What is Arthritis?

Arthritis is a broad term that describes numerous conditions affecting the joints, their surrounding tissues, and other connective tissues. The primary symptom is joint inflammation, which further escalates to pain, swelling, stiffness, and decreased range of motion. Arthritis is not a single disease but rather an umbrella term encompassing various forms of joint disorders, each with unique characteristics and causes.

While arthritis is most common in older adults, it can affect people of all ages, including children. This condition often presents symptoms like persistent joint pain, fatigue, and fever, which can significantly impact a child’s growth and development. Among adults, arthritis usually arises from wear and tear with age, autoimmune disorders, or even metabolic conditions like gout.

One of the most challenging aspects of arthritis is its chronic nature. Symptoms often persist over time and can worsen if left untreated. This makes early detection and management crucial to maintaining a good quality of life. Studies have revealed that arthritis is not just a physical ailment but can also affect mental health due to ongoing pain and limitations it can impose on daily activities.

Interestingly, arthritis doesn’t only affect joints. In severe cases, inflammation can spread to other parts of the body, such as the eyes, skin, lungs, or heart, depending on the specific type of arthritis.

How Common is Arthritis in India?

Arthritis affects over 700 million people worldwide, and its impact is acutely felt in India. An estimated 15% of the Indian population, nearly 180 million people live with some form of arthritis. In India, osteoarthritis is particularly common among women and older adults, with the knee being the most frequently affected joint. This prevalence is compounded by lifestyle factors, genetic predispositions, and a rapidly ageing population.

The Indian diet and cultural practices also influence arthritis patterns, says Dr Rajat Chopra, a senior orthopaedic surgeon. For example, diets rich in refined carbohydrates and low in essential nutrients like omega-3 fatty acids can exacerbate inflammation, contributing to conditions like rheumatoid arthritis. Conversely, traditional Indian dietary elements, such as turmeric which contains curcumin, ginger, and fenugreek, are known for their anti-inflammatory properties and are often incorporated into natural remedies for managing symptoms of arthritis.

Occupational factors also play a significant role in the prevalence of arthritis in India. Many people engage in physically demanding jobs, such as farming or manual labor, which stress joints over time. Additionally, the lack of awareness about ergonomic practices exacerbates the risk of joint injuries and arthritis.

India’s diverse climate can also influence arthritis symptoms. People living in colder or more humid regions often report increased joint pain and stiffness, which may be linked to changes in atmospheric pressure and temperature.

Arthritis Types

The two most common types of arthritis are:

Osteoarthritis (OA), the most common form of arthritis, is often called "wear and tear" arthritis. It occurs when the protective cartilage that cushions the ends of bones in the joints gradually deteriorates. This breakdown leads to bone-on-bone friction, resulting in pain, stiffness, and decreased mobility. OA typically affects weight-bearing joints such as the knees, hips, and spine but can also occur in the hands. Risk factors for this type of arthritis include ageing, obesity, joint injuries, and repetitive stress on joints. Though primarily mechanical, OA can also have an inflammatory component, particularly in advanced stages.
Rheumatoid Arthritis (RA) represents another major type, though it operates quite differently from OA. RA is an autoimmune disorder in which the immune system mistakenly attacks the synovium, the lining of the joints. This attack triggers inflammation, leading to swelling, pain, and eventual erosion of cartilage and bone within the joint. RA commonly affects smaller joints, such as those in the hands and feet, and is often symmetrical, meaning both sides of the body are impacted simultaneously. Unlike OA, RA can involve systemic symptoms, such as fatigue, fever, and organ complications. Early intervention is crucial to prevent irreversible joint damage.

Other notable types of arthritis include:

Psoriatic Arthritis (PsA) is a form of inflammatory arthritis linked to the skin condition psoriasis. PsA can cause pain, swelling, and stiffness in the joints, as well as the surrounding tendons and ligaments. It can affect any joint and is sometimes mistaken for RA or gout due to overlapping symptoms. A hallmark of PsA is dactylitis, or "sausage fingers," where entire fingers or toes swell. Skin and nail changes, such as pitting or thickening, are often concurrent with joint symptoms.

