Arthritis is a joint disorder featuring

inflammation. A joint is an area of the body where two different bones meet. A joint functions to move the body parts connected by its bones. Arthritis literally means inflammation of one or more joints.Arthritis is frequently accompanied by joint pain. Joint pain is referred to as arthralgia. The essential components of the joint are: Ligaments Rope-like bands that hold the bones together. Cartilage Smooth material that allows one bone to move over the other without friction. Synovium The joint-lining cells that produce a small amount of fluid (like oil) to lubricate the joint. Tendons Inelastic bundles of fibre that attach a muscle to a bone. The Types Of Arthritis Osteoarthritis (or degenerative arthritis) Osteoarthritis is the most common form. It occurs when the cartilage of the joint gradually wears away, exposing bare bones that rub against one another. This makes the joints stiff, creaky and painful. As this disease is a wear and tear disease, it tends to occur in older people and those whose joints have been damaged by injury. Primary Osteoarthritis usually indicates that the cause of OA is unknown, but is also directly related

to aging, or the gradual degeneration of cartilage due to stress placed on the joints. Symptoms If you have a form of OA you will most likely experience pain, stiffness, swelling in and around your joints, loss of mobility, and deformed joints. You may also have a symptom referred to as "Water on the Knee", which is the accumulation of excess fluid in or around the joint (this may result in swelling). Some individuals also encounter a crackling, crunching or creaking sound when you move (this is also referred to as "Crepitus"). Humid weather or noticeable changes in temperature often agitate these symptoms. Degree of Severity Grade One, also referred to as Condromalacia, involves the early onset of OA where the cartilage in the joint begins to soften thus stressing the joint and filling the joint cavity with fluid. Although you may not have any surface damage to the bones in your joint at this stage, your knee will become swollen and inflamed. Grade Two, also referred to as Fissuring, is the minute tearing or cracking of joint cartilage - this damage often goes unnoticed. Grade Three, also referred to as Fibrillation, indicates a later onset of OA with noticeable tearing

of the cartilage. At this point your injured cartilage will break into small pieces, and these pieces will release enzymes that will act to further damage your joint. Grade Four involves the exposure and damage of underlying bone in the joint. At this phase the injury will most likely need surgery to heal. Diagnosis: Osteoarthritis is often visible in x-rays. Cartilage loss is suggested by certain characteristics of the images: The normal space between the bones in a joint is narrowed. There is an abnormal increase in bone density. Bony projections, cysts, or erosions are visible.

If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests are necessary. It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise, some people may have minimal symptoms even though an x-ray clearly shows they have arthritis. An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects other causes of pain. X-rays are a form of ionizing radiation that can penetrate the body to form an image on film.

Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel. Blood Tests Blood test results may help identify other causes of arthritis (if present) besides osteoarthritis. Some examples include: Elevated levels of rheumatoid factor (specific antibodies in the synovium) are usually found in patients with rheumatoid arthritis The erythrocyte sedimentation rates (ESR, or "sed rate") indicates inflammatory arthritis or related conditions, such as rheumatoid arthritis or systemic lupus erythematosus. Elevated uric acid levels in the blood may indicate gout.

Cartilage cells in the fluid are signs of osteoarthritis. A high white blood cell count is a sign of infection, gout, pseudogout, or rheumatoid arthritis. Uric acid crystals in the fluid are an indication of gout.

or compression wrap to protect your injury. Compress the area if possible by adding light pressure to minimize swelling. Finally, elevate your injuryto relieve swelling and allow fluid to properly drain. Blood Flow Stimulation Therapy

