Rheumatic and musculoskeletal diseases are greatly prevalent in the world and none of us are unaware of the huge impact that they have, on the quality of life of the sufferer.
October 12 has been designated as World Arthritis Day by the WHO. 
This is because a prompt treatment of arthritis is largely dependent upon early identification of signs and symptoms of the disease by the patient and early reporting.
The term ‘Arthritis’ finds it origin in the Greek word ‘ARthros’ which means joint and the suffix ‘itis’ is added to indicate inflammation, making inflammation of the joints, the technical meaning of the term ‘Arthritis’. However, in reality it is not just the inflammation of joints and rather encompasses a huge variety of conditions that involve the joints, and connective tissues.
There are myriad types of arthritis, the most common being osteoarthritis, rheumatoid arthritis and gout with their causes as well as their treatment strategies differing slightly from eachother.
WHAT IS ARTHRITIS?
Arthritis is defined as inflammation of joints, localized at the joint or involving the ligaments and tendons surrounding it and usually characterized by swelling, redness, pain and restriction of movement, often leading to the development of various kinds of deformities in the affected part.
The evolution of the pathology may be gradual or rapid, but in both cases, it leaves the patient unable to perform the daily chores, thus significantly impairing the quality of his life.
ARTHRITIS: TYPES
While the world is a witness to over hundred varieties of arthritis, the broad classification of arthritis is done by rheumatologists, based on the pace of development of pathology into two distinct groups-
● Acute Arthritis including Gout.
● Chronic arthritis subclassified into
○ Chronic non inflammatory Arthritis including Osteoarthritis.
○ Chronic inflammatory Arthritis including Rheumatoid Arthritis
GOUT
Defined in the medical world as arthritis caused by hyperuricaemia (excess of uric acid in blood), Gout forms one of the most common forms of acute inflammatory monoarthritis. It is usually characterized by the deposition of uric acid crystals in and around the peripheral joints, more commonly those of the big toe which turns intensely painful and swollen with a subjective sensation of heat and redness.
Gout presents with alternating episodes of relapse and remissions where relapses occur as flares- the phase spanning from a few days to weeks in which the symptoms turn intense, and remissions, lasting for weeks to years where the patient experiences no symptoms at all.
OSTEOARTHRITIS
Osteoarthritis is the most common chronic non inflammatory arthritis seen in the older age group, and finds its trigger in general degeneration of the cartilage in the affected joint due to age-related wear and tear. Apart from age, there are several other contributors ranging from overuse of the joint to injuries etc.
Being non inflammatory in nature, the symptoms of osteoarthritis- pain, swelling and deformity are solely dependent on the gradual degeneration of the cartilage thus, appearing at a very slow pace over months or years.
RHEUMATOID ARTHRITIS
This chronic inflammatory arthritis is basically an autoimmune disorder which arises in consequence to the body’s immune system attacking its own cells and resulting in the typical signs and symptoms of inflammation (pain, swelling, redness, and heat) in the synovium of the affected joints with stiffness. The synovium is the tissue that lubricates the joint facilitating easy movement of the involved bones.
Unlike gout which is monoarticular, Rheumatoid arthritis is most of the times, polyarticular involving autoimmune destruction of multiple joints of the body.
What triggers the immune system to destoy one’s own tissues remains unknown but certainly there are certain risk factors that predispose the patient to fall prey to rheumatoid arthritis.
THE CAUSE OF ARTHRITIS
There are over hundred types of arthritis known to the world and none share a single cause. This implies that the causes of arthritis vary with the type of arthritis. However, what finds way into the list of general causes includes-
● Metabolic causes
Gout is caused by the deposition of uric acid crystals in joints. Uric acid is derived from the breakdown of certain organic compounds called Purines, that under healthy conditions are excreted in urine. All disorders or intake of drugs like diuretics and immune suppressors leading to an overproduction of urate or purines in the body or those causing inadequate excretion of the same may leave a person at risk of gout. Having certain health conditions such as congestive heart failure, Diabetes, metabolic syndrome and insulin resistance etc. also predisposes people to Gouty arthritis.
