There are many types of Rheumatism and Arthritis which differ in their cause, natural history of the disease and management. The types often differ in different age groups and sexes. It is important to recognize a particular type of Rheumatism, especially when chronic, before beginning long term treatment.

Some forms of arthritis like Rheumatoid Arthritis are more common in women, while gout and some forms of chronic disabling spondylitis chiefly affect men.

Yes! Unfortunately children can also suffer from many of the adult types of Rheumatism. Many forms of Juvenile Arthritis have some hereditary pattern. Rheumatic Fever Arthritis is much more common in children and usually follows after a sore throat. Chronic forms of Arthritis are more common in adults but no age is immune from Arthritis.

Arthritis can be broadly classified into the following groups -

• Associated with infections for example Rheumatic Fever Arthritis
• Degeneration of joints, often with age and excess body weight for example Osteo-Arthritis
• Non-infective forms of inflammatory Arthritis, often deforming for example Rheumatoid Arthritis
• Multiple systemic types (affecting lungs, heart, etc) for example lupus (SLE)
• Metabolic & miscellaneous causes for example gout, traumatic Arthritis

A Joint is a junction of two or more bones. Joints impart motion and mobility in various activities such as walking, running, talking, sitting, arising, etc. A Joint capsule made of fibrous tissue encloses the free ends of the bones. It makes the Joint compact and strong, and encloses the Joint cavity filled with synovial fluid. The synovial fluid is secreted by the synovial membrane. The membrane is made up of cells and elastic tissue and has a rich blood supply. This fluid nourishes and lubricates the joint. The cartilage covers the free end of the bone, thereby protecting it from erosion during motion and loading. Cartilage is not as hard as the bone and does not show up in an X-Ray. It has viscoelastic properties. Muscles and tendons are attached close to a Joint and are responsible for its motion. Along with ligaments, capsule and other supporting structure, they make the Joint stable. Joints also have nerves which perceive pain. Some Joints for example the spine and rib cage, do not have synovial membrane and only contain cartilage.

In majority of the Arthritis there is more than one causative factor. Degenerative Arthritis (Osteo-Arthritis) is related to age, body weight, and injury. Rheumatic fever Arthritis is preceded by infections with specific types of bacteria in the throat and upper respiratory tract. However, the bacteria themselves do not cause Rheumatic fever Arthritis but excite an abnormal immune response (usually concerned with defense mechanism of the body) in the joints and sometimes in the heart and kidney as well. Uncommonly, bacteria can directly cause pyogenic Arthritis. Several types of infections (for example urinary, diarrhoea, sexual diseases) can indirectly cause post-infective forms of Arthritis. In Rheumatoid Arthritis which is marked by multiple joint swellings and deformities the exact cause is not known, but hereditary and infections play an important role. Many of the spondylitic conditions associated with back pains are related to excess body weight, poor postures and injuries. Ankylosing spondylitis is an inflammatory disorder of the spine which is often seen in multiple male members of a family, and present with low back ache. Gout is caused by excess deposition of uric acid in joints. Though in many forms of Arthritis the precise nature of initial attack to the joints is not known the subsequent sequence of events which produce damage to the joints and also make it chronic and progressive are now well known. And the latter has made the new therapeutic strategies more effective.

There are innumerable misconceptions and myths associated with the role of diet and environment in the causation and progression of Arthritis. It is true that these too have an important bearing in the overall profile of Arthritis, but we still have limited scientific facts on this aspect. High protein precipitates gouty or uric acid crystals related Arthritis in a genetically pre-disposed individual. It is generally believed that certain dietary items like sour foods, milk, curds, etc. have some role in causing Arthritis and Rheumatism, but scientifically speaking, very few patients experience painful joints after consuming some of these food items. Probably some form of food allergy aggravates symptoms in these latter patients. Certain forms of soft tissue Rheumatism and Rheumatoid Arthritis are aggravated by some climatic conditions, especially the onset of monsoons. But again this association varies from patient to patient and is not constant. Sometimes change in weather or habitat of the patients brings about a significant improvement in Arthritis also.

