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ArthritisArthritis

Many people, and not just the elderly, are affected by some form of arthritis. It can cause temporary discomfort or long-term disability, but drugs and physiotherapy can do much to relieve the condition.

Arthritis is an inflammation of the joints that may cause pain, swelling and lack of mobility. Though many people think of it as a condition which affects mainly older people, it can afflict people of all ages and is a very common medical complaint. There are many types of arthritis, and it can be mild or severe, acute (relatively short-lived) or chronic (long-lasting) and affect just one joint or several. Arthritis has numerous forms, and is the subject of a well-established medical specialty, rheumatology.

Sometimes arthritis is brought on by an injury -- when it is known as traumatic arthritis -- or an infection of the lubricating fluid in the joint (septic arthritis). The causes of other types, though, are not always fully understood.

RHEUMATOID ARTHRITIS
Rheumatoid arthritis, for instance, is a fairly common disease in adults (it can also attack children, when it is known as Still's disease), but its cause is unknown. There is a theory that it may be due to a problem with the body's auto-immune system. Some event -- a severe illness or a shock -- is thought to trigger a chemical chain reaction in the body that produces a substance which attacks the synovium, the lining tissue of the joints, as if it were an intruder.

Rheumatoid arthritis is most common in adults between 20 and 55, and is three times more likely in women than in men. The usual symptom is a painful swelling in the knuckles of both hands and the joints of the toes, though many other joints may eventually be affected. It may be acute, starting with a fever or rash, or happen more gradually over the space of several weeks.

OSTEOARTHRITIS

Osteoarthritis occurs as joints age or are put under excessive strain. It mainly affects joints which have to bear a lot of strain, particularly in the hips, knees and between the vertebrate in the spine. In women, the hands are also often affected.

It is caused by a degeneration of the cartilage, the tough, elastic tissue that protects the surface of the joint. As a result, the underlying bone surface is compressed and the synovium lying over it becomes inflamed, causing pain and stiffness. Osteoarthritis is most common in older people, though it can also affect others -- professional sportsmen, for instance -- who put excessive strains on their joints.

Once a joint has become affected by osteoarthritis, the condition tends to get worse rather than better, although this process can be significantly slowed by relieving any strain on the joint and protecting it from knocks.

RIGID SPINE DISEASE

Ankylosing spondylitis affects the joints of the spine and the pelvis, and is thought, like rheumatoid arthritis, to be an auto-immune illness. Thee is a definite tendency for it to run in families. It's more common in men, affecting about one in every 200, and usually starts between the ages of 15 and 30.

Calcium is deposited in the ligaments, leading to stiffness. If it is not treated -- a mixture of drugs and exercises is the usual method -- the vertebrae can fuse together, hence its common name, 'poker back'. It tends to progress slowly over a few years, often spreading to the whole spine and hip joints, before gradually petering out.

Forms of arthritis that are rare -- at least in the modern developed world -- can result from tuberculosis or rubella (German measles). In recent years, other forms of transient (non-permanent) arthritis have been associated with infections. Among these is Reiter's disease -- named for the doctor who first described it -- which is associated with microbes which cause gastro-enteritis and with chlamydia, a sexually-transmitted disease also known as NSU (non-specific urethritis). The arthritis clears up when the original infection is properly treated.

'Lyme arthritis', common in parts of the USA, is also caused by an infection, carried by a tick. Treatment with antibiotics prevents the development of arthritis.

DIAGNOSIS AND TREATMENT
If you suspect you have some form of arthritis, the worst thing you can do is to 'just put up with it'. Go and see your doctor. Even if there is no cure, the condition can sometimes be prevented from getting any worse. In the case of a child with Still's disease, there is the risk of permanent deformity without proper hospital care.

Your doctor will ask for a history of your illness and give you an examination. Blood tests may be needed to test for the presence of infection or to determine the cause of the pain. There are special tests to discover the presence of rheumatoid arthritis and ankylosing spondylitis.

Another technique, called arthroscopy, involves the use of an instrument that is used to look inside the knee joint under local anaesthetic. Both the cartilage and the synovium can be examined by this means, and small pieces of tissue can be removed for further microscopic investigation. You may also need to have X-rays taken to discover the type of arthritis and the actual amount of damage to the affected joints.

The doctor may prescribe anti-inflammatory drugs and painkillers. There are specialized treatments for rheumatoid arthritis, which slow the progression of the disease, but they tend to be associated with various side-effects and are usually only prescribed in more severe cases. Perhaps the best known of these treatments is a weekly intra-muscular injection of gold.

You may have to rest the affected joints or wear a specially made splint to keep them in the best position and so prevent deformities, from occurring. A doctor may treat any swollen joints by drawing off excess fluid under a local anaesthetic or by injecting an anti-inflammatory drug directly into the affected joint.

Steroid drugs may be used to ease the inflammation, but as they may have unwelcome side-effects the doctor will only use them when other forms of treatment have proved unsuccessful.

Possible home treatments include exercises which will be taught by a hospital physiotherapist and various forms of heat treatment, including hydrotherapy (exercising in a small pool of very warm water), infra-red lamps and paraffin wax baths for the hands and feet which can help to relieve pain.

SURGERY

Another possibility is the surgical replacement of badly-damaged joints with artificial ones made of metal, plastic or ceramics. This technique is particularly useful in dealing with arthritic hips, though new artificial joints are constantly being developed for other parts of the body.

Surgery can also be used to alleviate pain by relieving pressure around a joint, removing the lining from an excessively inflamed joint, or fusing the joint. This involves some loss of mobility, though usually the sufferer finds it a small price to pay for being relieved of constant pain.

     
     

Rheumatoid Arthritis (RA)

Systemic Lupus Erythematosus

Psoriatic arthritis

Ankylosing Spondylitis (AS)

Reiter's syndrome

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Depression and Arthritis

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A balanced state of joints

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