About Arthritis Pain
Many Singaporean adults have some type of arthritis. It is a major cause of lost working time and serious disability for many people. While the most common type of arthritis is commonly associated with ageing, sometimes it can afflict younger patients who are engaged in high-impact sports or work.
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.
Diagnosing Arthritis Pain
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.
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 an 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% of people with this disease are over 30 years old. Many joints of the body may be involved at the same time.
Is there a cure for Arthritis?
At present, most types of arthritis cannot be cured. Researchers continue to make progress in finding the underlying causes for the major types of arthritis. In the meantime, pain physicians, working with other physicians, have developed many effective treatments for arthritis. In most cases, persons with arthritis can continue to perform normal activities of daily living. Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain and stiffness, and improve function.
The goals of treatment are to provide pain relief, increase motion, and improve strength. There are several kinds of treatment:
Many medications, including Arcoxia and 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 1,500mg of glucosamine to have any effect on reduction of arthritic symptoms.
- Injection of cortisone directly into the joint may temporarily help to relieve pain and swelling.
- Artificial lubricant (Synvisc or Monovisc) may increase the production of lubricant.
- Pulsed radiofrequency stimulation and ablation of painful nerves may be helpful for some OA knees for longer term pain control.
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 a 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 increased load to already fatigued and worn-out joints.