Arthritis

Arthritis is a group of conditions involving damage to joints. It is often accompanied by pain, stiffness and swelling, and can be caused by infection, trauma, degenerative processes, and metabolic disturbances, among others. Arthritis is the leading cause of disability in those over 55 years of age.

Symptoms of arthritis not directly associated with the affected joint(s) may include:

Skin nodules
Vasculitic (inflammed blood vessel) skin lesions
Swollen glands (enlarged lymph nodes)
Swelling from excessive accumulation of watery fluid (edema)
Ocular inflammation (light sensitivity, blurred vision, redness of the eye, pain, floaters)
Inflammation of the urethra (the tube leading from the bladder to discharge urine outside the body)
Diarrhea
Orogenital ulceration

Although all forms of arthritis feature pain, pain patterns may differ between different kinds. Rheumatoid arthritis is generally also associated with stiffness and symptoms tend to be worse in the morning. In children and the elderly, pain may not be the main feature. Older patients tend to move less and infants tend to refuse to use the affected limb.

The Arthritis Foundation lists over 100 types of arthritis and related conditions that presently affect about 46 million Americans. Some of the more prevalent categories of arthritis include osteoarthritis, ankylosing spondylitis, and rheumatoid, gouty, bacterial, and juvenile arthritis. A brief description of each of these categories follows:

Osteoarthritis – also referred to as “degenerative joint disease”, this is the most common form of arthritis. It can be caused by trauma to the joint, infection, or age, and abnormal anatomy might contribute to its early development.
Rheumatoid arthritis – a chronic autoimmune disease that results in inflammation and deformity of the joints, and can cause additional systemic problems (problems throughout the body).
Bacterial arthritis – also known as septic, infectious, or pyogenic arthritis, the condition occurs when a bacterial infection causes the joint to fill with pus cells that release substances aimed at combating the bacteria. This activity, however, can damage the surrounding cartilage and bone. It is a medical emergency that, if left untreated, can lead to loss of function of the joint and septic shock, a potentially fatal condition.
Gout and pseudogout – an inflammatory reaction of joint tissues due to the buildup of uric acid or calcium pyrophosphate.
Juvenile arthritis – generally refers to arthritis in children under the age of sixteen. While children can develop most types of arthritis that can affect adults, the most common type of juvenile arthritis is juvenile rheumatoid arthritis (recently also known as juvenile idiopathic arthritis or juvenile chronic arthritis). The course and characteristics of rheumatoid arthritis, however, tends to differ markedly in children from that in adults.
Still’s disease – although first discovered in children, it can less commonly also occur in adults. It is characterized by waves of high fevers and transient rashes. It’s cause remains unknown.
Ankylosing spondylitis – causes chronic inflammation of the spine and the sacroiliac joints. Can lead to a complete fusing of the vertebrae and loss of mobility of the spine.

Some forms of arthritis, however, can be secondary to other diseases, and there are also numerous diseases that mimic arthritis. Diseases that can cause arthritis include lupus erythematosus, allergic purpura, psoriasis (psoriatic arthritis affects approximately ten percent of people with psoriasis), Reiter’s syndrome (reactive arthritis), haemochromatosis, hepatitis, several vasculitis syndromes, Lyme disease, Familial Mediterranean fever, HIDS, TRAPS, and inflammatory bowel disease. Diseases that can mimic arthritis include clubbing, osteoporosis, multiple myeloma, and fifth disease.

While some medical literature suggests that antibiotics such as combinations of sulfonamide and trimethoprim may cause a form of immune-mediated arthritis, most of the literature regarding drug-induced arthritis relates to arthritis secondary to drug-induced lupus.

The symptoms of drug-induced lupus are similar to those of systemic lupus erythematosus. Drug-induced lupus, however, usually resolves within a few days after the causative agent is withdrawn. But one of the factors that make drug-induced lupus difficult to diagnose, not to mention the secondary arthritis caused by it, is that although drug-induced lupus may develop shortly after using the offending medication, it is more often triggered months to years after therapy with the medication in question was begun.

Typically, diagnosis is guided by elements of the history of the suspected arthritis, including:

The time and speed of its onset
The pattern of involvement of the joint(s)
The symmetry of the symptoms
Whether the stiffness, tenderness, and/or the locking or gelling with inactivity occurs early in the morning
Relieving and aggravating factors
Systemic symptoms

Physical examination may indicate whether the disease is systemic, as may be the case in many secondary forms of arthritis. Blood tests and X-rays of the affected joints may be performed to confirm the diagnosis, and radiographs may be used to assess the severity and/or follow the progression of the disease.

Depending on the type of arthritis, treatment may include: