MEN'S HEALTH QUESTIONS:Common types of arthritis
Q I have recently been diagnosed with rheumatoid arthritis. A friend of mine who is 48 has osteo- arthritis of his hip. We both have arthritis but what is the difference between these diagnoses?
A There are more than 100 different types of arthritis with approximately half to three- quarters of a million people suffering from these conditions in Ireland. The two common types of arthritis are rheumatoid or inflammatory arthritis and osteoarthritis. Aches and pains in your joints can also be caused by fibromyalgia which is not related to arthritis and it has been estimated that this can occur in up to 5 per cent of the population.
Before organising a successful management regime for arthritis it is necessary to have an exact diagnosis and in most cases this is very straight forward. This can be made from the patient's history, examination and results of laboratory tests.
Rheumatoid arthritis is a chronic disorder and is by far the most serious of the rheumatic diseases for which there is no known cure.
Fortunately, in the past few years, a shift in strategy toward the earlier institution of disease-modifying drugs and the availability of new classes of medications have greatly improved patient outcomes.
Strategies are all aimed at reducing pain and discomfort, preventing deformities and loss of joint function, and maintaining a productive and active life. Inflammation must be suppressed and mechanical and structural abnormalities corrected or compensated by assistive devices. Treatment options include medications, reduction of joint stress, physical and occupational therapy, and surgical intervention. There are three general classes of drugs commonly used in the treatment of rheumatoid arthritis: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs) such as Methotrexate.
Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis and is more common in women. Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone - causing the ends of your bones to become damaged and your joints to become painful.
It can affect any joint in your body, though it most commonly affects joints in your hands, hips, knees and spine. Osteoarthritis, unlike rheumatoid arthritis, typically affects just one joint, though in some cases, such as with finger arthritis, several joints can be affected. Osteoarthritis gradually worsens with time, and no cure exists. Taking steps to actively manage your osteoarthritis may help you gain control over your osteoarthritis pain and treatments can relieve pain and help you remain active.
Osteoarthritis is a degenerative disease that worsens over time. As many as a third of people with osteoarthritis will eventually experience significant disability. Joint pain and stiffness may become severe enough to make getting through the day difficult, if not impossible. Some people are no longer able to work. When joint pain is this severe, doctors typically suggest joint replacement surgery. For those who aren't able to undergo surgery, pain medications and assistive devices can make daily tasks more manageable.
It isn't clear what causes osteoarthritis in most cases. Researchers suspect that it's a combination of factors, including being overweight, the ageing process (people under 40 rarely experience osteoarthritis), joint injury or stress, heredity and muscle weakness. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
Injuries, such as sports injuries, may increase the risk of osteoarthritis. Carrying more body weight places more stress on your weight-bearing joints, such as your knees.
Fibromyalgia is a very common condition and is a clinical diagnosis, often accompanied by significant lack of energy, non-restorative sleep, pains and aches all over and the cause of this condition is unknown. Treatment involves a reasonable amount of exercise and developing strategies to reduce stress and learning coping skills.
An enormous amount of research has been undertaken to find new treatments particularly for rheumatoid arthritis, and several new biological agents are on the horizon.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Eoin Casey, consultant rheumatologist