Arthritis is a term that is used very loosely by patients, as well as, medical professionals. But, what is it? To understand arthritis, you first have to consider anatomy and realize that there are different types of arthritis. It is more of a descriptive term. Different types of arthritis include: Osteoarthritis (the most common), Rheumatoid arthritis, Gouty arthritis, Lupus arthritis, Psoriatic arthritis, Post traumatic arthritis and other inflammatory arthritis. These diseases are very different, but share one common problem – destruction and deterioration of the cartilage of the joint.
Regarding anatomy, there are a few principles that need to be discussed. First, every joint is padded on each side of the bone with a cartilage cap. This cartilage cap acts like a highly engineered cushion that absorbs the force and energy of weight bearing. This is the reason arthritis is more common in the weight bearing joints, such as the knees and hips. As a practical example, the white, smooth, and lubricated layer that is seen on the end of a chicken leg is the articular cartilage for the chicken’s leg and acts to cushion the leg joint. We have that same type of cartilage cap on the ends of our bones that make up the joint surface. When that highly engineered cartilage cushion becomes thin or rough, then we begin to experience pain. It is typically a progressive process and ultimately leads to complete loss of the cartilage. When that occurs, we refer to this as “bone on bone” arthritis. Often, patients develop bone spurs and structural changes, such as, bowing of the knees or short leg problems. This ultimately leads to an endpoint of either inability to walk or joint replacement surgery.
We stated earlier that there are different types of arthritis that have one common problem – destruction of the joint cartilage pad. The most common type of arthritis is, by far, Osteoarthritis. This accounts for 90% or greater of arthritis treated in doctors’ offices. It is typically a slow deterioration of the joint that is referred to as “wear and tear” arthritis. It typically worsens with age and can be affected by obesity, impact exercises, genetics, and other external factors. Early, it may present itself with stiffness and dull aching pain that is worse with activity. It more commonly affects the weight bearing joints, such as, knees and hips. It does tend to ultimately cause deformities. In the knees it is displayed as bowed legs or knock-knees. Short leg issues arise when Osteoarthritis affects the hips. Initially, it is treated with rest, ice, and medications, such as, ibuprofen or other anti-inflammatory medications. As it progresses, patients may use braces, get injections, and, ultimately, joint replacement surgery is required. Osteoarthritis is the most common reason for performing joint replacement surgery. Other terms to describe Osteoarthritis include, “wear and tear” arthritis and degenerative joint disease.
Many of the other arthritis disorders fall into a category of arthritis called inflammatory arthritis. These include: Rheumatoid arthritis, Gouty arthritis, Lupus arthritis and others. Cartilage destruction is still present, as with Osteoarthritis, but the cause of the destruction is different. The cause in inflammatory arthritis is that something has activated the body’s immune system to cause destruction in the joint. In Rheumatoid or Lupus arthritis, a biochemical marker activates the body’s immune system to attack the joint. This has been referred to in the past as “crippling arthritis”. Prior to some of the newer drugs that are targeted to stop the body’s immune system from causing destruction, patients would develop such dramatic joint deterioration and deformity that they could not walk or use their hands. Many patients, just one generation ago, were confined to wheelchairs and could not work because options in treating the disease were limited. Rheumatologists are physicians that specialize in treating these types of arthritis and managing, the sometimes complicated, medication regimen that is required to treat these diseases. However, the medical treatment of these diseases is very successful now and has changed the lives of these patients. These patients sometimes still require joint replacement surgery, however, Rheumatologist and Primary care physicians can manage the disease very effectively, medically, up to this point. Many times, early diagnosis and treatment can serve to avoid the severe deformities that, in the past, have plagued these patients. The symptoms vary depending on the type of inflammatory arthritis. They often include, morning stiffness and pain in non-weight bearing joints, such as the hands, and pronounced redness and swelling around the joint. Blood test may be helpful in the diagnosis.
The best place to begin evaluation of early arthritis symptoms is with your primary care doctor. They will evaluate your symptoms, order x-rays and blood work and treat or refer as needed. Typically, primary care physicians and Rheumatologists manage the non-surgical treatment of arthritis with medications and injections while orthopedic surgeons manage the surgical treatment.
Dr. Patrick Boyett
Dr. Bill Lawrence
OrthoSports Athens, LLC
15243 Greenfield Drive
By: Dr Patrick Boyett
