Medical student Michela Galea takes a look at the most common forms of arthritis and pinpoints measures that can be taken in order to relieve the symptoms, improve joint function and manage the condition.

Arthritis is characterised by a long-term or recurring inflammation of one or more joints. There are more than 100 types of arthritis, the commonest being osteoarthritis, rheumatoid arthritis and gout.

Although symptoms may vary with the type of arthritis, the main symptoms associated with this condition include pain, stiffness, swelling, redness, tenderness and decreased range of motion. It can occur at any age but it is more common in older adults.

The condition is linked to a number of risk factors such as family history, increased age, female gender, obesity and work factors that include repetitive movements.

Severe arthritis is also related to certain complications for instance, the inability to perform daily tasks, walking comfortably and sitting up straight. In the long term, joints become deformed.

Osteoarthritis

Osteoarthritis usually develops in individuals who are older than 50 years. Nevertheless, it can occur at any age following an injury or a joint-related condition. In such a degenerative disease, the cartilage, that is important in providing a cushioning effect between the bones, starts to wear away.

As a result, there is friction between the bones whenever there is movement of that particular joint, hence causing pain. Consequently, there is the formation of bony spurs called osteophytes and swelling of the joint due to an increased production of synovial fluid by the synovial membrane (the inner layer of the joint capsule).

The joints that are most commonly affected are the knees and hips. Less commonly affected joints are those of the hands and the back. It is also interesting to note that while in Malta knee osteoarthritis is four times more common than hip osteoarthritis, in the rest of Europe on average, hip osteoarthritis is three times more common than knee osteoarthritis.

Rheumatoid arthritis

On the other hand, rheumatoid arthritis is an autoimmune disease whereby the immune system produces antibodies that target its own tissues, thus causing chronic inflammation and swelling of the synovial membrane. Since it is a progressive condition, it can lead to permanent damage of cartilage, bones and ligaments.

Rheumatoid arthritis patients typically present with symmetrical bilateral inflammation of the small joints of the hand, wrists or feet but such a condition may also present with complications in other areas of the body such as the lungs, kidneys and eyes. Flare-ups may be triggered between asymptomatic periods by stress, infection and fatigue among other factors.

The cause of rheumatoid arthritis is still not wholly understood. Nonetheless, some theories suggest that genetics may play a role. Smoking and infections by viruses and bacteria have also been considered.

In addition, females are three times more likely to suffer from rheumatoid arthritis when compared to males.

Gout

Gout is characterised by a severe, sudden onset of pain, swelling and redness in the joint, most often that of the big toe. Even though the symptoms of a gout attack last for three to 10 days, further attacks occur in the life of the individual. This condition is caused by the accumulation of uric acid crystals in the joints, either due to an excessive production or insufficient excretion of uric acid from the body via the kidneys.

Uric acid is a breakdown product of purines, which are found in high concentrations in certain food substances such as liver, bacon, beef, sardines and anchovies. Hence, a diet rich in purines should be avoided since it increases the risk of suffering from gout.

Despite the fact that there is currently no medical cure for arthritis, measures can still be taken in order to relieve the symptoms, improve joint function and control the condition.

It is of utmost importance that lifestyle changes are adopted. Losing weight if one is obese is essential so as to reduce the pressure and stress on the joints. Moreover, a balanced, varied diet should be consumed and regular exercise such as aerobics or swimming should be carried out in order to maintain joint flexibility. Physical therapy is also beneficial since it aids in strengthening the muscles around the weakened joints and increases the range of movement possible.

In order to alleviate the pain and swelling, medications like non-steroidal anti-inflammatory drugs and analgesics can be administered.

In severe arthritic conditions, surgery is recommended. Such surgical procedures include arthroplasty i.e. the replacement of the worn out joint by an artificial one, joint fusion whereby the joint is removed completely and the bones are held together with plates, pins or screws, and osteotomy, which involves the cutting and removing of a section of the bone to improve joint alignment and weight bearing.

Managing the condition

Healthy living

Living with the pain and challenges of Rheumatoid and Musculoskeletal Disease (RMD) can sometimes have a profound psychological, as well as physical, impact on everyday life. It’s just as important to consider you emotional well-being, as it is your physical well-being.

Self-managing RMD can have a positive impact on both aspects. Alongside support from healthcare professionals, local patient groups and organisations, one can take action to help manage RMD, especially by opting for healthy lifestyle choices that include not smoking, avoiding stress, getting adequate sleep and reducing alcohol intake.

Eating a healthy and balanced diet is important for people with RMD. Some foods can react with medications. Doctors or nurses give their advice but one should also always read the product information leaflet before taking any medication. If one has any specific dietary concerns, talk to a doctor or a medically-qualified dietician or nutritionist.

Physical activity and fitness

Being physically active can have specific benefits for RMD sufferers. The most appropriate form of activity will depend on a number of factors, including the type of condition you have, which joints and muscles are affected and the level of joint and muscle damage. Therefore, it is important to consult your doctor or physiotherapist about the type of exercise most appropriate for your condition. One can try cycling, swimming, yoga or tai-chi for example.

For more information, visit www.worldarthritisday.org