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Arthritis- Doctor, I am here for aches and pains; what’s wrong?

Aches and pains remain one of the common reasons people visit the clinic.
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Aches and pains remain one of the common reasons people visit the clinic. Both patients and doctors sometimes tend to brush the issues away and treat these symptoms with simple pain relievers before issuing medical certificates. But are we doing enough to address any possible underlying issues?

What is arthritis?

Arthritis is a broad term for inflammation in and around a joint. There are more than 100 different types of arthritis [1]. Generally, arthritis manifests with joint pain as the primary symptom, and you also experience the occasional joint stiffness and swelling.

The point is that sometimes, we overlook or dismiss persistent aches and pains as mere inconveniences. However, it is important to recognise that these symptoms may indicate underlying conditions such as arthritis, which may require more comprehensive evaluation and management.

arthritis
Arthritis is characterised by inflammation in and around a joint.

What are the common symptoms of arthritis?

Symptoms of arthritis include: 

  • Joint pain
  • Stiffness
  • Swelling 
  • Limited range of movement 

These symptoms can vary in how they appear. They may show up intermittently, meaning they come and go. Alternatively, they could be consistently present and remain the same over time. Sometimes, the symptoms may be progressive, meaning they worsen with time.

How common is arthritis in Singapore?

In Singapore, common musculoskeletal diseases affecting patients include rheumatoid arthritis, gout, and osteoarthritis.

According to the Global Burden of Diseases (GBD) 2019 study [2], musculoskeletal diseases rank among the top 5 broad causes of medical conditions leading to disability and overall health burden [3]. This means that these conditions significantly impact a person’s ability to function and contribute to the overall burden of healthcare.

Am I at risk of developing arthritis?

When it comes to arthritis risk factors, we can categorise them into two main groups: modifiable and non-modifiable factors.

Modifiable risk factors include:

  • Smoking: if you are a smoker, it is important to know that smoking can increase your risk of autoimmune-related arthritis, particularly rheumatoid arthritis [4]. Furthermore, chronic smoking can worsen the symptoms of rheumatoid arthritis. Quitting smoking reduces this risk and promotes physical activity and overall well-being.
  • Elevated body mass index (BMI): maintaining a healthy weight is crucial to prevent osteoarthritis. Excess weight puts additional pressure on weight-bearing joints such as knees and hips, leading to more wear and tear [5]. Managing weight through a balanced diet and regular exercise is key to reducing this risk.
  • Physical injury: overusing your joints can cause damage to the joint and the surrounding tissues, increasing your susceptibility to osteoarthritis [6]. It is important to be mindful of your physical activity and avoid overuse or improper use of your joints to prevent injury.
  • Infection: joints can be vulnerable to bacterial or viral infections, leading to a condition known as infective arthritis [7]. If you suspect an infection in your joints, seek prompt medical attention. Timely treatment can prevent permanent damage to the affected joint.
smoking arthritis
Smoking increases the risk of arthritis.

Non-modifiable risk factors include:

  • Age: as you age, your risk of developing arthritis naturally increases. It is a condition that tends to become more common with advancing age [8].
  • Gender: your gender can also play a role in your arthritis risk [9]. Generally, women are at a higher risk of developing rheumatoid arthritis and osteoarthritis, while men are more likely to develop gout.
  • Family history: your family history can impact your arthritis risk [10]. Autoimmune-related forms of arthritis, such as rheumatoid arthritis and Lupus, may have a genetic component. If these conditions are present in your family history, you may have a higher predisposition.

What are the common types of arthritis?

