scleroderma and polymyositis, dermotomyositis and rheumatoid arthritis and is common among patients with a combination of any of these diseases. Connective tissues are structural portions of the body that hold cells together. Some people might have lupus with secondary rheumatoid arthritis as well as scleroderma or vice versa.
- MULTICENTRIC RETICULOHISTIOCYTOSIS: (Lipoid Dermatoarthritis): This rare disorder usually begins in the middle decades of life and affects females three times more frequently than males. It is characterized by the development of multiple histiocytic nodules in the skin and severe polyarthritis that may simulate rheumatoid arthritis. The firm reddish- brown or yellow papular nodules are most commonly found on hands, forearms, head, neck, and chest. Mutilating joint destruction, especially in the interphalangeal joints, occurs in approximately one half of patients with this syndrome. Diagnosis is made by demonstration of histiocytes and multinucleated giant cells containing PAS-positive material in skin or synovium. Similar infiltrates have been observed in other organs. Reports of apparent benefit from adrenocorticosteroid or immunosuppressive therapy is difficult to interpret because of the tendency for spontaneous remission in this disorder.
- OSTEOARTHRITIS: A degenerative form of arthritis found mainly in older patients from general wear and tear, and resulting either from overused or previously damaged joints or from hereditary factors. It is the most common form of arthritis. The majority of knee and hip replacements are performed in order to restore mobility and reduce the pain and inflammation of osteoarthritis.
- OSTEOPOROSIS: Thinning of the bones seen mostly in postmenopausal women and older men, causing weak and easily broken bones, especially of the spine, hip and wrist. Adequate calcium intake throughout life will help prevent this 'silent disease' - so called because there are no symptoms until the bone breaks.
- PAGET'S DISEASE (OSTEITIS DERFORMANS): A type of metabolic bone disease that is caused by normal bone formation that gets altered, thus changing the strength and shape of bones which results in bone destruction and bone deformity. Although not rare, this disease is most common in the United Kingdom. About 5 out of every 100 people over 50 years of age in the UK have Paget’s disease.
- POLINDROMIC RHEUMATISM: A rare inflammatory type of arthritis often mistaken for rheumatoid arthritis. Symptoms include multiple and recurrent attacks affecting one to a few joints, with tissue inflammation around and adjacent to them.
- POLYMYALGIA RHEUMATICA: A specific condition seen mostly in patients of caucasian descent older than 50, causing severe pain and stiffness of the hip and/or shoulder girdle and characterized by high blood sedimention rates in samples. It responds dramatically to small doses of prednisone and leaves no damaged joints or tissue.
- RESTLESS LEG SYNDROME: This sleep disorder is characterized by sensations in the lower legs which lead to discomfort unless the legs are moved. Several rheumatic conditions are associated with restless legs syndrome including osteoarthritis, rheumatoid arthritis and fibromyalgia. Symptoms include tickling, itching and feelling as though there are bugs crawling on your legs.
- RHEUMATIC FEVER: This systemic inflammatory disease can involve the nervous system, the heart, the skin and the joints. Rheumatic fever develops after streptococcal infections. Symptoms may include polyarthritis, skin rashes and nodules. This disease can occur at any age. It frequently occurs in children between the age of 6 - 15 years of age.
- RHEUMATOID ARTHRITIS: A systemic form of inflammatory arthritis affecting one’s general health as well as a variety of one’s joints. There are very specific criteria for its diagnosis. Modifying treatment is becoming more and more effective. If left untreated the disease could affect any anatomical part of the body. Rheumatoid arthritis is the most common of the auto-immune arthritis diseases, found in about 1 in 100 people worldwide.
- SYSTEMIC LUPUS ERYTHEMATOSUS (SLE, or LUPUS): An autoimmune disease primarily affecting the skin and vascular system, as well as the joints and many of the other internal organs. Most but not all patients with lupus develop a butterfly-shaped rash on the face. It affects predominantly young women aged between 15-40 with a strong familial tendency among first-degree relatives. In the US, Black and Hispanic people are the main sufferers and in South Africa, people of mixed lineage are more affected than either blacks or whites.
