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Understanding arthritis - treatments and pathophysiology

Photo: Understanding arthritis - treatments and pathophysiology
Arthritis is a blanket term which refers to a range of musculoskeletal diseases where cartilage is damaged and joint function is impeded. While it is commonly referred to as a single disease, there are over 100 conditions classified as arthritis. Common symptoms of arthritis include inflammation, joint pain, stiffness and joint cartilage damage. As a result, patients can end up suffering from joint weakness, instability, and skeletal deformities which can cause difficulty in carrying out basic daily tasks such as walking.

Arthritis is the second leading cause of disability and chronic pain in Australia. It is estimated that 3.85 million Australians are affected and cost the economy $23.9 billion per year as a result of medical care and indirect costs, including loss of earnings and productivity. As the population grows older, the number of arthritic Australians is also growing, and current trends estimate that by 2050, seven million Australians could be suffering from some form of arthritis (1).
Types of arthritis and treatments

The most common types of arthritis, which account for almost 95% of arthritis cases in Australia, are (1);
  • Osteoarthritis
  • Rheumatioid arthritis
  • Gout

Other types of arthritis include:
  • Ankylosing spondylitis
  • Juvenile arthritis
  • Systemic lupus erythematosus (lupus)
  • Scleroderma

While there is currently no cure for Arthritis, there are multiple ways in which the condition can be managed. Unfortunately, despite management efforts, the patient’s quality of life is still impacted and patients suffer from some level of discomfort and pain. (2).

The most appropriate treatment is dependent on which form of arthritis the patient has, what joints are affected, and what symptoms they have. Treatments can include (2);
  • medications which act as pain killers, anti-inflammatory drugs, and disease-modifying anti-rheumatic drugs
  • pain management techniques
  • surgery to replace or repair severely damaged joints

Patients are advised to maintain a healthy weight, eat a balanced diet, exercise regularly and seek support when required as ways to manage their condition (2).

Pathophysiology of arthritis

Although most forms of arthritis have similar signs and symptoms, the way that arthritis develops is distinct for each form.

Osteoarthritis is a degenerative disease caused by a cellular malfunction in the cartilage which impedes normal remodeling processes and results in an increase in cartilage degradation. 

As cartilage deteriorates, osteophytes are produced which leads to bone remodeling, a thickening of the subchondral plate and calcification of adjacent cartilage.

The main risk factors associated with Osteoarthritis are age, genetics and joint trauma, either from injury or abnormal biomechanics which place undue stress on the joints (such as those caused by obesity).

While Osteoarthritis is a largely mechanical disease, Rheumatoid arthritis is an autoimmune disorder. The triggers which instigate the onset of rheumatoid arthritis are largely unknown however it is thought that genetics, hormones and environmental factors may play a role.

When the immune response is triggered, antibodies and cytokines are produced resulting in inflammation of the joint lining (synovium) and pannus formation. Over time the pannus thickens and destroys joint cartilage and bone tissue.

For the most accurate diagnosis of arthritis, patients should consult with a rheumatologist. Rheumatologists are doctors who specialise in musculoskeletal disease and systemic autoimmune conditions.

In order to diagnose patient conditions, rheumatologists will assess patient history, complete a physical exam to look for signs of inflammation, and order additional laboratory tests such as blood tests and radiography testing to looks for musculoskeletal abnormalities. These results can all aid in determining a diagnosis and a personalised treatment plan for patients (4).

Sources:

1. Arthritis Australia
2. Health Direct
3. WebMD
4. ACR

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