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Other diseases
Here we propose to take a look at the diseases most frequently associated with osteoarthritis, which you will find described below, with their real causes, their symptoms, their treatments and how to prevent them whenever possible.
Osteoarthritis and inflammatory rheumatisms
Osteoarthritis comes under the label of “rheumatism”. You have probably already heard of arthritis, rheumatoid arthritis, gout and chondrocalcinosis. All of these diseases come under rheumatism but their symptoms, treatments and evolution are very different. Hence, one must distinguish between inflammatory rheumatism which arthritis belongs to and degenerative rheumatism which osteoarthritis belongs to.
What is arthritis?
Rheumatoid arthritis (from the Greek "arth" meaning joint or joint and "itis" meaning inflammation) provokes inflammation and stiffness of the joint. It is defined as any chronic or acute inflammatory disorder which affects the joints. However, it groups together several kinds of diseases that are responsible for this inflammation and for which the causes vary.
Arthritis can be:
• Of bacterial origin (streptococcus, gonococcus, Koch’s bacillus, staphylococcus, etc)
• Due to a traumatism
• following an illness (articular expression) such as psoriasis or Crohn’s disease.
• The result of an autoimmune disease such as rheumatoid arthritis
In addition, it can affect one or several joints. This is commonly known as mono-arthritis or oligo-articular arthritis when two, three or four joints are affected and above this, poly-arthritis or rheumatoid arthritis. The symptoms generally include:
• Pain, often experienced at night,
• Stiffness of the joints on awakening,
• The appearance of redness and/or swelling of the joint due to effusion of the synovial fluid.
What are the different forms of inflammatory arthritis?
Around one hundred diseases currently come under arthritis. However, each form has very different symptoms and evolves very differently. Hence the most frequent forms are:
-Infectious arthritis
Infectious or septic arthritis is caused by an infection of the joint by a pathogenic organism (bacteria or fungus). The latter penetrates into the joint through the blood (presence of an infection in another part of the body), or the skin (open wound). It is generally mono-arthritis, affecting only one joint.
Symptoms:
- Warm and swollen joints
- Redness at the inflammation site
- Rapid appearance of significant pain leading to great difficulty of movement
- Bouts of fever accompanied by shivering
Treatment:
As opposed to other forms of arthritis, it is diagnosed and treated quite early on as infectious arthritis can be cured quite quickly. On the other hand, if it is left untreated, the joints can be severely damaged. People suffering from diabetes, anaemia, Aids, cancer, alcohol addiction, serious kidney or immune system disorders are the most at risk.
-Aseptic inflammatory arthritis:
Acute articular rheumatism or Bouillaud's disease
Following an infection by group B beta-haemolytic streptococci (generally from an untreated throat infection), this disease has become very rare in France and Europe. This type of rheumatism is rather painful but the inflammation is short-lived. The disease affects, in particular, the joint of the knee, elbow and ankle.
Rheumatoid arthritis
This pathology is the most frequent of the chronic inflammatory rheumatisms (0.4% of the population). It belongs to the group of systemic or connective tissue diseases. Women in particular are concerned by it (3 out of 4 patients are women). Generally speaking rheumatoid arthritis can appear at any age but the average age of diagnosis is between 40 and 50 years. When the patient is aged below 15, it is known as juvenile chronic arthritis. It affects many joints, of which the main ones are the hands, wrists, front of the feet, elbows and ankles in a symmetric way, within the space of a few weeks.
Development mechanism
Rheumatoid arthritis belongs to the group of autoimmune diseases, but its causes remain unknown. The patient’s body produces antibodies directed against its own tissues provoking a strong inflammatory reaction.
The main tissue that is targeted is the synovial membrane which secretes the joints’ lubricant liquid: the synovial fluid (link towards the diagram of a joint). Under the impact of the inflammatory reaction, it thickens, leading to an erosion of cartilage. The joint becomes increasingly damaged and is gradually replaced by tissue which joins the two ends of the bone which make up the joint. The latter action is responsible for reduced joint mobility.
The inflammation also damages the binding that forms the joint (it slackens) and leads to longer-term symmetrical deformation of the joint under the effect of repeated movements.
