What is arthritis?
Long-term inflammation of one or more joints, or "arthritis", is one of the commonest of all health problems. Affected joints are typically sore, stiff and have less movement than normal. The usual cause is osteoarthritis, the so-called 'wear and tear' type. Second commonest is rheumatoid arthritis, which is a condition that can also affect parts of the body other than the joints. Arthritis Care, the main charity, estimates the total number of people in the UK with arthritis to be 9 million.
Osteoarthritis (OA)Most people with OA are over 55 and more women than men are affected. Sometimes there is a family history, suggesting a genetic link of sorts. Injury to a joint can cause it to develop OA later in life. Being overweight increases the chance of getting OA of the knees. Diagnosing OA involves assessing a person's symptoms, examining the joint and, sometimes, taking an X-ray.
Rheumatoid arthritis (RA)
Rheumatoid arthritis (RA) is a disease that mainly affects the lining of the joints. This lining, called the synovium, is like a flexible sealed bag attached around the edges of the joint and within which the joint moves. It produces the lubricating fluid that bathes the joint. In RA the synovium thickens and moves in and across the cartilage, attacking it as it goes. RA tends to affect many joints at the same time, often in a symmetrical pattern. It affects women three times more commonly than men and the peak age range is 40 – 60. RA affects about 1% of the population, whereas OA is twenty times more common.
In RA the general immune system of the body is activated, which can lead to tissues other than the joints being attacked. For example the tendons that attach muscles to bones may become weakened, sometimes leading to tendon breakage. Inflammation of the tear and saliva producing glands can give dry eyes and mouth problems. RA can cause anaemia (low blood count), which can make someone feel quite tired.
Symptoms and treatment
In OA joints tend to be stiff and sore at the start of the day and get better as the day goes on. Joints in RA tend to be the opposite – they improve with rest and get more uncomfortable with use.
Pain is the main symptom in arthritis and can lead to other problems such as poor sleep and depression. Pain relief is therefore the priority for most people who have arthritis. Paracetamol is often combined with codeine-type drugs for a greater effect. Unfortunately this also increases the chance of side effects such as nausea and constipation. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac are also commonly used by people with arthritis.
NSAIDs make arthritis more tolerable but they do not influence the underlying process of joint damage. OA largely takes its own course but RA can be slowed down by careful use of drugs that reduce the activity of the immune system. The problem is to balance the benefits against the possibility of serious side effects. We do not yet have the perfect drugs and more research is needed to be sure which are the safest drug combinations.
Other strategies are also important, such as keeping weight down and exercising appropriately. There is little evidence that diet influences arthritis, although fish oil may reduce pain in rheumatoid arthritis. Replacement surgery is now possible on a wide range of joints when medical treatment is no longer sufficient. Arthritis research is not standing still; new treatments and technologies will continue to improve our ability to tackle joint disease. In the meantime we need to make the best use of the treatments that we already have.