Arthritis
What is arthritis?
Arthritis is a condition that causes pain, stiffness and swelling in the joints. Arthritis is commonly caused by inflammation in the lining of the joints, which in addition to pain, may result in redness, heat, swelling and loss of movement in the affected joints. Over time, joints affected by arthritis may become severely damaged. There are different types of arthritis, and depending on the cause, may affect people of different ages. Some types of arthritis may cause to damage to other organs of the body in addition to the joints.
Who is at risk for developing arthritis?
Osteoarthritis occurs more frequently in older individuals, however, it sometimes develops in athletes from overuse of a joint or after an injury. Rheumatoid arthritis is more common in women than men and it usually develops in individuals over the age of 40.
What causes arthritis?
The symptoms of arthritis are commonly caused by damage to the joint, which typically develops from injury or overuse. The actual cause of an individual case of arthritis depends on the type of the disease, and maybe a result of excessive wear-and-tear or an immune system disorder that causes the body to attack its own joints.
What are the most common types of arthritis?
Types of arthritis include:
Osteoarthritis
Osteoarthritis is the most common form of arthritis. It develops as the cartilage protecting the bones of a joint wears down over time. It occurs more frequently in older individuals, however it sometimes develops in athletes from overuse of a joint or after an injury. It commonly affects the fingers, knees, lower back and hips and is often treated with medication and certain forms of exercise and physical therapy.
Rheumatoid Arthritis
Rheumatoid arthritis is considered an autoimmune disorder caused by the body attacking its own healthy tissue. Rheumatoid arthritis affects the lining of the joints, and in addition to joint pain and inflammation, it sometimes affects other organs of the body including the skin, eyes, heart, lungs and blood vessels. Rheumatoid arthritis is more common in women than men and it usually develops in individuals over the age of 40.
Gout
Gout is a form of arthritis that cause painful, swollen, red and inflamed joints. Gout is called by a build-up of uric acid within the body that forms crystals within the joints and surrounding tissues. This build-up of crystals causes acute pain and swelling that commonly affects the joint of big toe, but can also occur in the feet, ankle, knees and hands. The symptoms of gout often appear suddenly and without warning, often in the middle of the night.
Psoriatic Arthritis
Psoriatic Arthritis is a type of arthritis that affects people who have psoriasis, a skin condition characterized by red and scaly patches of skin. Psoriatic arthritis is considered an autoimmune disorder and causes joint inflammation, stiffness and pain that may affect the fingers, toes, feet and lower back.
What are the symptoms associated with arthritis?
The most common symptoms associated with arthritis include pain, swelling and stiffness of the affected joint. However, some patients may also experience fever, fatigue, and dry eyes and mouth, depending on which type of arthritis they have.
How is arthritis diagnosed?
Diagnosing arthritis depends on the type of disease, but usually involves diagnostic tests and imaging exams to evaluate the affected areas of the body. Tests to diagnose arthritis often include blood, urine and joint fluid tests, along with X-rays or MRI imaging exams. A doctor may also use arthroscopy to assess damage within the actual joint.
How can arthritis be treated?
Treatment for arthritis may include medication to control pain, minimize inflammation and slow the progression of joint damage. Exercise and physical therapy may also be effective at keeping joints flexible. In severe cases, surgery may be recommended to repair tendons or replace damaged joints. In addition to medical treatment, some forms of arthritis may respond to lifestyle changes such as losing weight, eating a healthy diet and exercise. Heat and cold therapy may also relieve pain and swelling in joints and assistive devices such as canes or walkers may assist individuals with arthritis with mobility.
Disk Herniations
A herniated disc (also called a ruptured or slipped disc) is a damaged "cushion" between two bones in the spine (vertebrae). Normally, the gelatinous discs between the vertebrae hold the bones in place and act as shock absorbers, permitting the spine to bend smoothly. When a disc protrudes beyond its normal parameters, and its tough outer layer of cartilage cracks, the disc is considered "herniated."
When a disc bulges through torn cartilage, it can press on a nerve in the spinal canal. This results in back pain; if pain extends to the buttocks and travels down the affected leg, it is called "sciatic" pain. Herniated discs occur most frequently in the lumbar (lower) region of the back, and are one of the most common causes of back pain. Cervical (neck) discs also herniate, resulting in pain in the neck and shoulders.
Causes of a Herniated Disc
During the normal process of aging, the discs in the back lose flexibility and wear down. Additional stress, whether from obesity, smoking, heavy lifting or sudden traumatic injury, can then cause herniation.
Symptoms of a Herniated Disc
In addition to pain emanating from the herniated area, patients can experience numbness, tingling, muscle spasms or weakness. The pain that results from a herniated disc is usually worsened by moving, and improved by rest. Sudden motions, such as bending or coughing, can elicit sharp, shooting pain.
Diagnosis of a Herniated Disc
In order to make a diagnosis, a patient's medical history is taken, and a determination made as to whether pain has been increasing gradually or was precipitated by a traumatic injury. A comprehensive physical exam, which includes a check of reflexes, sensation/numbness, posture and muscle strength, helps in assessing the situation. Usually, the patient is examined sitting, standing and walking.
