Arthritis
Anatomy
Joints in the body are made up of the cartilage which is a cap at the end of the respective bones. This is bathed with nutrients secreted from the synovial cells on the lining of the capsule of the joint. There are supporting structures to the joints called ligaments. Due to a variety of causes, chronic inflammation occurs in the joint initially with eventually full blown arthritis with joint destruction.
Causes
- Traumatic: Fractures into the joint with or without anatomic reduction and ligamentous injuries can lead to abnormal shear forces across the cartilage and subsequent arthritis.
- Osteoarthritis: Wear and tear arthritis secondary to the aging process; the most common cause of non traumatic arthritis.
- Rheumatoid arthritis.
- Gouty arthritis.
- Septic or infectious arthritis.
Symptoms
- Swelling around the joint.
- Cyst formation.
- Pain with range of motion.
- Stiffness.
- Subluxation or instability of the joint.
Examination
- Tenderness well localized to the joint.
- Joint swelling.
- Palpable cyst.
- Joint deformity or deviation.
- Pain with limited range of motion.
- Weakness.
- Compression of the joint produces discomfort.
- Excess deviation with stress of the joint and pain.
Tests
- X-ray of the involved joint
- Initially, widening of the joint space with soft tissue swelling and mild subluxation; further subluxation occurs with peripheral spur formation and calcification; later, joint space narrowing occurs with major joint subluxation.
- Laboratory analysis
- ANA, rheumatoid factor, ESR, uric acid.
Treatment
- Conservative
- NSAID’s (i.e. Advil) or steroids; chemotherapeutic agents and gold therapy for patients with rheumatoid arthritis or other autoimmune diseases; therapy for stiffness; intra-articular Celestone injections occasionally; splinting.
- Surgical
- Arthrodesis or arthroplasty depending on the joint involved and the physical demands put on the joint by the patient.