Arthritis, the most common joint disease in the world, is among the top five causes of disability in Singapore. Read on to learn more about arthritis, signs and symptoms, and what you can do to manage this disease.
What is Arthritis?
Arthritis actually refers to a collection of different conditions which affect the joints – there are at least 100 different forms of arthritis. The symptoms of the different types of arthritis overlap, but there are also many variations in types, symptoms and treatment, which means that it’s essential to have painful joints examined by a qualified doctor to ensure the right diagnosis and treatment plan.
There are other conditions that may trigger arthritis-type symptoms, including autoimmune conditions such as lupus, inflammatory conditions such as Crohn’s Disease, and chronic pain conditions such as fibromyalgia or polymyalgia rheumatica.
When someone attends a doctor’s appointment with joint pain, the doctor will use a combination of methods to arrive at a definite diagnosis. This usually begins with an examination of the shape and function of the joints and a discussion about symptoms, medical and family history.
Some forms of arthritis can be confirmed or ruled out by blood tests. The results of some blood tests can take a few days to come back. The doctor may also arrange for some form of medical imaging such as an X-ray, CT, or MRI scan to help visualize the joints and make a proper diagnosis and treatment plan.
What causes arthritis?
The deterioration of our cartilage, a flexible connective tissue in our joints, is a common cause of arthritis. This may be caused by general wear and tear, joint infection or prior injury. For some forms of arthritis, family history of the condition may contribute to your risk of developing it too. A common form of arthritis, rheumatoid arthritis, is an autoimmune disorder and occurs when our body’s immune system attacks the body’s own tissues. While the exact cause is unknown, genetics may influence our chances of developing this disorder.
Who is at risk of arthritis?
Some people are more at risk of developing arthritis than others – a family history of any form of arthritis seems to make people more at risk of that type of arthritis. Women are at higher risk than men, and seem to develop worse symptoms. People of any age can develop arthritis, and the symptoms often begin in a joint that has been damaged in the past.
Autoimmune forms of arthritis are more common in people who already have autoimmune conditions, even those that seem unrelated such as Inflammatory Bowel Disease or Hashimoto’s Thyroiditis.
Types of arthritis
There are more than 100 different types of arthritis, and the most common ones include:
Rheumatoid Arthritis (RA)
RA is an autoimmune disorder which causes problems with the joints and movement. RA is often linked with other autoimmune diseases, and at least 25% of people with one autoimmune disease develop further related conditions. RA is the most common form of arthritis in Singapore, and can lead to swollen and misshapen joints, and long-term damage. Treatments for RA include immunosuppressant and biologic medications to reduce the disease as well as treatments for the symptoms.
Osteoarthritis is a degenerative condition that gets worse over time, and occurs when the natural layers of cartilage cushioning our joints wear down, causing pain and difficulty with movement between the bones. Damaged bones become worn and the tissues can break down, or can grow layers of bone which cause further problems. Osteoarthritis is often most pronounced in joints that have been damaged in the past. Being overweight can also make osteoarthritis particularly bad. Often, careful symptom management or even surgery in later stages are required.
Gout is a specific form of arthritis caused by a build-up of crystals of uric acid in the joints. It tends to follow a pattern of acute flare-ups and can often be well managed with diet and healthy lifestyle.
The uric acid crystals which cause gout are formed when the body breaks down foods that contain purines. Avoiding foods high in purines can help to avoid or reduce the impact of gout. Foods that are high in purines include meat, seafood, alcoholic drinks and drinks containing highly-processed sugars.
Psoriatic arthritis is a type of autoimmune arthritis similar to RA, but occurs in people who have the autoimmune skin condition psoriasis. It is uncommon but possible for someone to develop psoriatic arthritis without ever having had the skin condition. As with RA, psoriatic arthritis is commonly treated with biologic and immunosuppressant drugs.
Reactive arthritis is an acute condition where the body’s response to a current or recent infection causes the immune system to attack healthy tissues, especially in the joints. Reactive arthritis is most closely linked with sexually transmitted infections such as chlamydia, or with some forms of food poisoning.
It’s important to see a doctor to treat the underlying cause to clear up the infection and manage the symptoms of arthritis as complications may occur. Some people with reactive arthritis after an infection may even develop problems with their eyes and sight if left untreated. Reactive arthritis can sometimes last for up to a year after the infection that triggered it has gone.
Septic arthritis is an infection in the joint. It usually only affects one joint, but may also occur in two or more at the same time. It is an acute condition, meaning that it develops and can become serious very quickly, but can be well resolved with the right treatment. Septic arthritis tends to occur when there has been a prior injury to a joint, or after a surgery on or around the joint. People with other forms of arthritis are more at risk of developing septic arthritis.
