What is Arthritis?
Arthritis, by definition is simply inflammation of a joint. Unfortunately however, that inflammation is typically accompanied by swelling and pain in and around that joint or joints. Arthritis has multiple causes; a simple sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis is commonly associated with many different systemic illnesses.
Arthritis is a frequent component of other complex diseases that may involve more than 100 identifiable disorders. Our feet seem most prone to arthritic development than other parts of the body in part due to the complexity of the foot structure containing 33 joints along with the tremendous weight bearing burden our feet are subject to during the normal course of the day.
Arthritis at times can be a disabling and occasionally a lifestyle limiting and crippling disease. Nearly 40 million Americans are affected by arthritis in one form or another. In some forms hereditary tendencies and genetic influence play a big part in arthritic development. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.
Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.
Besides heredity, arthritic development may arise in a variety of ways:
Injuries and/or repetitive trauma – notably from aggressive athletics or heavy physical labor intensive work can lead to wear and tear on our joints.
Bacterial, viral and fungal infections – the same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease can also cause arthritis.
Inflammatory Bowel Disorders – such as colitis, diverticulitis and ileitis diseases can be tied to arthritic joint involvement.
Certain medication use and/or abuse – be it prescription drugs and/or illegal street drugs, can induce arthritic joint involvement.
Autoimmune diseases and immunocompromise – immune system weakness can lead to the development of arthritic involvment of our joints.
Symptoms and Types:
1. Osteoarthritis –
the most common form of arthritis. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury however the typical onset is generally gradual. Aging and repetitive use of our joint ultimately to the thinning down or articular cartilage and swelling of joints leading to pain. Dull aching and throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Walking may become unsteady and result in falls. Being over weight or obese places tremendous additional stress on our joints and also leads to postural and positional changes of our joints which accelerates the wear and tear destruction of our joints.
2. Rheumatoid arthritis (RA) –
is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory autoimmune disease, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern involving both sides of our skeleton equally. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men to suffer RA. RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute RA. However, the disease system has been known to be active for months, or years, then abate, sometimes permanently.
3. Gout (gouty arthritis) –
is a very painful and temporarily disabling form of arthritis. In the past, it was commonly referred to as the “Disease of Kings”. People believed that it came about as the result of a daily diet rich in meats and wine that only a king could afford. We know now however that this painful condition can affect anyone, rich or poor, and is the result of multiple risk factors. It affects more than 3 million Americans and is more common in men than women. Gout is a condition caused deposition of microscopic needle-shaped uric acid crystal into a joint. The joints of the lower leg and foot and particularly the big toe joint are commonly the affected. Dietary influences, particularly protein rich meals that include routinely include red meats and certain seafoods along with alcohol and sugary drinks/treats laden with high fructose corn syrup, contribute to elevations in uric acid levels that lead to gouty flare ups.
4. Psoriatic arthritis –
Psoriasis, another form of autoimmune disease, is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches and plaques. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the joint pain and swelling.
5. Traumatic arthritis –
Traumatic arthritis is a form of arthritis that is caused by blunt, penetrating, or repeated trauma or from forced inappropriate motion of a joint or ligament. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.
6. Septic Arthritis –
bacterial, viral and even fungal infections can enter a joint leading to inflammation, pain and swelling. The onset can occur suddenly from a penetrating injury to the joint seeding the organism into the joint or gradually if a wound or ulcer involving the overlying skin surrounding the joint becomes infected and the infectious organism manages to gain access into the joint. In rare circumstances, blood borne bacteria can end up in a joint or bone. Individuals with infectious arthritis common have associated symptoms of fever or chills and sometime have red streaking of the skin developing away from the involved joint known as lymphangitis which is the infections way of entering into the circulatory system. When any of these signs or symptoms are present it is important to seek medical help immediately. Infectious arthritis is extremely serious and requires immediate attention and treatment. Individuals with autoimmune disease or are immunocompromised are more prone to developing infectious arthritis.
Diagnosis and Treatment:
Different forms of arthritis affect the body in different ways; many have distinct systemic effects that are not common to other forms. Early diagnosis is important to effective treatment of any form. Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn’t treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most forms of arthritis cannot be cured but can be controlled or brought into remission; perhaps only five percent of the most serious cases, usually of rheumatoid arthritis, result in such severe disability that walking aids or wheelchairs are required.
The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if possible. Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.
Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by medication. In such a complex disease system, it is no wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line drug of choice for most forms of arthritis and the benchmark against which other therapies are measured.
The control of foot functions with shoe inserts called orthotics, or with braces or specially prescribed shoes, may be recommended. Surgical intervention is a last resort in arthritis, as it is with most disease conditions. Surgical repair of severely damaged and arthritic joints can be modified or replaced with artificial joint implants.
Not all types of arthritis are preventable however most are quite manageable and/or treatable through a variety of measures. Conservatively through a combination of medicine and structural and biomechanical adjustments or in some circumstances through surgical repair or reconstruction. Maintaining a healthy lifestyle through good nutrition and an active lifestyle is perhaps most important. Each type of arthritic condition often warrants a different approach to treatment and prevention and is best determined through an accurate assessment and an ongoing dialogue with you doctor. Osteoarthritis may be helped by correcting any faulty biomechanics that lead to instability and mal positioning of the joint. Custom orthotics made by a podiatrist can be designed to provide a stable platform to assure that the foot structure and function is properly maintained. Controlling the uric acid levels in people prone to gout helps to prevent gouty attacks and thereby reduces the chance of the associated arthritis. Again however, most importantly is early recognition by the individual experiencing these signs or symptoms involving their joints and seeking professional help for a thorough evaluation and initiation of treatment.
The Podiatrist Role in the Treatment of Arthritis:
Podiatrists are well versed in the diagnosis, treatment and long term management of arthritis. We work closely with your primary care provider or rheumatologist to help you manage your disease. When experiencing symptoms as described above, the sooner you seek professional help, the sooner treatment and relief can be achieved as well as active long term management and prevention of disease progression. If you feel you are suffering from g, schedule an appointment with Dr. Bertolo today.