Arthritis

Arthritis
What is arthritis?
Who is affected?
What treatment options are available?
What is Arthritis?
arth - joint
itis – inflammation
Arthritis – inflammation of the joint(s).
What is Inflammation?
Inflammation is one of the body’s normal reactions to injury or disease. It is part of the
body’s natural defenses, and works to repair the problem. When injury occurs in a
damaged or diseased joint, the end result is swelling, pain, and stiffness.
Osteoarthritis
There are more than 100 different types of
arthritis. The most common type is called
osteoarthritis, which is sometimes known as
degenerative joint disease (DJD). It is most
often the result of normal “wear and tear” and
occurs to some extent in all people as they
age.
Joints Affected by Osteoarthritis
Hip
Knee
Spine
All joints can be effected, however, the most commonly involved are the weight bearing
joints such as the hip, knee and spine. They must withstand the significant forces
generated by walking and running, and therefore are prone to wearing out.
What are Joints?
Joints are the places where the bones meet. The body
would be immobile if not for the movements afforded by
the joints. Joints can be large or small, and permit
movements as varied as walking, bending, reaching, and
performing fine motor skills.
Hip joint
The hip is a simple ball and socket joint. The upper end of the thigh bone (femur) is the ball.
It fits snugly into the socket, a part of the pelvis called the acetabulum.
Knee Joint
The knee is the largest joint in the body,
and one of the most easily injured. It is
made up of the lower end of the thighbone
(femur) which rotates on the upper end of
the shinbone (tibia), and the knee cap
(patella) which slides in a groove on the end
of the femur.
Cartilage
Within the joints, the ends of the bones are covered
with a smooth, white, glistening material called hyaline
cartilage. When normal, this material cushions the
underlying bone against excessive pressure and allows
the joint to move easily and without pain.
Menisci
• The articular cartilage
on both ends of the knee
joint never actually
come in direct contact
with one another. They
are separated by a thin
film of joint fluid and
two “shock absorbers”
made of a different type
of cartilage and known
as the menisci
(meniscus).
Cartilage
When the articular cartilage is damaged or injured, it usually goes through a staged
process of softening, flaking, fragmenting, and finally complete loss, where the
underlying bone is exposed. This process is commonly known as osteoarthritis or OA.
Knee Arthritis
Arthritis Risk Factors
 Obesity - Generally, the more weight a person carries, the
greater the pressure on weight-bearing joints of the body.
 Past injury in a joint - There is an increased risk of

developing OA in a joint that is not properly aligned or one
that has been injured.
 Occupational factors - Repetitive tasks, overworking the

joints and overtiring muscles that protect a joint increase the
risk for OA in that joint.
 Genetics - osteoarthritis in all its various forms appears to

have a strong genetic connection. Gene mutations may be a
factor in predisposing individuals to develop OA.
Who is At Risk For Arthritis ?
Prevalence of
arthritis, among
adults by gender
Prevalence of
arthritis, among
adults by age
group
Who is At Risk For Arthritis ?
Prevalence of arthritis among
Adults by physical activity level.
Prevalence of Arthritis or Chronic Joint Symptoms (CJS) Among

Adults by Body Mass Index
Arthritis signs and symptoms
Joint Pain
Crepitis (grinding)
Joint Deformity
Osteophytes
Joint Stiffness
Joint Pain and Stiffness

 The main symptoms associated with
osteoarthritis are painful and stiff joints.
 The symptoms can be quite debilitating.
 Typically, stiffness is worse in the morning,
lasting less than 30 minutes.
Creaking or Grinding Sounds

