Arthritismeaning “inflammation of a joint”first originated in 1540 from the Latin language1. “Arthritis” is the most common chronic condition affecting Canadians, approximately 6 million Canadians are affected by it. It can manifest in both children and adults, approximately 1 in 5 Canadians (20.4%) over the age of 15 suffer from it. The prevalence of “arthritis” is increasing: it is expected to affect over 40% of the Canadian population by the year 2035. It affects women (approximately 60%) more commonly than man. 1 in 4 women or 1 in 6 men have arthritis. If not diagnosed and treated on time, it can lead to permanent disability2.
According to Statistics Canada 2008 report on arthritis, it is more prevalent in seniors over age 65: 1 in 3 males and 1 in 2 females reported it. Importantly, this disorder affecting the joints, has also been reported in working individuals between the ages of 45-64; 17.2% men and 24.8% females3.
There are currently approximately 100 types of arthritis. The most commonly encountered are osteoarthritis and rheumatoid arthritis. Osteoarthritis is a non-inflammatory arthritis affecting most joints in the body, especially hands, knees, hips and the lower back (lumbar spine). On the other hand, rheumatoid arthritis is the commonest inflammatory joint disease that predominantly affects hands, wrist and the forefoot but also can affect elbows, shoulders, knees and hip.
Arthritis care involves inter-disciplinary care by various disciplines of Medicine. These can range from a family doctor, physician assistant (PA), nurse practitioner (NP) – nurses specially trained in dealing with arthritis, orthopedic surgeon, physiotherapist, occupational therapist sports medicine specialist and of course a rheumatologist. It’s diagnosis usually involves a detailed history and examination of a patient by one of these professionals. The most common complaint is pain and stiffness or swelling affecting the joint. There is difficulty in walking or weight bearing in patients affected by arthritis. Diagnosing It usually entails whether it is inflammatory or “non-inflammatory”? The inflammation could involve the joint or structures around the joint. Assessing the pattern and extent of joint inflammation and deformity and morbid disability from arthritis is an essential part of the assessment.
As there is no cure for arthritis, management strategies should focus primarily on reducing pain and morbidity in the short term and disability in the long-term. According to The Arthritis Alliance of Canada (AAC) 2011 report “The Impact of Arthritis in Canada: Today and Over the Next 30 Years”, the most return on investment in management of arthritis could be gained by having effective pain management strategies, reduction of obesity and total joint replacement (TJR) interventions in osteoarthritis and early diagnosis and institution of disease modifying anti-rheumatic drugs (DMARDs) or biologics in those not responding to DMARD treatments4.
The general management of arthritis involves controlling joint pain, encouraging mobility by exercises and physiotherapy, resting and avoiding weight bearing on inflamed joints and addressing modifiable risk factors such as obesity. Joint pain is treated initially with over the counter measures (OTC) such as Acetaminophen (Tylenol), Ibuprofen (Advil) or Aleve and topical analgesics (Voltaren, or Acetylsalicylic acid etc.). If it is not effective then prescription strength Non-steroidal anti-inflammatory drugs (NSAIIDs) Naproxen and Celebrex etc. could be used. Tylenol with codeine or opiates (morphine or hydromorphone) are used where NSAIDS are not tolerated or contraindicated. Intra—articular steroid injections (depo—medrol or Triamcinolone acetonide) are a last measure in joint pain control and usually should be administered by a specialist such as a rheumatologist. Encouraging joint mobility and range of motion (ROM) exercises are recommended after resolution of the acute joint inflammation to avoid disuse atrophy and joint contractures. This should be administered under the care of an experienced physiotherapist. Obesity is a modifiable risk factor for osteoarthritis. Addressing obesity (with the help of a nutritionist) with active lifestyle changes in these patients could be rewarding.
The Arthritis Alliance of Canada (AAC) recommended to develop a “national framework for arthritis” focusing on providing efficient and effective care, disease prevention, mechanism for a dialogue between the arthritis community and the government and research in both clinical and preventive arthritis care.
In summary, arthritis is the most common chronic health condition affecting Canadians. The most common types are osteoarthritis and rheumatoid arthritis. Early diagnosis and treatment with referral to a specialist such as a rheumatologist are of prime importance in treating and preventing long-term disability from arthritis.References:
- ACREU Report 2017 Population level health data. https://www.arthritis.ca/about-arthritis/what-is-arthritis/the-truth-about-arthritis
- Bombardier C, Hawker G, Mosher D. The Impact of Arthritis in Canada: Today and Over the Next 30 Years.http://www.arthritisalliance.ca/images/PDF/eng/Initiatives/20111022_2200impact of arthritis.
- Kontiaz, A. Osteoarthritis In: Bone, Joint, and Muscle Disorders/Joint Disorders. Merck Manual (www.merckmanuals.com).
- Review: Stages of Osteoarthritis of the knee. https://reachmd.com/news/review-stages-of-osteoarthritis-of-the-knee/506/.
- E Fahri, Sarikaya IA, Can A, et al. Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: A report of two cases.Acta Orthopaedica et Traumatologica Turcica2018;52(1):65-69.