‘Women more prone to arthritis’

  
Former Head of Department of Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria and consultant orthopaedic/trauma surgeon, University of Nigeria Teaching Hospital, Enugu, Dr. Nwankwo Okechukwu, in this interview with MOTUNRAYO JOEL, talks about issues related to arthritis

 What is arthritis?        

It is the inflammation of a joint linked with an infection of a single joint or a state (condition) characterised by inflammation of joints as in osteoarthritis, rheumatoid arthritis, rheumatic fever arthritis, rheumatism, gonococcal arthritis, gouty arthritis and psoriatic arthritis.

How can it be diagnosed?

Diagnosis can be made by taking the history of the patient and examining his or her entire body, particularly the involved limbs and joints. One can also diagnose it through laboratory investigations especially the blood/urine/joint aspirate profiles and imaging of the affected joints by x-rays, computed tomography scan, magnetic resonance imaging and ultrasonography. One can choose the best suited for the condition.

What are its types?          

The four major groups are – Infective or septic arthritis e.g. pyogenic (suppurative) or  tuberculous (granulomatous) infection, etc. In this group, microorganisms such as bacteria gain access into the joint commonly through the blood from a distant focus of contamination or infection in the body. The organism can also reach the joint through direct wound as during trauma, by operation, by injection into the joint or aspiration from the joint or by contiguous spread from a nearby infected site in the body.

Besides, degenerative arthritis (osteoarthritis) can be primary (cause not known) or secondary when it is predisposed to by an injury or other disease conditions affecting the joint(s). This condition whether primary or secondary is a progressive joint disorder characterised by erosion of articular cartilage which becomes softened, frayed and thinned out especially under the weight of the body exposing the underlying (subchondral) bone which becomes dense and smoothened like ivory (eburnation).

Tiny outgrowths of bone and cartilage called osteophytes develop from the margins of the articular bones in the body’s effort to effect repair and stabilise the joint. Some degree of inflammatory reaction is provoked with thickening of the synovium and increase in its secretion resulting in swelling of the joint with mild effusion. There is also capsular fibrosis. These result in pain and stiffness and some degree of loss of function. This condition affects mainly the weight-bearing joints of the body and it is more common in older persons and worsens with age being a degenerative condition. X-ray surveys suggest that the prevalence rises from one per cent below the age of 30 years to over 50 per cent in people above the age of 60 years. Men and women are equally likely to develop osteoarthritis but more joints are affected in women than men.

Why is this so?    

Osteoarthritis is the commonest of all joint diseases. It is a universal disease affecting both sexes and races. Everyone who lives long enough will have it somewhere in some degree. Also, crystal deposition disorder arthritis e.g. uric acid deposition in joints called gouty arthritis and calcium deposition in the joint which may occur as calicific material in articular cartilage and mensci called chondrocalcinosis, calcium crystal induced synovitis called pseudo-gout and chronic arthropathy from calcium pyrophosphate deposition. Rheumatic disorder arthritis such as rheumatoid arthritis, juvenile chronic arthritis, ankylosing spondylitis, rheumatic fever, systemic lupus erythematosus, reiter’s syndrome, scleroderma are conditions are the connective tissue widely in the body mainly in the musculoskeletal system. They cause chronic pain, stiffness and swelling around joints and tendons. They are distinguished from other common diseases like malaria associated with aching muscles and joints by their chronicity, the appearance of local and systemic features of inflammation and many result from a faulty immune reaction to antigenic stimulus against a background of genetic predisposition.

The most known in this group is rheumatoid arthritis. Rheumatoid arthritis is a systemic disease affecting the connective tissue with the dominate clinical manifestation involving the joints often symmetrically especially those of the hands and feet accompanied by thickening of articular soft tissue with extension of synovial tissue over the articular cartilages which become gradually eroded affecting the function of the joints. The course is variable but often is chronic and progressive leading to deformities and disabilities. It has its peak incidence in the fourth or fifth decade with women being affected three or four times more than men.

How is rheumatoid arthritis different from other types of arthritis?

Rheumatoid arthritis is primarily a systemic disease affecting connective tissues of the body with arthritis as its main clinical manifestation among many other clinical manifestations. There is also rheumatoid factor in the blood of most people with this disease.

What are the treatments available for it?

The most qualified person to treat arthritis especially the first two groups is the orthopaedist (orthopaedic surgeon). Crystal deposition and rheumatic disorder arthritis groups will need a physician initially but very soon, the services of an orthopaedist will be required. Treatments available are medical (with drugs), physical therapy and surgical (by operation).

What are the developmental stages of arthritis?      

It depends on the type – the infective type has very good prognosis if adequately treated early before the articular surfaces are affected. In the rheumatic disorder, type of prognosis depends on how well the primary disease is controlled but because of their chronicity, invariably the joints are usually affected to the extent that secondary osteoarthritis develops.

Degenerative arthritis cannot be cured but can be controlled if managed well such that the patient will lead a near normal life at every stage of the disease.

What is your advice to a new sufferer?      

To seek the services of an expert very early so that proper diagnosis will be made and appropriate treatment instituted early enough.

Does the disease trigger other conditions?  

Yes, it may trigger off complications like joint stiffness, muscle wasting and weakness, joint deformity and damage.

What has changed over the years about it?

New drugs such as chondroprotectives have been introduced and many joints can now be replaced in situations of partial or complete joint damage.

What makes people prone to the condition?          

Infection elsewhere in the body may be the source of infective arthritis and even arthritis of rheumatic fever. Injury to the joint, joint infection, angular deformities like bow or k-leg and some diseases like osteomalacia, etc can predispose to secondary osteoarthritis.

What age category or sex suffers it the most?

Only infective arthritis is more common in young people because sources of infection like septic wounds are more frequent in children. Rheumatoid arthritis is not seen more in young people but a variety called juvenile arthritis is seen in children. Rheumatoid arthritis is commoner in women and reason for this is not known. Degenerative arthritis is rarely seen in young people.

How can it be prevented?                  

For infective cases; treat infections/wounds promptly and adequately to avoid seeding of microorganisms to the joint. For degenerative types, avoid above-mentioned conditions that predispose to secondary osteoarthritis. Then for rheumatoid arthritis, it cannot be prevented but early and adequate control of the conditions helps protect the joint from damage.

How can affected persons live better?

Sufferers can live better by seeking the services of expert early enough.

Copyright PUNCH.