Gout is a metabolic type of arthritis, is characterized by sudden, intense pain and swelling, usually in one joint at a time, most commonly the big toe. It occurs when uric acid builds up in the blood and forms sharp crystals in the joints. These flare-ups can be triggered by diet, alcohol consumption, dehydration, or due to side effects of certain medications. Chronic gout can lead to joint damage and the development of tophi, or lumps of uric acid crystals under the skin.
Ankylosing Spondylitis (AS) primarily affects the spine, causing inflammation in the vertebrae and the sacroiliac joints, which connect the spine to the pelvis. Over time, this inflammation can lead to the fusion of vertebrae, resulting in a rigid spine and reduced mobility. Symptoms often include back pain and stiffness that improve with exercise but worsen with rest. AS is also associated with systemic symptoms like fatigue and, in some cases, inflammation of the eyes, known as uveitis.
Lupus-Related Arthritis is one of the many forms of Systemic Lupus Erythematosus (SLE), an autoimmune condition. In lupus-related arthritis, inflammation affects the joints, causing pain and stiffness without significant joint erosion, which differentiates it from RA. This type often accompanies other lupus symptoms, such as skin rashes, kidney issues, and cardiovascular complications.

Recognizing the type of arthritis early can significantly impact long-term outcomes, which further emphasises the importance of understanding these distinct conditions.

How Arthritis Affects Different Age Groups?

In children: Juvenile idiopathic arthritis can cause joint pain and mobility issues in children and teenagers under the age of 16.
In young adults: Sports injuries and repetitive strain can lead to early-onset OA.
In middle-aged adults: Hormonal changes and lifestyle factors may trigger autoimmune arthritis.
In seniors: OA and RA are most common due to wear and tear or weakened immune systems.

Juvenile Arthritis

Juvenile arthritis, or juvenile idiopathic arthritis (JIA), refers to a group of autoimmune and inflammatory conditions affecting children under sixteen years of age. Unlike adult arthritis, which is caused by joint wear and tear, juvenile arthritis occurs when the immune system attacks the body’s tissues, leading to joint pain, swelling, and stiffness that can disrupt a child’s growth and daily activities. The most common type, Oligoarticular JIA, affects up to four joints, often involving the knees, ankles, and elbows, and may also cause eye inflammation. Polyarticular JIA impacts five or more joints and resembles adult rheumatoid arthritis, while Systemic JIA includes symptoms like fever, rash, and organ inflammation. Other forms, such as enthesitis-related and psoriatic JIA, involve inflammation in ligaments or skin conditions like psoriasis. Symptoms for JIA vary but it generally includes persistent joint pain and swelling. Getting tired easily and having difficulty doing even light physical activity can be due to this condition. If left untreated, this condition can escalate to growth delays, joint deformities and chronic pain from a very early age, affecting both the physical and mental health of a child.

Arthritis and Women

Women are disproportionately affected by arthritis, with hormonal changes playing a significant role in the development and progression of this condition. During menopause, the decline in estrogen levels can exacerbate the risk of both rheumatoid arthritis (RA) and osteoarthritis (OA). Estrogen is known to have a protective effect on joints, and its reduction may lead to increased inflammation and joint degeneration.

Pregnancy can also influence arthritis symptoms. For some women, the hormonal shifts and immune system changes during pregnancy may alleviate arthritis symptoms, but for others, they can trigger or worsen joint discomfort. Post-pregnancy, the added strain on joints from weight gain and physical demands of childcare can further contribute to arthritis symptoms.

Certain types of arthritis, such as Lupus, disproportionately affect women. Lupus, for example, is nine times more common in women than men.

Lifestyle factors can also amplify the risk. Obesity, which places extra stress on weight-bearing joints, and a sedentary lifestyle are key contributors. Women with arthritis are often encouraged to maintain a healthy weight and engage in low-impact exercises such as swimming, yoga, or walking to improve joint mobility and reduce pain.

What are the Symptoms of Arthritis?

Arthritis manifests in various ways, with Arthritis symptoms often varying based on the type and severity of the condition. Recognising these signs early is essential for effective management and ensuring sustained quality of life.

