arthritis

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ARTHRITIS
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Arthritis has been with humankind since the
beginning of recorded history. It belongs to a
set of diseases known as autoimmune diseases, in
which the body falsely identifies its own tissue
as foreign matter (as invaders) and attacks it by
producing antibodies to fight against it. The
most prevalent of these autoimmune diseases is
arthritis, and it has a very significant
relationship to our immune functioning and it is
also one of the most common chronic disorders and
causes of disability.
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Arthritis, a condition characterized by
inflammatory lesions in the joints that produce
pain, heat, redness and swelling. Hence it is
basically an inflammation in a joint, usually
with swelling, pain, and restriction of
movements. It most definitely affects the
quality of ones life. This disease refers to
more than 80 diseases that attack the joints or
other connective tissues. Although it is rarely
fatal, arthritis ranks second only to heart
disease as the most widespread chronic disease in
the United States today
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The prevalence rate of arthritis is increasing,
with 15 of the population affected in 1990 but
an expected prevalence of 18.2 by 2020 (Wang et
al., 2001). Furthermore, disability rates
produced from arthritis also appear to be
growing, with those affected reporting more
suffering from arthritis (Wang et al.,2001
Yelin,1992). The severity of and prognosis for
arthritis depend on the type the disease ranges
from a barely noticeable and occasional problem
to a crippling, chronic condition. Arthritis can
also be caused by other disease processes or from
a variety of other infections affecting the body,
e.g. gonorrhoea and tuberculosis.
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The three major forms of arthritis are rheumatoid
arthritis, osteoarthritis, and gout. Rheumatoid
arthritis (RA) A generative disease of unknown
cause that affects 1 to 3 of the population. It
mostly affects women and is the most crippling
form of arthritis (Arthritis Foundation, 2004).
The disease first strikes primarily the 40 60
age group, although it can attack people of any
age group, including children (known as juvenile
rheumatoid arthritis or Stills disease). It is
believed that about 16 of female population over
65 suffer from this disease. It usually affects
the small joints of the hands and feet, as well
as the wrists, knees, ankles, and neck. In mild
cases, only one or two joints are involved, but
sometimes the disease becomes widespread. In
severe cases, there may be inflammation of the
heart muscle, blood vessels, and tissues just
beneath the skin.
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RA may be brought on by an autoimmune process
(Firestein, 2003) agents of the immune system
that are supposed to protect the body instead
attack the thin membranes surrounding the joints.
This attack leads to inflammation, stiffness, and
pain. If not controlled, the bone and surrounding
muscle tissue of the joint may be destroyed.
Almost half of RA patients recover completely,
nearly half remain somewhat arthritic, and about
10 are severely disabled.
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Possible Causes there appears to be a genetic
predisposition and an immunological disorder,
probably triggered by an infection. Sufferers
also have the presence of antiglobulin antibodies
or rheumatoid factors circulating in their
blood. Symptoms RA causes joint deformities
and disability as a result of a long-term
destructive process affecting typically the small
joints of fingers and hands, but progressing to
involve the wrists, elbows, shoulders and other
joints. Clawing of toes and other foot distortion
also occurs. RA does not only affect the joint.
There is a loss of appetite and weight, lethargy,
muscle pain, development of nodules under the
skin, tendon inflammation, eye inflammation
etc. Treatment this may involve the use of
drugs, rest, supervised exercise, physiotherapy
and even surgery for the extreme cases.
Corticosteroids can have dramatic effect lasting
for weeks or months alone. Non-steroidal
anti-inflammatory drugs are widely used, which
also relieves pain, as in aspirin in large dosage
for those who can tolerate it.
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Increasingly, psychologists have used
cognitive-behavioral interventions in the
treatment of RA, where the patients are taught
skills in managing stress, pain, and symptoms of
the disease, or they received an arthritis
self-help book containing useful information
about arthritis self-management. The
cognitive-behavioral treatment was designed to
increase perceptions of self-efficacy with
respect to the disease. Overall,
cognitive-behavioral interventions, including
biofeedback, relaxation training, problem-solving
skills, and cognitive pain coping skills
training, have been modestly successful in aiding
pain management for RA patients. Coordinating
these cognitive-behavioral interventions with the
use of drug therapies to control pain appears to
provide the most comprehensive approach at
present.
