Osteoarthritis is a degenerative arthritis, a condition in which joint cartilage degenerates or breaks down. New tissue, which grows at the ends of bones, now has no cartilage cap to control it. Instead, this new bone forms into strange lips and spurs that grind and grate and get in the way of movement of the joint. Osteoarthritis is common in older people after years of wear-and-tear that thin the cartilage and the bones. Osteoarthritis can also result from diseases in which there is softening of the bone, like Paget’s disease in which the long bones of the body curve like a bow, or osteoporosis with its bowing of the shoulder called “dowager’s hump,” or other bone degeneration. Other forms of arthritis can also cause a secondary osteoarthritis. Osteoarthritis is not an inevitable problem of aging. Those who don’t suffer from it may have their heredity and possibly the strength of their immune systems to thank. Medical science is not quite sure of all the factors that come into play in deciding who gets osteoarthritis and who doesn’t.
Rheumatoid arthritis is an inflammatory arthritis. It is second only to osteoarthritis in the number of its victims. It affects primarily the small joints in the hands and feet and the synovium, causing crippling deformities. This is an arthritis that usually starts in middle age or earlier. Estimates of the incidence of rheumatoid arthritis run as high as one person in every hundred, and females are two to three times as likely to suffer from it. It seems to start more in the winter and after some siege of sickness, but it is not considered an infective arthritis. Nobody knows what causes rheumatoid arthritis. There may be some hereditary trait, and there seems to be some connection to viral infections like German measles and serum hepatitis, the liver disease brought on by an injection of one kind or another. Because of this, scientists theorize that rheumatoid arthritis may be an autoimmune disease, one in which the body acts as though it were allergic to itself. The immune system gets mixed up and attacks normal joint tissue instead of the stuff it is supposed to attack.
Polyarteritis Nodosa is also an inflammatory arthritis, fortunately it is a rare form of arthritis. It can lead to complications that are dangerous to life. It affects four times as many males as females, mostly young adults. There is joint and muscle pain, ulcers or sores on the legs and gangrene of the fingers and toes because of interrupted blood supply to those parts. The organs of the body are almost all involved, producing symptoms like sudden blindness, hemiplegia, and heart disease. Aggressive treatment prevents death, which at one time resulted within five years. Miraculously, some cases simply get better for no apparent reasons, called spontaneous remission.
Ankylosing Spondylitis is an inflammatory arthritis of the spine which causes ankylosing or fusing of the vertebrae. It is more common in young men that women, and more common in the population than is generally realized. Statistics show that this condition may affect as many as one in every one hundred persons. There is an Indian tribe in Vancouver, in which over 6 percent of the population suffers from ankylosing spondylitis, and this and other statistics show that there is a strong hereditary element. Ankylosing starts in the lower part of the spine and causes a mild stoop at first. As the vertebrae ankylose further up the spine, the stoop gets more pronounced. If the ankylosis reaches the cervical vertebrae, the head bows and the body makes a C. Now the victim of ankylosing spondylitis can only look downward and within the field of eye movements. This constricted field increases the awkwardness of the person’s manner of walking. Despite this disability, function is usually good except for fatigue. Sometimes the heart, stomach, and kidneys can be affected by abnormal posture.
Still’s disease is the other kind of inflammatory arthritis. It is often called juvenile rheumatoid arthritis. It is not a young form of rheumatoid arthritis, but it is an inflammatory arthritis of juveniles. Still’s disease is a rare disease that can affect children to the age of 16, affecting the growth of the limbs so that normal length in one or both legs may not be achieved. It also can cause eye disease and even blindness. Although usually classified as an inflammatory arthritis, Still’s disease may also be considered an infective arthritis because it is usually secondary to infections like leukemia, rheumatic fever, sickle cell anemia, and other diseases. Osteoarthritis of the spine is called Spondylosis. The joints degenerate and the weight of the body is supported incorrectly.
Bacterial infective arthritis is an infective arthritis. A deep wound that penetrates a joint is a direct source of bacterial infection. But usually the infection is elsewhere, in a cut or abscessed teeth or boils, in a sickness caused by Staphylococcus, Streptococcus, or Proteus bacteria. The arthritis these cause is accompanied by high fever and chills. Gonorrhea, a sexually transmitted disease, can cause arthritis, Gonorrheal arthritis generally attacks only one or two joints but makes patients very sick, with a lot of pain, fever, and skin sores. Syphilis, a venereal disease that can progress through three stages of disability, often shows arthritis in the second and third stages.
