Arthritis

Arthritis is a medical term for joint disease. A joint is where two bones meet, such as the hip between the back bones. There are 100 types of arthritis.

Osteoarthritis

Osteoarthritis (or OA) is the commonest type of arthritis. It is a degenerative process that is associated with age. Ordinarily, there is cartilage between bones. This rubbery material protects the joints in much the same way as grease prevents car parts from wearing out. Over time, cartilage between the degenerates, the bones rub on one another, and there is pain.

OA is more common as we age. It can cause symptoms which range from mild to severe. In the back, pain is frequent. One cannot cure arthritis but it is possible to stop the pain.

Symptoms of osteoarthritis include:

• Joint pain and stiffness, worse with movement
• Increased symptoms after overuse or inactivity
• Arm or leg pain from nerves pinched by arthritic joints

Factors that worsen OA include:

• Obesity (from overloading the spine and other joints)
• Injury (such as a broken bone)
• Heredity (if your parents have arthritis, you may have the same problem)
• Overuse (repetitive or high impact activities cause the joints to wear out)
• Age (you can grow older gracefully and arthritis is not inevitable)

Doctors base the diagnosis on the symptoms (the location and the type of pain), the examination (the joints have a characteristic appearance), X-rays or scans (one can see the arthritis), and laboratory tests (to determine the type of arthritis).

Seeing abnormal joints on an X-ray does not mean that you will have problems. The X-rays show wear and tear in most people, even when there is no pain. Blood tests do not show osteoarthritis or “wear and tear” but can make rule out other types of arthritis.

Rheumatoid arthritis

Rheumatoid arthritis is different than osteoarthritis. It is a medical condition that causes the joints to wear out more quickly. The symptoms are similar but the examination findings and laboratory tests can confirm this diagnosis.

In most people, rheumatoid arthritis develops gradually over the years. The cause unknown, but it is probably due to genetic, environmental and hormonal factors. The immune system functions abnormally causing the body to break down its own joints.

The diagnosis of rheumatoid arthritis is based on a:

• The location of the pain
• The presence of morning stiffness
• Finding nodules under the skin
• X-rays
• A blood test called the “rheumatoid factor”

There are many ways to treat rheumatoid arthritis, including medications, rest, exercise, and surgery.

Other Types of Arthritis

All of the other types of arthritis are uncommon. Each has a characteristic set of symptoms, examination findings, X-ray abnormalities, and blood tests. We can help you sort out the diagnosis and treatment.

The Treatment of Arthritis:

Most patients with arthritis will get relief with simple, non-surgical therapy. Non-steroidal anti-inflammatory medications (such as Motrin and Naprosyn) work especially well. Exercise and other lifestyle changes are also helpful. Facet blocks can help those with arthritic facet joints. Steroid epidural shots are helpful for those with arm or leg pain. See epidurals, and selective blocks. Surgery is needed only when all other care fails, when pain cannot be controlled, when symptoms limit daily activities, or when there is severe numbness or weakness. See also bloodless surgery, minimally invasive surgery, cervical discectomy, disc decompression, and lumbar discectomy.

Elderly patients with spinal stenosis require special care. If they are unable to walk far enough to do activities of daily living, and if medications do not work, a cortisone shot may relieve the symptoms. If everything else fails, and if symptoms are extreme, there is a straightforward surgery that usually will give relief. Since stenosis is a narrowing of the spinal canal, with compression of the nerves to the legs, the operation is needed to widen or open up the lower spine. The operation can be done safely in the elderly in experienced hands. A skilled surgeon can do the procedure in about 90 minutes with very little blood loss. The results of the surgery are particularly gratifying for those with severe spinal stenosis.

Alternative Therapy:

Physical therapy is helpful for arthritis sufferers. Physical therapists are skilled in teaching the exercises needed to maintain flexibility and strength. Arthritis often responds well to both chiropractic and to acupuncture. Chiropractors are especially skilled in mobilizing the spine as well as instructing patients in appropriate exercise.

Know Your Arthritis:

• There are over one hundred types.
• Gout is one type of arthritis that is easily treated.
• By 2030 over 65 million of Americans will have arthritis.

Go to the next page on chronic pain.

Click here to go the next chapter on procedures.

See the Glossary or the Abbreviations list.