My joints are pain, is this a sign of arthritis?

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In previous blog articles, we talked about Upper Crossed Syndrome and Lower Crossed Syndrome, both are postural disorders. In this session, we look at a common structural joint damage, arthritis.

Arthritis is the weakening of the joints that causes intense pain and affects your mobility. There are over 100 different arthritis with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).

Osteoarthritis and rheumatoid arthritis

Osteoarthritis (OA) is a degenerative joint disease which develops over time caused by wear and tear of your cartilage. When your bone rubs against bone, it causes pain, swelling and stiffness. Over time, joints become weak and pain becomes chronic. Often, the breakdown of cartilage tissue can exacerbate when there is an infection or injury to the joints. OA is more commonly seen in the knees, hands, hips, and spine of an adult over 65 years old, especially in women and obese people. It can also happen in younger adults, teens and children, and men if certain risk factors are met.

Rheumatoid arthritis (RA) is an autoimmune disorder categorised under inflammatory arthritis. It occurs when your body’s immune system attacks the tissues of the joints. This inflammation thickens the lining of membranes called synovium that surround your joints and may eventually erode the cartilage and bone. The cause of RA is still unknown; however, scientists believe that a combination of genetics and environmental factors can trigger autoimmunity. Other types of inflammatory arthritis include psoriatic arthritis, ankylosing spondylitis, and gout.

Statistics and trends

In Singapore, OA is the most common form of arthritis affecting 10% of the general population and 20% of the elderly population, while RA is affecting about 1% of the population.

OA affects both men and women, with women being reported to be the majority. OA rates increase sharply after the age of 50. It is projected that in 2030, 26% of the elderly population will suffer OA.

In recent years, there is a rising trend of young population between the age of 18 and 50 suffering from premature osteoarthritis due to sport injuries.

What are the symptoms of arthritis?

The most common symptoms of arthritis are pain, stiffness, and swelling at the joints. Because of pain, your range of motion will be restricted and this will subsequently weaken your muscles surrounding the affected joints. People with arthritis often notice their symptoms, especially upon waking up in the morning, after sitting at a desk, or after sitting in a car for a long time. The onset of pain can occur even when resting, usually at the ankles, knees, and hips.

With RA, you will notice painful swelling of your joints, typically at the small joints such as wrist, ankles, hands, and feet. You may become anaemic (decreased red blood cell count) or show symptoms of mild fever. Severe RA, if left untreated for long time, can lead to joint deformity.

Are you at risk?

Age: The risk of developing most types of arthritis increases with age, while RA most commonly begins in middle age.
Gender: 60% of people with arthritis are female, while gout is more common in males than females.
Genetic factors: Specific genes are associated with a higher risk of certain types of arthritis, such as RA, systemic lupus erythematosus (SLE) and ankylosing spondylitis. If a member of your family has RA, you may have an increased risk of the same disease.
Overweight and obesity: Excess weight can contribute to both the onset and progression of knee OA.
Occupational hazards: Some occupations that require repetitive knee bending and squatting are associated with knee OA.
Joint injuries: Damage to a joint, especially during sports, can contribute to the development of OA in that joint.
Infection: Many microbial agents can infect joints and trigger the development of various forms of arthritis.
Smoking. Cigarette smoking increases your risk of developing RA, especially when you have a genetic predisposition for developing the disease.

What are the complications?

Unlike OA, RA is an autoimmune disease. Generally, it presents more clinical complications. These include:

Osteoporosis. RA can increase your risk of osteoporosis.
Rheumatoid nodules. Formation of firm lumps mostly around pressure points, such as the finger joints and elbows.
Dry eyes and mouth. People who have RA are much more likely to experience Sjogren’s syndrome, a disorder that decreases the amount of moisture in your eyes and mouth.
Carpal tunnel syndrome. If RA affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
Heart problems. RA can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
Lung disease. People with RA have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
Lymphoma. RA increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.
Infections. The medications used to suppress RA can impair or shut down the immune system, leading to increased infections.

How is arthritis being diagnosed?

During a medical consultation or health screening, doctors usually perform diagnosis by a typical symptom profiling and physical examination.

Physical examinations may include:

X-rays or Magnetic resonance imaging (MRI) to get a better insight into the joint condition.
Joint aspiration to extract fluid sample of the joint for analysis and to exclude the possibilities of gout and cancerous conditions.

Is there any cure & treatment for arthritis?

Both OA and RA are irreversible conditions, pain is the main discomfort that is affecting your mobility and quality of life. Hence, the treatment for arthritis mainly aims to control pain, minimise joint damage, and improve or maintain normal functions.

Physical treatment
The primary goal of treatment is to reduce the intensity of pain and prevent additional damage to the joints. Some people find heating pads and ice packs to be soothing (hot and cold therapies). Others use mobility assistive devices, such as splints or joint assistive aids, canes or walkers, to prevent further injury and take pressure off the sore joints.

Rehabilitation
Rehabilitation therapy involving exercises that help to strengthen the muscles around the affected joint.

Medication

There are different medications that treat arthritis:

Analgesics are effective for pain management, but not helping to decrease inflammation.
Nonsteroidal anti-inflammatory drugs (NSAIDs) help control pain and inflammation.
Menthol or capsaicin creams block the transmission of pain signals from your joints.
Immunosuppressants help reduce inflammation.

For immediate relief of pain, your doctor would recommend an injection called viscosupplementation. It is a hyaluronic acid injection that replaces and mimics the lubricants in your joints. Alternatively, some doctors also inject steroid (cortisone injection) that reduces inflammation and suppress pain. However, both injections can only suppress pain for six weeks to six months.

Depending on the severity of arthritis, your doctor may prescribe corticosteroids or disease-modifying antirheumatic drugs (DMARDs), which suppress your immune system.

Surgery
If your joint symptoms are severe and pain is unbearable, causing limited mobility and affecting quality of life, joint replacement (arthroplasty) may be an option. This form of surgery is most commonly performed to replace hips and knees. The implants usually last between 15 to 20 years on average.

In some cases, doctor may perform a joint fusion surgery (arthrodesis) to fuse the affected joints, so that it can strengthen and stabilise the joint and prevents any movement between the bones. This surgery can eliminate pain, but it would also affect your mobility.

Living with arthritis

To ease your arthritis symptoms, you have to reduce the burdens to your joints. One good way is to maintain your body weight at healthy BMI and reduce damages to your joints and cartilages. Light exercise can also improve blood circulation and keep your joints healthy.

If you are suffering from OA,

Take more foods that are high in healthy fats (unsaturated fat) such as salmon, avocados, almonds, peanut butter.
Consume foods that are high in antioxidant such as Vitamin C and D as they are associated with reduced cartilage degeneration.
Avoid fried foods, processed foods, dairy products, and high intakes of meat.

If you are suffering from RA,

Seek treatment early. Your doctor will prescribe medications to relieve the pain and slow down the joint damage.
Surgery may help to restore the affected joints and quality of life.

What to do if there is still time?

Weight loss and maintain a healthy weight can reduce your risk of developing OA.

Eating a healthy diet is important to achieve weight loss.
Choosing a diet with lots of antioxidants, such as fresh fruits, vegetables and herbs, fish and nuts, can help to reduce inflammation.

Staying active and exercising regularly will keep your joints flexible.

Swimming is often a recommended exercise as it doesn’t put pressure on your joints.
Every time before exercising, you should also perform proper warm-up.
Exercise such as weight-lifting should be avoided or performed with proper control and supervision.
As you age, avoid vigorous exercise to reduce your risk of injury to the joints is important. You may engage in some slow-pace exercises such as Yoga and Tai Chi Quan.