joints
Content:
- Arthritis
- Osteoarthritis
- Rheumatism
- Hip dysplasia
Arthritis
If you feel pain and stiffness in your body or have trouble moving around, you might have arthritis. Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Over time, a swollen joint can become severely damaged. Some kinds of arthritis can also cause problems in your organs, such as your eyes or skin.
One type of arthritis, osteoarthritis, is often related to aging or to an injury. Other types occur when your immune system, which normally protects your body from infection, attacks your body's own tissues. Rheumatoid arthritis is the most common form of this kind of arthritis. Juvenile rheumatoid arthritis is a form of the disease that happens in children. Infectious arthritis is an infection that has spread from another part of the body to the joint.
Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in your joints. It can affect any joint but is common in the wrist and fingers. More women than men get rheumatoid arthritis. It often starts between ages 25 and 55. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime.
Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth and lungs. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body's own tissues.
No one knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute. Treatments include medicine, lifestyle changes and surgery. These can slow or stop joint damage and reduce pain and swelling.
Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth and lungs. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body's own tissues.
No one knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute. Treatments include medicine, lifestyle changes and surgery. These can slow or stop joint damage and reduce pain and swelling.
Juvenile rheumatoid arthritis (JRA) is a type of arthritis that happens in children age 16 or younger. It causes joint swelling, stiffness and sometimes reduced motion. It can affect any joint, and in some cases it can affect internal organs as well.
One early sign of JRA may be limping in the morning. Symptoms can come and go. Some children have just one or two flare-ups. Others have symptoms that never go away. JRA causes growth problems in some children.
No one knows exactly what causes JRA. Scientists do know it is an autoimmune disorder, which means your immune system, which normally helps your body fight infection, attacks your body's own tissues. Medicines and physical therapy can help maintain movement and reduce swelling and pain.
One early sign of JRA may be limping in the morning. Symptoms can come and go. Some children have just one or two flare-ups. Others have symptoms that never go away. JRA causes growth problems in some children.
No one knows exactly what causes JRA. Scientists do know it is an autoimmune disorder, which means your immune system, which normally helps your body fight infection, attacks your body's own tissues. Medicines and physical therapy can help maintain movement and reduce swelling and pain.
Osteoarthritis
Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint.
Causes, incidence, and risk factors
Osteoarthritis is a normal result of aging. It is also caused by 'wear and tear' on a joint.
Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another.
If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness.
Bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint become weaker and stiffer.
Often, the cause of OA is unknown. It is mainly related to aging.
The symptoms of OA usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor.
Before age 55, OA occurs equally in men and women. After age 55, it is more common in women.
Other factors can also lead to OA.
OA tends to run in families.
Being overweight increases the risk of OA in the hip, knee, ankle, and foot joints because extra weight causes more wear and tear.
Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and ligaments in your joints.
Jobs that involve kneeling or squatting for more than an hour a day put you at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk.
Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increase the risk of arthritis.
Medical conditions that can lead to OA include:
Bleeding disorders that cause bleeding in the joint, such as hemophilia
Disorders that block the blood supply near a joint and lead to avascular necrosis
Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis
Symptoms
Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint.
If you have osteoarthritis, your joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint.
The phrase "morning stiffness" refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint.
During the day, the pain may get worse when you're active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night.
Some people might not have symptoms, even though x-rays show the changes of OA.
Signs and tests
A physical exam can show:
Joint movement may cause a cracking (grating) sound, called crepitation
Joint swelling (bones around the joints may feel larger than normal)
Limited range of motion
Tenderness when the joint is pressed
Normal movement is often painful
No blood tests are helpful in diagnosing OA.
An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.
Treatment
OA cannot be cured. It will most likely get worse over time. However, your OA symptoms can be controlled.
You can have surgery, but other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.
MEDICATIONS
Over-the-counter pain relievers, which you can buy without a prescription, can help with OA symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs. If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.
Other medications or supplements that you may use include:
Corticosteroids injected right into the joint to reduce swelling and pain
Over-the-counter remedies such as glucosamine and chondroitin sulfate
Capsaicin (Zostrix) skin cream to relieve pain
Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee to relieve pain for 3 - 6 months.