No! Arthritis per se is not life threatening. Rheumatic fever Arthritis often leaves sequele in the heart which can be serious. Chronic intake of drug, especially haphazardly taken can lead to serious damage in the body which can then threaten life. Uncommonly, multiple systems including heart, can be affected in some rare forms of chronic Arthritis (e.g. Lupus). However, chronic Arthritis, can seriously affect the quality of life - both physical and mental.

Though there are many forms of Arthritis, there are few laboratory investigations which are diagnostic. Most of the investigation results only provide some clue towards the diagnosis. It is not correct to quickly jump to a diagnosis based on laboratory or X-ray result only. Investigation results have to be properly interpreted with the patient's clinical picture. In fact, the doctor should order investigations based on the likely clinical diagnosis. Routine blood test for haemoglobin and ESR is often done and repeated in chronic cases. Though blood haemoglobin depends upon nutrition (especially iron in diet), it is often reduced by the Arthritis disease process. ESR is a measure on inflammation or the disease process in Arthritis (characterized with painful swellings) but it does not tell us about the exact diagnosis. ESR is often done repeatedly to monitor the reduction in disease activity. Rheumatoid factor is positive in blood in almost 80% of patients of Rheumatoid Arthritis. Another test ASO is positive in blood in patients with Rheumatic fever Arthritis. Laboratory investigations are also done to diagnose infections (urine, stool, etc.) which may lead to Arthritis. Many more specialized and expensive tests (for example, ANA) are available for some uncommon forms of Arthritis (for example, SLE) and these need not be done routinely. There is no need to take X-rays of all the painful joints. In fact, in early Arthritis X-rays do not help in diagnosis. Only in chronic or progressive Arthritis X-rays can show certain degree of damage to banes and joints which helps in diagnosis and planning special therapies. X-rays are also required to plan surgery. Infrequently, arthroscopy (a viewing tube like instrument surgically introduced into the joint) may be done to diagnose affections of a single large joint, for example, knee.

Yes! The exact diagnosis of the type of Arthritis certainly helps in planning the long term management, because prognosis and extent of cure differs in the different types. Sometimes it is difficult to arrive at the final diagnosis in the early stage, but the same is made obvious during a careful follow-up of the patient disease. Patients may also suffer from more than one type of Arthritis. Sometimes the exact cause of joint pain is a simple mechanical factor, for example, bad worn out chappals may cause foot and heel pain. Bad posture often causes painful back.

Usually patients go to family General Practitioner for advice. Therefore it is important that the General Practitioner recognizes the disease and begins appropriate therapy. The GP should take help from a specialist before planning a long term management strategy. This may be particularly important in chronic, progressive or deforming type of Arthritis. A physiotherapist should form part of the term. In case of deformities, an orthopedic surgeon needs to be consulted for advice regarding the role of surgery. Medical social workers can be useful in educating the patient about their disease and therapy. Therefore, a continuous team effort is required to effectively manage chronic Arthritis.

Any form of Arthritis can be effectively treated with modern therapeutic and supportive regimens. Some forms of Arthritis like Rheumatic fever and infective Arthritis are curable. In fact, early diagnosis and treatment of Rheumatic fever Arthritis, common in children, cures the Arthritis and long term penicillin therapy further prevents complications in the heart. Rheumatoid Arthritis and chronic inflammatory spondylitis can be treated and controlled to such an extent that the disease does not affect the life - style of the individual patient. The therapeutic success in chronic forms of Arthritis really depends on the state of the disease at which long term treatment has begun. Similarly, many forms of soft tissue Rheumatism are curable, especially when the factors responsible for their causation are recognized and managed. But the success of treatment in Arthritis depends not only on drugs but also on patient-doctor relationship, regular exercise programme and change in the mental attitude of the patients. Sometimes orthopedic surgery is performed as an important step in the treatment of chronic Arthritis with disabling deformities, to alleviate pain and improve ambulation and quality of life. Arthroscopy of certain joints, for example, knee, shoulder, may be surgically done to remove the cause of pain and disability. A totally useless but painful joint may be replaced by an artificial prosthesis to restore painless function. Similarly, certain deformities may be corrected by special surgery.

