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Arthritis

Arthritis is a musculoskeletal disorder threatening healthy aging globally, and is one of the most common causes of disability, giving rise to immense healthcare expenditure and loss of work [1], [2]. Incidence cases are expected to continue rising over the next decade, and since there is no evidence-based cures as of yet, a proper understanding of this disorder and its management may help ease the burden of disease [3].


Arthritis is a common health disorder where chronic inflammation causes pain and damage to joints, bones, and depending on the type, other parts of the body [4]. The two most common are osteoarthritis (OA) and rheumatoid arthritis (RA) [5].


Osteoarthritis, a degenerative joint disease, is the most common cause of arthritis, often affecting the articular cartilage at the hips, hands, knees, and lower spine region [6], [2]. The degenerative changes usually develop slowly and progressively get worse, causing pain, stiffness, swelling, and sometimes reduced mobility in the affected area [6]. Globally, about 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis [2].


On the other hand, rheumatoid arthritis is a systemic autoimmune and inflammatory disease usually involving the joints, connective tissues, muscles, tendons, and fibrous tissue often around the hands, wrists, and knees [7], [2]. It is a chronic disabling condition often affecting several joints at once and often presenting around the age of 40 [2]. Typical symptoms of RA include pain, stiffness, or tenderness in more than one joint, and commonly mirrored on both sides; weight loss; fever; fatigue; and weakness [7].


As described by the Center for Disease Control and Prevention (CDC), osteoarthritis is caused by damage or breakdown of the cartilage between the bones of a joint [6]. Initial degeneration progresses when OA affects the smooth cartilage lining of the joints, causing difficulty in movement, pain, and stiffness [8]. As the cartilage wears out, the tendons and ligaments work harder, which results in inflammation and the formation of bony spurs called osteophytes [8]. In severe OA, this can result in contact between bones and malpositioned joints [8].


The chances of a person developing osteoarthritis increases when combined with risk factors such as:

  • Age – There is an increased risk in proportion to age [6];

  • Sex – Women are more likely than men to develop OA, especially after 50 [6];

  • Obesity – Extra weight stresses the joints, especially weight-bearing joints like the hips and knees [6];

  • Joint injury or overuse – Overexertion or injury of the joints can damage the joint and increase the risks of OA in that joint [6];

  • Genetics – People who have family members with OA are more prone to developing the disorder [6]; and,

  • Race – some Asian populations have been shown to be less likely to develop OA compared to other populations [6].

In contrast, the specific cause of rheumatoid arthritis is unknown [7]. However, when several genetic and environmental factors were analyzed, there were risk factors noted that increased the likelihood of developing the disease, while other factors reduced the risk [7].


These factors that increased the risk include:

  • Age – though RA can develop at any age, the chances increase with age. The greatest onset of RA is among adults in their sixties [7];

  • Sex – Just like OA, RA is typically more prevalent in women than men, typically two to three times higher [7];

  • Genetics/inherited traits – genetic material such as HLA (human leukocyte antigen) class II genotypes can worsen the symptoms of arthritis. When people with these type of genes are exposed to environmental factors like smoking or obesity, the risk of RA is extremely high [7];

  • Smoking – not only does smoking increase the risk of developing RA, it also worsens the disease [7]; and,

  • Obesity – studies have found that the more overweight a person was, the greater their risk of developing RA [7].


One characteristic that was noted, however, was that women who breastfed their infants had a decreased risk of developing rheumatic arthritis [7].


Even though arthritis is often associated with older people, it can also still affect children [8]. Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA) [8]. This type of arthritis causes pain and inflammation in 1 or more joints for at least 6 weeks, and though the origin is unknown, symptoms often improve well enough that the child can usually lead a normal life later on [8].


Generally, arthritis is usually diagnosed with the physician running a physical exam to check the joints for signs of inflammation and mobility, and occasionally lab tests and imaging techniques like x-rays, computerized tomography (CT) scans magnetic resonance imaging (MRI), and ultrasound [9].


Since there are no currently proven cures for arthritis, treatment is based upon relieving symptoms and improving the quality of life. Painkillers, nonsteroidal anti-inflammatory drugs, counterirritants, and disease-modifying antirheumatic drugs (DMARDs) are chiefly prescribed for management [9].


Physiotherapy has also been shown to be beneficial to some types of arthritis [9]. Exercise, a healthy diet, and reducing red meat intake have additionally been shown to be very beneficial [10].


According to a study published in 2019, the benefit of a plant-based diet while eliminating animal meat was shown to drastically improve arthritis symptoms [10]. Excessive body weight and diets that included animal meat worsened symptoms while diets rich in vegetables, fruits, and fibers were associated with lower BMI, have anti-inflammatory properties, and reduced the pain in patients [10]. However, they concluded that further testing was needed to test the effectiveness of a plant-based diet [10].


Though arthritis is ranked as one of the most disabling diseases in the world, in most cases, it can be managed well. Reducing risk factors while increasing positive practices will help in the long run. Most often than not, proper rest, exercise, a nutritious diet, and abstinence from harmful substances are usually the best way to lead to a more normal and healthy life.








References


  1. S. L. Brennan-Olsen, S. Cook, M. T. Leech, S. J. Bowe, P. Kowal, N. Naidoo, I. N. Ackerman, R. S. Page, S. M. Hosking, J. A. Pasco and M. Mohebbi, "Prevalence of arthritis according to age, sex and socioeconomic status in six low and middle income countries: analysis of data from the World Health Organization study on global AGEing and adult health (SAGE) Wave 1," BMC Musculoskeletal Disorders, vol. 18, no. 271, 2017.

  2. "Chronic rheumatic conditions," World Health Organization, [Online]. Available: https://www.who.int/chp/topics/rheumatic/en/. [Accessed 4 May 2021].

  3. "Global Rheumatoid Arthritis Epidemiology Report 2019-2029," Intrado, 9 December 2020. [Online]. Available: https://www.globenewswire.com/news-release/2020/12/09/2142440/28124/en/Global-Rheumatoid-Arthritis-Epidemiology-Report-2019-2029.html. [Accessed 4 May 2021].

  4. J. Kubala, "8 Foods and Beverages to Avoid with Arthritis," Healthline, 24 September 2020. [Online]. Available: https://www.healthline.com/nutrition/foods-to-avoid-arthritis. [Accessed 4 May 2021].

  5. "Arthritis," Mayo Clinic, [Online]. Available: https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772. [Accessed 5 May 2021].

  6. "Osteoarthritis (OA)," Centers for Disease Control and Prevention, 27 July 2020. [Online]. Available: https://www.cdc.gov/arthritis/basics/osteoarthritis.htm. [Accessed 5 May 2021].

  7. "Rheumatoid Arthritis (RA)," Centers for Disease Control and Prevention, 27 July 2020. [Online]. Available: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html. [Accessed 5 May 2021].

  8. "Arthritis," NHS, 14 December 2018. [Online]. Available: https://www.nhs.uk/conditions/arthritis/. [Accessed 5 May 2021].

  9. "Arthritis - diagnosis," Mayo Clinic, [Online]. Available: https://www.mayoclinic.org/diseases-conditions/arthritis/diagnosis-treatment/drc-20350777. [Accessed 5 May 2021].

  10. J. Alwarith, H. Kahleova, E. Rembert, W. Yonas, S. Dort, M. Calcagno, N. Burgess, L. Crosby and N. D. Barnard, "Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review," Frontier Nutrition, vol. 6, no. 141, 2019.


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