Causes, incidence, and risk factors
Osteoarthritis is a normal result of aging. It is also caused by 'wear and tear' on a joint.
Cartilage is the firm, rubbery tissue that cushions your bones at the joints, and allows bones to glide over one another.
If the cartilage breaks down and wears away, the bones rub together. This causes pain, swelling, and stiffness.
Bony spurs or extra bone may form around the joint. The ligaments and muscles around the joint become weaker and stiffer.
Often, the cause of OA is unknown. It is mainly related to aging.
The symptoms of OA usually appear in middle age. Almost everyone has some symptoms by age 70. However, these symptoms may be minor.
Before age 55, OA occurs equally in men and women. After age 55, it is more common in women.
Other factors can also lead to OA.
OA tends to run in families.
Being overweight increases the risk of OA in the hip, knee, ankle, and foot joints because extra weight causes more wear and tear.
Fractures or other joint injuries can lead to OA later in life. This includes injuries to the cartilage and ligaments in your joints.
Jobs that involve kneeling or squatting for more than an hour a day put you at the highest risk. Jobs that involve lifting, climbing stairs, or walking also put you at risk.
Playing sports that involve direct impact on the joint (such as football), twisting (such as basketball or soccer), or throwing also increase the risk of arthritis.
Medical conditions that can lead to OA include:
Bleeding disorders that cause bleeding in the joint, such as hemophilia
Disorders that block the blood supply near a joint and lead to avascular necrosis
Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis
Symptoms
Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint.
If you have osteoarthritis, your joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint.
The phrase "morning stiffness" refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint.
During the day, the pain may get worse when you're active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night.
Some people might not have symptoms, even though x-rays show the changes of OA.
Signs and tests
A physical exam can show:
Joint movement may cause a cracking (grating) sound, called crepitation
Joint swelling (bones around the joints may feel larger than normal)
Limited range of motion
Tenderness when the joint is pressed
Normal movement is often painful
No blood tests are helpful in diagnosing OA.
An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.
Treatment
OA cannot be cured. It will most likely get worse over time. However, your OA symptoms can be controlled.
You can have surgery, but other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.
MEDICATIONS
Over-the-counter pain relievers, which you can buy without a prescription, can help with OA symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs. If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). Types of NSAIDs include aspirin, ibuprofen, and naproxen.
Other medications or supplements that you may use include:
Corticosteroids injected right into the joint to reduce swelling and pain
Over-the-counter remedies such as glucosamine and chondroitin sulfate
Capsaicin (Zostrix) skin cream to relieve pain
Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee to relieve pain for 3 - 6 months.
Rheumatism
Rheumatism refers to various painful medical conditions which affect bones, joints, muscles, tendons (see illustration). Rheumatism may also involve internal organs including:
heart
skin
kidneys
lungs
The term "rheumatism" is not frequently used in current medical text, but is more often found in historical medical text. Rheumatism does not refer to a single disease or condition. There are over 100 conditions commonly referred to as rheumatism.
Rheumatism has been more specifically classified, based on location and characteristics of symptoms, as:
localized rheumatism (e.g. bursitis)
regional rheumatism (e.g. temporomandibular joint pain)
generalized rheumatism (e.g. fibromyalgia)
psychogenic rheumatism (e.g. muscle and joint pain is inconsistent with actual physiology and patient is thought to have psychological reasons for the symptoms)
What Are Rheumatic Diseases/Conditions?
Rheumatic diseases and conditions primarily affect joints, tendons, ligaments, bones, and muscles (see illustration). Rheumatic diseases are characterized by the signs of inflammation - redness, heat, swelling, and pain. Also, rheumatic diseases are characterized by loss of function among one or more connective or supportive structures of the body. Rheumatic diseases can affect internal organs.
Common Rheumatic Diseases
ankylosing spondylitis
fibromyalgia
lupus
scleroderma
polymyositis
dermatomyositis
polymyalgia rheumatica
bursitis
tendinitis
vasculitis
carpal tunnel syndrome
heart
skin
kidneys
lungs
The term "rheumatism" is not frequently used in current medical text, but is more often found in historical medical text. Rheumatism does not refer to a single disease or condition. There are over 100 conditions commonly referred to as rheumatism.
