Arthritis, joint inflammation, and its repercussions Arthritis is an umbrella term derived from the Greek arthro-, which means “joint,” and -itis, which means “inflammation.” Arthritis can be a significant cause of incapacity. In the United States, for instance, statistics obtained between 2007 and 2009 revealed that 21 million people were affected by arthritis and were limited in their physical activity as a result. By 2030, it is anticipated that 67 million adults will have been diagnosed with arthritis in that country. Similarly, in the United Kingdom, arthritis and related illnesses prompted almost 10 million adult visits to the doctor annually. Although osteoarthritis and rheumatoid arthritis are the most frequent kinds of arthritis, there are numerous other varieties, including those caused by infection and metabolic disorders.
Osteoarthritis, commonly known as degenerative joint disease, is the most prevalent form of arthritis, affecting about one-third of individuals over 65 years old. It is characterized by joint pain and moderate inflammation caused by the degeneration of articular cartilage, which normally cushions joints. The development of joint discomfort is gradual, arriving after extended activity, and is often dull and achy. One of many joints may be afflicted, with the knee, hips, spine, and fingers most commonly impacted.
Approximately 90% of patients report crepitus (crackling noises) when moving the afflicted joint. When patients are reluctant to move painful joints, muscle weakness and joint laxity or stiffness can develop. Patients have poor joint stability and are susceptible to meniscal and anterior cruciate ligament rupture. Arthritis of the hip can impact gait, while arthritis of the hands can diminish dexterity. Osteophytes, which are enlargements of the bony processes around afflicted joints, are prevalent.
The cartilaginous alterations that contribute to osteoarthritis can be caused by joint damage, advancing age, obesity, certain genetic variables and employment, and excessive joint stressors caused by hobbies or sports. The development of microscopic, perpendicular cartilage fissures is the first sign of joint damage. Cartilage eventually erodes and separates, allowing for painful bone-on-bone contact. Over time, pathologic skeletal alterations, such as osteophytes and subchondral bone cysts, manifest and further impair joint mobility and integrity.
Osteoarthritis can be split into two categories: primary and secondary. Primary osteoarthritis is age-related, affecting 85 percent of people aged 75–79. The cause of primary osteoarthritis is uncertain, however, it is related to diminished water-retention capacity in the cartilage, akin to a dried-out rubber band that readily breaks. Secondary osteoarthritis is brought on by a condition such as joint trauma, congenital joint malalignment, obesity, hormonal problems, or osteonecrosis. Exercise, weight loss, nonsteroidal anti-inflammatory medications, steroids, and complete joint replacement surgery may be used to reduce pain and correct joint mechanics in osteoarthritis patients.
Joint inflammation and damage generated by one’s immune system characterize autoimmune arthritis. The incorrect immune response can be triggered by genetic predisposition and triggering circumstances, such as infection or trauma. Rheumatoid arthritis, an autoimmune illness, is frequently associated with elevated serum levels of rheumatoid factor autoantibody, whereas seronegative arthropathies are not.
Rheumatoid arthritis is a progressive inflammatory disorder that can result in diminished mobility and abnormalities of the joints. The global incidence is 0.8%, with a 2:1 preference for females over males. Initial symptoms include fatigue, weakness, malaise, weight loss, and mild, generalized joint pain. The start of the disease, which primarily occurs in the third and fourth decades of life, maybe abrupt or gradual, with initial symptoms including fatigue, weakness, malaise, and weight loss. Rheumatoid arthritis has a symmetrical effect on the hips, knees, elbows, ankles, spine, hands, and feet. Periods of remission are followed by gradual exacerbations in which specific joints become heated, swollen, and painful. Rheumatoid arthritis is characterized by morning stiffness, which normally lasts around two hours. Patients with rheumatoid arthritis often experience joint discomfort after long periods of inactivity, whereas osteoarthritis symptoms are typically increased by prolonged exercise. Rheumatoid arthritis can be very incapacitating and result in a range of abnormalities. Complete remission often occurs within two years after disease initiation for certain people.
Although the precise origin of rheumatoid arthritis is uncertain, it is characterized by inflammation of the tissues around the joint area. The thin lining of the joint area becomes thick and inflamed, assuming the shape of a mass with fingerlike projections (pannus) that invades the joint space and the bone around it. This initially causes joint laxity. However, when the condition progresses, the bones might fuse (ankylosis), limiting mobility.
The impact of rheumatoid arthritis on the hands is a distinguishing feature. Clinically, it differs from osteoarthritis depending on the distribution of damaged joints in the hands. Osteoarthritis tends to affect the distal joints of the hands and fingers, whereas rheumatoid arthritis affects the proximal joints. In extreme situations, joint laxity and tendon rupture results in a characteristic finger and wrist deformity.