Symptoms and evolution
The development of rheumatoid arthritis is manifested most often by flare-ups during which one can observe swelling of the joints, stiffness of the joints which are difficult to use on awakening, the onset of constant pain during flare-ups which wakes patients up during their sleep.
If left untreated, the succession of these flare-ups leads to deformation of the joints and the disease spreads to other locations around the body.
Its evolution is quite variable and differs from one patient to another. Rheumatoid arthritis is a long-term disease. After 10 years, more than 56% of patients are able to live normally. Being treated early on enables calming the symptoms in three out of four people.
Diagnosis:
The diagnosis needs to be established as early as possible to avoid the development of irreversible damage.
Treatments:
Various types of treatment are prescribed to take care of the symptoms and the causes (long-term treatment).
Drugs used:
Treatments and symptoms:
• Non steroidal anti-inflammatory drugs (NSAIDs)
• Anti-inflammatory corticosteroids (cortisone)
• Analgesics
Long-term treatments:
• Gold salts
• Synthetic anti-malarial drugs
• Methotrexate
• Tiopronin
• Sulphasalazine
• Certain Biologic Response Modifiers (anti-TNF-alpha) may bring an improvement
• Leflunomide
These drugs can have undesirable side-effects. Medical follow-up during these treatments is thus of the highest importance. This notably involves regular blood tests.
Local treatments are also prescribed to prevent deformations and relieve pain: injections directly into the affected joint, synoviorthesis, synovial ablation and surgery.
If you would like to know more about this disease, you can contact:
The Arthritis Society of Canada
AFP:
Association Française des Polyarthritiques
Ankylosing spondylitis
This type of aseptic inflammatory arthritis is a chronic disease that predominantly affects males. The joints that are primarily affected are the sacroiliac joint and the spine.
Development occurs between 15 and 30 years of age and there may be a hereditary predisposition (HLA B 27 carrier). It occurs in isolation or following digestive inflammatory infections.
This chronic inflammatory disease is one of the spondylarthropathies that affects the joints of the spine.
Symptoms and evolution:
The symptoms are generally pain in the buttocks, middle of the back and backs of thighs. The pain is more present in the morning on awakening and in the evening. Morning joint stiffness has also been observed. The bouts of inflammation causing this pain are chronic, interspersed with asymptomatic periods. The disease is progressive, generally beginning at the sacroiliac joint, it gradually extends towards the back, to reach the cervical spine. Hence the joints of the limbs are not particularly affected. Its evolution is progressive and variable according to each individual patient. It manifests itself with flare-ups which, if left untreated, could lead to stiffness of the whole spine.
Treatments:
It is primarily treated with non steroidal anti-inflammatory drugs (NSAIDs). If this proves insufficient then Sulphasalazine may be prescribed. If the condition is disabling, it is possible to inject corticosteroids directly into the joint to relieve the stiffness. Promising new treatments are in the process of being assessed.
Psoriasic arthritis
Psoriasic arthritis is an aseptic inflammatory arthritis that affects, among other things, the distal joints of the fingers. It occurs in 1 out of 10 people suffering from cutaneous psoriasis, however, these two pathologies often evolve independently from one another.
Psoriasic arthritis manifests itself by affecting the joints in an asymmetric way unlike rheumatoid arthritis.
Treatments are similar to those for rheumatoid arthritis, except for cortisone which is used very little because it is less effective and the skin condition may worsen on stopping the treatment. (Creation of a sort of addiction to cortisone, which, on stopping the treatment engenders a significant increase in scaly skin patches).
Some drugs are also not recommended when the cutaneous symptoms appear, such as aspirin, lithium and certain antibiotics.
Juvenile rheumatoid arthritis or Still’s disease
Juvenile chronic arthritis is an inflammatory arthritis of unknown origin which occurs in children under 16 years of age and which develops beyond three months. There are three types:
• The oligoarticular type which affects fewer than 4 joints.
• The polyarticular type which mainly affects girls, affecting the joints in a symmetric and diffuse way.
• The systemic form which especially affects children below 5 years of age. The symptoms include a high fever (unlike the two other types), inflammation of the lymphatic ganglions, skin rash and hypertrophy of the spleen.
