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Arthritis Dischem

The many faces of arthritis

Arthritis is the destruction of the joints and their surrounding lining. There are three main types of arthritis, with different causes and treatments available, namely Osteoarthritis, Rheumatoid arthritis and Juvenile chronic arthritis.

Osteoarthritis

At some stage in our lives we will all become sufferers of "arthritis" through normal everyday wear and tear. Osteoarthritis comes from the Greek language, osteo meaning bone, arthro meaning joint and itis meaning inflammation.

Osteoarthritis affects mainly the large joints especially the hips, knees and base of the thumbs. Due to repetitive use, injuries or infection the cartilage (soft spongy material which does not contain nerves) surrounding the bone, is gradually worn down exposing the hard, nerve rich bone beneath. The exposed bone on one side of the joint rubs against exposed bone on the other during any movement causing extreme pain and inflammation in the affected joint. The joint becomes swollen, painful and creaks and cracks as you move around getting worse as the day wears on.

Currently there is no proven cure to regenerate the damaged cartilage and reverse the process of osteoarthritis (this is controversial as there are many products on the market claiming to be able to regenerate cartilage, e.g. supplements containing glucosamine and hyaluronic acid).

Prevention is the best form of cure and includes weight-loss, low impact regular exercise and a well balanced diet with sufficient calcium. Treatment of symptoms includes pain killers, anti-inflammatory tablets, physiotherapy and hydro-therapy. When the arthritis has progressed to a point where it is either impairing your job or the pain is affecting your life and not being controlled by the pain killers, consult your doctor or Orthopaedic surgeon for further treatment. This will range from washing out the joint through key-hole surgery to a total joint replacement. The outcome is excellent and most patients return to their normal lives free from pain.

Rheumatoid arthritis

Rheumatoid arthritis is an auto-immune disease, meaning your body incorrectly thinks that the lining of your joints (synovial membrane) are the enemy and sends its soldier cells (inflammatory cells) to attack and destroy the lining causing joint destruction in the process.

This is a systemic disease, affecting all the organs and system of the body and not just the joints. The disease begins by destroying the lining of the joints, but the inflammatory cells also damage the surrounding cartilage and slowly "eat" away at the bones of the joints, destroying the articulating

surfaces in the process. If left untreated it can progress to become a devastating disease leaving the sufferer contorted and crippled.

Rheumatoid arthritis starts at a much younger age and first involves the small joints of the hands and feet. Only in the late stages does it affect the larger joints. Those affected, experience morning stiffness in symmetrical joints of hands or feet with the joints slowly loosening up as the day progresses. Inflammation causes warm, swollen and painful joints which slowly begin to deform the fingers and toes giving them the typical crooked "witch fingers" appearance.

Treatment is a team approach consisting of general practitioners, rheumatologist, orthopaedic surgeon, physiotherapist and occupational therapist. Markers in your blood can be tested to confirm the disease and tailor the most effective treatment. Disease modifying drugs are used to bring the inflammation and synovitis (joint lining inflammation) under control (cortico-steroids and cancer type drugs e.g. methotrexate).

The Occupational therapist and physiotherapist will supply exercises that keep the joints mobile and avoid deformities that may occur from the destruction of the joints. Once pain and deformity have set in the Orthopaedic surgeon steps in to perform preventative or corrective surgery. This involves surgery which either cleans out the inflammation that surround the joint or performing a total joint replacement.

Unfortunately this is a life ling disease, but if the disease is kept in check with medication and the joints are cared for with exercise or surgery you can continue with a normal pain free active life.

Juvenile chronic arthritis

Juvenile Chronic Arthritis is defined as a group of Systemic Inflammatory Disorders affecting children below the age of 16 years. This disease is also an auto-immune disorder (i.e. our own soldier/white cells attack our joints).

The disease starts at an early age affecting large joints usually symmetrically. This is also accompanied by systemic symptoms e.g. fever, rash, weight loss, malaise. If the disease is not brought under control early the results can be devastating with complete destruction and pain of all the joints.

Treatment is the same as Rheumatoid arthritis, using anti-inflammatory medication and disease modifying dugs like anti-cancer medication. Exercise is essential especially swimming and cycling, to keep the joints mobile and supple. Physiotherapists and occupational therapists keep the joints mobile, prevent injuries and treat any deformities that are present. Orthopaedic surgeons when needed surgically remove the inflammation around joints and any other operation when required.

DR JASON CRANE

As a full time orthopaedic surgeon at Mediclinic Cape Town, Doctor Jason Crane offers advanced orthopaedic care in a state-of-the-art medical facility on the slopes of Table Mountain.

CONTACT

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jason@capetownorthopaedic.co.za

Mediclinic Cape Town, Suite B105, 1st Floor (Doctors Block)
21 Hof Street, Oranjezicht, Cape Town, South Africa