● Genetic causes
Certain genes called Human Leucocyte Antigen class II are more likely to leave a person vulnerable to some specific types of arthritis such as Osteoarthritis. In such cases often the patient finds herself suffering from some other prominent signs and symptoms too indicating the presence of a syndrome of which osteoarthritis is just a part. Studies have shown genes like SLC2A9 underlying Gout too but understanding this association requires a detailed research.
● Autoimmunity
The failure of the body’s immune system to differentiate between one’s own cells and foreign cells causes Rheumatoid arthritis. The triggers of autoimmunity largely remain unknown and therefore Rheumatoid arthritis is a lifelong condition which significantly affects one’s quality of life.
RISK FACTORS OF ARTHRITIS
● Dietary Factors
Being a metabolic disorder, the form of arthritis most intimately associated with dietarry factors is Gouty arthritis. Injudicious intake of foods rich in purines such as dairy, poultry, fish, alcohol, organ meets and sugars might leave a person at risk of Gout.
● Obesity
A higher BMI clearly forms a prodrome to speedy degeneration of joints, particularly the ones that bear all the weight of the body such as the hips, knees, ankles, feet and toes, making weight management a necessity.
● Joint injury
Repeated injuries to a joint or its overuse can damage it and increase the risk of osteoarthritis.
WHAT ARE THE TYPICAL SYMPTOMS OF ARTHRITIS?
The development and manifestation of the symptoms of arthritis vary widely with its type in terms of their character and intensity.
A few noteworthy clinical features that indicate arthritis and must never be overlooked are-
● Intense pain in single or multiple joints
Pain from arthritis often develops gradually but heightens in intensity quickly. In some cases, it is episodic and comes and goes in phases lasting from a few days to a few weeks whereas in others, it may be constant.
● Swelling
In some cases, the joint may appear swollen with redness of the skin over it. Such swelling and redness indicate the underlying inflammation in the affected joint and are seen most commonly in almost all forms of chronic inflammatory arthritis like Rheumatoid arthritis.
● Stiffness
Stiffness accompanies fatigue in Rheumatoid arthritis while it is isolated in cases of osteoarthritis. The difference between the stiffness in rheumatoid arthritis and osteoarthritis lies in the span of time that it persists for. While in rheumatoid arthritis, the stiffness is typically felt in the morning and lasts for more than 30 minutes, in osteoarthritis, it is milder and lasts for less than 30 minutes in the morning. However, in both cases, it is a prodrome to difficult movement of the affected joint.
DIAGNOSIS OF ARTHRITIS
The first step to recovery is reporting to a rheumatologist if any of the aforementioned symptoms are noted. A rheumatologist might examine the affected joint and if required other joints physically and order investigations such as blood tests (ANA, CRP, RF) and imaging (X ray, MRI, CT) to analyze the joints.
WHAT IS THE TREATMENT OF ARTHRITIS?
The management strategies that rheumatologists advise to their patients depend upon the type of arthritis that they are suffering from.
A majority of the cases require an amalgamation of medicinal treatment and lifestyle fixes.
MEDICINAL TREATMENT
Different forms of arthritis require myriad forms of medicines that range from steroids to antirheumatic drugs.
Some drugs that find way into the rheumatologists’ prescription irrespective of the variant of arthritis include-
● Analgesics for pain management
● NSAIDs for the management of inflammation
LIFESTYLE MODIFICATIONS
Arthritis, irrespective of its type, is a chronic illness that demands certain changes in the patient’s lifestyle both to manage the existing damage and to prevent further damage of the affected joint.
Some lifestyle changes include-
● Diet Modification
● Weight loss
● Physiotherapy
● Exercise regime
● Home remedies
● Mobility assistance
THE CONCLUSION
Arthritis has more than a hundred forms each with a different set of causes, clinical manifestations and treatment modalities which often includes a blend of medication, lifestyle changes and occasionally surgery.