Persistent Joint Pain: One of the evident and common symptoms of arthritis is ongoing joint pain that doesn’t subside with rest. This pain can range from a dull ache to sharp discomfort, depending on the affected joint and the underlying type of arthritis. It is a common symptom in OA and RA.
Swelling and Tenderness: Swelling around the joints is a common symptom. The affected area may feel tender to the touch, and in severe cases, the swelling can be visibly noticeable. This inflammation often results from the body’s immune response or fluid buildup within the joint. This symptom is common in certain types of arthritis including RA, PsA and gout.
Stiffness: People often experience difficulty moving their joints upon waking, with the morning stiffness lasting anywhere from a few minutes to several hours. This is a common symptom in OA and RA.
Redness or Warmth: Inflammatory arthritis may cause redness and warmth around the affected joint. These symptoms indicate increased blood flow and inflammation in the area. The skin over the joint may also appear shiny or stretched due to swelling. This symptom is commonly associated with inflammatory types of arthritis, such as RA, PsA and gout.
Reduced Range of Motion: Arthritis can limit the movement of the affected joints, making daily activities challenging. This reduced range of motion may result from joint damage, inflammation, or muscle weakness around the joint. Over time, this can lead to decreased flexibility and even deformities in severe cases. Both conditions can progressively impair joint mobility, especially in OA or RA.
Fatigue and Systemic Symptoms: In some types of arthritis, systemic symptoms like fatigue, fever, or weight loss may accompany joint issues. These symptoms are commonly associated with inflammatory types of arthritis, particularly RA, PsA, AS and SLE.

What are the complications of Arthritis if left untreated?

When arthritis is left untreated, it can result in several serious complications, such as:

Severe joint damage
Reduced mobility and quality of life
Heart disease
Lung complications
Osteoporosis
Diabetes
Fatigue and sleep disturbances
Skin issues (rashes, nodules, lesions)
Eye problems (uveitis)
Nerve compression (e.g., carpal tunnel syndrome)
Digestive issues (e.g. IBD)
Emotional and mental health challenges
Infections

Proactively managing arthritis with appropriate treatments and lifestyle changes can help prevent these complications and support better overall health.

Arthritis Diagnosis and Treatments

Diagnosing arthritis involves a comprehensive approach to identifying the type and extent of the condition. This typically includes:

Physical Examinations: Doctors check for joint swelling, tenderness, range of motion, and signs of inflammation.
Imaging Tests: X-rays can reveal joint damage, bone changes, or cartilage loss, while MRIs and ultrasounds provide detailed images of soft tissues, such as ligaments and tendons, helping identify inflammation and structural abnormalities.
Laboratory Tests: Blood tests detect markers of inflammation (like C-reactive protein and erythrocyte sedimentation rate) and specific antibodies (e.g., rheumatoid factor or anti-CCP) to distinguish between different types of arthritis.

In some cases of arthritis, assistive devices such as braces or orthotics and surgical procedures may be necessary.

Early Signs of Arthritis

Identifying early signs can help in better arthritis management. Common early signs include:

Mild joint discomfort
Occasional stiffness
Subtle swelling
Fatigue or malaise
Minor redness or warmth
Difficulty in climbing stairs, holding objects or doing household chores

Risk Factors for Arthritis

Arthritis can affect people of all ages. However, understanding the risk factors can help manage the condition more effectively or even reduce the likelihood of its onset. Here's a more detailed breakdown:

Age: As one age, normal wear and tear on joints increase the likelihood of osteoarthritis (OA). Aging also slows the body's ability to repair cartilage damage, making joint degeneration more common.
Gender Differences: Women are disproportionately affected by Rheumatoid Arthritis (RA) due to hormonal and immune system differences, while men are more prone to Gout because of higher uric acid levels and dietary habits.
Genetics: A family history of arthritis, especially RA or Gout, heightens the risk. Specific genetic markers, like HLA-B27, are associated with an increased predisposition to inflammatory arthritis.
Obesity: Carrying excess weight stresses load-bearing joints like the knees, hips, and spine. It also promotes chronic low-grade inflammation, exacerbating arthritis symptoms and progression. Dr Chopra explains that the extra load on the knees because of obesity can create significant strain on the cartilage, which isn’t well equipped to handle these forces over time.
Injuries and Overuse: Past joint injuries or repetitive strain from activities or jobs can lead to joint instability, making cartilage breakdown and OA more likely.
Lifestyle Habits: Smoking impairs joint health by increasing inflammation and reducing the body's ability to fight autoimmune diseases like RA. Poor diet, particularly one high in processed foods and sugars, can also drive inflammation, making arthritis symptoms worse.

