Arthritis, or rheumatism as it is often called by the lay public, means many things to different people. Essentially, it is inflammation in a joint or many joints resulting in pain, stiffness and swelling. It can be the result of many causes and is not a single, straightforward condition. It may affect one joint or many joints simultaneously in the body. It may merely produce a temporary mild discomfort or a severe pain that gets worse over a period of time resulting in disability or deformity.
So common is arthritis that up to 2 5 per cent of all consultations with family doctors are made up of discussions revolving around a patient’s rheumatological complaints. There has been a huge increase in the awareness of generalized conditions that can affect the onset and progression of rheumatic diseases, and at the same time there has been a huge rise in the number and complexity of diagnostic and therapeutic procedures that may be used to treat these conditions. Unfortunately, increasingly sophisticated and accurate technology has not always been matched by improvements in sympathetic attitudes or practical help from doctors.
Much research continues into finding stronger and more powerful drugs to combat arthritis, all of which can produce serious side effects, but little thought has been given to the underlying causes. Even the commonest drugs that are used in treatment rectify the symptoms rather than the underlying problem. Yet rheumatoid arthritis, for example, is a relatively modern disease. As an ailment resulting in sometimes gross and very obvious joint deformity, it has never been found in the skeletons of Egyptian mummies and it has not been depicted in the paintings of the Great Masters during the Renaissance period. In fact, typical rheumatoid arthritis only began to emerge at the beginning of the twentieth century. This suggests that some new environmental factor may have arisen which stimulated its outbreak at that time. This may have been a micro-organism, but equally it could have been due to our changing diet or new substances around us in our immediate environment. Since so little is known about the underlying causes of the various forms of arthritis, orthodox doctors should be less dismissive of much of the useful work being carried out to explore some of the newer and more controversial treatments.
There are many different types of arthritis, but of all those seen in general and hospital practice the following are among the most common.
This is the result of injury to a joint. It is therefore as common in the elderly who stumble and fall as it is in younger patients pursuing various sports as a leisure activity. A joint may be sprained resulting in damage to the ligaments around it, or the capsule which binds it; it may be dislocated, where the articular bone ends are disrupted from their normal position so that they cannot function properly; or there may even be a fracture through the joint resulting in bleeding into the joint space and the likelihood of secondary arthritis in later years.
Generally known as degenerative or ‘wear and tear’ arthritis, this type of arthritis is extremely common in older people or in those who have had operations on, or severe injury to, their joints. Other factors such as metabolic diseases or infections may be responsible, and certainly there is a large genetic component which may make some families more vulnerable to it.
This is the most severe kind of inflammatory arthritis and is the result of an autoimmune disorder. Here, the immune system for some reason recognizes the joints as foreign in some way, and produces antibodies which work against the joints, damaging them and their surrounding soft tissue. Beginning in early middle age, mainly in women, the smaller joints of the wrists, ankles, hands and shoulders become extremely painful, swollen and stiff. The disorder may come and go in lapses and remissions, but more often than not, it is gradually progressive, resulting in some degree of disability and restriction of movement.
This is a form of rheumatoid arthritis occurring in children mainly under the age of 4. It is otherwise known as juvenile rheumatoid arthritis. Although this generally settles down after a number of years (unlike adult rheumatoid arthritis), it can still leave a child with stunted growth and irreversible joint deformities which can threaten their quality of life.
When bacteria find their way into the joint from an infected wound or the bloodstream, a septic or ineffective arthritis is produced. Generally the joints will be red and hot as well as swollen and painful. This type of arthritis may be the result of viral infections such as rubella and chickenpox, but can also be associated with rheumatic fever and some sexually transmitted diseases such as non-specific urethritis and gonorrhea.
This disorder occurs due to a build-up of uric acid in the blood. This is one of the body’s waste products and when it accumulates in the joints, it forms tiny crystals which mechanically irritate the sensitive lining of the joint producing intense pain, swelling and redness. Usually it only affects one joint at a time, in particular the large joint at the base of the big toe.