Bloated joint

Published November 22, 2020, 11:29 PM

by Dr. Jose Pujalte Jr.


Dr. Jose Pujalte, Jr.

“..he never straightens his knee joints… and in walking he does not tread but shovel and slide.” – Thomas Carlyle (1795–1881), Scottish essayist, Collected Letters, vol. 3.

Thomas Carlyle probably described arthritis when he first met another literary giant – Samuel Taylor Coleridge (The Rime of the Ancient Mariner). Still, it would have been hard to pinpoint exactly what kind of joint disorder it was because there are 100 different types of arthritis. He wouldn’t know where to start.

Definition. Arthritis is inflammation of one or more of the joints. A normal joint or articulation moves smoothly in its complete arc, without pain. A joint has cartilage or the smooth ends of a bone; a joint capsule which encloses a joint and a synovium, secreting the fluid that lubricates the joint. Any or all of these are damaged in arthritis. In disease or degeneration, a joint can become inflamed and painful. It is not true that only old people get arthritis. An example is rheumatoid arthritis which occurs even in children.

Signs and Symptoms. These are: pain, stiffness, loss of motion, swelling, and redness of the joint. If the arthritis is inflammatory (auto-immune), infectious, or septic in nature, look for: fever, rash, weight loss, dry eyes and mouth, and night sweats. In the Philippines, we still see many cases of tuberculosis of the spine (Pott’s disease) and the joints.

Risk Factors. What will predispose to arthritis? There’s a strong family history. I tell my patients that some families have cancer and diabetes and it’s the same with some types of arthritis, too. But the “glass-is-half-full” take on this is that people don’t die of arthritis but rather live with it. Previous joint injury (post-traumatic) can lead to arthritis. There is also the factor of obesity because joints can only take so much load.

Diagnosis. Doctors to visit for arthritis are: general practitioners/family medicine, rheumatologists, rehabilitation medicine specialists, endocrinologists, orthopedic surgeons, and neurosurgeons. Xrays may not pick up early arthritis but they are necessary to track its progression. Doctors may also request blood tests for arthritis.

Treatment. Your doctor may want you to lose some weight, particularly for osteoarthritis (the most common degenerative type). Medications for pain start with acetaminophen, often interchanged with non-steroidal anti-inflammatory drugs (NSAIDs) like mefenamic acid, ibuprofen, diclofenac, naproxen, and piroxicam. Corticosteroids are injected directly into the joint to reduce inflammation. Viscosupplementation for osteoarthritis is another option. A substance that mimics healthy joint fluid is injected into the knee. It provides lubrication and a cushioning effect for the joint, relieving pain for up to six months. Patients with end-stage arthritis benefit from joint replacement. Metal alloy and plastic parts replace worn out or diseased joint surfaces. The reasons for surgery are: to relieve intolerable pain, return motion, and correct deformity. Adjusting to arthritis means a commitment to weight loss, exercise – to strengthen muscles around the joints; application or heat or cold and use of assistive devices – from canes to walkers and elevated toilet seats.

Saying NO to arthritis is saying YES to a better quality of life. At no other time has there been so many options to combat arthritis. Coleridge would have certainly envied us. He looked like he had bad knees at 52.

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