The evolution of juvenile chronic arthritis depends on the form. In general, the oligoarticular type responds well to treatment. The polyarticular and systemic forms are more difficult to treat.
Symptoms: The presence of fever, skin rash or enlarged lymphatic ganglions.
Treatments: Primarily aspirin and local and oral steroids which aim at treating the symptoms of the disease.
Microcrystalline arthritis: Gout
Microcrystalline arthritis is caused by inflammation provoked by the presence and accumulation of micro-crystals in the joints. This type of arthritis engenders severe pain in the joints accompanied by temporary swelling.
Gout is a genetic disease, responsible for an imbalance of the metabolism, leading to excess uric acid in the body. It is this accumulation of uric acid micro-crystals in the joints that provokes bouts of arthritis.
Causes:
Gout mainly affects middle-aged men. It can also be triggered following certain haematological pathologies, or certain medications. It is sometimes associated with obesity. Some foods rich in purine (which uric acid results from after digestion) may trigger bouts in individuals who already have a family history of the disease. Other causes exist such as a traumatism which can lead to local detachment of uric acid crystals. But a lot of people have a high level of uric acid and never get gout.
Symptoms and evolution:
In general the affected joints are the big toes, ankles and knees and sometimes the wrists and fingers. During flare-ups, the pain is severe or even acute, and comes on suddenly. The patient’s joint swells and turns red and shiny. If left untreated, the joints become deformed. In the long-term they are destroyed and one can observe areas of tumefaction under the skin by the tendons, ears and soft tissues. (These are deposits of uric acid).
Treatments:
The pain is mainly treated with colchicine and non-steroidal anti-inflammatory drugs. The excess production of uric acid is treated differently according to each individual case:
• Prescription of uricosuric drugs when the patient has difficulty eliminating the uric acid
• Hypo-calorific diet and elimination of alcohol, when the excess is due to a diet that is too rich
• Treatment with Allopurinol which lowers the level of uric acid
What is arthritis?
Rheumatoid arthritis (from the Greek "arth" meaning joint or joint and "itis" meaning inflammation) provokes inflammation and stiffness of the joint. It is defined as any chronic or acute inflammatory disorder which affects the joints. However, it groups together several kinds of diseases that are responsible for this inflammation and for which the causes vary.
Arthritis can be:
• Of bacterial origin (streptococcus, gonococcus, Koch’s bacillus, staphylococcus, etc)
• Due to a traumatism
• following an illness (articular expression) such as psoriasis or Crohn’s disease.
• The result of an autoimmune disease such as rheumatoid arthritis
In addition, it can affect one or several joints. This is commonly known as mono-arthritis or oligo-articular arthritis when two, three or four joints are affected and above this, poly-arthritis or rheumatoid arthritis. The symptoms generally include:
• Pain, often experienced at night,
• Stiffness of the joints on awakening,
• The appearance of redness and/or swelling of the joint due to effusion of the synovial fluid.
What are the different forms of inflammatory arthritis?
Around one hundred diseases currently come under arthritis. However, each form has very different symptoms and evolves very differently. Hence the most frequent forms are:
-Infectious arthritis
Infectious or septic arthritis is caused by an infection of the joint by a pathogenic organism (bacteria or fungus). The latter penetrates into the joint through the blood (presence of an infection in another part of the body), or the skin (open wound). It is generally mono-arthritis, affecting only one joint.
Symptoms:
- Warm and swollen joints
- Redness at the inflammation site
- Rapid appearance of significant pain leading to great difficulty of movement
- Bouts of fever accompanied by shivering
Treatment:
As opposed to other forms of arthritis, it is diagnosed and treated quite early on as infectious arthritis can be cured quite quickly. On the other hand, if it is left untreated, the joints can be severely damaged. People suffering from diabetes, anaemia, Aids, cancer, alcohol addiction, serious kidney or immune system disorders are the most at risk.
-Aseptic inflammatory arthritis:
Acute articular rheumatism or Bouillaud's disease
Following an infection by group B beta-haemolytic streptococci (generally from an untreated throat infection), this disease has become very rare in France and Europe. This type of rheumatism is rather painful but the inflammation is short-lived. The disease affects, in particular, the joint of the knee, elbow and ankle.
