Arthritis: Joint trouble

Arthritis can make simple day-to-day tasks difficult. But it can be managed with exercise, diet and support of family members

old couple on a swingArthritis is derived from two words, "arthro" means joint and "itis" means pain or inflammation. Thus, arthritis means pain in the joints. There are more than 100 types of arthritis. Arthritis is the most common self-reported alarming condition predominantly affecting women, ranking ahead of hypertension, ischemic heart disease and other chronic diseases including breast cancer and malignancy of the female reproductive tract. About 60 per cent of people who are affected with arthritis are women.

Arthritis array

The major categories of arthritis are:

Osteoarthritis: This type of arthritis occurs in the joints especially in the hands and the weight bearing parts of the body like knee, hip and spine. This type of arthritis occurs because of the breakdown in cartilage. Cartilage is a tissue that cushions the ends of bones within the joint. In osteoarthritis, the cartilage begins to fray and may entirely wear away. Osteoarthritis can cause joint pain and stiffness.

Rheumatoid Arthritis: It is a type of chronic disease which mainly affects the joints in the body. Here the immune system of the body causes swelling in the joints. This inflammation then spreads to surrounding tissues damaging the cartilage and the bones. This causes pain, stiffness, swelling, joint damage and loss of function of some bones.

Juvenile Rheumatoid Arthritis: This is a rare type of arthritis which mainly affects children. It causes pain, stiffness, swelling and loss of function in joints. The cause for this type of arthritis is not yet known, but it is considered as an autoimmune disease. Juvenile rheumatoid arthritis is not hereditary.

Gout: Gout is created because of the deposits of needle-like crystals of uric acid in the joints. These crystals cause inflammation, swelling, and pain in the affected joint, which is often the big toe. Apart from toe, it affects the foot, ankle, and knee.

Causes and symptoms

An individual can develop arthritis due to several factors. Some of the causes are gender, age, weight, previous injury and nutritional factors. Other causes could involve wear and tear of joints causing inflammation, systemic diseases, infections and fractures.

Depending on the affected joint, people may experience specific symptoms in the joints such as pain, stiffness, swelling and bone enlargement.

Treatment options

Several therapies help treat arthritis. They include medication and exercise—flexibility, stretching, strengthening, and aerobic [walking, jogging, and swimming]. Yoga [sukhasna and parighasana] can help strengthen joints and reduce stiffness. As pain is the maximum in the morning when you get up, you need to mobilise all joints by making slow movements rather than getting out of the bed immediately. Due to morning stiffness, patients who have acute joint pain even suffer from locking or clicking of the joints.

  • A surgery is recommended in acute cases of arthritis.
  • Physiotherapy includes exercises targeted at specific muscles, pain relief measures such as diathermy and ultrasound therapy, and occasionally traction and splints as well.
  • Proper footwear helps cushion the impact of walking. Also various insoles are available to correct simple deformities such as flat feet and bowlegs, which can increase knee pain.
  • Joint protection techniques help patients perform their daily chores without straining painful joints.

However, new techniques have emerged that can be tailored to the needs of each individual. They are less invasive and enable quicker recovery.

Although hip/knee replacement is a common option today, the decision to opt for surgery cannot be taken lightly. The operation must be carefully selected to suit each patient. Unicompartmental knee resurfacing and hip resurfacing are advanced joint preservation techniques. Less invasive, these offer immediate pain relief and quick recovery. They are excellent options for those in the early stages of osteoarthritis, when damage is restricted. If performed at the right time, it is possible to preserve the rest of the joint and avoid complete replacement.

Surgical techniques with smaller incisions cause less damage to soft tissues, while the use of lightweight material like titanium for hip implants allow more range of movement to patients.

On the other hand, total hip/knee replacements are a great boon to those with advanced arthritis affecting the entire joint. Newer techniques of computer-assisted surgery, minimally invasive methods, better anaesthesia and pain management regimes have made painless and rapid recovery from these operations a reality.

Living with arthritis

While arthritis may not be a curable disease, it can be managed effectively by simple measures like diet, exercise and suitable treatment options.

  • Eating a healthy, well-balanced diet maximises intake of vitamins, minerals, antioxidants and other nutrients to help maintain recommended weight.
  • Minimising stress helps. When a person is under excessive stress, breathing becomes shallow, limiting oxygen supply to the body. Start breathing deeply to consciously ward off the effects of stress. Take 5–10 deep breaths when you feel stressed and fatigued. Breathing exercises and meditation are techniques you can practice any time; practicing them provides tools you need to react to stress and fatigue.
  • Using joint protection techniques helps ease the pain. Joint protection can reduce stress on arthritic joints and decrease pain. There are several joint protection principles which, if followed, will help to conserve energy. Use adaptive equipment to protect joints too.
  • Exercising regularly can help strengthen muscles around joints and help increase bone density. It also reduces wear and tear of the joints.
  • Giving up smoking and drinking helps preserve bone density. This in turn can help stave off arthritis. Avoid smoking and limit your alcohol consumption, as both habits weaken the structure of bone, which put you at higher risks of osteoporosis and ultimately fractures.