Rheumatoid nodules are dense fibrous nodules that develop in rheumatoid arthritis as a result of severe tissue inflammation. Typically, these nodules form in pressure areas, including the elbows, Achilles tendon, and flexor surfaces of the fingers. Destruction of peripheral blood arteries (vasculitis) due to inflammation can occur in any organ, resulting in renal failure, myocardial infarction (heart attack), and intestinal infarction (death of part of the intestine). Moreover, rheumatoid arthritis is linked to an increased risk of infections, osteoporosis (bone thinning), and atherosclerosis (hardening of arteries).
Rheumatoid arthritis is diagnosed based on the presence of multiple clinical characteristics, including rheumatoid nodules, high levels of rheumatoid factor, and radiographic alterations. Although rheumatoid factor is present in 70 to 80 percent of persons with rheumatoid arthritis, it cannot be used as a diagnostic tool on its own because it is related to many illnesses.
As there is no cure for rheumatoid arthritis, treatment focuses on reducing symptoms of pain and inflammation. The surgical treatment may consist of total joint replacement, carpal tunnel release (severing the carpal ligament), and tendon repair. Hand splints are employed to retard the growth of finger and wrist deformities.
The average life expectancy of patients with rheumatoid arthritis is reduced by 5–10 years and is strongly dependent on the severity of the condition. Serum rheumatoid factor levels are directly correlated with disease severity and the risk of extra-articular symptoms.
Multiple variants of rheumatoid arthritis exist. The hallmark symptoms of Sjogren syndrome are dry eyes, dry mouth, and rheumatoid arthritis. Felty syndrome is linked to splenomegaly, neutropenia, and rheumatoid arthritis. Rheumatoid arthritis in children is the most prevalent kind of childhood arthritis. The etiology and clinical course of juvenile-onset rheumatoid arthritis often differ from that of adult-onset rheumatoid arthritis, and patients are prone to acquire various rheumatologic disorders, including rheumatoid arthritis.
Spondyloarthropathies include the disorders of ankylosing spondylitis, Reiter syndrome, psoriatic arthritis, and arthritis associated with inflammatory bowel illness. The sacrum and spinal column are typically damaged, and back discomfort is the most common presenting complaint. Spondyloarthropathy is characterized by enthesitis, inflammation at the insertion of a tendon or ligament into bone. Spondyloarthropathies, unlike rheumatoid arthritis, are not associated with higher levels of serum rheumatoid factor. Spondyloarthropathies are especially prevalent in males and people with the HLA-B27 genetic variant.
Ankylosing spondylitis is the most prevalent form of spondyloarthropathy, affecting between 0.1% and 0.2% of the U.S. population. In a region of Turkey, the prevalence was determined to be 0.25 percent, but the prevalence in the United Kingdom is predicted to range from 0.1 to 2 percent. In all regions, males are affected more frequently than females and between the ages of 15 and 40 on average. More than ninety percent of individuals with ankylosing spondylitis who are white and of western European heritage are HLA-B27 positive, according to genetic studies.
Ankylosing spondylitis is characterized by spinal and sacroiliac joint arthritis. Extensive inflammation of the spinal column is evident, resulting in the radiographic appearance of a “bamboo spine.” Arthritis begins in the sacroiliac joints and develops gradually along the vertebral column, resulting in spinal deformity and immobility. Back pain, which lessens with movement, and heel pain due to enthesitis of the plantar fascia and Achilles tendon are typical symptoms. Hip and shoulder arthritis may develop early in the disease’s progression.
The combination of urethritis, conjunctivitis and arthritis characterizes Reiter syndrome, a kind of reactive arthritis. Patients often develop acute oligoarthritis of the lower limbs (two to four joints affected) within weeks of getting a gastrointestinal infection or a sexually transmitted disease. Reiter arthritis is not considered an infectious form of arthritis due to the absence of microorganisms in the joint area. Instead, an infection external to the joint is the cause of this type of arthritis. Additionally, fever, weight loss, back pain, enthesitis of the heel, and dactylitis may be present (sausage-shaped swelling of the fingers and toes). The majority of cases cure after a year, while 15–30% of patients acquire persistent, sometimes progressing arthritis. Reiter syndrome occurs nearly primarily in men and is significantly associated with the HLA-B27 gene variation, which is present in 65 to 96% of symptomatic people.
Psoriasis is an immune-mediated inflammatory skin condition characterized by red plaques with silvery scales, which can be unpleasant and itchy at times. Plaques are frequently observed on the elbow, knees, scalp, and ears, but they can appear anywhere on the body. Approximately 10% of psoriasis sufferers develop psoriatic arthritis, a specific form of rheumatoid arthritis. In other parts of the world, this percentage may reach 30%.
Psoriatic arthritis often develops many years after psoriasis has been established. In some instances, though, arthritis may precede psoriasis; the two conditions emerge together much less frequently. Population-specific estimates of the prevalence of psoriatic arthritis differ. However, it is believed to affect approximately 1% of the general population, with a peak onset age of between 30 and 55. Typically less damaging than rheumatoid arthritis, psoriatic arthritis is typically moderate and progresses slowly. However, rare varieties, such as arthritis mutilans, can be fairly severe. Occasionally, the start of symptoms associated with psoriatic arthritis is sudden; however, it is more frequently gradual, manifesting first as oligoarthritis with enthesitis. Over time, arthritis affects numerous joints (polyarthritis), particularly the hands and feet, causing dactylitis. Unlike rheumatoid arthritis, the polyarticular pattern of psoriatic arthritis typically affects a separate subset of finger joints. Psoriatic arthritis may not impact the axial joints, causing inflammation of the sacroiliac joint (sacroiliitis) and intervertebral joints, until years after peripheral arthritis has occurred (spondylitis).
