Published On: Fri, Jun 2nd, 2017

Management Of Arthritis In The Elderly (1)

By  Obiageri Ikwu B.Pharm

Arthritis can be defined as acute or chronic inflammation of one or more of the joints, usually accompanied by pain and stiffness, resulting from infection, trauma, degenerative changes, autoimmune defects and diseases.

According to Centre for Disease and Control (CDC), in public health, it is used to refer, more generally, to more than 100 rheumatic disease and conditions that affect joints, the tissues that surround the joints and other connective tissue.

The pattern, severity and location of symptoms can vary depending, on the type of disease.

 

Symptoms of arthritis

The symptoms of arthritis can develop gradually or suddenly. Symptoms of arthritis include:

  1. Fatigue.
  2. Joint pain.

iii.            Joint tenderness.

  1. Joint swelling.
  2. Joint redness.
  3. Joint warmth.

vii.          Joint stiffness: loss of joint                          range of motion.

viii.Many joints affected                               (polyarthritis).

  1. Joint deformity.
  2. Both sides of the body affected.

 

Types of arthritis

There are more than 100 different forms of arthritis and related diseases. The most common types include:

  1. Osteoarthritis (OA)
  2. Rheumatoid arthritis (RA)

iii.            Psoriatic arthritis.

  1. Fibromyalgia
  2. Gout

All these cause pain in different ways. We will examine the three most common type of arthritis.

Osteoarthritis

This is the most common form of arthritis affecting millions of people worldwide. It occurs when the protective cartilage on the ends of the bone wears down over time.

Although osteoarthritis can damage any joint in the body, the disorder most commonly affects the joint in the hand, knee, hips and spine.

Symptoms often develop slowly and worsen over time.

Signs and symptoms include:

*             Pain: The joints may hurt                              during or after movement.

*             Tenderness:  The joint

feels tender on                                                 application of light                                           pressure.

*             Stiffness: Joint stiffness                                may be most noticeable                               on waking up in the                        morning and period of                   inactivity.

*             Loss of flexibility:                                 Individual may not be able       to move his/her joint through its full range of motion.

*             Grating sensation: Hearing of feeling a grating sensation on using the joint.

In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, there will be a situation of bone rubbing on bone.

 

Rheumatoid arthritis

This is the most common type of auto-immune arthritis. It is triggered by a faulty immune system (the body’s defense system) and affects the wrist and small joints of the hand, including the knuckles and the middle joints of the fingers. This is the most disabling form of arthritis.

RA is an auto-immune disease, thus the cause is not known. Certain cells of the immune system do not work properly and start attacking healthy tissues.

 

Gout

This kind of arthritis causes an attack of sudden burning pain, stiffness and swelling in a joint usually the big toe. These attacks can happen over time unless the gout is treated. Over time, it can harm the joints, the tendon and other tissues.

Gout is most common in men. Gout is caused by too much uric acid in the blood. Most of the time, having too much uric acid is not harmful. Many people with high levels of uric acid in their blood never get gout. But when uric acid levels in the blood is too high, the uric acid may form hard crystals in the joint. Chances of getting gout are higher when the patient is overweight, drinks too much alcohol or eats too much meat and fish high in purines.

 

What causes arthritis?

There is no single cause for all types of arthritis. The cause of arthritis varies according to the type or form of arthritis. However potential causes of arthritis may include:

* Injury – leading to degenerative arthritis.

* Abnormal metabolism – leading to gout.

* Inheritance – such as in osteoarthritis.

* Infections – such as in arthritis of Lyme disease.

* Immune system dysfunction – such as in RA.

 

Most types of arthritis are caused by a combination of many factors working together. Some people are more susceptible to some kind of arthritis due to genetic make-up, infections, smoking, and physically demanding jobs; these can interact with a person’s gene to increase arthritis risk.

 

Risk factors for arthritis

The risk factors for arthritis are divided into

Non-modifiable.

Modifiable.

 

The non-modifiable factors include:

*    Age: The risk of developing most types of arthritis increases with age.

* Gender: Most types of arthritis are common in females. 60 per cent of all people with arthritis are females. Gout is more common in men.

* Genetics: Specific genes are associated with a higher risk of certain types of arthritis such as Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE) and ankylosing spondylitis.

 

Modifiable arthritis risk factors include:

* Overweight and obesity.

* Joint injuries.

* Infections.

*Occupation–certain occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.

 

Epidemiology of arthritis

Osteoarthritis (OA) is the most common joint disorder in the United States. OA occurs in 10 per cent men and in 13 per cent women aged 60 years and older. The number of people affected with symptoms of OA is likely to increase due to aging population and obesity epidemic.

According to Centre for Disease Control, although Rheumatoid Arthritis (RA) is an international problem, there is a wide geographical variation in its prevalence. It is relatively common in Europe and North-America, while in developing countries like Nigeria and Pakistan it is less prevalent.

 

Prevalence of arthritis

The prevalence of osteoarthritis is high and will get even higher as the number of older people increases.   Because of its prevalence it is recognised as a significant public health problem. Women have a higher prevalence of OA, and the risk of developing OA increases with age, obesity, and joint mal-alignment.

Diagnosis of arthritis

Diagnosis of arthritis is the first step towards arthritis treatment. The diagnosis process includes eliminating problems other than arthritis. Diagnosis involves.

* Physical exam – to determine which joint shows visible sign of swelling, stiffness or redness.

*  Lab test – blood may be drawn to check for levels of inflammation, presence of antibodies and the status of the general system.

* Imaging test – x-rays are frequently used to visualise a joint. The ultrasound and Magnetic Resonance Imaging (MRI) are also used. The image would be read for structural changes in the joint, signs of joint erosion, cartilage loss, soft tissue tears, inflammation; as well as location and amount of fluid and presence of lost tissue fragments.

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Management Of Arthritis In The Elderly (1)