The pain in arthritis is two-fold, one is the physical pain and the other is the mental trauma of not being able to be socialise. The person is not able to perform simple daily tasks like bending, walking, climbing stairs, and even praying. Thus, family support forms an important part of undergoing arthritis treatment. Surgery can effectively help get the person back to enjoying life. However, once the patient has undergone surgery the next step is to give the patient time and comfort to once again stand on his feet, and slowly and steadily take up his daily routine.

Hence, the patient along with his family should take a step forward to deal with arthritis.

The emotional side of arthritis

How arthritic patients take the pain plays a large part in how life will be for them.Neuro-rheumatologist Anthony K P Jones, MD and his colleagues from the University of Manchester Rheumatic Diseases Centre, UK were the first to directly examine how the brain processes arthritis pain using a specific type of brain imaging. The fear and distress arthritis patients feel about their condition can make a big difference in how they perceive the pain that comes with it. Interventions designed to reduce pain-related fear and anxiety such as behavioural therapy can make life easier for patients with chronic arthritis.

Additionally personality psychologists are also examining the relationship between basic personality disposition and forms of adaptation to arthritis. Problems caused by arthritis that make adaptation necessary include: living in chronic pain, dealing with physical limitations, battling chronic fatigue, loss of abilities and independence and other health problems. The frustration of limited mobility, the anger at being the sufferer, the guilt because of causing inconvenience to others requires much more than just coping skills. Research has suggested that people possessing personality traits within the categories of extraversion, openness, agreeableness, and conscientiousness have more effective coping skills than people with traits falling within the category of neuroticism.

— Team CW

Knee replacement surgery basics

What is knee replacement surgery and how is it done?

Knee replacement involves replacing a knee joint that has been damaged or worn out due to arthritis. During knee replacement surgery, the bone and cartilage at the bottom end of the thigh bone and top of the shin bone are replaced by metal and plastic implants. During the procedure, it is ensured that the movement in the knee is full, smooth and stable.

What is the pre-surgery care or preparation required?

Once the patient and the orthopaedic surgeon decide for surgery, there are few steps that one must keep in mind to make sure all goes well. Firstly, it is essential to have surgical consultation, which will include pre-operative X-rays, a complete past medical history, a surgical history, and list of all medications and allergies. Secondly, a complete physical examination with the patient's family physician to determine if s/he is in the best possible condition to undergo knee surgery.The most important thing is to remain active, because it is the key to the success of the surgery.

Is surgery the last option for arthritis?

Early diagnosis and treatment of arthritis is important for long-term mobility. If arthritis of the knee remains painful despite medication, exercise, rest and support to assist your mobility, the patient will benefit from a total knee replacement. So, if the doctor has recommended a knee replacement, it is better not to delay. Delaying surgery can lower your quality of life, both before and after surgery.

Where in India is this surgery available? What is the cost?

The new advanced implants are available across India in leading government and private hospitals in metros and mini-metros. The cost varies from hospital to hospital. A good implant would cost Rs 85,000 each and the cost of the procedure varies from Rs 1.5 to Rs 1.75 lakh per knee, if the best implant is used.

What post surgery care should be taken? What is the approximate recovery time?

Old couple walking in the parkUpon returning home for few weeks, the patient needs to continue taking regular medications and exercise as directed by the surgeon. Remaining active and exercising are the quickest ways to full recovery. Though recovery differs in each patient, in most cases they begin walking the next day; by the 7th day they resume their activities and within 3 weeks regain total normalcy. They can even beging brisk walking, sitting cross-legged in 5–6 months.

Does this surgery affect the patient emotionally? How to cope with it?

It is essential to work as a team with your family and adopt a positive attitude towards the success of the surgery. Family should be supportive, motivate the patient, help with the daily exercises and make sure that the patient takes a good diet.

Does the surgery affect the patient's daily life activities?

In most cases, successful joint replacement surgery will relieve your pain and stiffness, and allow you to resume many of your normal daily activities. Patients regain total normalcy within three weeks.

Milind Patil is Consultant Orthopaedics Surgeon, Wockhardt Hospital, Mumbai

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Sushil Sharma
Sushil Sharma is a Delhi-based Senior Orthopaedic surgeon and the Chairman of Arthritis Foundation of India Trust[AFI], a non-profit making organisation, and a member of International Osteoporosis Foundation. He is also an expert on Arthritis and joint replacement surgery, with fellowship from Switzerland.

2 COMMENTS

  1. Joint pain problem is mainly found in old age people and sometime in sportsperson also. There many special remedies and therapies we provide which is really good for joint pain. These therapies is very simple and easy to do. It will surely give positive results to the joints. I like your information, please update some more information on this topic.

    Thanks

  2. I am suffering from pain in knees for the last 2 years.

    Suggest me the relevant exercises for the same

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