Treatments there is no known cure or preventative methods for OA, however there are treatments available that can provide relief from pain and other symptoms associated with OA. Pain, swelling and inflammation of any kind can be reduced through Cold Compression Therapy (R.I.C.E.), Blood Flow Stimulation Therapy and Therapeutic Ultrasound. Cold Compression Therapy - The R.I.C.E. Method Cold Compression Therapy is ideal when you are experiencing pain, swelling or "Water on the Knee". In order to reduce swelling and rest your injured area you may choose to administer the R.I.C.E. method. Begin R.I.C.E. treatments by resting your Therapeutic ultrasound is a method of stimulating tissue beneath the skin's surfaceusing sound waves. It is like a high frequency massage that can penetrate up to 4" below the surface of the skin. The heating and massaging effects of therapeutic ultrasound can reduce swelling. Essentially, the nutrient absorption rate and blood flow within the injury will be greatly enhanced through the use of an ultrasound device. Portable ultrasound therapy is recommended and administered by many doctors and physical therapists. injury as much as possible and restrict any of movement that may aggravate your OA. Ice the swollen area at least 3 times a day for approximately 15 to 20 minutes (allow for 45 minute periods between treatments). Do not apply ice directly onto your injury as this may cause cryoburn (freezer burn to the skin) - use a piece of cloth, towel If your injury is still inflamed and the area is no longer swollen you may want to explore the use of Blood Flow Stimulation Therapy (BFST). BFST decreases inflammation and increases blood circulation. Blood is the transport mechanism for oxygen, nutrients, water and antibodies, thus proper blood flow is essential when treating pain from OA. BFST is provided through the use of heat therapy which can be found in heating wrap products. Therapeutic Ultrasound

A number of other blood tests may help identify other rheumatological illnesses. Tests of the Synovial Fluid If the diagnosis is uncertain or infection is suspected, a doctor may attempt to withdraw synovial fluid from the joint using a needle. There will not be enough fluid to withdraw if the joint is normal. If the doctor can withdraw fluid, problems are likely, and the fluid will be tested for factors that might confirm or rule out osteoarthritis:

injury. At this point the surgeon can view inside of When applied directly to the skin, the transducer head of an ultrasound unit cannot effectively transfer sound waves into the body. A conductive medium (ultrasound gel) is required to facilitate therapeutic ultrasound. Ultrasound can also be used to administer therapeutic medicines into the body which provides the added benefit of delivering soothing medicated gel to the site of the pain. This is a process known as Phonophoresis. Surgery urgery is often reserved for extreme cases of OA where individuals are experiencing debilitating pain and severe dysfunction of joints. Some surgical procedures that may be performed include: arthroscopy, joint replacement (arthroplasty), fusing of bones (arthrodesis). There are also a variety of alternative procedures that are conducted for specific joints, as well as new experimental procedures. Arthroscopy Arthroscopy may be performed in order to surgically remove cartilage or bone fragments from the OA injury. This procedure involves inserting a fiber optic camera through a small incision on the outside of the the joint in order to view the amount of damage around your joint. The surgeon will remove damaged cartilage and fragments. This particular procedure may slightly reduce pain from OA, but there has also been some debate as to the effectiveness of this surgery in relieving pain. Joint Replacement (Arthroplasty) This procedure is most common with hip and knee replacements and involves the insertion of artificial prosthetic joint implant. Replacement of joints in the shoulders, elbows, hands and feet are much less common. Individuals who have severe cases of osteoporosis or other medical conditions may not be viable candidates for this procedure. There are also many complications and limitations that may arise due to this surgery, therefore it is wise to discuss these issues with your surgeon before going forward with a joint replacement procedure. Fusing of Bones (Arthrodesis) This particular surgery usually involves treating pain in smaller joints in the hands, feet or spine because fusion of these bones will directly affect range of motion (ROM) or movement of the joint. This surgery can diminish or eliminate pain as the surgeon fuses the bones in the joint affected by OA together. Although this procedure will diminish pain from OA, it

will be nearly impossible to move the joint in any way.

Rheumatoid arthritis Rheumatoid arthritis, on the other hand, is an inflammatory arthritis. The synovium (see above) becomes much thicker and changes its character so that the inflammatory cells within it start to eat away at everything they touch. Joints affected by rheumatoid arthritis often become unstable and slip out of place, causing deformities of the hand, for example. It commonly affects younger women aged 20 to 50 years.

