Arthritis Pain

Many Singaporean adults have some type of arthritis. It is a major cause of lost work time and serious disability for many people. While the most common type of arthritis is commonly associated with aging, sometimes it can afflict younger patients who are engaged in high impact sports or work.

What is a joint?

A joint is where the ends of two or more bones meet. For example, the knee joint is formed by a bone of the lower leg, called the shin or tibia and the thighbone. The hip is a ball and socket joint. It is formed by the upper end of the thigh bone the ball fitting into the socket part of the pelvis called the acetabulum.

The bone ends of a joint are covered with a smooth material called cartilage. The cartilage cushions the bone and allows the joint to move easily without pain. The synovium is a fibrous envelope which produces a fluid (gel) that helps to reduce friction and wear in a joint. It is this gel that is lost in degenerative changes of joints. Ligaments connect the bones and keep the joint stable. Muscles and tendons power the joint and enable it to move.

What is inflammation?

Inflammation is one of the body's normal reactions to injury, degeneration or disease. In an injured or diseased joint, this results in swelling, pain, and stiffness. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability.

Types of Arthritis

What is osteoarthritis?
The most common type of arthritis is osteoarthritis. It is seen in many people as they age, although it may begin when they are younger as a result of injury or overuse. It is often more painful in weight bearing joints such as the knee, hip, and spine. All joints may be more affected if they are used extensively in work or sports, or if they have been damaged from fractures or other injuries.

In osteoarthritis, there is loss of gel lubricant and subsequently the cartilage covering the bone ends gradually wears away. In many cases, bone growths called "spurs" can develop in osteoarthritic joints. The joint inflammation causes pain and swelling. Continued use of the joint produces pain. Some relief may be possible through rest or modified activity.

What is rheumatoid arthritis?
Rheumatoid arthritis is a long-lasting disease that can affect many parts of the body, including the joints. In rheumatoid arthritis, one’s immune system has become sensitized and overactive, the joint lining swells, invading surrounding tissues, and producing chemical substances that attack and destroy the joint surface. This commonly occurs in joints in the hands and feet. Larger joints such as hips, knees, and elbows also may be involved. Swelling, pain, and stiffness are usually present even when the joint is not used. Rheumatoid arthritis can affect people of all ages, even children. However, more than 70 percent of people with this disease are over 30 years old. Many joints of the body may be involved at the same time.

Cause of Arthritis

Arthritis pain is caused by several factors, such as:

• Inflammation, the process that causes the redness and swelling in your joints;
• Damage to joint tissues, which results from the disease process or from stress, injury or pressure on the joints; Loss of gel within the knee joint.
• Fatigue that results from the disease process, which can make your pain seem worse and harder to handle

How is Arthritis Diagnosed?

Making a diagnosis of arthritis often includes a thorough assessment including evaluating symptoms, a physical examination, and X-rays, which are important to show the extent of damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis.

How Is Arthritis Treated?

The goals of treatment are to provide pain relief, increase motion, and improve strength. There are several kinds of treatment:

Medications

Many medications, including arcoxia, celebrex (common anti-inflammatory drugs) may be used to effectively control pain and inflammation in arthritis. Ultracet (Paracetamol and Tramadol) may be used to effectively control pain. Patients with ulcers, asthma, kidney, or liver disease may not be able to safely take anti-inflammatory medications. Some immune modulating drugs can be used selectively with improved outcomes.

Glucosamine and possibly Chondroitin minerals have been proven to be effective in halting the ongoing destruction of osteoarthritis. There are many different types of glucosamine in the market - each of them may be compounded with different salts for different stability and absorption by the digestive system. The amount of glucosamine to be taken is also important. Research supports the consumption of at least 1500mg glucosamine to have any effect on reduction of arthritic symptoms.

Injections

1. Injection of cortisone directly into the joint may temporarily help to relieve pain and swelling.
2. Artificial lubricant (Synvisc) may increased the production of lubricant.
3. Pulsed radiofrequency stimulation and ablation of painful nerves may be helpful for some OA knees for longer term pain control.

Interventional Procedure for Arthritis knee or shoulders

Pulsed Radiofrequency Stimulation is likened to applying a laser on the sensitized nerves to stimulate recovery of the sensitized nerves. It does not generate any heat and is not harmful to nerves, when applied appropriately. The RFA is directed through a needle to the particular nerves or ganglion (nerve plexuses), under Xray guidance. It uses electro-motive forces to encourage increased nutrient transport and recovery of the sensitized nerves. Once accurate placement of the RF needle on the nerve, it allows for obliteration of pain and surrounding supporting structures (muscles) to recover. Once the pain cycle is broken, the original painful joint is rehabilitated under active physiotherapy.

There are occasions where RF only partially reduces the pain, then the residual pain is usually coming from chronically damaged ligaments/tendons.

Prolotherapy may be a helpful adjunct to therapy by strengthening ligaments/tendons and tightening the loosened or distorted joints. This then results in less pain and greater function.

Combined together with artificial lubricant addition to the knee joint will improve outcomes.

Joint protection

Once arthritis has set in, rehabilitative measures can reduce the acceleration of the ongoing tissue injury. Aids such as canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learning methods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises (strengthening of thigh muscles) and physical therapy (such as heat treatments) may be used to decrease stiffness and to strengthen the weakened muscles around the joint.

Weight management has significant impact on further injury to the affected joints. It is good to keep BMI (Body Mass Index) within 25. Patients with excessive weight can cause increase load to an already fatigued and worn out joints.