Virus infections like rubella, mumps, some flu, and some upper-respiratory infections may sometimes bring on a temporary bout of arthritis or inflammation of the synovium. Viral hepatitis can also cause arthralgia, pain in the joints that is like arthritis. Only rarely dos a true arthritis result from viral hepatitis.
Viral infective arthritis is an infective arthritis. Some fungal infections can cause arthritis, but it is very rare because fungi do not seem to attack the skeletal system to any degree. When they do, other systems are also involved. The primary cause of fungal infective arthritis is the long-term antibiotic therapy used to combat the fungus.
Gout is a metabolic arthritis that for some reason has always been laughed at, by every body but those who have it. Many is the old movie, like Little Lord Fauntleroy, that derides some crotchety old man with his heavily bandaged and protected foot propped up on a gout stool wielding his cane at anyone coming anywhere near him. And well he might, for that foot has a big toe with a giant pain that is exquisitely sensitive to touch. We know that gout attacks other joints than the big toe, in particular the knee and the thumb. One of the end products of the metabolism of certain foods is uric acid, found normally in urine. Excessive uric acid stays in the bloodstream and crystallizes around the joints. These irritating chemical crystals cause gout, which is sometimes called crystal arthritis. They can also form kidney stones.
Psoriatic arthritis is a metabolic arthritis that is a common, inherited disease of the skin, a chronic condition that seems to be made worse by stress. Lesions of psoriasis may involve only a small area of the skin or, in its worst form, cover the entire body. When the skin is broken down over very large portions of the body, the internal temperature is affected, often resulting in high fevers, and the protection of the skin gives against invading infections is lost. For some unknown reason psoriasis is accompanied by its own form of arthritis. When the psoriasis gets worse, so does the arthritis, unless the joint has suffered too much damage. The hands particularly can be very disabled.
Enteropathic arthritis is an arthritis that is associated with intestinal diseases. It affects the large joints of the lower limbs, then gradually disappears. Post-enteric arthritis is really an infective arthritis, but it is classified here with its relative. This arthritis starts after a gastrointestinal infection, particularly one caused by the bacteria Salmonella.
Allergy causing substances can cause an arthritis is a relatively new and not widely accepted concept. Serum sickness, the hypersensitivity to drugs, can also cause an allergic arthritis.
Treatment for arthritis depends on the symptoms and varies with the physician, who may be a rhematologist, an orthopedist, a physiatrist, or a general practitioner. But there are some specifics. Surgery can be performed on vertebrae to relieve the exaggerated stoop of spondylitis or to remove the bone growth pressing on nerves in spondylosis. An arthritic knee or hip joint can be replaced with an artificial joint that works amazingly well, particularly in the hip, and relieves limping and pain. Bunions can be surgically removed, ligaments repaired, offending bony growths or calcifications removed. Of course, not everyone can undergo the trauma of surgery. The elderly, the overweight, the diabetic, the patient with heart or lung disease face more danger from surgery than from arthritis. And not many arthritic conditions benefit from surgery. Anti-inflammatory substances are administered when the joints show inflammation. Corticosteroids, substances derived from hormones produced in the outer layer of the adrenal gland, are often used to reduce inflammation. Direct injection into an inflamed bursa or joint or synovial tissue helps relieve pain in traumatic arthritis and the acute stages of the inflammatory arthritides. But the side effects of steroids on their organs of the body limit their use. In children, steroids can stunt growth. Other anti-inflammatory agents are drugs like ibuprofen, indomethacin, and gold. Instead of trying to turn salt into gold, today’s alchemists turn gold into a salt form and use it as an anti-inflammatory agent in early rheumatoid arthritis and some cases of lupus and osteoarthritis. The first consideration in every arthritis is to relieve pain. The most common pain reliever is aspirin. Heat is also used to relive pain. Most arthritides have no cure, and in those cases therapy is directed toward making the patient more comfortable and more functional.