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by Dr Umang Khanna (BHMS)
Arthritis isn’t a single disease; the term refers to joint pain or joint disease, and there are more than 100 types of arthritis and related conditions. People of all ages, races and sexes live with arthritis, and it is the leading cause of disability in the U.S. It’s most common among women, and although it’s not a disease of aging, some types of arthritis occur in older people more than younger people. Common arthritis symptoms include swelling, pain, stiffness and diminished range of motion in joints. Symptoms vary from mild to severe and may come and go. Some may stay about the same for years, but symptoms can also progress and get worse over time. Severe arthritis can result in chronic pain, difficulty performing daily activities and make walking and climbing stairs painful and grueling. Arthritis can also cause permanent joint changes. These may be visible, such as knobby finger joints, but often the damage can be seen only on X-rays. Some types of arthritis affect the heart, eyes, lungs, kidneys and skin as well as the joints.
Is the most common type of arthritis. It can damage almost any joint but mainly occurs in the hands, spine, hips and knees. OA was once considered a wear-and-tear disease in which cartilage — the protective layer on the ends of bones — wore down after years of use. But with further research, the thinking about OA has changed. Doctors now know that OA is a disease of the whole joint, not just cartilage. Bones in affected joints become weaker, the connective tissue that holds the joint together deteriorates and inflammation damages the joint lining. Contrary to decades of belief, inflammation plays a key role in OA, just as it does in most other types of arthritis.
A healthy immune system is protective. It generates inflammation to clear infections and heal injuries. But in inflammatory arthritis, the immune system is overactive, attacking healthy tissue, including joints in the spine, hands and feet. In some people, inflammation becomes systemic, damaging the eyes, skin, heart and other organs. Many, but not all types of inflammatory arthritis are considered autoimmune diseases because the immune system loses the ability to distinguish self from not-self and attacks the body it’s supposed to protect.
Rheumatoid arthritis (RA) is the most common form of autoimmune inflammatory arthritis. Psoriatic arthritis (PsA) axial spondyloarthritis (axSpA), gout and juvenile arthritis are less common and can be more challenging to diagnose.
A bacterial, viral or fungal infection triggers infectious arthritis. It usually starts when an infection from another part of the body travels to a joint, usually the knee. Symptoms like swelling, pain and fever can be sudden and intense, but treatment with antibiotics or antifungals usually clears the infection pretty quickly. Most viral infections last a week or two and go away on their own. Some people with infectious arthritis may need to have their joint fluid drained to remove infected synovial fluid, reduce pain and inflammation and prevent joint damage.
Metabolic or gouty arthritis — commonly known as gout — results from a buildup in joints of painful uric acid crystals. These are a byproduct of the breakdown of purines — substances normally found in human cells and many foods, especially red meat, organ meats, some seafoods and alcohol. Normally the body gets rid of excess uric acid, but when it doesn’t, it can accumulate in joints, causing sudden and intense bouts of pain, especially the big toe.
However, most people with high uric acid levels never develop gout and many gout patients have normal uric acid. Some research suggests that certain factors in addition to uric acid might trigger gout. Possible culprits include damage from OA, disruptions in the microbiome and even white blood cells in the fluid inside joints.
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