Arthritis

Arthritis, inflammation of one or more joints. Over 100 different diseases can produce arthritis. In its most common and troubling forms arthritis may occur in several joints of the body and is usually a long-term condition that may cause progressive disability. Inflammation of the joints can be caused by gout, rheumatic fever, or ankylosing spondylitis, a disease that affects the spine.

Osteoarthritis, the most common form, affects an estimated 80 per cent of people over 65 years of age, although only 25 per cent may actually have symptoms of the disease. It is usually a mild, sometimes painful disease occurring primarily with advancing age, when degenerative changes alter the structure of the joints. Symptoms may be relieved and the condition controlled with drugs, exercise, and other measures, sometimes including orthopaedic surgery.

Rheumatoid arthritis is by far the more serious, painful, and potentially crippling form; it is chronic, is characterized by flare-ups and remissions, and occurs throughout the world, in all climates and ethnic groups. The prevalence in developed countries is generally about 3 per cent, with three times as many women as men affected.

Rheumatoid arthritis attacks the joints primarily, but may affect supporting connective tissues throughout the body, causing fever, weakness, fatigue, and deformity. The cause is not known, but a hereditary predisposition and an environmental agent, such as a virus, are suspected. Although no cure has been discovered, the disease can be controlled. Pain-relieving and anti-inflammatory drugs are used, as well as programmes of exercise, rest, heat, and assistive devices to maintain joint motion and function. Most forms of arthritis respond to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, which inhibit synthesis of prostaglandins. Aspirin is also widely used in treating the disease, although it can cause gastrointestinal irritation, as can the NSAIDs, but less severely. Severe cases may be treated with gold compounds or the drugs hydroxychloroquine or penicillamine. Disability in advanced cases can be markedly reduced, and surgery is often effective in correcting abnormalities.