- SYSTEMIC SCLEROSIS (SCLERODERMA): A collagen-vascular disease causing tight skin as well as organ damage in some cases. It is vital to seek advice early on.
- TUBERCULOUS ARTHRITIS: A type of arthritis caused by tuberculosis. Common joints involved are the spine, hips, knees, wrists and ankles. Tuberculous arthritis is a type of infectious arthritis. The hunchback of Notre Dame had a gibbous deformity thought to have been caused by tuberculosis. This type of arthritis is also known as Granulomatous Arthritis.
Drugs used to treat arthritis
Some drugs control symptoms. For example, analgesics reduce pain and anti-inflammatory drugs reduce swelling and stiffness. Other drugs reduce the action of the disease. A combination of drugs may be used to treat various forms of arthritis.
Groups of drugs used to treat arthritis
Drugs used to treat arthritis can be divided into three broad groups:
These relieve pain. They are used for many different types of arthritis and are often used together with other drugs.
Non-steroidal anti-inflammatory drugs (NSAIDs)
These reduce inflammation of the joint as well as pain. They are used for many different types of arthritis, often with other drugs. If one type does not work, your doctor may try another. They are usually given by mouth but may also be given by suppository or in slow-release preparation (also called ‘retard’). ‘Slow-release’ means that the drug is gradually absorbed by the body a little at a time, rather than all at once. NSAID creams or gels may also be used by rubbing onto the skin over a painful joint or muscle.
NSAIDs can damage the lining of the stomach and cause bleeding, particularly if taken in higher doses or over a long period of time. They should therefore only be used with caution and only continue to be used if they are controlling your symptoms. You should not take them if you have a history of indigestion or stomach ulcers.
Some of the newer NSAIDs known as COX-2 inhibitors (or ‘coxibs’) are less likely to cause stomach problems. However, several have been linked to an increased risk of heart attack and stroke, so they are not suitable for people who have had heart problems or stroke, or for people who have uncontrolled high blood pressure.
Disease-modifying anti-rheumatic drugs (DMARDs)
The first of the five types of DMARDs is sometimes called second line drugs, and includes chloroquine, lefluomide, penicillamine and sulfasalazine. They are used mainly in the treatment of rheumatoid arthritis but also in some other rheumatic diseases. They reduce pain, swelling and stiffness. They do not work at once but may take several weeks to become effective. If you do not do well on one of these drugs, or if you develop any side-effects, then your doctor may try one of the others or a combination of several.
Another group of DMARDs is the immunosuppressant drugs. They are termed ‘immunosuppressant’ because they suppress the inflammatory action of the immune system (the body’s own defence system which is malfunctioning in auto-immune arthritis diseases). This group includes azathioprine, cyclosporin, cyclophosphamide and methotrexate. Because they affect the immune system they may produce side-effects, and so need careful monitoring. Immunosuppressant drugs are often used to treat cancer but you can be reassured that your arthritis has nothing to do with this disease, and when used for arthritis lower doses of the drug are required.
There is a relatively new group of DMARDs called biologics, such as the anti-TNF drugs adalimumab, etanercept and infliximab, which act on your body's T-cells. Anti-TNF drugs can reduce inflammation in people with rheumatoid arthritis. These drugs are currently only being used in people who have not responded to other DMARDs. The B-cell drug rituximab is the newest drug in this group. Currently they are extremely expensive due to extensive research and development, plus a complex and lengthy manufacturing process. The prices are beginning to come down due to increased competition as more manufacturers bring biologics to market.
Corticosteroids are very effective in controlling inflammation and may have some disease-modifying effects. However, if used for a long time (many months) or in high doses they produce side-effects. For this reason doctors try to avoid these drugs or use them in as low a dose as possible. Osteoporosis (thinning of the bones) can be caused by steroids and for this reason your doctor may prescribe treatment to protect your bones while taking steroids. However, they do have an important role to play in many different rheumatic diseases. For example, if one particular joint is inflamed, your doctor may inject it with a steroid preparation. Steroids can also be injected into a vein or a muscle.