What is Arthritis?

Because there are many types and causes of arthritis, it is important to first identify the etiology of the arthritis before rendering treatment. The types of arthritis that commonly affect the foot include: osteoarthritis, gout, psuedogout, rheumatoid arthritis.

Osteoarthritis:

Osteoarthritis is a very common joint disorder due to degenerative changes in the joints from wearing away and the disintegration of the tissues.

Osteoarthritis affects millions of Americans and affects any age, causing varying degrees of pain, inflammation and limited movement. Usually weight-bearing joints, such as your feet, are very susceptible to osteoarthritis.

Causes: As cartilage slowly deteriorates over several years, you can develop chronic pain and discomfort when standing and walking. The synovial membrane and cartilage that line the joint surface are gradually worn away, exposing the underlying bone.

The bone becomes smooth and its edges rough, with small areas of bony formation, known as osteophytes. The surrounding ligaments and membranes also become thickened because of the recurrent slight strains that occur in an osteoarthritic joint.

Symptoms: Symptoms include increasing pain, with restriction of movement. The joints may feel particularly stiff when getting up in the morning or after sitting for any length of time.

Treatment: Treatment is directed toward improving general health and maintaining as normal a lifestyle as possible. Treatment can consist as conservatively as hot and cold packs, NSAIDS, strengthening exercises.

Gout:

Historically, gout was considered primarily a disease of the wealthy because it seems to be caused by eating rich foods and by drinking too much alcohol. Gout is also one of the oldest diseases of medical history.

Gout is a hereditary, metabolic disorder characterized by inflammation by sudden, severe attacks of pain and tenderness in joints. Gout usually affects the large joint of the big toe but can also occur in other joints such as the knees, ankles, hands and wrists.

Causes: Gout occurs more frequently in men. There is usually an excess of uric acid in the blood and tissues. Microscopy analysis of the joint fluid reveals needle-like crystals of uric acid that form under the skin and in the joints, causing pain, swelling and, in some cases, destruction of the joint.

Gout occurs either when too little uric acid is excreted or when there is too much of the acid for the kidneys to excrete. Uric acid is formed from the breakdown of substances called purines.

Foods high in purines include; organ meats (liver, brains, kidney and sweetbreads), anchovies, herring and mackerel. Smaller amounts are found in all meats, fish and poultry. Alcohol may increase the incidence of attacks of gout.

Symptoms: The onset of an attack is severe. It is usually at night. There is severe pain and swelling in a joint. The overlying skin becomes red, hot and swollen. A severe attack may cause fever and nausea.

Untreated, an attack of gout lasts between three to seven days. Even when the symptoms disappear, further attacks are very likely.

Treatment: The first modification is diet. Patients need to be aware of what they are ingesting and stay clear from high purine content foods.

Patients should also be seen by a physician for proper medical treatment to help alleviate future attacks. Drugs prescribed for an acute attack include sulindac, ibuprofen, naproxen, and indomethacin.

After an attack, treatment is aimed at reducing the blood level of uric acid by means of drugs and an increased intake of fluids. Colchicine can be taken regularly, as can probenecid, sulfinpyrazone, or allopurinol.

If gout is not treated in its early stages, the condition may become chronic. Chronic gout results in deposits of uric acid (tophi) in the joints. These deposits may cause permanent arthritis. The most serious danger from the metabolic disorder that causes gout is that uric acid crystals may be deposited in the kidneys, forming possible kidney stones and blockage.

Psuedogout:

Pseudogout is a form of arthritis caused by the deposition of crystals in one or more joints. Unlike the usual gout that is due to crystals of uric acid, in pseudogout the crystals are calcium pyrophosphate dihydrate (CCPD).

Whereas gout occurs overwhelmingly in men, pseudogout occurs with about the same frequency in women and men and increases with age. The symptoms are analogous to gout, as well as treatment.

Rheumatoid: Is caused by an immune disorder. Its symptoms are more generalized and usually more severe. The disease typically strikes your hands, feet and other joints.

It causes painful swelling, inflammation and sometimes deformity. The disease affects about 2.5 million between ages 20 and 50, but can also affect very young babies and older people.

Causes: Lining each of your joints is a membrane called the synovium. When you have rheumatoid arthritis, white blood cells move from your bloodstream into your synovium. The blood cells appear to cause the synovial membrane to become inflamed. The inflammation results in the release of chemicals that over months or years cause thickening of the synovium.

The chemicals also digest cartilage, bone, tendons and ligaments in the joint. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

Symptoms: The most common signs and symptoms of rheumatoid arthritis are joint swelling, stiffness and pain. The pain may be similar to that of a headache or toothache. Affected joints may also feel warm to the touch, and the skin covering them may appear reddish.

Symptoms may include fatigue, loss of appetite, fever, sweats and difficulty sleeping. About one-fifth of people with rheumatoid arthritis also develop rheumatoid nodules - lumps of tissue under your skin, often over bony areas such as your elbows. The disease varies from person to person. Some people experience symptoms that come and go. These episodes are called flares and remissions. Others may have continuous symptoms that generally worsen with time.

Treatment: There is no treatment that can cure or reverse rheumatoid arthritis. However, there are medications that can relieve its symptoms and slow or halt its progression.

Therapies include, but are not limited to: Nonsteroidal anti-inflammatory drugs (NSAIDs), Cox-2 inhibitors, Disease-modifying antirheumatic drugs (DMARDs), Corticosteroids, Surgery.