Many painkiller drugs for example aspirin, brufen, voveran, etc. provide quick symptomatic relief of pain and swelling. However in chronic cases though these drugs are used for prolonged periods, they do not provide long term relief. It may be remembered that numerous pain relieving drugs if not taken properly produce numerous side effects especially in the stomach and kidney. A special class of drugs are used to treat chronic forms of Arthritis, and are called disease modifiers (for example gold salts, salazopyrin, methotrexate, etc.). These drugs are slow to produce relief but can effectively control the disease for long periods of time. These drugs improve quality of life and reduce the requirement of pain killers. But they need special monitoring to avoid side effects. Cortisones are very powerful anti-inflammatory anti-Arthritic drugs and can produce immense relief. But their use should be restricted to severe forms of Arthritis. However, cortisones are notorious to produce side-effects and are probably the most misused and abused drugs in management of Arthritis today. Many indigenous formulations, even those available across the counter have been found to contain cortisones. Doctors often dispense cortisones in anonymous formulation to produce quick relief. Such medicines lead to a long term drug dependence for relief and cause serious side-effects and toxicity, affecting multiple systems in the body.

The length of the therapy will depend on the type of Arthritis. In some forms of Arthritis like Rheumatic fever Arthritis, the treatment is for few weeks, while in chronic forms of Arthritis like Rheumatoid Arthritis, it may take months to years to produce an arrest of the disease activity. In the case of gouty Arthritis intensive treatment is given for few days at a time to overcome the acute stage, and this may be required several times. However, drugs may be given for prolonged period to patients of gout to prevent acute attacks. In chronic deforming Arthritis, the patient has to take some form of therapy throughout the life to maintain good quality of life style.

Every medicine with good effect has some degree of side-effects or toxicity. Medical science hopes to take advantage of the dominant good effects of every drug in clinical use. Most of the times, side effects are minimal or not visible either clinically or by investigations. Also the body has the capacity to overcome minor side effects. Except for allergy which usually manifests with the first dose, majority of the side-effects depend on dose and the duration of the drug use. An experienced and knowledgeable doctor can ensure that the patient does not suffer from side-effects by advising certain precautions like timing of the drug and consuming plenty of fluids. The doctor can also teach the patient to recognize the early signs of side-effects. All patients on long term therapy must be regularly seen by their family doctor and specialist in certain cases. Patients should never take potent medicines without expert medical supervision especially when suffering from chronic Arthritis. All analgesics or pain killer medicines can affect the stomach and kidney when taken in high dose or over prolonged periods. Even stomach ulcers can be caused. Cortisones or steroids if used without caution can cause numerous side effects, for example, increased body weight, high blood sugar, high blood pressure, easy fractures of bones, etc. Highly potent anti-Arthritis medicines for example gold salts, methotrexate, etc. need regular monitoring for their effect on blood, liver, kidney and skin. To repeat, every drug is like fire. Fire has many good uses but can also burn. While starting treatment, the benefits of every drug must outweigh its likely side-effects. A certain amount of risk has to be accepted because the disease if not treated may lead to severe complications. Patients must trust their doctors and doctors must closely monitor patients taking drugs over prolonged periods. Side-effects when detected early can be properly treated without leaving any residual damage. It is reassuring to know that science is constantly improving the safety profile of drugs. When indicated, patients must take their medicines without fear, but exercise caution as advised by doctors.

Exercise and physiotherapy play an important role in the overall rehabilitation of the patient suffering from Arthritis. Physiotherapy includes exercises, traction, heat therapy, shortwave diathermy, ultrasound, etc. The timings of exercise in the natural history of Arthritis is very important. In the acute stage joints need rest, but once the swelling begin to subside the joints need to be exercised through their normal range of movement. Exercise to begin with, should be supervised by the physiotherapist, but later can be easily performed by the patient. Individuals who maintain proper body weight and exercise regularly rarely suffer from severe forms of degenerative arthritis. However, despite exercise and sometimes yoga too, chronic Arthritis, like Rheumatoid Arthritis, can manifest in a genetically predisposed individual. But exercise continues to be an important step in the long term management.

