Arthritis

Arthritis is the inflammation of one or more joints. There are many types of arthritis which include: osteoarthritis, rheumatoid arthritis, septic arthritis, juvenile idiopathic arthritis (JIA) to name a few; the most common of which is osteoarthritis.

Arthritic symptoms may include pain in the affected joint(s) with activity and at the end of the day, swelling in the affected joint(s), decreased functionality, hypomobility that usually occurs in the morning, deformity of the joint(s), weakness in the muscles supporting the affected joint(s) and instability in the affected joint(s) (Senthelal et al., 2023).

Osteoarthritis

Osteoarthritis is a degenerative joint disease that results in less cartilage in the joint, changes to the layer of bone below the cartilage, formation of osteophytes and laxity of ligaments. (Yu & Hunter, 2015). Osteoarthritis occurs due to mechanical stress placed on the joint over an extended period that the joint is not equipped to handle (Grässel & Muschter et al., 2020).

Yu & Hunter (2015) and Senthelal et al. (2023) stated that the hand, hip and knee are the most common joints affected. According to Yu & Hunter (2015), most people affected by osteoarthritis are the average age of 65 years.

Grässel & Muschter (2020) stated that osteoarthritis is commonly caused due to age-related changes in the joint or due to trauma. People are more susceptible to osteoarthritis the older they are, if their genetics predispose them to the condition and if they have metabolic syndromes such as obesity (Senthelal et al., 2023; Yu & Hunter, 2015), but this list is not exhaustive.

Kindly go to your general practitioner or physiotherapist if the pain begins to restrict your mobility and/or functionality.

Management

Yu & Hunter (2015) stated that there are a range of management options whether topical, oral, injection, education, exercise based, use of assistive devices and/or joint replacement surgery.

Topical capsaicin with a concentration of 0.025% used 3-4 times daily reduces pain by 50% with minimal side effects. Diclofenac sodium 1% gel 3-4 times daily can also be used.

Oral and transdermal opioids can relieve pain and improve function but have a myriad of adverse effects. Duloxetine and oral non-steroidal anti-inflammatory medications (NSAIDs) decrease pain and improve function. NSAIDs and proton pump inhibitors are especially effective for patients with comorbidities. COX2 inhibitors with metformin reduce the need to get joint replacement surgery in Diabetic patients when studied over a 10-year period (Grässel & Muschter, 2020).

Intra-articular corticosteroid injections are better for pain management in short term for acute exacerbations when compared to intra-articular hyaluronic acid injections which are effective in pain management after eight weeks. Intra-articular injection should be taken no less than every four months due to the resultant joint damage that will occur if taken more frequently.

Education on the importance of self-management is also a valuable step in the rehabilitation process. Clients also need to be aware of possible adverse reactions to the various medications, topical, oral or via injection, to make informed decisions regarding their treatment.

Exercise based treatment may include aqua therapy, strengthening of the major muscle groups supporting the joint(s) affected, stretching and flexibility programmes and aerobic exercise either individually or as a group.

Assistive devices, knee braces, foot orthoses can also be very helpful to decrease pain and improve the function of the affected joint during daily activities.

Joint replacement surgery can be used in severe cases that have not responded well to conservative management (Yu & Hunter, 2015).

Other forms of arthritis

Rheumatoid arthritis is a gradual inflammatory form of arthritis that usually occurs in early adulthood and is triggered by environmental factors. Treatment takes the form of pharmaceuticals, with the most effective being early use of disease-modifying anti-rheumatic drugs (DMARDs), biologics, anti-inflammatories and in severe cases, corticosteroids (Senthelal et al., 2023).

Septic arthritis is a rare acute arthritis that is typically caused by bacterial infection. The most susceptible people are those who have immunodeficiency, advancing age, diabetes mellitus, prosthetic joints, rheumatoid arthritis, and engage in intravenous drug abuse. Septic arthritis is treated by draining the affected joint(s) and administering antibiotics (Senthelal et al., 2023).

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that is present in people under the age of 16 years who had arthritic symptoms for at least six weeks. Treatment is most effective when individualised where a unique blend of medications including nonsteroidal anti-inflammatory drugs (NSAIDs), Disease-Modifying Antirheumatic Drugs (DMARDs) and corticosteroids, physiotherapy and occupational therapy are completed (Huang et al., 2024).

References

Grässel, S., & Muschter, D. (2020). Recent advances in the treatment of osteoarthritis. F1000Research, 9, F1000 Faculty Rev-325. https://doi.org/10.12688/f1000research.22115.1

Huang, H. Y. R., Wireko, A. A., Miteu, G. D., Khan, A., Roy, S., Ferreira, T., Garg, T., Aji, N., Haroon, F., Zakariya, F., Alshareefy, Y., Pujari, A. G., Madani, D., & Papadakis, M. (2024). Advancements and progress in juvenile idiopathic arthritis: A Review of pathophysiology and treatment. Medicine, 103(13), e37567. https://doi.org/10.1097/MD.0000000000037567

Senthelal S, Li J, Ardeshirzadeh S, et al. Arthritis. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/

Yu, S. P., & Hunter, D. J. (2015). Managing osteoarthritis. Australian prescriber, 38(4), 115–119. https://doi.org/10.18773/austprescr.2015.039