In most cases, imaging tests are administered to provide a more precise visualization of the spine. They are used to determine whether there is a disc injury and, if there is one, to delineate its size and location. Tests include X-rays, MRI or CT scans, electromyograms (which measure nerve impulses), and myelograms (in which contrast dye highlights the affected region).
Treatment of a Herniated Disc
Conservative treatment for herniated discs usually begins with bed rest and taking anti-inflammatory and pain medications as needed. Applying hot or cold compresses, sometimes alternately, may be recommended. Muscle relaxants may be prescribed to diminish muscle spasms in the back. Sometimes, a course of physical therapy to stretch and strengthen back and abdominal muscles provide relief. Epidural injections of a corticosteroid may be administered to reduce nerve irritation and facilitate healing. For some patients, chiropractic care or some type of alternative medicine provides relief.
When the condition does not respond to these measures, and the patient is still experiencing pain, surgery may be necessary. This is true in approximately 10 percent of herniated disc cases. The type of procedure performed depends on where the herniated disc is located, and the severity of the damage. There are several surgical options. All of these operations are performed in the hospital under general anesthesia:
- Laminotomy
- Discectomy
- Arthroplasty
- Spinal fusion
During laminotomy, the protruding portion of the disc is excised, whereas, during discectomy, the entire disc is removed. During arthroplasty, the herniated disc is replaced with an artificial disc. In more severe cases of herniation, spinal fusion may be necessary. During this procedure, vertebrae are fused using a bone graft or metal rod.
Sacroiliac Joint Dysfunction
Sacroiliac joint dysfunction, also known as sacroiliitis, is the inflammation of one or both of the sacroiliac joints, the joints that link the pelvis and lower spine by connecting the sacrum to the iliac bones. Sacroiliac joint dysfunction may be caused by injury, pregnancy, osteoarthritis, degeneration of cartilage, or inflammatory joint disease. At times, a structural abnormality, such as legs of differing lengths or severe pronation, may put increased stress on the joint, resulting in this problem. Patients with sacroiliac joint dysfunction typically experience pain in the buttocks and lower back that worsens when running or standing. While a traumatic injury may cause this problem, it more often develops gradually over a long period.
The most common symptom of sacroiliac joint dysfunction is pain, either in one side of the lower back or in the hip. Pain usually increases when the patient bends, stands after a long period of sitting or reclining, or climbs stairs, and decreases when the patient lies down. Sacroiliac joint dysfunction is diagnosed through physical examination, during which the physician moves the patient's legs and hips into varying positions, and through imaging tests like X-rays or a CT scan. Anesthetic injections may also be used as a diagnostic tool.
Conservative treatment methods are usually sufficient to treat sacroiliac joint dysfunction. The most important of these, when acute pain is present, is rest. Patients are instructed to restrict activity, particularly activity that increases pain levels. Other techniques to reduce pain include application of ice for 20 to 30 minutes two to three times a day and intermittent application of heat to help loosen tight muscles. Massage, physical therapy, or chiropractic treatment may also be helpful. Over-the-counter pain medication is usually prescribed and sometimes corticosteroid injections are administered as well. Surgery is normally not considered to treat this condition.
Spinal Stenosis
Spinal stenosis is the narrowing in one or more areas of the spinal canal as a result of injury or deterioration of the discs, joints, or bones of the spine. Most cases of spinal stenosis develop as a result of the degenerative changes that occur during aging. Osteoarthritis is the main cause of spinal stenosis since this condition causes deterioration of the cartilage in the area that leads to the bones rubbing against each other. As bones make repeated abnormal contact, bone spurs form, narrowing the spinal canal.
Other causes of spinal stenosis are traumatic injury, herniated disc, ligament thickening, and, in rare cases, spinal tumors, any of which can damage the alignment of the vertebrae. A subtype of spinal stenosis is foraminal stenosis. This condition is caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through.
Symptoms of Spinal Stenosis
Patients with spinal stenosis may experience a number of troubling symptoms. These may include:
- Pain in the back, neck, shoulders or extremities
- Muscle cramping
- Loss of sensation in affected areas
- Loss of balance
- Bladder or bowel dysfunction
The loss of bladder or bowel control is a rare, but particularly distressing symptom, for which surgery is most often necessary.
Diagnosis of Spinal Stenosis
In order to diagnose spinal stenosis, a medical history and a physical examination are always necessary. The condition is often difficult to diagnose, not only because its symptoms may resemble the symptoms of other conditions, but because they may only occur intermittently. A diagnosis of spinal stenosis is usually achieved only after ruling out other disease conditions. Typically, imaging exams such as a spinal X-rays, MRI, CT or bone scans are administered to definitively diagnose the condition and to pinpoint the spinal region affected. An electromyography (EMG) may also be administered to measure electrical impulses in the affected skeletal muscles.
Treatment of Spinal Stenosis
Effective treatment for myofascial pain usually involves a combination of approaches. Patients may benefit from physical therapy exercises, including stretching and massage, to relieve tension in the affected area. Another possible remedy is trigger-point injection, which involves inserting a needle into the affected muscle to relieve the tension causing the trigger point. Anti-inflammatories and anti-depressants may temporarily relieve symptoms, and help patients to sleep better.