While there are over 100 types of arthritis, we can broadly classify them into the following:

  • Mechanical arthritis: also known as degenerative arthritis, it involves the wear and tear of cartilage – a protective covering at the end of bones which allows for smooth and pain-free movement [11]. An example of mechanical or degenerative arthritis is osteoarthritis.
  • Autoimmune arthritis: autoimmune diseases such as autoimmune arthritis occur when the body’s immune cells attack their own body. When this happens at the joints, it results in autoimmune arthritis – examples include rheumatoid arthritis, psoriasis arthritis, juvenile arthritis, systemic lupus erythematosus-related arthropathy, and spondylarthritis [12].
  • Infectious arthritis: as its name suggests, infectious arthritis is caused by an infection, such as a bacterial infection. This arthritis is usually acute, occurring suddenly and causing painful, permanent damage to joints [13]. 
  • Inflammatory arthritis: commonly referred to as gout, occurs due to an accumulation of uric acid crystals in the joint [14]. This condition causes sharp pain and inflammation in joints, especially the big toe. Individuals with metabolic syndrome are more prone to gout.
metabolic arthritis
Gout is a form of inflammatory arthritis often associated with metabolic syndrome, thus earning it the name of metabolic arthritis.

What are the differences between rheumatoid arthritis, gout, and osteoarthritis?

Rheumatoid arthritisGoutOsteoarthritis
Cause/type of arthritisAutoimmune disorder – the body’s immune cells attack their own bodyInflammatory – high purine diet and lifestyleMechanical – progressive wear and tear of joints
Joint locationSmall joints such as hands/feet are usually symmetrical in nature (though larger joints can be affected)Single joints such as big toe/feet/ankle/kneeLarge weight-bearing joints such as hip and knee
Pain onsetProgressive, though symptoms can be acute during a flare-upAcute, which intensifies progressivelyInsidious and progressive
Associated symptoms- Affected joints can be warm, tender to touch, and swollen-Lethargy-Weight loss-Fever-Affected joint is likely warm, tender to touch and swollen-Fever-Cracking of the joints-Worsening pain upon repeated use of the joint/end of the day
Other systemic symptoms-Chest pain-Shortness of breath-Reduced exercise tolerance-Red eyes-Rash-Hair loss-Blood in urine-Painful urination-Lower back pain associated with kidney stones-Possible associated chronic conditions such as hypertension/ hyperlipidaemia/ diabetes -Spine/back pain due to ageing/degenerative process-Associated raised BMI/obesity

When should I consider seeing my doctor, and what can my primary doctor do?

If you notice symptoms of arthritis, such as joint pain, swelling, and stiffness, you should speak to your primary care doctor. They will evaluate your symptoms based on your medical history and physical examinations of the joints. Your doctor may also recommend blood tests and X-rays to confirm the nature of your condition.

Determining the specific type of arthritis you have is crucial as it guides the choice of the most appropriate treatment plan. Early diagnosis and proper management can help you effectively address arthritis and improve your overall joint health and quality of life.

diagnosing arthritis
A doctor can help evaluate your symptoms and diagnose you accurately.

What should I expect when I see my doctor for arthritis?

The primary goal of seeking prompt medical attention when you experience symptoms of arthritis is to ensure you receive an accurate diagnosis and early treatment without further delay. This approach aims to effectively manage and alleviate your symptoms and prevent the condition from progressing.

The key objectives for arthritis treatment are to:

  • Manage and control joint pain symptoms
  • Reduce further joint damages
  • Keep and maintain the daily function of the joint

In cases of autoimmune arthritis, such as rheumatoid arthritis, your doctor may refer you to a rheumatologist or orthopaedic specialist for specialised care and management.

What happens if I don’t treat or diagnose arthritis?

When arthritis is left untreated, it has the potential to cause permanent and irreversible damage to your joints [15]. This can result in a loss of joint function, ultimately leading to difficulties in carrying out your daily activities and routines.

In certain forms of arthritis, particularly rheumatoid arthritis, the impact can extend beyond the joints, affecting other vital organs, including the heart, eyes, kidneys and lungs [16]. This highlights the importance of managing joint symptoms and addressing the underlying causes and potential complications associated with arthritis.

Is there a cure or treatment for arthritis?

