Arthritis Articles

Arthritis can largely be divided into 2 main categories and depending which category a specific arthritis falls into, largely determines the type of treatment that is used to control the symptoms.

The 2 main categories are, inflammatory and degenerative.

Degenerative arthritis

Degenerative arthritis (or osteoarthritis) is predominantly due to ‘wear and tear’ and is an unfortunate fact of life in the ageing process. It typically affects the larger joints (knees, hips, shoulders, elbows) but can also affect specific joints related to that individual’s work or sport interests ( for example thumbs in secretaries and typists, and cervical spine in rugby players and surfers).

In osteoarthritis it is usually the bones and cartilage that are affected in the joints.

Typical features are:

• loss of protective cartilage
• degeneration of the articular surfaces
• loss of joint space
• calcification of tendons
• development of osteophytes (new spurs of bone being formed)
• bone cysts developing just below the articular surfaces

Excess synovial fluid, in response to trauma (because the joint is more unstable) causes swelling in the joint and a low grade inflammation affects the surrounding tissues. The whole joint becomes painful and stiff.

Athletes and people who have had sports injuries are much more likely to develop osteoarthritis of the affected joint

Blood tests for inflammation are all typically negative.

Inflammatory arthritis

Inflammatory arthritis is quite different and is seen in conditions such as rheumatoid arthritis, the arthritis seen in some patients with psoriasis, ankylosing spondylitis and some of the rarer autoimmune conditions such as mixed connective tissue disease.

Inflammation of the supporting structures around the joint is the predominant feature and in particular the synovium, with the joints being warm, swollen and painful. Typical features include;

• involvement of the smaller joints (such as in the hands, feet and wrists) although larger joints can be affected too
• cervical spine involvement in rheumatoid arthritis is fairly common but can be serious due to instability of the cervical vertebrae with risk of damaging the spinal cord
• morning stiffness of the affected joints is typical

As the inflammatory condition progresses, erosions are seen in the bones with thinning of the cartilage and damage of the surrounding supporting structures making the joints unstable and partial dislocation (or subluxation) of the joint is common, causing the classic appearances seen in the hands of rheumatoid sufferers.

With inflammatory arthritis, inflammation markers are usually elevated, there is a low grade anaemia and special tests for immune disease (such as rheumatoid factor and ANA) are often positive.