Understanding Arthritis

By Deborah Holmes, PT

Arthritis has plagued humans for centuries and millions today are affected. Just what is this crippling disease?
The word arthritis is taken from Greek words meaning “inflamed joints” and is associated with a group of well over 100 rheumatic diseases and conditions. These diseases may affect not only the joints but also the muscles, bones, tendons, and ligaments that support them. Some forms of arthritis can damage your skin, internal organs, and even your eyes. Let us focus on one disease commonly associated with arthritis – osteoarthritis (OA).

Joint Architecture

A joint is where two bones meet. A synovial joint is surrounded by a tough capsule that protects and supports it. The joint capsule is lined with a synovial membrane. This membrane produces a slippery fluid. Within the joint capsule, the ends of the two bones are covered with a smooth elastic tissue known as cartilage. This prevents your bones from rubbing and grinding against each other. Cartilage acts as a shock absorber as well, cushioning the ends of your bones and distributing stress evenly across your bones.

Osteoarthritis

Osteoarthritis (OA) rarely spreads to other body parts but concentrates its erosive influence in one or just a few joints. As cartilage is slowly eroded, bone begins grinding against bone. This is accompanied by bony outgrowths called osteophytes. Cysts may form, and the underlying bone thickens and becomes deformed. Other symptoms include knobby knuckles, grating and grinding sounds that emanate from arthritic joints, and muscle spasms, along with pain, stiffness, and loss of mobility.
Primarily OA results from many causes, including metabolic, genetic, chemical and mechanical factors. Secondary OA usually follows an identifiable predisposing event most commonly trauma to the joints, congenital deformities, or obesity. This can lead to degenerative changes in the joints, pain and inflammation. As the joint degenerates and frays, stress increases on the underlying cartilage and bone. Pathological changes occur as the body attempts to repair the damage to the structures in and surrounding the joint. Once deterioration begins, being overweight can exacerbate OA.

Treatment

Treatment for arthritis usually involves a combination of medication, exercise, and life-style modification. A physical therapist may initiate a specific therapeutic exercise program after identifying the movement impairment. It may incorporate range-of-motion, isometric, aerobic, and isotonic or weight-bearing exercises. These have been shown to improve a multitude of symptoms including joint pain and swelling, fatigue, malaise, and depression. Physical therapists can also instruct energy conservation techniques to protect the arthritic joint using healthy solutions. The goal of treatment is to relieve pain, maintain or improve mobility, and minimize disability.
Surgical intervention may be needed for persons who have severe disability or uncontrollable pain. This could include, but is not limited to, a partial or a total joint replacement, surgical fusion or scraping and the removal of deteriorated bone and cartilage from the joint. Your physical therapist works closely with the surgeon before and after the surgical treatment to strengthen and restore function using various therapeutic approaches.