Dear Bloggers,
I probably have told you in earlier stories about my stiffness in joints
and on a rainy and cold day it is harder to get out of bed and go on the move.
No, I am not a complainer somehow there is a feeling that people around don’t
know a lot about the condition and that there is a lot of pain involved. (One
of the reasons that I only write once a month instead of every week.) I have
used quite some pain relievers during the last fifteen years. As I stopped last
year with the medication on advice of the rheumatologist. The inflammations
took a flight. From sour joints until inflammatory bursitis in my hip and being
treated with a nerve Intercostal Block on my rib.
Inflammatory arthritis
is a condition many people endure for a lifetime. Thanks to advances in
treatment, however, innovative medications can delay and even halt the
progression of the disease, and non-drug approaches have can help relieve
symptoms so you can live a full and productive life.
What is inflammatory arthritis?
Inflammatory arthritis
describes a group of diseases caused by an overactive immune system. The most
common symptoms are joint pain and stiffness. Affected joints may feel warm,
swollen, and tender. But inflammatory arthritis can also affect other tissues
in the body, including the lungs, heart, eyes, skin, and other organs. Left
untreated, it can cause irreversible damage. Early treatment is the best way to
relieve symptoms and limit the effects of inflammatory arthritis on the body.
While it’s not known
what causes inflammatory arthritis in every patient, what is known is that the
immune system does not know when to put on the brakes. Normally when we are
exposed to bacteria, viruses, or fungi, the immune system produces white blood
cells called lymphocytes as well as immune proteins to mount an attack against
these invaders. Lymphocytes and immune proteins cause inflammation, which under
typical circumstances is limited and resolves once the foreign substance is
defeated.
But in someone with
inflammatory arthritis, the immune response does not know when to stop. It
turns on your body, attacking your own tissues instead of the foreign substance
and causes continued inflammation. For this reason, inflammatory arthritis is
known as an "autoimmune disease" − auto meaning "self" and
“immune” because the immune system loses its ability to distinguish self from
foreign.
How are inflammatory arthritis and osteoarthritis different?
Although they share some common symptoms, inflammatory
arthritis and osteoarthritis are quite different diseases. Osteoarthritis
is a common condition causing wear-and-tear of the cartilage of the joints due
to age and/or prior injury. Here are some other differences:
Inflammatory Arthritis - A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skin. Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on blood tests. Autoimmune disease related to body-wide inflammation.
Osteoarthritis - Symptoms are limited to the joints. Blood tests for biomarkers are negative. Mechanical wear-and-tear on joints due to age or injury.
What are the different types of inflammatory arthritis?
If you are
experiencing symptoms that suggest inflammatory arthritis, your doctor will
perform a number of tests, including a physical exam, blood tests, and imaging
exams (such as X-rays, joint ultrasound, and/or MRI or CT scans). Sometimes the
physician takes a sample of fluid from an affected joint for analysis − a
procedure called joint aspiration.
Based on the results
of these exams, your physician will determine if you have inflammatory
arthritis and if so, which type:
Rheumatoid Arthritis (RA) is the most common
form of inflammatory arthritis. It tends to involve more than one of the small
joints of the hands and feet. In particular, the lining of the joint or tendons
(the synovium) is inflamed, causing warmth, pain, and stiffness. In 30% to 60%
of people with RA, blood tests confirm the presence of proteins called
rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP)
antibodies. It is very important to control inflammation in the synovium to
stop joint destruction and to treat RA to minimize damage to the heart, lungs,
and eyes.
Psoriatic Arthritis is a type of arthritis called a "spondyloarthropathy" that is a combination of psoriasis (red, scaly patches on the skin, especially the knees, elbows, and scalp) as well as pain and swelling in the large and small joints and sometimes the spine. It can cause complete swelling of a finger or toe − a condition called "dactylitis."
Juvenile Idiopathic Arthritis (JIA) affects young people
under age 16, causing inflammation in the joints and sometimes in the spine and
ligaments (tissues that connect bone to bone) that lasts for more than six
weeks. Swelling or mobility problems, including a limp if the legs are
affected, may be the only signs of JIA. Some types of JIA cause eye
inflammation that can occur without symptoms, so prompt diagnosis, treatment,
and monitoring of JIA are vital to prevent permanent damage. Children and teens
with JIA are best treated by a pediatric rheumatologist.
Ankylosing Spondylitis (AS) affects primarily the spin and hip joints, breastbone, and large joints in the body. Over time, AS can result in noticeably reduced motion in the spine. Up to half of people with AS have a gene called HLA-B27, the presence of which can help confirm the diagnosis of this condition when it is found in combination with AS symptoms.
Gout & Pseudogout (calcium pyrophosphate dehydrate deposition disease or CPDD) are forms of arthritis caused by elevated levels of certain crystals in the body. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones. CPPD occurs when calcium salts form in the joints and are engulfed by white blood cells, provoking inflammation − most commonly in the wrists and knees.
Other autoimmune
diseases can cause inflammatory arthritis as a symptom. Examples include
Sjogren’s syndrome and lupus.
You and your
rheumatologist: A lifetime partnership
If you have
inflammatory arthritis, it is imperative that you see a rheumatologist on a
regular basis to monitor your health and customize your treatment.
Rheumatologists are medical doctors with special training in the care of people
with joint diseases and autoimmune diseases. They are different from
orthopedists, who are trained in surgery and who may also be involved in the
care of people with inflammatory arthritis when medical treatments are not
enough.
How do you know
whether to start with a rheumatologist or orthopedist? If you have ongoing
joint discomfort without chronic swelling or other symptoms, such as fatigue,
you may be able to see an orthopedist first. But if your joint pain is
accompanied by warmth, swelling, other signs of inflammation, fatigue or
discomfort in other parts of your body, a visit to a rheumatologist may be in
order. Your primary care physician can guide you.
Because inflammatory
arthritis is an autoimmune disease that can affect multiple parts of your body,
you may need to see other specialists, too, to keep your symptoms in check and
maintain the best quality of life possible.
To prepare for your
visit with a rheumatologist:
·
Bring in a full list of your
medications, including vitamins and supplements.
·
If you are already taking medications
for inflammatory arthritis, make any notes about reactions or side effects you
may be experiencing.
·
Provide a list of all health conditions
you have had, prior surgeries, and symptoms you may be experiencing.
·
Prepare a list of questions you may have
for your doctor.
Your rheumatologist
may choose from a variety of treatment options for inflammatory arthritis,
depending on the type and severity of your disease, such as:
·
Nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen and naproxen.
·
Steroid medications (corticosteroids)
such as prednisone, which are typically used for shorter periods of time
because of their side effects.
·
Traditional disease-modifying
antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine,
sulfasalazine, minocycline, and leflunomide.
·
Biologic DMARDs, which target the
proteins driving inflammation, such as infliximab, etanercept, abatacept,
adalimumab and rituximab. These medications have revolutionized the care of
people with inflammatory arthritis, sparing many from surgery.
·
Surgery may be indicated for specific
joints with damage that can no longer be controlled by medications.
A diagnosis of
inflammatory arthritis can initially feel overwhelming. It can take weeks or
even months to come to terms with and understand what having this disease can
mean in your life. By developing a close working relationship with your
rheumatologist and other caregivers, however, there is much you can do to
control inflammatory arthritis and maintain an independent and active
lifestyle.
The Old Sailor,