Rheumatoid arthritis
This pathology is the most frequent of the chronic inflammatory rheumatisms (0.4% of the population). It belongs to the group of systemic or connective tissue diseases. Women in particular are concerned by it (3 out of 4 patients are women). Generally speaking rheumatoid arthritis can appear at any age but the average age of diagnosis is between 40 and 50 years. When the patient is aged below 15, it is known as juvenile chronic arthritis. It affects many joints, of which the main ones are the hands, wrists, front of the feet, elbows and ankles in a symmetric way, within the space of a few weeks.
Development mechanism
Rheumatoid arthritis belongs to the group of autoimmune diseases, but its causes remain unknown. The patient’s body produces antibodies directed against its own tissues provoking a strong inflammatory reaction.
The main tissue that is targeted is the synovial membrane which secretes the joints’ lubricant liquid: the synovial fluid (link towards the diagram of a joint). Under the impact of the inflammatory reaction, it thickens, leading to an erosion of cartilage. The joint becomes increasingly damaged and is gradually replaced by tissue which joins the two ends of the bone which make up the joint. The latter action is responsible for reduced joint mobility.
The inflammation also damages the binding that forms the joint (it slackens) and leads to longer-term symmetrical deformation of the joint under the effect of repeated movements.
Symptoms and evolution
The development of rheumatoid arthritis is manifested most often by flare-ups during which one can observe swelling of the joints, stiffness of the joints which are difficult to use on awakening, the onset of constant pain during flare-ups which wakes patients up during their sleep.
If left untreated, the succession of these flare-ups leads to deformation of the joints and the disease spreads to other locations around the body.
Its evolution is quite variable and differs from one patient to another. Rheumatoid arthritis is a long-term disease. After 10 years, more than 56% of patients are able to live normally. Being treated early on enables calming the symptoms in three out of four people.
Diagnosis:
The diagnosis needs to be established as early as possible to avoid the development of irreversible damage.
Treatments:
Various types of treatment are prescribed to take care of the symptoms and the causes (long-term treatment).
Drugs used:
Treatments and symptoms:
• Non steroidal anti-inflammatory drugs (NSAIDs)
• Anti-inflammatory corticosteroids (cortisone)
• Analgesics
Long-term treatments:
• Gold salts
• Synthetic anti-malarial drugs
• Methotrexate
• Tiopronin
• Sulphasalazine
• Certain Biologic Response Modifiers (anti-TNF-alpha) may bring an improvement
• Leflunomide
These drugs can have undesirable side-effects. Medical follow-up during these treatments is thus of the highest importance. This notably involves regular blood tests.
Local treatments are also prescribed to prevent deformations and relieve pain: injections directly into the affected joint, synoviorthesis, synovial ablation and surgery.
If you would like to know more about this disease, you can contact:
The Arthritis Society of Canada
AFP:
Association Française des Polyarthritiques
Ankylosing spondylitis
This type of aseptic inflammatory arthritis is a chronic disease that predominantly affects males. The joints that are primarily affected are the sacroiliac joint and the spine.
Development occurs between 15 and 30 years of age and there may be a hereditary predisposition (HLA B 27 carrier). It occurs in isolation or following digestive inflammatory infections.
This chronic inflammatory disease is one of the spondylarthropathies that affects the joints of the spine.
Symptoms and evolution:
The symptoms are generally pain in the buttocks, middle of the back and backs of thighs. The pain is more present in the morning on awakening and in the evening. Morning joint stiffness has also been observed. The bouts of inflammation causing this pain are chronic, interspersed with asymptomatic periods. The disease is progressive, generally beginning at the sacroiliac joint, it gradually extends towards the back, to reach the cervical spine. Hence the joints of the limbs are not particularly affected. Its evolution is progressive and variable according to each individual patient. It manifests itself with flare-ups which, if left untreated, could lead to stiffness of the whole spine.
Treatments:
It is primarily treated with non steroidal anti-inflammatory drugs (NSAIDs). If this proves insufficient then Sulphasalazine may be prescribed. If the condition is disabling, it is possible to inject corticosteroids directly into the joint to relieve the stiffness. Promising new treatments are in the process of being assessed.
