What is arthritis?
Arthritis is a broad term to describe pain and inflammation in the joints. This can occur in almost any joint in the body. The joints are hot and therefore can easily create inflammation and swelling. The main hallmark of that for patients is complaining of morning stiffness, which can last for around an hour and in many cases several hours.
The most common form of arthritis is osteoarthritis, which sometimes can cause morning stiffness but usually lasts less than twenty minutes and is characterised by pain which gets worse as the day goes on. Inflammatory joint disease or inflammatory arthritis is characterised by pain that is reduced with exercise.
How is arthritis diagnosed?
Most patients are diagnosed on the basis of their history, a medical examination, and then some further investigations. For patients with an inflammatory joint disease, the history is 90% of the diagnosis.
Sometimes the examination can give clues to what is causing the patient's joint pain. For example, there may be symptoms suggesting the patient has skin psoriasis, which is a scaly, flaking condition of the skin. This then gives a diagnosis that it is psoriatic arthritis. The diagnosis will also consider any other rashes and symptoms that can be associated with the joint pain. And the distribution of the joint pain on examination is also quite important. Which joints were involved can reveal what type of arthritis the patient has.
Blood tests may also be conducted, and sometimes x-rays and not infrequently further imaging techniques like ultrasound and MRI scan are used increasingly in the investigation of joint pain.
What are the different types of arthritis treatments available?
Sometimes education, an explanation of the type of arthritis, and an exercise regime are all that's required. Physiotherapy and gentle therapy treatments might be prescribed. Or simply analgesics will help patients.
For patients with rheumatoid arthritis, a more interventionist strategy might be required, through the use of disease modifying drugs. These are drugs which can alter the course of the condition. They switch off the inflammation before the joints start to become damaged. And there is a wide array of these drugs, most of which can be taken as infrequently as once a week and only some are daily. They can also now be given by injection. And then there is a new group of drugs called biologic drugs which are for patients who do not respond to the oral agents. Some of those drugs are now being looked at in clinical trials to be available imminently, even for patients who have not yet been diagnosed with arthritis in an effort to more accurately identify the early stages of arthritis.
The key to successful treatment of inflammatory joint disease is treating early. The earlier the doctor can intervene, the less likely there is to be damage.
Other treatments available are joint injections. Sometimes if a joint is particularly painful or swollen, a local injection into the joint will have a dramatic effect. Steroid injections to soft tissue areas can also give patients great pain relief.
What are the benefits of arthritis treatment?
The central benefit of treating inflammatory joint disease early is that it prevents long term damage. It also prevents the patient from requiring orthopaedic treatment for joint replacement surgery. Rheumatoid treatment is usually successful and diminishes the need for orthopaedic surgery by 50%.
For psoriatic arthritis, rheumatoid arthritis, and other inflammatory conditions, including ankylosing spondylitis which is a condition that causes inflammation in the spine and the large peripheral joints, treatments are highly effective at switching the conditions off. But getting diagnosed with arthritis early is crucial to receiving the full benefits of treatment. There are still conditions where rheumatoid treatment is less successful. For example, there is currently no disease modifying drug available for osteoarthritis.
What are the risks to arthritis treatment?
Like everything, there is always a potential downside. Many of the drugs, particularly the disease modifying treatment, can potentially cause some inflammation to the liver or a drop in a patient’s blood count.
Prior to the use of disease modifying drugs, the usual prescription was anti-inflammatories, which are available over the counter in chemists. These can cause liver failure, gastric ulcers, high blood pressure, and kidney damage. Any drug taken in an inappropriate way can cause damage.
But most of the drugs prescribed to patients today are in a controlled way and are very closely monitored to make sure no further problems develop. The smallest dose of medicine is usually prescribed which switches off arthritis and keeps the patient fit and healthy. Therefore, for most patients, the risks tend to be small and the benefits substantial.
Who administers arthritis treatment?
Most treatments are administered by patients themselves. Doctors may prescribe drugs for the patients to take in their own time. For joint injections, the patient would see a doctor who would administer these in a consulting room. There are also infusion therapies which are given by nurses on the ward and only takes half an hour. The way a patient is treated can be fit around their lifestyle. Busy working people might prefer to have their treatment on the go. Whereas people with slightly more time may like the social interaction of visiting the hospital to receive their treatment. The treatment is also tailored to how aggressive someone's arthritis is and in terms of how much treatment they require.
What measures can the patient implement in their daily lives, in addition to receiving treatment?
The rheumatologist’s aim is to return the patient to normal, which can be an ambitious task without cooperation from the patient themselves. They should ideally get to a point in which they are able to do all the things they could before their joints became painful. Being honest about the symptoms is important. Trying to be as fit and healthy and do as much exercise, having a healthy diet, and quitting smoking are crucial. Studies have shown that there is a very strong link between smoking and developing rheumatoid arthritis. The drugs prescribed for rheumatoid arthritis are 50% less effective if the patient continues to smoke. Patients with rheumatoid arthritis also have a 250% increased risk of heart disease. Stopping smoking will lower this risk.
Who are the types of people who get arthritis?
Anybody can get arthritis and is not purely dependent on the patient’s age. It is often a condition which can affect people in the third decade and the fifth decade of life. Inflammatory joint disease tends to occur in those two age groups.
It can also occur, however, post-partum. After the delivery of a baby, it is not uncommon for women to experience inflammatory joint disease. With rheumatoid arthritis, for example, it gets better during pregnancy but flares up afterwards. There are other conditions called connective tissue diseases which can get worse during pregnancy.
There are many different conditions and they can appear at different times in one’s life. There is not one particular type of person. Women more than men tend to get inflammatory joint disease. This varies between 3 to 1 for rheumatoid and 15 to 1 for conditions like lupus.
Arthritis can also be associated with inflammatory bowel diseases. Ulcerative colitis and Crohn's disease patients have an increased chance of developing arthritis. Patients over the age of 50 can develop osteoarthritis, which is the more common type of arthritis affecting up to 50% of people over-50. Over the age of 60, it is a very common condition. At this point, it is more indolent, progresses at a slower rate, effects joints like hips and knees, and can ultimately lead to joint replacement.
Does genes or family history have a part to play in diagnosing arthritis?
Absolutely. If a patient’s family has a history of rheumatoid arthritis in particular, or a family member has an auto-immune disease, such as an underactive thyroid or diabetes which contributes to joint pain, this increases the likelihood of them developing arthritis.
What steps can people take earlier on in life to reduce their chances of developing arthritis?
Lifestyle is of course key, and the risk is reduced by stopping smoking, losing weight, maintaining an active exercise regime, and eating healthily.
There is also an ongoing study looking into potentially prescribing treatment before a patient has been diagnosed with rheumatoid arthritis but who has positive blood tests indicating they might be diagnosed with the disease at a later stage. Clinical trials have already been conducted, and whilst they have not prevented the disease from developing, they have suggested it may be possible to delay the onset by up to a year in patients treated with a particular drug.
Furthermore, by conducting a blood test it would be possible to predict a person’s likelihood of developing rheumatoid arthritis. This would then allow for earlier intervention at the point when the patient is just experiencing mild aches and pains in their joints to hopefully prevent developing full-blown arthritis. But having this particular sort of blood test would mean the patient is likely to need life-long treatment.