Arthritis is an umbrella term used to categorise more than 100 musculoskeletal conditions which specifically affect joints throughout the body. The pathophysiology, symptoms, location and severity of arthritis can vary greatly between individuals and is highly dependent upon the type of arthritis. Typically arthritis is characterised by joint inflammation, pain, stiffness, and structural damage to aspects of the joint itself.
According to the most recent data provided by the Australian Bureau of Statistics (2012), 14.8% (~3.3million) of Australians were living with some form of arthritis in 2012. The prevalence of arthritis was shown to be greatest in women (17.7%) in comparison to men (11.8%), and the proportion of Australians with arthritis increased with age.
Although there are more than 100 forms of arthritis, the three most common forms are osteoarthritis, rheumatoid arthritis and gout, which account for more than 95% of all diagnosed cases within Australia.
Even though arthritis is characterised by similar signs and symptoms, how arthritis develops can be very distinct. By looking at the three most common forms of arthritis (osteoarthritis, rheumatoid arthritis and gout), we can see that there is a clear distinction in how arthritis forms.
Within a healthy joint, cartilage can remodel and repair itself using cells known as chondroblasts and chondrocytes. Chondroblasts are the precursor cells to chondrocytes and are imbedded in developing cartilage where they are stored in spaces called lacunae. Once the chondroblasts are trapped within the lacunae they take on their role as chondrocytes, which play the key part in maintaining the cartilaginous matrix. However, as the chondrocytes are limited to their lacunae, they are unable to migrate to other areas of cartilage damage and as a result it has negative implications for cartilage/joint healing. This limitation, in conjunction with poor blood supply to joint cartilage, results in a very slow healing process due to slow cartilage formation.
Currently, it is not known exactly what triggers the initial phases of osteoarthritis development, but it is believed that chondrocyte dysfunction is one of the key factors. During the early stages of osteoarthritis, alterations occur within the composition of the joints’ cartilage which results in the cartilage having a reduced ability to retain water. Overtime this can result in dehydration in cartilage and eventually compromise the structural integrity, leaving the structure brittle and weak. Once this alteration to the cartilage’s composition occurs, the chondrocytes’ ability to maintain a healthy cartilage matrix is reduced as cartilage damage starts to occur faster than the cells can repair the matrix. For this reason, osteoarthritis is categorised by its progressive cartilage loss. Signs and symptoms may also progress as more cartilage is lost, due to an increase in bone on bone contact within the joint space.
Dissimilar to osteoarthritis, rheumatoid arthritis is an autoimmune condition which typically affects smaller joints and usually develops bilaterally. Although the exact cause of rheumatoid arthritis is not known, it is suspected that factors such as hormones, genetics and environmental factors may play an important role in triggering the initial immune response.
After the initial immune response occurs, antibodies and inflammatory cytokines cause inflammation to the joint capsule/s which leads to secondary issues. These secondary issues result in excessive synovial fluid (joint lubricant) retention as well as the development of fibrous scar tissue, known as pannus, within the joint space. The pannus can also cause further damage to underlying cartilage and bone, which may result in joint deformity and loss of function.
Gout is characterised as an acute recurrent inflammatory form of arthritis which is caused by excessive levels of circulating uric acid (hyperuricemia). Currently, uric acid is not believed to serve any known physiological purpose and is simply a by-product of purine metabolism. The known contributors to hyperuricemia are a variety of lifestyle (particularly diet), genetic, and medical (conditions and medication) factors. Although uric acid has no known vital role within the body, elevated serum uric acid levels (>7 mg/dl) can result in the formation of monosodium urate crystals in joints, tendons and their surrounding tissue. The presence of these crystals may then trigger a localised immune response which results in joint inflammation, pain, redness and burning sensations.
Signs, Symptoms and Detection
Due to the vast scope of conditions that arthritis encompasses, there can be significant differences in the signs and symptoms experienced between individuals with arthritis. As mentioned previously, it is highly dependent upon the individual, cause and type of arthritis. However, if you are experiencing any of the following symptoms there is a chance that you may be suffering from arthritis.
- Joint inflammation / swelling
- Joint pain / tenderness / burning
- Redness localised around the affected joint
- Joint stiffness
- Decrease in joint range of motion / function
- Muscle aches
- Joint deformity
- Loss of apetite
If you suspect you may be suffering from arthritis, please consult your local physician regarding the matter. Your doctor may request you undergo a physical examination, X-ray and/or blood tests in order to determine if arthritis is present. Early detection can improve long-term symptom management and reduce arthritis progression.
Prevention and Management
Currently there is no cure for arthritis; however, there are a variety of pharmaceuticals which may assist with symptom management depending on the type of arthritis – please consult your doctor for further information. Additionally, there are a number of lifestyle changes you can implement to better manage arthritis:
- Exercise – Performing regular physical activity has been shown to improve joint mobility, muscular strength, posture and balance, as well as reducing joint pain, muscular soreness and fatigue. Individuals with arthritis should aim to complete at least 30minutes per day, 5-7days per week. Low-impact exercises (walking, swimming, strength training, pilates etc.), are recommended and they should not aggravate pain symptoms during or after completion. Consult your doctor or local exercise physiologist before commencing an exercise regime.
- Eat a healthy diet – Ensure you are eating plenty of fruits and vegetables. Low-fat and low-calorie meals are preferable. It is recommended that you consult a dietician if you are concerned about your dietary intake or if you would like to better manage your arthritis.
- Maintain a healthy weight – Maintaining a healthy weight is very important for improving arthritis management. Additional weight will place unwanted stress through joints and increase the severity of the symptoms being experienced.
- Avoid alcohol – Alcohol is recognised as a major contributor to certain forms of arthritis, particularly gout. Furthermore, the use of alcohol to manage pain may lead to further structural damage due to its numbing effect reducing awareness of abnormal joint function. It is also important to note that alcohol has a high caloric value and will negatively affect weight management.
- Avoid smoking – Toxins within tobacco have been linked with various forms of arthritis due to their ability to trigger immune system responses which may result in joint inflammation.
- Avoid high-impact activities – Avoid high-impact activities that will place unnecessary jarring/stress through the joints. It is important to remember that arthritis can affect the structural integrity of joint cartilage and therefore high-impact activities may be causing damage to the joint.
- Only take medication as directed by your doctor – Pharmaceutical drugs can play a very important role in managing arthritis symptoms and limiting the progression of the condition. Taking more or less than the recommended amount may result in adverse side-effects or hinder drug effectiveness. It is important that you only take medication prescribed to you and that you consult your physician if you have any concerns.
- Use dietary supplements – Fish oil and Omega-3a can help to manage the inflammatory response.