The present day allopathic modern system of medicine offers the maximum success in the treatment of various types of difficult-to-treat Arthritis. There is no cure for many chronic forms of Arthritis (e.g. Rheumatoid Arthritis). Many alternate systems of medicine like homeopathy, ayurveda, unani medicine do have their own means and methods of treating chronic Arthritis and are easily available. Then there are methods like acupuncture, acupressure which possibly can be useful adjuncts in the overall management of chronic Arthritis affecting numerous joints. Some different therapeutic modalities can be combined by qualified doctors. Unfortunately an Indian patient with chronic Arthritis often switches from one system of medicine to another, too soon, to really achieve benefits and in the process the disease deteriorates rapidly. Once the joints are seriously deformed, hardly much can be done to correct them through medication, though medicine can still arrest the basic disease process. It is important to clearly understand the expectations and limitations of any system of medicine on the part of the doctors and patients. Patients should be aware of the tall claims made by unscrupulous doctors or quacks. However, it is being increasingly realized that an integrated approach comprising of allopathy and other system should be used to give maximum cure to any patient with chronic deforming Arthritis.

Unfortunately, most of the chronic forms of Arthritis are not preventable because of the hereditary / genetic element and other unknown factors in their causation. Still, it is important to maintain a good physical condition of body and mind to enjoy healthy life free from problems of the joints. Degenerative Arthritis, for example, Osteo-Arthritis and spondylitis can be prevented by maintaining correct body weight and exercising regularly. Rheumatic fever Arthritis is due to infections of the throat acquired from the community and is perhaps the best example of a preventable type of Arthritis. Gouty attacks can be prevented by proper care in the diet and observing personal habits (for example, alcohol) in moderation. Gout attacks are usually precipitated by rich non-vegetarian diets and alcohols. Many forms of soft tissue rheumatism, joint aches and pains and low backache are due to bad posture. While working, certain occupations also contribute to these problems, for example women squatting to work for prolonged hours in fields often suffer from low back ache. Such problems can be prevented by adopting proper posture and care, both during work and rest. Prolonged work in fixed posture should be avoided. There should be intermittent periods of rest or change in posture to avoid these soft tissue problems.

The Indian patient often finds himself at the cross-road of so many systems of medicine available. In search of short term immediate gains, he tries each system. The doctors themselves do not pay attention to the patients problems. Tall claims are made by each doctor and various 'pathies'. Each system whether it be allopathy, homeopathy or any other pathy, has significant limitations. Success depends upon the doctors EXPERTISE and DILIGENT long term management program. At a general practice level, often numerous drugs with differing potency are tried in a shotgun or 'blunderbuss gun' manner to provided quick relief. Often the patients suffer from side-effects of such medications. By the time a specialist is consulted, the patient is frustrated and has lost faith in medication. Surprisingly, supervised exercised/physiotherapy program are missing in most of the management plans. Concurrent medical illnesses are often overlooked. The patient moves from 'pillar' to 'post' and soon finds himself crippled by physical deformities and psychogenic stress. Community misconceptions and superstitions about Arthritis are widely prevalent and practiced in the Indian community and this further compounds the problem.

Also, the patient is constantly bombarded by half baked advice from close relations, friends, acquaintances and even strangers who happen to meet him. Unlike in case of heart and other major diseases, the patient of Arthritis is unable to hide his painful and deformed joint. The expense of treatment is a major factor governing the patient's ability to seek relief.

Much can be done to reduce the burden of a patient with crippling Arthritis. Besides proper and adequate medication, the patient would need close rapport with the doctors. The doctor has to patiently help the patient in overcoming both mental and physical problems. The patient would need a good supervised exercised program. Attention has to be given to the nutritional status and other medical problems of the patient. Perhaps some surgery may be required to improve the functions of particular joints. It is obvious then that the team approach is best suited while treating such a patient. One may add, that the treatment of such a patient is long drawn, challenging and demanding. Sometimes despite unsatisfactory therapeutic results the doctors has to maintain an optimistic approach and inculcate positive attitudes in the patient.

