Arthritis

Arthritis

The word "arthritis "comes from the Greek arthron"joint" and itis "inflammation". The word encompasses over 100 different conditions involving the various joints of the body, but always signifies the existence of varying degrees of inflammation which, if left unchecked, or if persisting over sufficient time, causes pain and ultimate destruction of the joint surfaces. Rheumatism, from the Greek rheumatismos"flowing condition", is used by the public (but rarely by medical practitioners) to describe any acute or chronic aching or stiffness of muscles, tendons, ligaments and joints, including arthritis and painful muscle conditions. An estimated 4 million Canadians have arthritis.

The rheumatic diseases are important both clinically and economically. The economic impact of musculoskeletal diseases in Canada, including expenditures for research, health care professionals, drugs, hospital and nursing care combined with the indirect economic costs (eg, lost productivity of otherwise able-bodied people) is approximately $18 billion per year. About 1 in 50 Canadians by the age of 75 years (in a female to male ratio of 65.4% to 34.6%) will have suffered some form of rheumatic complaint. Although between 7% and 10% of visits to doctors' offices relate to musculoskeletal problems (ranking only behind circulatory, respiratory and endocrine disorders), this percentage does not reflect the prevalence of the disease, because as many as 75% of individuals with rheumatic complaints do not seek medical attention. The prevalence rate for women is 21% and for men, 16%.

The Campaign Against Rheumatic Disease

The fight against this disease is conducted by professional societies, voluntary health organizations and official governmental agencies. The International League Against Rheumatism was founded in 1927. The Pan-American League is one of its subdivisions, and in Canada the Arthritis Society co-ordinates and supports much of the work and research at all levels.

Osteoarthritis and Rheumatoid Arthritis

These are the most prevalent forms of arthritis. Osteoarthritis affects about 1 in 10 people and is characterized by morning stiffness, pain proportional to activity, swelling and grating of the joints with movement and a gradual loss of motion. The articular surface gradually thins and the joint becomes mechanically unsound. It is most common with the elderly, but it is unclear if it is simply a manifestation of aging. It is usually classed as a degenerative condition and occurs mainly in the chief weight-bearing joints (eg, hips and knees). Treatment can include the use of anti-inflammatory medications (eg, aspirin), physiotherapy and walking aids. Total replacement of a joint, particularly the hip, by an artificial joint is possible. In Canada, over 20 000 hip replacements and more than 22 000 knee replacements are performed each year.

Rheumatoid arthritis is a chronic inflammatory disorder of unknown cause, although it may be related to the body's immune system. It affects approximately 1% of the North American population over the age of 15 years with an overall female-to-male ratio of 3 to 1. Although rheumatoid arthritis affects the joints, it is a systemic illness and affects most other tissues of the body to varying extents. This disease, which usually starts with swelling, warmth, pain and stiffness in one or more joints, is classically symmetrical, that is, it affects the small joints of the hands, wrists and feet but tends, except in its severe, progressive forms, to spare the hips and spine. Treatment can include anti-inflammatory medications such as gold therapy, rest, splints, walking aids and physiotherapy. Artificial joints made of a combination of metal and various plastics and silastic materials can also be implanted.

Less Common Forms

Of the less common forms of arthritis a particularly virulent type, juvenile rheumatoid arthritis, commonly affects children (male and female) between the ages of 1 and 5 years. Characterized by a high fever, a rash, joint pains and sometimes heart trouble, the disease may destroy many of the joints.

Other arthritides include ankylosing spondylitis, psoriatic arthritis, fibromyalgia, lupus and Reiter's syndrome. Ankylosing spondylitis, a genetic disease to which native people seem particularly vulnerable, primarily affects young men, particularly their spines and large pelvic joints. It affects between 150 000 and 300 000 Canadians, men 3 times more often than women, and usually appears in people between 15 and 40. It has been known through the years by various names, including poker back, rheumatoid spondylitis, and Marie-Strumpells spondylitis. Psoriatic arthritis, an inflammatory arthritis, is associated with the skin disease psoriasis. It affects men and women equally, usually between the ages of 20 and 50. Up to 30% of people with psoriasis will also get psoriatic arthritis.

Reiter's syndrome is associated with infections of the urinary tract or bowel. It is a form of reactive arthritis and occurs more often in men than women. It is genetic; 75% of the people who develop Reiter's syndrome have a certain type of body tissue called HLA-B27. Fibromyalgia, known as soft tissue rheumatism or fibrositis, causes fatigue, stiffness, numbness, joint or soft tissue swelling, among other symptoms. It affects 3 in 100 Canadians, affects women more than men at a ratio of 4 to1 and is most common in women 50 years of age or older. Lupus is a chronic autoimmune disease which affects about 15 000 (1 in 2 000) Canadians, 90% of whom are women, and usually occurs in women between 15 and 45. A malfunctioning immune system generates antibodies that attack healthy tissue in the body. Resulting inflammation can occur in the skin, muscles, joints, heart, lungs, kidneys, blood vessels and nervous system.

Gout

Gout, in which the body's inefficiency to handle certain chemicals allows the precipitation of crystals of uric acid (monosodium urate) in and around joints, is the best-known metabolic cause of arthritis. Other crystals identified as causing arthritis include calcium pyrophosphate, which leads to a disease called "pseudogout" because of the similarity of the symptoms to gout. Gouty infections affecting joints lead to rapid destruction of the articular surface because of the enzymes liberated by the body's white blood cells. These enzymes digest the substance of the joint surface, depriving it of its mechanical properties.