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As Time Ticks On and Joints Wear Out
(Osteoarthritis & Rheumatoid Arthritis)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 14 in the July 12-13, 2003 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.

Arthritis is a term that refers to any inflammation of the joint, and is used much too loosely. There are numerous classifications of diseases that affect the joints. Viral and bacterial infections, precipitation of uric acid, auto-antibodies can all cause different types of arthritis. Osteoarthritis is the most common type of joint problem. It is considered to be a "wear and tear" type of condition. Do not confuse it with osteoporosis which refers to bone thinning. Worn out joints will affect all people at some time in their later years. Osteoarthritis can also occur after an injury. It is a disease that primarily affects the hyaline cartilage and causes some enlargement of the bone around it. Cartilage is the shiny tissue at the ends of joints that allows for smooth movement. As the cartilage erodes away, bone spurs form around the edges, sometimes breaking off and floating in the joint. Classically, we see swelling of the finger joints called Heberden's Nodes. Osteoarthritis typically shows up as morning stiffness that improves through the day. Prevention through maintaining an ideal weight, exercising, and minimizing repeated joint stress is the key to controlling it. Obese people tend to suffer more joint problems. There can be swelling of the joint along with pain. Therapy is aimed at reducing these features by employing anti-inflammatory medication and mild analgesics. Exercise appears to help. The chronic degeneration that occurs with osteoathritis is the reason for a great deal of hip and knee replacements.

Rheumatoid arthritis is thought to be an autoimmune disease. It is one of many entities within a broad category of Diffuse Connective Tissue Diseases. It is a chronic disease that tends to affect joints symmetrically on both sides of the body, but it can also affect organs. Typically, it begins at a young age, and women are much more affected than men. The delicate synovial membrane that produces fluid in the joint thickens and develops a lot of folding. This can erode into the cartilage and surrounding bone. The reaction causes many factors to be released such as Rheumatoid Factor, a diagnostic sign that can sometimes be picked up in a blood test. There is stiffness, pain and warmth in the joints. Deformities develop as the joint starts to lose function. The fingers all tend to "slip," pointing towards the baby finger, a sign called ulnar deviation. Rheumatoid nodules may develop under the skin. The symptoms can overlap with other diseases such as Lupus, Gout or Lyme disease. Rheumatoid arthritis is more difficult to treat and there exists a wider spectrum of medications all aimed at different parts of the physiological cascade. Anti-inflammatory, steroids, gold, and immunosuppressive drugs all have a role in controlling the disease. Copper bracelets may help the few rare people who are copper deficient, but many people purchase them in an attempt to alleviate the pain. Magnets have not shown to have any benefits.

The initial work-up consists of a good history and examination. Blood tests and x-rays usually follow. Medication and an exercise program come next, with joint replacement surgery being considered in the most severe cases. Maintaining a good diet helps since cartilage is 70% water. Ensure that your Calcium and Vitamin D intake is adequate. Glucosamine- Chondroitin is not a herb but rather a non-prescription drug combination of a steroid and basic amino acid that is non-regulated, and can help. Please ensure that your physician is aware of all substances that you ingest and use regularly.




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