What is arthritis?
Arthritis is a general term that describes a group of diseases or problems that affects our joints. The term is derived from Greek arthro-(which means joint) + -itis, inflammation. The underlying disease process is that of joint inflammation. With inflammation, there is destruction of the smooth surface of the joint, which is made up of cartilage. The cartilage will be worn out, exposing the bone surface.
Another term frequently used is osteoarthritis(OA). There are many causes of arthritis. Osteoarthritis is the most common form of arthritis. It is a degenerative joint disease, which means it is a result of ‘wear and tear’ from aging, overuse or trauma. Other causes are autoimmune causes. The common autoimmune causes of arthritis are rheumatoid arthritis and psoriatic arthritis. Arthritis from infection is called septic arthritis(joint infection). Septic arthritis is a surgical emergency. Early surgery can help reduced the damage from septic arthritis.
Symptoms and Signs of Arthritis
The symptoms of arthritis are mainly pain and stiffness.
Patients will have pain in the joints when they move the joint. There may also been tenderness when the joint is touched. It may also lead to stiffness of the joint. In the early stages, stiffness occurs in the morning and the stiffness will reduce as the day progresses. With more advanced disease, the joint may be deformed or look crooked. Joint swelling may also occur. There will be occasional flare-ups accompanied by joint swelling.
Septic arthritis, which is an emergency, presents with joint pain and swelling, stiffness and fever. A fever maybe absent occasionally. If septic arthritis occurs, emergency surgery is necessary to wash the joint and antibiotics should be given. If delayed, further destruction of the joint occurs and sepsis may ensue endangering the life. Septic arthritis can affect anybody, including children.
The initial treatment of arthritis except septic arthritis is painkillers, activity modification and physiotherapy. Use of a walking aide may also help. Medications that are used for arthritis treatment is for controlling the pain and inflammation. These are the NSAIDs(Non-steroidal anti-inflammatory drugs) like diclofenac, ibuprofen, naproxen or the Coxibs like etoricoxib or celecoxib. Occasionally short-term corticosteroids are used. If severe swelling is present, aspiration(sucking –out the fluid with a needle) may help the discomfort.
These oral medications can be supplemented by intra-articular injections of visco-supplementation with hyaluronate. This aims to increase the lubrication in the joint to reduce pain.
If this conservative arthritis treatment fails or side-effects occur, then it may be necessary to perform surgery. An interim procedure maybe an arthroscopic debridement & wash-out(keyhole surgery). In this procedure, an arthroscope is inserted and the joint is debrided(frayed parts of the joint is trimmed) and a washout is done. This washes out the chemical irritant of the inflammatory process and gives pain relief. Arthroscopic debridement is done if the patient has severe pain but does not want a total knee replacement. This buys time and does not give a permanent solution. In early osteoarthritis, some procedures can be performed to promote new cartilage formation. This may include microfractures or injection of Platelet-Rich Plasma (PRP). Autologous Cartilage Transplant can also be done in selected cases.
If the arthritis is too severe, Orthopaedic surgeons will then do a joint replacement. The term for the operation for the knee is a total knee replacement or arthroplasty. If the arthritis is localised to half the knee, then a unicompartmental knee replacement can be done. A unicompartmental knee replacement is a smaller operation than a total knee replacement. For the hip, the term is called a total hip replacement or arthroplasty. Procedures for other joints are total shoulder replacement, total ankle replacement and total elbow replacement. This procedure involves the replacement of the worn out cartilage with an artificial joint. Surgical arthritis treatment of the knee and hip are well-established procedures and have very good results for the hip and knees.