Dear Readers,

B.M. from Portmore, St. Catherine, is a 64-year-old lady who suffers with arthritis. B. says she suffers greatly as her knees are beginning to look a bit like the letter 'K'. She complains that as deformity sets in, her back and knees pain her although she has recently changed her medication. She also experiences pain in her neck and left shoulder. B. says she would just like to have some pain relief so that she can get on with the activities in her life which include teaching, taking care of her home and walking for exercise in the evenings. Sometimes these activities are curtailed due to pain.

Arthritis is an inflammatory condition which can affect any joint in the body, resulting in pain and disability which worsens as the joint continues to degenerate. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis occurs more commonly but rheumatoid arthritis can be truly devastating, affecting internal organs and even causing death.

Osteoarthritis

Osteoarthritis is the arthritis of 'old age as it tends to occur due to the wear and tear of long use of joints, or after injury to a joint.

The cartilage in the joint, which functions like a 'washer' in a pipe as well as a 'cushion' against injury, becomes worn out. The pain of osteoarthritis is due to the bones rubbing together as well as the stretching of ligaments and tendons. In osteoarthritis the weight bearing joints such as the spine hips and knees are usually the most involved joints while in rheumatoid arthritis the wrists, elbows, feet and ankles are usually the most affected areas. The most common symptoms for both kinds of arthritis is pain.

Osteoarthritis is characterised by:

pain

joint inflammation

restricted movement at the joint

loss of function

joint instability

Rheumatoid arthritis is characterized by:

pain

joint inflammation

joint stiffness

subcutaneous nodules

fatigue

fever

Distinguishing between the two types of arthritis is based on the symptoms, the examination of the joints for the location of the joint disease as well as findings on radiological examination and MRI. Blood tests may assist with diagnosis rheumatoid arthritis.

Side effects

Treatment can involve lifestyle changes with weight loss, some exercise, proper supportive foot wear and the use of canes and walkers in advanced disease glucosamine and chondroitin help some persons with relief of pain. These substances act within the joint and are thought to be very safe to use.

They improve joint cushioning in some individuals but if little benefit is perceived after two months use, they should be discontinued.

Over the counter pain killers for example, Panadol, Aspirin and Advil are quite efficient in mild to moderate arthritis and are inexpensive.

Aspirin and even Advil should be used with care as they can irritate the gastrointestinal tract. They should not be used at all in persons with peptic ulcer or gastric ulcer disease.

Topical agents including rubs like Bengay and Ice often contain camphor, menthol and methyl salicydate or capsacin which produce a local anti-inflammatory effect. Nonsteroidal anti inflammatory rubs include Volteren rub, Diclofenac gel, Feldene rub, Hotemin or Rheumaderk cream and several others.

These latter topical agents reduce pain by reducing the production of protaglandins locally.

Prescription medications for the treatment of arthritis include the group of oral non-steroidal anti-inflammatory drugs, for example, Voltacen, Cataflam, Feldine, Ponstan, Indomethacin, Ibuprofen, Naposyn and others. These drugs inhibit the hormone prostaglandin in the joints which when present cause pain and inflammation. Prolonged use can result in gastro intestinal disturbance and even ulceration so they should be taken under the advise of a physician.

Treatment agents

another anti arthritic agent, the cox-two selective inhibitions such as Celebrex and Mobic are safer for use but are relatively costly. Disease modifying antirheumatic drugs work to slow bone deformity and joint erosion.

They include cyclosporine, and Interleukin-two antagonist, as well as methotrexate and clycophasphamide which are antiproliferative agents and slow progression of rheumatoid arthritis. Hydroxy-chloroguine is another useful drug for treating rheumatoid arthritis as are the Tetracyclines Doxycycane and Minocyclic, which protect joint cartilage.

Corticosteroids are also useful in pain management but prolonged use has significant side effects allowing for limited use under strict medical management.

If B.M. is not yet under the care of a physician she should see one for assessment of her joint pain. If necessary she should be refereed to the rheumatologist.

If deformity of a joint is significant joint replacement is available and works well.