Causes of rumatory arthritis: The exact causes are not known yet. Various factors may contribute to the development of autoimmune diseases such as rheumatoid arthritis. These factors include heredity, hormonal imbalances, and possibly infection by a bacterium or virus. Typical symptoms of rheumatoid arthritis joint pain is one of the most typical symptoms of rumatory arthritis. In most cases, this goes along with warmth, redness and swelling in the joints. Some people also experience morning stiffness. Oftentimes, these symptoms occur symmetrically on both sides of the body. Treatments for rumatory arthritis

Basically, the treatment of rheumatoid arthritis consists of two components: Reducing inflammation and preventing joint damage and Relieving symptoms especially pain Most common treatments: Cortisone therapy: This provides temporary pain relief, however the long-term side effects of cortisone treatment are not desirable. On the other hand, using low dosages of daily cortisone can be used in addition to a specific anti-rheumatic treatment. Disease modifying antirheumatic drugs (DMARDs): These are the newest group of drugs used for treating rumatory arthritis. They are produced from living cells and work on the immune system to limit inflammation and reduce the signs and symptoms of rheumatoid arthritis. Light physical activity: Regular exercise is crucially important and should be part of any treatment plan. Some people say that exercise is bad for the joints, but thats completely wrong. Research has shown that exercise helps reduce pain and fatigue, increases your range of motion and strength, and keeps you feeling better overall. Holding your joints still for long periods promotes stiffness, whereas regular movement keeps them flexible. 3 types of exercises should be used: Range-of-motion exercise, strengthening exercise, and endurance exercise. One of the best types of exercises for rumatory arthritis is swimming and water aerobics.

This strengthens the muscles around the joints and helps to increase the range of motion and endurance while at the same time keeping weight off the joints of your lower body. Sea bathing is considered to be very beneficial for rumatory arthritis treatment. Walking is also a great exercise for arthritis patients. It burns calories, strengthens the muscles and builds denser bones. If you are sitting most of the day, get up every hour, walk around and stretch yourself. As a general rule, avoid keeping your joints in the same position for too long.

joint in any way that causes pain. Never put any strain on swollen and painful joints. Your joints are more susceptible to damage at such times. Never bandage your joints too tightly. This limits movement and blood circulation. Try meditation or yoga. Meditation is known to positively influence the healing process of any illness. Start with a few minutes a day. Lie down on your back or sit on a chair, close your eyes and enjoy he silence within for a few minutes. Thats really all simply stop the flow of thoughts for a moment and enjoy the feeling that arises from inner silence. Massages with warm olive oil helps to relieve pain increase the flexibility of your muscles and tendons. Dilute Garlic, Juniper, Lavender, Sage, Rosemary, Thyme, or Sassafras oils in the proportions of one part to 10 parts of olive oil and use it to massage the joints for immediate relief of rheumatoid arthritis pain. Do a massage with Rosemary, Lavender or Chamomile oils they contain high antiinflammatory properties. Arthcare Oil is also known to be highly anti-inflammatory and it is often used to relieve rumatory arthritis pain.

Have a well balanced diet with lots of fruits and vegetables, some proteins, fish and avoid too many unsaturated fatty acids. Also make sure to get enough vitamin C, zink and calcium. Have a glass of water every 1-2 hours drink at least 2 liters of water a day. If you are overweight, try to lose a bit of weight. This takes stress off your joints and reduces pain. Live a healthy life: Quit smoking, avoid alcohol, drink less coffee, eat less sugar, avoid fast food and an excess of unsaturated fatty acids in your nutrition. 1 3 times a day, move each joint through its full range of motion. Do not move the

Rub the aching joints with hot vinegar before going to bed. 6-50 grams of fresh or powdered ginger per day can reduce the symptoms of rumatory arthritis. Another great tip for rumatory arthritis patients: Add 4 table spoons of Epsom salt to your bathing water this is known to reduce inflammation and stiffness of joints.

Complications in Other Areas of the Body Rheumatoid arthritis can affect other parts of the body as well as the joints. Some patients with severe disease may then be at higher risk for complications, such as the following: Peripheral Neuropathy. This condition affects the nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning. Muscle problems. Many patients have weakness of the muscles. Anemia. People with RA may develop anemia, which involves a decrease in the number of red blood cells. Scleritis and Episcleritis. This is an inflammation of the blood vessels in the eye that can result in corneal damage. Symptoms include redness of the eye and a gritty sensation. Infections. Patients with RA have a higher risk for infections, particularly if they are treated only with immune-suppressing drugs (corticosteroids, anti-tumor necrosis factors, disease modifying drugs).