There is no cure for arthritis; however, as previously mentioned, the primary goal in treating arthritis is to manage symptoms; this includes:

  • Pain management: effectively managing and alleviating joint pain.
  • Preventing joint damage: prevent and minimise any further damage to the affected joints.
  • Maintaining joint function: ensuring that your affected joints continue to function properly.

The specific treatment for arthritis depends on the type and underlying causes of the condition. While a primary care doctor can diagnose arthritis, there may be situations where collaborative care with specialists from various disciplines is necessary.

You may be offered medication based on the type of arthritis to control the symptoms. Additionally, your doctor will guide you on suitable regular physical exercises to keep your affected joints active and ensure your overall functionality is not compromised. In more severe cases, surgical options may be considered to manage the affected joint.

In conclusion

Listening to your body and recognising the symptoms it is signalling is the crucial initial step in addressing a potential arthritis condition. Taking the proactive step of getting checked and evaluated by your general practitioner is essential to addressing a brewing arthritis condition. So, don’t delay further; seek medical attention to start the journey toward diagnosis and appropriate treatment!

References

  1. Arthritis Foundation. (2023, September 25). How Arthritis Hurts. Retrieved from Arthritis Foundation: https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/sources-of-arthritis-pain
  2. Shiwen Liu, B. W. (2022). Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study. BMJ Open, doi: 10.1136/bmjopen-2022-062183.
  3. Ministry of Health. (2020, December 30). Disease Burden. Retrieved from Ministry of Health Singapore: https://www.moh.gov.sg/resources-statistics/singapore-health-facts/disease-burden
  4. Kathleen Chang, S. M. (2014). Smoking and Rheumatoid Arthritis. International Journal of Molecular Sciences, doi: 10.3390/ijms151222279.
  5. Benjamin Raud, C. G.-A. (2020). Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Nature.
  6. Rees, M. (2022, May 27). What to know about post-traumatic arthritis. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/post-traumatic-arthritis
  7. Medline Plus. (2016, August 25). Infectious Arthritis. Retrieved from Medline Plus: https://medlineplus.gov/infectiousarthritis.html
  8. A. Shane Anderson, R. F. (2010). Why is Osteoarthritis an Age-Related Disease? Best Practice & Research: Clinical Rheumatology, doi: 10.1016/j.berh.2009.08.006.
  9. Vollenhoven, R. F. (2009). Sex differences in rheumatoid arthritis: more than meets the eye... BMC Medicine, doi: 10.1186/1741-7015-7-12.
  10. Júlia Kurkó, T. B. (2013). Genetics of Rheumatoid Arthritis — A Comprehensive Review. Clinical Reviews in Allergy & Immunology , doi: 10.1007/s12016-012-8346-7.
  11. Chang, X. (2021). Degenerative or Mechanical Arthritis. Journal of Arthritis.
  12. Rachel Nall, S. B. (2023, May 30). Autoimmune arthritis: Types, symptoms, and treatment. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/322975
  13. Arthritis Foundation Organisation. (2023, September 25). Infectious Arthritis. Retrieved from Infectious Arthritis- Arthritis Foundation: https://www.arthritis.org/diseases/infectious-arthritis
  14. Edward Roddy, M. D. (2010). Gout. Epidemiology of gout. Arthritis Research and Therapy, doi: 10.1186/ar3199.
  15. John P. Cunha, C. B. (2023). What Will Happen if Arthritis Is Left Untreated? Retrieved from eMedicine Health: https://www.emedicinehealth.com/ask_what_will_happen_if_arthritis_left_untreated/article_em.htm#doctor%E2%80%99s_response
  16. Rheumatology & Immunology, Singapore General Hospital; Department of Orthopaedic Surgery. (2021). Rheumatoid Arthritis. Retrieved from SingHealth: https://www.singhealth.com.sg/patient-care/conditions-treatments/rheumatoid-arthritis

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