Psoriasic arthritis
Psoriasic arthritis is an aseptic inflammatory arthritis that affects, among other things, the distal joints of the fingers. It occurs in 1 out of 10 people suffering from cutaneous psoriasis, however, these two pathologies often evolve independently from one another.
Psoriasic arthritis manifests itself by affecting the joints in an asymmetric way unlike rheumatoid arthritis.
Treatments are similar to those for rheumatoid arthritis, except for cortisone which is used very little because it is less effective and the skin condition may worsen on stopping the treatment. (Creation of a sort of addiction to cortisone, which, on stopping the treatment engenders a significant increase in scaly skin patches).
Some drugs are also not recommended when the cutaneous symptoms appear, such as aspirin, lithium and certain antibiotics.
Juvenile rheumatoid arthritis or Still’s disease
Juvenile chronic arthritis is an inflammatory arthritis of unknown origin which occurs in children under 16 years of age and which develops beyond three months. There are three types:
• The oligoarticular type which affects fewer than 4 joints.
• The polyarticular type which mainly affects girls, affecting the joints in a symmetric and diffuse way.
• The systemic form which especially affects children below 5 years of age. The symptoms include a high fever (unlike the two other types), inflammation of the lymphatic ganglions, skin rash and hypertrophy of the spleen.
The evolution of juvenile chronic arthritis depends on the form. In general, the oligoarticular type responds well to treatment. The polyarticular and systemic forms are more difficult to treat.
Symptoms: The presence of fever, skin rash or enlarged lymphatic ganglions.
Treatments: Primarily aspirin and local and oral steroids which aim at treating the symptoms of the disease.
Microcrystalline arthritis: Gout
Microcrystalline arthritis is caused by inflammation provoked by the presence and accumulation of micro-crystals in the joints. This type of arthritis engenders severe pain in the joints accompanied by temporary swelling.
Gout is a genetic disease, responsible for an imbalance of the metabolism, leading to excess uric acid in the body. It is this accumulation of uric acid micro-crystals in the joints that provokes bouts of arthritis.
Causes:
Gout mainly affects middle-aged men. It can also be triggered following certain haematological pathologies, or certain medications. It is sometimes associated with obesity. Some foods rich in purine (which uric acid results from after digestion) may trigger bouts in individuals who already have a family history of the disease. Other causes exist such as a traumatism which can lead to local detachment of uric acid crystals. But a lot of people have a high level of uric acid and never get gout.
Symptoms and evolution:
In general the affected joints are the big toes, ankles and knees and sometimes the wrists and fingers. During flare-ups, the pain is severe or even acute, and comes on suddenly. The patient’s joint swells and turns red and shiny. If left untreated, the joints become deformed. In the long-term they are destroyed and one can observe areas of tumefaction under the skin by the tendons, ears and soft tissues. (These are deposits of uric acid).
Treatments:
The pain is mainly treated with colchicine and non-steroidal anti-inflammatory drugs. The excess production of uric acid is treated differently according to each individual case:
• Prescription of uricosuric drugs when the patient has difficulty eliminating the uric acid
• Hypo-calorific diet and elimination of alcohol, when the excess is due to a diet that is too rich
• Treatment with Allopurinol which lowers the level of uric acid
Lyme disease
Lyme disease is an infectious disease which affects the joints, the nervous system and the heart. The pathogenic agent responsible for this infection is a species of bacteria: borrelia burgdorferi which is transmitted to man by ticks.
• Evolution and symptoms:
The infection develops in three stages.
The first stage is when the individual is bitten by a tick. Within a period of three days to one month the bite is followed by a rash (known as Erythema chronicum migrans) corresponding to localised redness at the site of the bite, expanding outwardly in a concentric way from it. Then it fades after three weeks. This rash is often accompanied by a bout of fever and pain in the joints and muscles.
The second stage (which lasts from a few weeks to several months) corresponds to the appearance of erythema flare-ups accompanied by neurological problems such as meningitis and heart problems. In addition, joint pain of an inflammatory origin occurs.
The third stage often occurs several years later. It is characterised by the reappearance of the skin rash but accompanied by progressive atrophy of the skin. In addition, the individual develops benign pseudo-lymphoma and suffers from chronic arthritis.