Skin Problems. Skin problems are common, particularly on the fingers and under the nails. Some patients develop severe skin complications that include rash, ulcers, blisters (which may bleed in some cases), lumps under the skin, and other problems. Severe skin disease can reflects a more serious case of RA in general. Osteoporosis. Osteoporosis, a disorder in which bone density decreases, is more common than average in postmenopausal women with RA. The hip is particularly affected. The risk for osteoporosis also appears to be higher than average in men with RA who are over 60 years old. Lung Disease. Patients with RA are susceptible to chronic lung diseases, including interstitial fibrosis, pulmonary hypertension, and other problems. Both rheumatoid arthritis itself and some treatments may cause this damage. Kidney. Although rheumatoid arthritis only rarely involves the kidney, many of the drugs used to treat it can damage kidneys. Vasculitis. Vasculitis involves autoimmune inflammatory abnormalities in very small vessels and can affect many organs in the body. Manifestations of vasculitis include mouth ulcers, nerve disorders, rapid worsening of the lungs, inflammation of coronary arteries, and inflammation of the arteries supplying blood to the intestines. Heart Disease. Patients with RA have increased risk for death from coronary artery disease. Research suggests that he chronic inflammation associated with RA may be a factor. Lymphoma and Other Cancers. Patients with RA are more likely than healthy

patients to develop non-Hodgkin's lymphoma. RA's chronic inflammatory process may play a role in the development of lymphoma. There has also been concern that some RA treatments may increase the risk for lymphoma. Periodontal Disease. People with RA may be twice as likely as non-arthritic individuals to have periodontal disease. Chronic inflammation and immune dysfunction are central to both diseases. Pregnancy. Women with RA have an increased risk for premature delivery. They are also three times more likely than healthy women to develop hypertension during the last trimester of pregnancy. For many women with RA, the disease goes into remission during pregnancy but after birth the condition recurs and symptoms can increase in severity.

GOUT Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection. The joint most commonly involved in gout is the first metatarsophalangeal joint (the big toe), and is called podagra. Any joint may be involved in a gout attack (and it may be more than one) with the most frequent sites being in the feet, ankles, knees, and elbows. Cause Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons, including diet,

genetic predisposition, or underexcretion of urate, the salts of uric acid Signs and symptoms Gout presenting in the metatarsal-phalangeal joint of the big toe. Note the slight redness of the skin overlying the joint. Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases. Other joints, such as the heels, knees, wrists and fingers, may also be affected. Joint pain usually begins over 24 hours and during the night.[3] The reason for onset at night is due to the lower body temperature then. Other symptoms that may occur along with the joint pain include fatigue and a high fever. Long-standing elevated uric acid levels (hyperuricemia) may result in other symptomatology, including hard, painless deposits of uric acid crystals known astophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in

the kidneys, resulting in stone formation and subsequent urate nephropathy.

Diagnosis of Gout:
A diagnosis of gout can be made with the documentation of the presence of uric acid crystals in synovial fluid or from a tophaceous deposit. In the setting of an acute gout attack, aspiration of joint fluid (by using a needle to draw fluid out of the swollen joint) and examination of the fluid under polarized light can yield the definitive diagnostic finding of needle shaped negatively-birefringent uric acid crystals (yellow when parallel to the axis of polarization). Intracellular crystals within a neutrophil are characteristic during an acute attack. As the clincal features of acute gout and a septic joint (bacterial infection) can be very similar, arthrocentesis is important to rule out infection by sending the joint fluid for culture in these circumstances. Importantly, gout and infection can co-exist in the same joint (they are not mutually exclusive) and consideration should be made for sending joint fluid for culture even in a patient with an established history of gout if they are at risk for infection. Tophi can be aspirated or the tophaceous material expressed and examined under polarize microscopy as well to confirm a diagnosis of chronic tophaceous gout. Serum uric acid concentrations may be supportive of a diagnosis of gout, but alone the presence of hyperuricemia or normal uric acid concentrations do not confirm or rule out the diagnosis of gout as frequently uric acid levels may be normal during an acute gout attack.

To stop a gout attack, your doctor can give you a shot of corticosteroids, or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away. To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another antiinflammatory medicine can also help you feel better. But don't takeaspirin. It can make gout worse by raising the uric acid level in the blood. To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives. Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to control your weight and get the nutrients you need. Avoid regular daily intake of meat, seafood, and alcohol (especially beer). Drink plenty of water and other fluids.

DANICA DENICE C. DELACRUZ

TREATMENT