 Crepitis is the medical term for the grinding sound often heard when
attempting to move the affected joint.
 Sometimes moving the joint through the full normal range of motion may not
even be possible.
Joint Deformity
The arthritic knee joint can
develop a deformity in which the
joint itself becomes angled.
Valgus deformity is the term used to

describe what many people
commonly refer to as being “knock
kneed.”
Varus deformity is the term used to
describe what is referred to as being
“bowlegged.”
Joint Deformity
Osteophytes
Joints also may appear swollen, caused by new bony growths called
osteophytes (bone spurs) or sometimes, by extra fluid in the joint.
How is Arthritis Diagnosed?
Signs and symptoms
History and physical examination
X-Rays
Blood Tests
Analysis of Joint Fluid
Treating Arthritis
 Although there is no cure for osteoarthritis,
proper treatment can help relieve the
symptoms and prevent or correct serious joint
problems.
 There are two general classes of treatments,

surgical and nonsurgical.
Treating Arthritis
 Nonsurgical
1. Health and behavior modifications - physical therapy,
exercise, weight loss.
2. Drug therapy – Pain relievers, NSAIDs, COX2

inhibitors
3. Intra-articular injections – steroids,

viscosupplementation
 Surgical
1. Arthroscopy - Day surgery, done through small holes
2. Arthroplasty - Total Joint Replacement

Drug Therapy
NSAIDs
NSAIDs – Non Steroidal Anti-inflammatory Drugs
 NSAIDs are first line therapy drugs that are used to both relieve pain
and to decrease inflammation.
 Some examples of NSAIDs are Motrin, Feldene, and Indocin.
 Many people cannot take NSAIDs because of there side effects
including GI upset and an increased risk of bleeding
COX2 Inhibiters
 COX2(cyclooxygenase-2) Inhibiters are a relatively new class of
medicines that also relieve arthritis pain by decreasing inflammation.
 COX2 Inhibiters have fewer side effects than NSAIDs. However,

recent studies have shown that they may cause an increased risk of
heart problems in some patients.
 Examples include Celebrex, as well as Bextra and Vioxx which

were recently removed from the market.
 COX2 Inhibiters tend to be expensive and are not always covered by

insurances.
 ****significant increase in heart attacks and strokes****
Intra-articular Injections
There are two main types
of intra-articular
injections.
1. Steroids – Injected into the joint to decrease inflammation.
2. Visco supplementation – Injected into the joint to provide lubrication.

Steroids
 Steroid injections are commonly referred to
as “cortisone shots.” However the steroid we
most commonly used is Kenalog.
 Kenalog is a potent anti-inflammatory
medication that relieves the symptoms of
arthritis but doesn’t treat the disease
itself.
 All patients have different results with
cortisone shots.
 As a general rule only three steroid shots
should be given in one years time.
Viscosupplementation
 Viscosupplementation is a relatively new method of
treatment that in some cases can be effective for treating
osteoarthritis of the knee.
 The active ingredient in the injections is called hyaluronic
acid.
Hyaluronic acid is a naturally occurring substance found
in the synovial (joint) fluid. It acts as a lubricant to enable bones
to move smoothly over each other.
 There are five major preparations of hyaluronic Acid available;
all have similar properties and none has been clinically proven
more effective.
Viscosupplementation
 Orthovisc is injected into the knee once a week for three weeks.
 There is a very low incidence of adverse reactions.
 Results differ from patient to patient.
 The beneficial effects of orthovisc can last for up to one year.

Arthritis

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Arthritis

 Past injury in a joint - There is an increased risk of

 Occupational factors - Repetitive tasks, overworking the

 Genetics - osteoarthritis in all its various forms appears to

Prevalence of Arthritis or Chronic Joint Symptoms (CJS) Among

Joint Pain and Stiffness

Creaking or Grinding Sounds

Valgus deformity is the term used to

 There are two general classes of treatments,

2. Drug therapy – Pain relievers, NSAIDs, COX2

3. Intra-articular injections – steroids,

2. Arthroplasty - Total Joint Replacement

 COX2 Inhibiters have fewer side effects than NSAIDs. However,

 Examples include Celebrex, as well as Bextra and Vioxx which

 COX2 Inhibiters tend to be expensive and are not always covered by

1. Steroids – Injected into the joint to decrease inflammation.

2. Visco supplementation – Injected into the joint to provide lubrication.

 There is a very low incidence of adverse reactions.

 Results differ from patient to patient.

 The beneficial effects of orthovisc can last for up to one year.

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