Unfortunately there are very few "specialized centers" looking after the overall management of Arthritis in India. In a majority of the medical centers in India, "Arthritis" forms part of Orthopedic and general medical care. Now with the progress in Rheumatology (science connected with Arthritis and Rheumatism), specialized centers / departments are being set up general hospitals. The same has been done in Pune by the author this team.

Much research is being done to formulate new medicines which will cure the chronic forms of Arthritis at an early stage without producing much side effects or toxicity. Also safer pain relieving drugs for long term use are required. New methods are being developed to correct the "immunological" abnormalities in Arthritis which perpetuate the damage. Replacement of deformed useless joints by artificial joint is an exciting field and success has been obtained for hip, knee, elbow and shoulder, to a significant extent. However, an important step in combating would be, to find out means and methods of detecting potential disease in asymptomatic individuals belonging to families with Arthritis patients.

A Disease affecting the joints and soft tissues of the body.

Rheumatoid Arthritis is the form in which most of the joints are affected with higher possibility of deformation. Ankloysis Spondylitis affects the spine. SLE is a multiple systemic type affecting the lungs, heart, kidneys, etc. Gouty Arthritis is seen in patients suffering from Gout, a metabolic disease. The Arthritis affecting the muscles is called Soft Tissue Rheumatism (STR). Degeneration of joints related to age is called Osteoarthritis. Not all forms of Arthritis are crippling or deforming.

In Arthritis, there may be more than one causative factor In Rheumatoid Arthritis in which multiple joints pain, swelling and deformities are involved the exact causes are not known, but heredity and infections play a very important role In Degenerative Arthritis, i.e. Osteoarthritis, age, body weight and injury could be the causative factors Ankylosing Spondylitis is an inflammatory disease of the spine seen in many patients and presents itself with low back pain. The cause could be trauma, obesity and poor posture Soft Tissue Rheumatism is often related with mental stress and occupation Gouty Arthritis is caused due to excess deposition of uric acid in the joints.

Mostly when one suffers from joint pains, he consults an Orthopaedic doctor or his family doctor. The family doctor after recognizing the disease should begin appropriate therapy. The family doctor can always take help from a specialist (Rheumatologist) for long term management of disease.

Any type of arthritis can be treated with modern medicines. Some like Rheumatic Fever and Infective Arthritis are curable, and early diagnosis in such cases is helpful in treatment Rheumatoid Arthritis and Ankylosing Spondylitis can be controlled with the help of the medicine to such an extent that it does not affect one's lifestyle Many forms of soft tissue Rheumatism are definitely curable when one finds their causative factors.

Arthritis is a long-term disease. So, with regular medication it is required that your blood tests be done, because they help the doctor to monitor the disease.

Arthritis like Diabetes and Hypertension is a long-term disease, so it is of utmost importance that the patient takes his medication regularly as it helps in controlling the disease. Not all types of Arthritis require long term medication. It is not recommended that you stop the medicines without consulting your doctors, because he will be the one who will decide when and how to reduce or stop the medicines.

Patients suffering from Rheumatoid Arthritis, Gout, AS, SLE, etc, in whom the disease has flared up, pregnancy could cause complications. The patients, after consulting their doctor and when the Arthritis is under control, could try for a child, but whether the child too will suffer from the same disease cannot be predicted.

There are many misconceptions on this issue as it is said that sour and cold foods, curds, etc. have an effect on Arthritis. In some cases, effect of diet may be directly linked with Arthritis, but there is no scientific reason to prove it. In Gout, the patient is asked to avoid alcohol, non-vegetarian diet in order to control the uric acid level in blood Being overweight affects the joints because the joints that are already painful and swollen have to bear more weight, which in turn increases the pain and the patient is unable to walk for a long period A change in the weather could aggravate pain in Arthritis, especially in the monsoon, but again may vary with patients.

Once Arthritis steps into your life, not everything is the same. Most of the patients are psychologically depressed because of the disease and think that there is nothing in life to live for. But that is not true. Accepting the truth and fighting the disease with the backing of your family will help the patient to rise again.