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The main complications of RA are pain,
limitations in activities i.e. the frustrations
of being unable to do things that one used to do
and the need to be dependent on others ( Van
Lankveld et al., 1993). In addition, because RA
primarily affects older people, its sufferers
often have other chronic conditions present as
well, such as poor cognitive functioning and poor
vision, which may interact with arthritis to
produce high levels of disability (Shifren et
al.,1999). Not surprisingly, one of the most
common complications of RA is depression (Dickens
et al.,2002). Depression may feed back into the
pain process enhancing pain from the RA (Zautra
et al.,2001). At one time, psychologists
speculated that there might be a rheumatoid
arthritis personality. This personality type was
said to be perfectionistic, depressed, and
restricted in emotional expression, especially
the expression of anger. Recent research however
casts doubt on the accuracy and value of such a
profile, at least as a cause of arthritis.
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Stress and RA stress may play a role both in
the development of RA and in its aggravation. In
particular, disturbances in interpersonal
relationships may contribute to the development
of the disease and/or its course. Juvenile RA
another form of RA is juvenile RA. Its causes
and symptoms are similar to those of the adult
form, but the victims are children between the
ages of 2 and 5. Among them, the disease flares
up periodically until puberty. The disease is
rare and affects girls 4 times as often as boys
. Osteoarthritis A degenerative joint disorder
damage to the cartilaginous bearing surfaces and
sometimes widening or re-modelling of the ends of
the bones involved in the joint. Osteoarthritis
is closely age related and many people of 30 or
45 and above show early osteoarthritic changes.
By age 65, about 80 of people have objective
evidence of the disorders, but only a quarter of
these have symptoms.
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The elderly women than the men tend to be more
severely affected. Hence, the basic problem with
all forms of arthritis is the resultant cartilage
destruction. A cartilage is the cushion of the
joint and in its absence the joint becomes rough,
painful and deformed. Irrespective of the cause
or type of arthritis, the final result in all
these is end-stage arthritis in which the
cartilage is completely lost and surgeries are
the only remedy.
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Possible Causes the disorder develops when the
smooth lining of a joint, known as the articular
cartilage, begins to crack or wear away because
of overuse, injury, or other causes. Thus, the
disease tends to affect the or weight-bearing
joints, such as the hips , knees and spine. As
the cartilage deteriorates, the joint may become
inflamed, stiff and painful. The disease afflicts
many elderly people and some athletes too. As is
true for other forms of arthritis, more serious
and extensive symptoms require more aggressive
treatment and lead to a poorer quality of
life. Obesity is an important aggravating
factor. Depression may also result in such
patients and in turn these depressive symptoms
elevate the pain and distress. Symptoms
osteoarthritis most commonly involves the spine,
knee joints and the hip joints. Joint movements
become progressively more limited, initially
because of pain and muscle spasm, but later
because the joint capsule becomes thickened and
less flexible. Movement may cause audible
creaking and swelling also results.
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Treatment it includes keeping ones weight
under control through exercises and taking of
aspirin. It is also important to avoid undue
stress or injury to joints. Rubber heels can
reduce jarring and a walking stick can be
valuable. A change of occupation may also be
necessary. In some cases, injection of
corticosteroids into the affected joint can
markedly reduce pain and disability. Occasionally
, use of more potent pain relievers,
anti-inflammatory drugs, can also be
administered. Those who manage the pain through
active coping efforts and spontaneous pain
control efforts appear to cope better with the
disease.
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Gout The third form of arthritis is gout. About
1 million Americans suffer from gout, and it is
nine times more prevalent in males than in
females. This condition is caused by a buildup of
uric acid in the body due to the kidneys
inability to excrete the acid in the urine.
Consequently, the uric acid forms crystals, which
may become lodged in the joints. The area most
likely to be affected is the big toe (because the
blood supply there is too small to carry away the
uric acid crystals). The joint then becomes
inflamed, causing severe pain. Occasionally, the
uric acid crystals can become lodged in the
kidney it self, causing kidney failure.
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The exact cause is unknown, but a genetic
component is believed to play a role, and the
condition can be triggered by stress as well as
by certain foods. Other causal factors include
infections and some antibiotics and
diuretics. Gout can be managed by limiting the
intake of alcohol and certain foods and by
maintaining proper weight, exercise and fluid
intake. Hence, arthritis rarely kills its
victims, but it causes substantial pain,
discomfort and creates problems of management.
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