Other Forms of Arthritis

Here are several other forms of Arthritis.
GOUT

gout in the foot

Gout is more common in the Western world.
Sometimes, crystals of salts get deposited in the joints. This leads to a condition known as gout. The crystals deposited are of monosodium urate and are associated with increased uric acid levels in the body. I will be writing a separate article about Gout and its treatment.

INFECTIVE ARTHRITIS
As the name indicates infective arthritis is the inflammation of joints as a result of infection. Infection of the joints is common but nevertheless important because of the damage it can cause.

The most important test in the diagnosis of infective arthritis is Synovial Fluid Culture. Synovial fluid is drawn from the joint space with the help of a long needle and checked for the presence of any microorganisms. Different types of microorganisms may be seen in infective arthritis. Bacteria are the commonest. Others include viruses, algae and some parasites.

SEPTIC ARTHRITIS
Septic arthritis is a non-specific type of arthritis which can result from infection of the joints by one of the bacteria from a group of organisms known as ‘pyogenic organisms’. Most common causative bacteria is Staphylococcus aureus. Others are other subtypes of staphylococci, Neisseria or Gram-negative bacilli. Organisms reach the joint from another focus of infection in the body, like the ear or a boil by travelling in the blood stream. It occurs mostly in individuals with low immunity like very young and very old people or persons receiving immunosuppressive drugs.

Usually, the onset is sudden with only one joint being affected, often the knee. The affected joint is red, warm and swollen and fever is usual. The rule is to test any suddenly painful joint to exclude infection. Treatment is started immediately as cartilage destruction can occur in a few days after the onset of infection. Antibiotics are given for a period of 6 weeks usually in the form of intramuscular and intravenous injections. Infections directly into the joints should be avoided as this may further exacerbate the condition. Drainage of the joints to remove any debris is performed daily until no pus or fluid remains in the joints. Septic arthritis usually resolves completely within days to weeks after the start of appropriate antibiotic therapy.

TUBERCULOUS ARTHRITIS
In 1% of the people suffering from tuberculosis, there is involvement of bones and joints. In most cases, only one joint is affected most common being joints of the spine (50%), knee (30%) or the hip joint (20%). Synovial fluid culture or in some cases a synovial biopsy may be required to confirm a diagnosis. Treatment is the same as for that for tuberculosis elsewhere.

GONOCOCCAL ARTHRITIS
This type of infective arthritis is seen in young females and homosexual males. Usually, more than two joints are involved. A clue to diagnosis is the presence of small pustular skin lesions near the affected joints. Treatment is with penicillin given for two weeks.

VIRAL ARTHRITIS
A number of viruses cause arthritis. The commonest is Rubella which causes arthritis in young adult females. Arthritis may also occur after rubella vaccination. Arthritis may also occur as a complication of mumps. This type of arthritis is usually self-limiting. Transient arthritis may also be seen in chicken pox and hepatitis B infection

FUNGAL ARTHRITIS
Fungal infections of the joints are rare. Actinomycosis can affect the temporomandibular joint or the vertebrae. Destructive joint lesions may rarely occur as a result of infection by the fungus blastomycosis.

Basic Information about Arthritis

 

knee skeletalskeletal image of RA in hands

The term arthritis literally means ‘inflammation of the joint/s’. There are around 206 bones in our body and each of them forms a joint with another bone. So a joint is made up of two articulating bone surfaces which are covered with a cartilage. The space between the two bones – the joint space, is filled with a fluid known as synovial fluid. The synovial fluid is secreted by a membrane present in the joint known as ‘synovium’ and the function of the synovial fluid is to lubricate the joint and ensure smooth movements. Inflammation or long term damage to any of these structures is likely to result in arthritis.

The first symptom of arthritis would naturally be painful joints. The site of the pain is according to the joint affected and more advanced the disease worse will be the pain. In some cases, particularly in arthritis of the joints of spine, nerves may become compressed between the affected joints leading to pain which will be radiating away from the joints into the area of supply of those nerves.

Arthritis is divided into two main sub types depending on the underlying disease process. First is inflammatory arthritis; most of the causes of arthritis like rheumatoid arthritis, ankylosing spondylitis, infective arthritis are of inflammatory origin. In this type of arthritis the person’s own infection fighting cells come and attack the joints. The second is degenerative arthritis which results from the wear and tear of the joints over a prolonged period of time, the most common example of this type of arthritis is osteoarthritis.

The different types of arthritis have their own specific symptoms and signs.

Here are some of the medical terms that are used.

• Monoarticular: arthritis affecting only one joint
• Polyarticular: arthritis affecting more than one joint.
• Migratory: arthritis moving from joint to joint.
• Small joints; joints of the hand and feet
• Large joints: any other joints besides hands and feet.
• Contractures: abnormal and permanent contraction of the muscle surrounding the affected joints, resulting in severe limitation of movements.

INVESTIGATIONS

The diagnosis of arthritis is based mainly upon the history and examination. However in most cases certain tests are done.

• Tests for rheumatoid factor (RF): the major value of RF is to confirm the diagnosis of rheumatoid arthritis.
• ESR and C reactive protein: provide a guide to the activity of inflammation. These are blood tests with little diagnostic value but are very useful to monitor the response of treatment.
• Blood uric acid level: good confirmatory test for gout.
• Synovial fluid exam: synovial fluid is drawn from the joint with a long needle and examined. This test is of particular importance if infective arthritis is suspected.
• Antinuclear antibodies (ANA): these are a variety of antibodies including (ANCA), anticardiolipin antibodies, antibodies against double stranded DNA. The level of each of these antibodies rises in specific types of arthritis.

Jude Cresswell DSH BHSc Homoeopathy

Natural therapist and Homeopath for over 20 years, in the UK and Australia, Jude has recently been focusing on pain reduction for arthritic clients.