Arthritis mutilans is a severe and uncommon form of psoriatic arthritis characterized by bone degeneration and telescoping of the fingers or toes. It occurs in less than 5 percent of patients. Additionally, people with psoriatic arthritis require more intensive treatment if the ailment manifests before the age of 20, if there is a family history of psoriatic arthritis, if there is substantial skin involvement, or if the patient possesses the HLA-DR4 genotype.
Twenty percent or more of people with Crohn’s disease and ulcerative colitis also suffer from spondyloarthropathy. Although arthritis associated with inflammatory bowel disease mainly affects the lower extremities, up to 20% of cases exhibit ankylosing spondylitis-like symptoms. Arthritis is typically aggravated in association with exacerbations of inflammatory bowel illness and lasts for several weeks thereafter.
The precipitation of crystals in the joint area can lead to joint inflammation, degeneration, and discomfort. Gout and pseudogout are the two most common forms of crystalloid arthritis, each of which is produced by distinct crystalloid precipitates.
A gout is a severe form of arthritis characterized by the deposition of needle-shaped monosodium urate crystals within the joint area (a urate is a form of uric acid). Initially, gout normally affects a single joint, typically the big toe (podagra), but it can also affect the knees, fingers, elbows, and wrists. Intense pain, which commonly begins at night, can make patients sensitive to even the smallest touch. Urate crystal deposition is linked to the accumulation of excessive serum uric acid (hyperuricemia), a byproduct of normal metabolism that is filtered by the kidneys and eliminated in the urine. Leukemia or lymphoma, alcohol consumption, and chemotherapy are causes of excessive uric acid production. Hyperuricemia can be caused by kidney disease and some drugs, such as diuretics, that inhibit uric acid excretion. Even though acute gouty attacks are self-limiting if hyperuricemia is left untreated for years, such attacks can return intermittently and involve many joints. Chronic tophaceous gout occurs when, after approximately 10 years, chalky, pasty deposits of monosodium urate crystals begin to collect in the soft tissue, tendons, and cartilage, resulting in the development of large, spherical nodules known as tophi. At this stage of the disease, joint discomfort becomes persistent.
Because males often have greater baseline serum uric acid levels, gout is most prevalent in men in their forties. Globally, the prevalence of gout appeared to be on the rise at the beginning of the 21st century, most likely due to increasing lifespan, changing dietary and lifestyle variables, and the rising incidence of insulin-resistant disorders.
Pseudogout is produced by the deposition of rhomboid-shaped calcium pyrophosphate crystals (CPPD) into the joint space, which results in symptoms resembling gout. Self-limiting in nature, pseudogout typically affects one or two joints, such as the knee, ankles, wrists, or shoulders, and can last between one day and four weeks. The presence of high amounts of pyrophosphate in synovial fluid is a key risk factor. Because an excess of pyrophosphate can result from cellular damage, pseudogout is frequently precipitated by trauma, surgery, or severe sickness. Another probable reason for pyrophosphate excess is a deficit in alkaline phosphatase, the enzyme responsible for breaking down pyrophosphate. The synovial CPPD is also related to hyperparathyroidism, hypothyroidism, hemochromatosis, and Wilson disease. In contrast to gout, pseudogout affects both men and women, with over half of those affected being aged 85 or older.
Infectious arthritides are a group of arthritic diseases induced by microorganism exposure. In some cases, germs invade the joint space and cause destruction, whereas, in others, an infection induces an incorrect immune response that results in reactive arthritis. Infectious arthritis is typically caused by bacterial infections, although it can also be caused by fungal and viral infections.
Typically, septic arthritis affects a single major joint, such as the knee. Although numerous organisms are capable of causing arthritis, Staphylococcus aureus is the most prevalent infection. The bacteria that causes gonorrhea, Neisseria gonorrhoeae, is a prevalent infection affecting sexually active young adults.
After a bloodstream infection, the most likely route for germs to infiltrate the joint area is through the circulatory system. Microorganisms can also be introduced into the joint by a penetrating injury or surgical procedure. Very young or old age (e.g., infants and the elderly), recent surgery or skin infection, previous arthritic disease, immunosuppression, chronic renal failure, and the presence of a prosthetic joint are risk factors for septic arthritis.
After a variety of infections, postinfectious arthritis may occur. Following the resolution of certain gastrointestinal illnesses, urinary tract infections, and upper respiratory tract infections, arthritic symptoms may develop. Reiter syndrome and arthritis associated with rheumatic fever are examples.