ARTHRITIS

Arthritis is a broad term used to describe disorders that cause inflammation of the joints, leading to symptoms such as pain, swelling, stiffness, and redness. Arthritis encompasses over 100 types of joint inflammation, each with distinct causes and characteristics.

ARTHRO – Joint

ITIS – Inflammation 

TYPES OF ARTHRITIS

  • Infectious or septic arthritis: This occurs due to an infection in the joint, often caused by bacteria, leading to severe pain and swelling.
  • Crystalline arthritis: This type of arthritis is caused by the accumulation of crystals in the joint, leading to sudden, severe pain and swelling. 
  • Gout- deposition of Uric acid crystals in the joint
  • Pseudogout- deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the joint
Crystalline arthritis

Autoimmune inflammatory arthritis:

This broad category can be further divided into several sub-categories. 

 

  • Rheumatoid arthritis – seropositive or seronegative arthritis.
  • Juvenile idiopathic arthritis- It is an umbrella term for arthritis of unknown origin, lasting for more than 6 weeks with onset before 16 years of age.
  • Seronegative spondyloarthritis – This family of HLA-B27-associated arthropathies includes psoriatic arthritis, ankylosing spondylitis, reactive arthritis, arthritis associated with inflammatory bowel disease, and non-radiographic spondyloarthritis.
  • SAPHO syndrome – which involves synovitis, acne, pustulosis, hyperostosis, and osteitis.
 

Degenerative arthritis : 

  • Osteoarthritis: It was known as the “wear and tear of the cartilage”, generally associated with aging. But now, it is a disease of the entire joint, including bone, cartilage, ligaments, fat, and the synovial membrane. Osteoarthritis can degrade cartilage, change bone shape, and cause inflammation, resulting in pain, stiffness, and loss of mobility.

ARTHRITIS – SYMPTOMS AND SIGNS: 

INTRA-ARTICULAR SIGNS AND SYMPTOMS

Joint Inflammation and Damage

 

It is characterized by persistent joint inflammation, leading to joint damage and loss of function. This inflammation is the primary pathological hallmark of the disease, resulting in symptoms such as pain, swelling, redness, and stiffness in the affected joints.

 

Disease Activity and Severity

 

The severity of joint disease is often correlated with the presence of extra-articular features. Patients with more severe articular inflammation tend to have higher disease activity scores, which can be indicative of more aggressive disease progression.

EXTRA-ARTICULAR SIGNS AND SYMPTOMS

Anjusha et al. (2020) reported that Common Extra-articular manifestations include rheumatoid nodules, secondary Sjögren’s syndrome, pulmonary manifestations, and Raynaud’s phenomenon. These manifestations are associated with more severe disease and increased mortality.

 

Systemic Involvement

Arthritis can affect multiple organ systems, including the skin, eyes, heart, lungs, kidneys, and nervous system. Pulmonary involvement, such as interstitial lung disease, is particularly common, affecting 30-40% of patients.

Figus et al. (2021) reported that Cardiovascular disease is another significant concern, with Rheumatoid Arthritis patients having an increased risk of myocardial infarction and cardiovascular mortality. 

1. Osteoarthritis (OA)

Typically develops after age 40 and becomes more common with aging. The Global Burden of Disease (2019) reported that OA incidence rises sharply in people over 50, particularly affecting weight-bearing joints like the knees and hips.

 

2. Rheumatoid Arthritis (RA)

It can develop at any age, but commonly starts between 30 and 50 years of age. Symmons et al. (2002) found that RA most often develops in the 4th and 5th decades of life, with a higher prevalence in women.

 

3. Juvenile Idiopathic Arthritis (JIA)

Diagnosed in children under 16 years old. Prakken et al. (2018) stated that JIA affects 1 in 1,000 children, with symptoms starting as early as infancy.

 

4. Psoriatic Arthritis (PsA)

It often develops between 30 and 50 years old, but can occur earlier. Gladman et al.. (2005) found that 85% of PsA cases occur in people with psoriasis, and the average onset is around 40 years.

RISK FACTORS OF ARTHRITIS

1. Genetic Factors

  • Family history – Having a first-degree relative with inflammatory arthritis increases the risk.
  • HLA genes – Certain human leukocyte antigen (HLA) genes, like HLA-DR4 and HLA-DR1, are associated with RA, while HLA-B27 is linked to Ankylosing Spondylosis.
  • Gene mutations – Variants in genes related to immune system function (e.g., PTPN22, STAT4) increase susceptibility.

2. Environmental Triggers

  • Smoking – Strongly linked to Rheumatoid Arthritis, as it increases citrullinated protein antibodies (ACPA).
  • Infections – Some infections (e.g., Epstein-Barr virus, gut microbiota changes) may trigger immune system dysregulation.
  • Air pollution – Long-term exposure to pollutants may increase systemic inflammation.
  • Diet – High consumption of processed foods, red meat, and sugar can contribute to inflammation, while Mediterranean diets (rich in omega-3s) may be protective.
  • Obesity – Increased body weight puts mechanical stress on joints and contributes to systemic inflammation, increasing the risk of RA and PsA. 

HOW TO DIAGNOSE ARTHRITIS?