• Treatment
It is essentially based on antibiotics which enable keeping the first clinical signs in check and preventing the onset of neurological problems in the second stage.
• Evolution and symptoms:
The infection develops in three stages.
The first stage is when the individual is bitten by a tick. Within a period of three days to one month the bite is followed by a rash (known as Erythema chronicum migrans) corresponding to localised redness at the site of the bite, expanding outwardly in a concentric way from it. Then it fades after three weeks. This rash is often accompanied by a bout of fever and pain in the joints and muscles.
The second stage (which lasts from a few weeks to several months) corresponds to the appearance of erythema flare-ups accompanied by neurological problems such as meningitis and heart problems. In addition, joint pain of an inflammatory origin occurs.
The third stage often occurs several years later. It is characterised by the reappearance of the skin rash but accompanied by progressive atrophy of the skin. In addition, the individual develops benign pseudo-lymphoma and suffers from chronic arthritis.
• Treatment
It is essentially based on antibiotics which enable keeping the first clinical signs in check and preventing the onset of neurological problems in the second stage.
Paget’s disease
Paget’s disease is a chronic bone disease belonging to the group of osteodystrophies. It can affect every part of the body but is rarely generalised over the whole skeleton. The disease affects one or several areas (generally between 3 to 6 areas) of the skeleton which are most frequently the cervical spine, pelvis, tibia and the skull.
It is responsible for the uncontrolled production of bony tissue with a crude, irregular and less resistant structure that gradually replaces normal bone tissue. This change in bone structure gradually leads to an increase in bone density, ending in hypertrophy of the affected bones. This disease affects men aged over 50 in particular. The causes are unknown.
• Symptoms and evolution:
Paget’s disease often causes no symptoms and is discovered by chance during x-rays for other pathologies.
However, when the symptoms are present, the patient suffers from bone pain similar to that of osteoarthritis: leading to limping or sciatica, lumbago, cervicobrachial nevralgia, etc. These bone pains may be accompanied by deformations or the appearance of warm areas around the joint.
Other symptoms have also been observed:
• Hearing loss
• Increased head size
• An increase in the amount of alkaline phosphatase and osteocalcin in the blood.
The evolution of the disease is slow and differs from one patient to another. (In general, on a long bone like the tibia or femur, it progresses by one centimetre a year). In some subjects it can remain stable for several years or evolve by flare-ups leading to complications (fracture, arthropathy, deafness, etc).
• Treatments:
The evolution is often very slow and does not require a treatment.
During painful episodes, non-steroidal anti-inflammatory drugs are prescribed to provide patients with pain relief.
If the disease evolves very quickly the treatment is based on taking calcitonine and diphosphonates.
Orthopaedic treatment and surgery are also used to correct some deformations in long bones, affected joints or in treating certain fractures.
It is responsible for the uncontrolled production of bony tissue with a crude, irregular and less resistant structure that gradually replaces normal bone tissue. This change in bone structure gradually leads to an increase in bone density, ending in hypertrophy of the affected bones. This disease affects men aged over 50 in particular. The causes are unknown.
• Symptoms and evolution:
Paget’s disease often causes no symptoms and is discovered by chance during x-rays for other pathologies.
However, when the symptoms are present, the patient suffers from bone pain similar to that of osteoarthritis: leading to limping or sciatica, lumbago, cervicobrachial nevralgia, etc. These bone pains may be accompanied by deformations or the appearance of warm areas around the joint.
Other symptoms have also been observed:
• Hearing loss
• Increased head size
• An increase in the amount of alkaline phosphatase and osteocalcin in the blood.
The evolution of the disease is slow and differs from one patient to another. (In general, on a long bone like the tibia or femur, it progresses by one centimetre a year). In some subjects it can remain stable for several years or evolve by flare-ups leading to complications (fracture, arthropathy, deafness, etc).
• Treatments:
The evolution is often very slow and does not require a treatment.
During painful episodes, non-steroidal anti-inflammatory drugs are prescribed to provide patients with pain relief.
If the disease evolves very quickly the treatment is based on taking calcitonine and diphosphonates.
Orthopaedic treatment and surgery are also used to correct some deformations in long bones, affected joints or in treating certain fractures.
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