By recognizing these factors, one can focus on protective measures like maintaining a healthy weight, following an anti-inflammatory diet and avoiding smoking or high-risk activities. Small lifestyle changes can significantly reduce the impact of these risks over time.

Arthritis Prevention

While some types of arthritis, such as rheumatoid arthritis or those with a genetic origin cannot be entirely prevented, certain lifestyle measures can help reduce the risk of developing or worsening arthritis:

Maintain a Healthy Weight: Excess weight increases pressure on weight-bearing joints like the knees and hips, accelerating cartilage wear and tear. Shedding even a small amount of weight can significantly lower the risk of joint damage.
Protect Joints During Physical Activities: Use proper techniques and equipment during exercise or heavy lifting to avoid unnecessary stress on joints. For example, bend at the knees instead of the waist when lifting objects.
Avoid Repetitive Motions: Activities involving repetitive joint movements, such as typing or playing certain sports, can cause strain and inflammation. Take regular breaks and stretch to reduce the risk.
Manage Chronic Conditions: Diseases like diabetes and hypertension can exacerbate inflammation and joint damage. Keeping these conditions well-controlled can help protect joints.

Natural Remedies and Alternative Therapies for Arthritis

In addition to medical treatments, several natural methods can assist in arthritis management:

Acupuncture: This ancient Chinese therapy involves inserting thin needles at specific points in the body, which may help reduce pain, improve joint mobility, and boost overall well-being.
Herbal Supplements: Turmeric and ginger have anti-inflammatory properties that can help reduce joint inflammation and stiffness.
Cannabinoid Medications: CBD (Cannabidiol) and THC (Tetrahydrocannabinol)- based medications can help reduce pain and inflammation. CBD helps regulate inflammation and pain through the endocannabinoid system, while THC provides pain relief and muscle relaxation.
Hot and Cold Therapy: Applying heat can relax muscles and improve circulation, while cold packs can numb pain and reduce swelling. Alternating between the two is particularly effective for managing flare-ups.
Yoga and Meditation: Yoga improves flexibility and joint mobility while reducing stiffness. Meditation helps manage stress, which can exacerbate arthritis symptoms.

Nutrition and Diet Tips for Managing Arthritis

One’s dietary habits play a significant role in managing arthritis symptoms:

Anti-inflammatory Foods: Fatty fish, berries, leafy greens, nuts and seeds.
Foods to Avoid: Processed foods that are high in trans fats and additives, excessive sugar and salt.
Hydration: Drinking plenty of water.
Supplements: Omega-3 fatty acids and vitamin D.

Exercises to Ease Arthritis Pain

Regular movement helps strengthen muscles, improve flexibility, and alleviate stiffness:

Low-impact Exercises: Swimming, cycling, and walking are gentle on the joints while boosting cardiovascular health.
Stretching Routines: Stretching improves range of motion and reduces stiffness, especially after periods of inactivity.
Strengthening Exercises: Focus on building muscles around affected joints to provide better support and stability. Resistance bands or light weights can be helpful.
Balance Exercises: Practices like ‘tai chi’ improve coordination and reduce the risk of falls, which can be particularly harmful to individuals with arthritis.

Conclusion

Arthritis is a widespread disease, leading to pain, inflammation and reduced mobility in the joints. Effective management of arthritis typically involves a combination of medical treatments, lifestyle modifications, and home remedies to alleviate symptoms and improve quality of life. As research continues to evolve, early diagnosis and personalised treatment plans are crucial in mitigating the effects of this chronic condition. This will allow individuals to maintain their daily activities and overall well-being.