Inflammatory Markers in Blood:

  • Elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and anti-cyclic citrullinated protein (Anti CCP) are common in all inflammatory arthropathies.

Synovial Fluid Analysis:

  • Aspiration of the synovial fluid and detailed analysis are critical in the evaluation of inflammatory arthritis.
  • Septic arthritis and crystalline arthropathies usually have neutrophilic predominance, while rheumatoid arthritis usually has lymphocytic predominance in the synovial fluid. 

Imaging : 

  • Plain radiographs may be initially normal in early inflammatory arthritis or may show periarticular osteopenia. As the disease progresses, periarticular erosions can be seen in inflammatory arthritis such as rheumatoid arthritis.
  • In X-Ray, early axial spondyloarthropathies are normal but can show bamboo spine and sacroiliac joint fusion and erosions later in the disease process.
  • MRI can be a beneficial tool, especially if radiographs are nondiagnostic. MRI is more sensitive than plain film in evaluating synovitis, erosions, and sacroiliitis, with a much higher sensitivity than X-rays.

HOW TO PREVENT ARTHRITIS?

While genetic predisposition cannot be changed, modifying environmental factors like smoking, diet, and physical activity significantly reduces arthritis risk. Encouraging a healthy lifestyle early can prevent or delay the onset of inflammatory arthritis.

Lifestyle Modifications (for environmental Triggers)

Quit Smoking

  • Smoking is one of the strongest modifiable risk factors. Quitting can significantly lower inflammation and reduce the production of autoantibodies like citrullinated protein antibodies (ACPA).

Prevent Infections

  • Maintain good hygiene, wash hands frequently, and get recommended vaccines (e.g., flu, pneumococcal, COVID-19) to prevent infections that may trigger immune system dysfunction.

Adopt an Anti-Inflammatory Diet

  • Increase: Whole foods, vegetables, fruits, nuts, seeds, fish, and olive oil (Mediterranean diet).
  • Reduce: Processed foods, red meats, sugar, and trans fats that contribute to inflammation.
  • Hydration & Supplements: Stay hydrated and consider vitamin D and omega-3 supplements if needed.

Maintain a Healthy Weight

  • Obesity increases systemic inflammation and joint stress
  • Regular low-impact exercises (walking, swimming) help in weight management and improve joint function.
  • Strength training maintains muscle mass and joint stability, reducing arthritis progression.

WHAT TO EAT?

To support joint health, opt for anti-inflammatory vegetables:

  • Leafy greens (kale, broccoli, bok choy)
  • Cruciferous vegetables (Brussels sprouts, cauliflower, cabbage)
  • Carrots, sweet potatoes (rich in beta-carotene)
  • Garlic and onions (contain sulfur compounds that reduce inflammation)

TREATMENTS FOR ARTHRITIS:

Inflammation is generally reversible, but the joint destruction is irreversible. Early and appropriate treatment may prevent disease persistence/progression, joint damage, and disability. 

A multidisciplinary approach involving education, exercise, diet, and lifestyle modifications improves outcomes. 

Of all the types, Septic arthritis requires urgent diagnosis and treatment to prevent joint destruction and life-threatening complications like sepsis. 

Possible Treatment Approaches: 

Medications: 

Anti-inflammatory and anti-rheumatoid drugs like NSAIDs, DMARDs, and corticosteroid injections can reduce the inflammation. 

Physiotherapy: 

Physiotherapy approaches can help in improving strength and range of motion, preventing muscle atrophy, maintaining or preserving functional independence, and improving confidence to move forward and manage Arthritis. 

It plays a crucial role in managing symptoms, improving function, and enhancing quality of life.

  • Studies suggest early physiotherapy interventions can enhance joint mobility and prevent complications post-infection (Mathews et al., 2010) in septic arthritis.
  • A systematic review (Zhang et al., 2011) highlights exercise as a key strategy for improving joint function and reducing recurrence in crystalline arthritis.
  • A Cochrane review (Hurkmans et al., 2009) supports the use of exercise therapy in improving physical function and reducing pain in Rheumatoid Arthritis (RA) patients.
  • A study by Klepper (2011) indicates that physical activity enhances function and reduces disability in children with Juvenile Idiopathic Arthritis  (JIA).
  • A meta-analysis (Dagfinrud et al., 2008) found physiotherapy interventions effective in improving function and quality of life in Seronegative Spondyloarthritis patients.

Surgery for arthritis: 

When the conservative treatments don’t work and the arthritic joint damage is severe, surgery can be an option. 

The most commonly done surgeries for severe arthritis are: 

  • Joint fusion (arthrodesis) ]
  • Joint replacement (Arthroplasty)
  • Joint fusion surgery (arthrodesis): a surgical procedure that permanently fuses two or more bones in a joint, eliminating movement to reduce pain and provide stability.  
  • Joint replacement surgery (Arthroplasty): a surgical procedure where a damaged arthritic joint is replaced with an artificial implant (prosthesis) to restore function and relieve pain. It is commonly used for osteoarthritis and rheumatoid arthritis. It can be a partial or complete joint replacement depending upon the severity of damage and the patient’s needs.