Arthritis

Different parts of the joint are affected by different kinds of arthritis that can result in the joint changing alignment or shape. Common symptoms of arthritis are stiffness, pain and fatigue. The disease is considered to be chronic or ongoing. Arthritis can also affect the skin or internal organs. Each type of arthritis requires different treatment.

Most Common Arthritic Conditions:

• Back Pain
• Bursitis and Tendonitis
• Carpal Tunnel Syndrome
• Gout
• Osteoarthritis
• Osteoporosis
• Rheumatoid Arthritis

Medications for Arthritis:

COX-1 Inhibitors
A COX-1 inhibitor impedes the action of the COX-1 enzyme. Commonly used anti-inflammatory drugs such as aspirin, ibuprofen and naproxen block the action of both COX-1 and COX-2 enzymes. While these drugs can reduce inflammation, they might also decrease the natural protective mucus lining of the stomach causing stomach upset, ulcers or intestinal bleeding. A buffered form of a COX-1 inhibitor might reduce these adverse effects.

COX-2 Inhibitors
COX-2 inhibitors such as rofecoxib and celecoxib were developed to selectively block the COX-2 enzyme that causes inflammation. Blocking this enzyme slows the production of the chemical messengers (prostaglandins) that cause the pain and swelling associated with arthritis.

The COX-2 inhibitors are a new class of nonsteroidal, anti-inflammatory drugs or NSAIDS. These drugs differ from traditional NSAIDS because they only block the COX-2 enzyme and not the COX-1 enzyme.

Corticosteroids
Corticosteroids can sometimes dramatically reduce inflammation and thus relieve pain. Corticosteroids can be taken by mouth, inhaled, applied to the skin, given intravenously (into a vein) or injected into the tissues of the body. Examples of corticosteroids are prednisone (taken by mouth), solumedrol (given by injection) along with celestone, triamcinolone, kenalog, celestone, depomedrol and others.

Injections
Synvisc, Hyalgan, or Supartz injections are sometimes used to relieve pain after simple medications and non-drug treatments have failed to offer pain reduction.

Surgical Treatment of Arthritis:

Since arthritis is generally chronic in nature, it can lead to disability and a reduced quality of life. When non-surgical treatment – rest, heat and cold treatments, exercise, splints or medication – has failed to alleviate discomfort, surgery may be a way to lessen your pain and reclaim a more active lifestyle.

The most important byproducts of joint surgery are relief from pain and improved mobility. You could also expect an improvement in the appearance of deformed joints – especially of the hand – with some kinds of surgery.

Talking with your physician is the best way to determine whether or not a surgical intervention would help improve your quality of life. If you are unsure, a second opinion should be sought from a physician with arthritis experience. Ultimately it is your decision and you must be committed to utilizing physical therapy and following your doctor’s instructions carefully.

Joint Surgery
A joint is where two bones come together. The bones are attached by fibrous cords (ligaments). Muscles are also connected to bones by fibrous cords (tendons). The cushion between muscles or tendons and bones is a fluid-filled sac (bursa).

The joints have a tissue lining (synovium). With some arthritic conditions, such as rheumatoid arthritis, the synovium becomes irritated and inflamed. This causes chemicals to be released from the synovium that, over time, thicken the synovium and damage the surrounding connective tissue that covers the ends of bones (cartilage) and bone. This inflammation causes pain and swelling.

In osteoarthritis, the cartilage becomes pitted and then cracks; smooth movement of the joint is impossible. If cartilage degenerates on a weight-bearing joint such as the knee or hip, pain, loss of movement and deformity can be expected.

Synovectomy
Synovectomy is the removal of diseased synovium. Although it does reduce the pain and swelling of rheumatoid arthritis and will slow down or prevent the further destruction of joints, the synovium can grow back and the problem recurs.

Osteotomy
An osteotomy corrects bone deformity by cutting and repositioning the bone, then resetting it in a better position.

Resection
Resection is the removal of all or part of a bone. Resection is sometimes done to remove bunions and when degenerated joints in the foot make walking painful. It can also be performed on the thumb, wrist or elbow to relieve pain and improve motion.

Arthrodesis
Bone fusion, or arthrodesis, relieves pain usually in the fingers, thumbs, ankles and wrists. Fused joints can better bear weight, offer better stability and are no longer painful.

Arthroplasty
Arthroplasty is the rebuilding of joints by either relining or resurfacing the ends of bones where the cartilage has worn away or the bone is destroyed. It can also mean total joint replacement where part or the entire joint is removed and replaced with plastic, ceramic and metal parts.

This widely used and commonly successful procedure can be performed on knees, hips, shoulders, elbows, ankles and knuckles. It has allowed many people in severe pain to return to normal activity.

Arthroscopy
A button hole-sized incision is made and a thin tube with a lighted end, known as an arthoscope, is connected to a closed-circuit television, enabling physicians to see right into a joint. Several other incisions may be necessary to insert other instruments or see other parts of the joint.

Arthroscopic surgery is used to determine the type and extent of arthritis present. The surgeon can also remove loose tissue that might be causing pain, repair torn cartilage, perform a biopsy or smooth a roughly surfaced joint.

Arthroscopy does not require as much anesthesia or cutting as a standard operation and patients recover faster. The procedure is most often done on the knee, hip or shoulder. Patients are given a general, spinal or local anesthetic depending on the joint or condition being treated.

Procedures often performed by arthroscopy include:

Torn ligament repair;
Removal of loose bone or cartilage in knee, shoulder, elbow, ankle or wrist;
Carpal tunnel release;
Removal of inflamed lining (synovium) in the knee, elbow, shoulder, ankle and wrist;
Rotator cuff procedure;
Anterior cruciate ligament reconstruction in the knee
Repair or resection of torn cartilage (meniscus) from the shoulder or knee.
After surgery, the small incisions are covered with a dressing and patients often need little or no pain medication.

According to the Arthritis Foundation, one in every seven Americans – or 43 million people – suffers from arthritis. Although it can affect people of any age, it usually occurs later in life.