Septic arthritis usually requires hospital treatment, including intravenous antibiotics and blood tests to monitor infection markers. A doctor may need to drain fluid from the joint using a fine needle. Septic arthritis can trigger serious sepsis affecting the whole body, so it’s important to seek prompt medical help.
Juvenile Idiopathic Arthritis (JIA)
JIA is a form of arthritis that affects children and young people. There are a number of different types of JIA, affecting different groups of joints. Children with JIA have painful, swollen, and stiff joints. They may feel generally unwell, with unexplained tiredness or recurrent low-grade fevers.
Like other forms of arthritis, different types of JIA have different causes and treatments. JIA always requires diagnosis and treatment by licensed healthcare professionals, but in general, has a high recovery rate.
Treatments for Arthritis
Any form of arthritis should be managed under the care of a licensed doctor. As the treatment for different forms of arthritis are so varied, there is no ‘one size fits all’ solution, and each individual should have a personalized, dedicated treatment plan.
Maintaining a healthy weight through good diet and exercise can help to manage the symptoms of arthritis – being overweight puts extra pressure on the spine, hips and knees in particular. If these joints are already painful, any extra weight can increase the pain and damage.
Treatments for arthritis follow two paths: treating the cause and managing the symptoms. Inflammatory conditions can be both treated and the symptoms managed by anti-inflammatory medications, whereas autoimmune conditions may require specialist immune-modulating treatment as well as pain relief.
Painkillers can be used to manage the symptoms of arthritis. These can be simple over-the-counter painkillers or stronger painkillers prescribed by your doctor when necessary.
Non-Steroidal Anti-Inflammatory Drugs – ‘NSAIDs’ like ibuprofen and naproxen can be used as simple pain-blocking relief, but also act to treat the underlying cause of the pain – inflammation or swelling. NSAIDs are commonly available in pill or capsule form, but some are also used in the form of a cream or ointment to rub on the affected areas.
For types of arthritis that are related to autoimmune conditions, such as RA or psoriatic arthritis, specific medications can be used to manage the underlying condition.
In the later stages of OA or RA, non-invasive treatments may not be able to fix the damage to the joints. Surgery may be required to repair or replace the affected joints. Hip and knee replacements are common surgical procedures which can have life-changing results for people with severe joint damage in arthritis.
Complications of Arthritis
Severe flare-ups of arthritis and arthritis in its later stages can have a serious impact on a person’s ability to care for themselves. The chronic pain that comes with arthritis also impacts their quality of life.
As most forms of arthritis develop or worsen with age, arthritis may arise in tandem with other health conditions commonly associated with ageing. The combination of two or more conditions can seriously affect a person’s standard of living, physical and mental health.
The small bones in the hands and feet are often severely affected by arthritis, and the feet, in particular, are often overlooked. Referrals to podiatric services for foot care in severe arthritis can help manage the condition.
People with reduced mobility caused by arthritis are also at risk of developing skin problems such as bedsores, clotting problems like deep vein thrombosis in the legs, or other conditions related to lack of exercise. Having caregivers around can help individuals with arthritis stay fit and active, and adhere to exercise plans set by physiotherapists or other healthcare professionals. Physiotherapists can also visit you at home when it’s hard to get out and about.
Can arthritis be cured?
Arthritis is a chronic condition with no ultimate cure. With careful treatment, some forms of arthritis may go into ‘remission’ – this means that a person still has the underlying condition, but can be symptom-free for a period of time.
There are ways to manage the symptoms of arthritis and to slow its progression. Many people find that their arthritis symptoms tend to fluctuate over time. Sometimes it’s possible to identify triggers for a flare-up of arthritis – for example, osteoarthritis is often reported to get worse in cold or damp weather.
Living with Arthritis
Arthritis can be extremely disabling at times, remember that you are not alone. It is a common condition and people are making constant innovations to help people with arthritis live as independently and easily as possible.
Occupational therapists can assess you at home and provide tools and aids to make it easier to perform normal activities with arthritis, such as:
- Cutlery with specially-shaped handles to make it easier for painful, swollen hands to grip it
- Seat raisers or toilet frames for people who find it difficult to rise from low seats
- Grab rails or extra banisters in the home
- Jar or bottle openers
- Medicine aids – such as easy-open pill boxes, or inhaler aids to give extra leverage for pressing inhalers or spray medications
People with arthritis may need extra help with personal care, mobility, shopping and preparing food, or any of their normal daily activities. Having a network of support including family, doctors and dedicated caregivers can enable continued quality of life.
Support can come in the form of organised care or informal carers such as family or neighbors. If you need more support, there are a number of organisations like the National Arthritis Foundation which provide advice, peer support, and links to local networks and events.