Rheumatism has been more specifically classified, based on location and characteristics of symptoms, as:
localized rheumatism (e.g. bursitis)
regional rheumatism (e.g. temporomandibular joint pain)
generalized rheumatism (e.g. fibromyalgia)
psychogenic rheumatism (e.g. muscle and joint pain is inconsistent with actual physiology and patient is thought to have psychological reasons for the symptoms)
What Are Rheumatic Diseases/Conditions?
Rheumatic diseases and conditions primarily affect joints, tendons, ligaments, bones, and muscles (see illustration). Rheumatic diseases are characterized by the signs of inflammation - redness, heat, swelling, and pain. Also, rheumatic diseases are characterized by loss of function among one or more connective or supportive structures of the body. Rheumatic diseases can affect internal organs.
Common Rheumatic Diseases
ankylosing spondylitis
fibromyalgia
lupus
scleroderma
polymyositis
dermatomyositis
polymyalgia rheumatica
bursitis
tendinitis
vasculitis
carpal tunnel syndrome
Hip dysplasia
Hip dysplasia, developmental dysplasia of the hip (DDH) or congenital dysplasia of the hip (CDH)is a congenital or acquired deformation or misalignment of the hip joint.
Hip dysplasia can range from barely detectable to severely malformed / dislocated. The congenital form, teratologic or non-reducible dislocation occurs as part of more complex conditions.
The condition can be bilateral or unilateral:
The condition can be bilateral or unilateral:
If both hip joints are affected one speaks of "bilateral" dysplasia. In this case some diagnostic indicators like asymmetric folds and leg-length inequality do not apply.
In unilateral dysplasia only one joint shows deformity, the contralateral side may show resulting effects. In the majority of unilateral cases the left hip has the dysplasia.
If the joint is fully dislocated a false acetabulum often forms (often higher up on the pelvis) opposite the dislocated femoral head position.
In actetabular dysplasia the acetabulum (socket) is too shallow or deformed. The center-edge angle is measured as described by Wiberg. In coxa vara the femur head grows at too narrow an angle to the shaft, in coxa valga the angle is too wide.
A rare type, the "Beukes familial hip dysplasia" is found among Afrikaners that are members of the Beukes family. The femur head is flat and irregular. Sufferers develop osteoarthritis at an early age.
In unilateral dysplasia only one joint shows deformity, the contralateral side may show resulting effects. In the majority of unilateral cases the left hip has the dysplasia.
If the joint is fully dislocated a false acetabulum often forms (often higher up on the pelvis) opposite the dislocated femoral head position.
In actetabular dysplasia the acetabulum (socket) is too shallow or deformed. The center-edge angle is measured as described by Wiberg. In coxa vara the femur head grows at too narrow an angle to the shaft, in coxa valga the angle is too wide.
A rare type, the "Beukes familial hip dysplasia" is found among Afrikaners that are members of the Beukes family. The femur head is flat and irregular. Sufferers develop osteoarthritis at an early age.
Hip dysplasia is considered to be a multifactorial condition. That means that several factors are involved in causing the condition to manifest. Cause is unknown but common in breech position or large fetal size.
Congenital
Some studies suggest a hormonal link. Specifically the hormone relaxin has been indicated.
A genetic factor is indicated by the trait running in families and increased occurrence in some ethnic populations (e.g. native Americans, Lapps / Sami people. A locus has been described on chromosome 13. Beukes familial dysplasia, on the other hand, was found to map to an 11-cM region on chromosome 4q35. With nonpenetrant carriers not affected.
Acquired
As an acquired condition it has often been linked to traditions of swaddling infants, use of overly restrictive baby seats, carriers and other methods of transporting babies, or use of a cradle board which locks the hip joint in an "adducted" position (pulling the knees together tends to pull the heads of the femur bone out of the sockets or acetabulae) for extended periods. Modern swaddling techniques allow some room for leg movement.
Further risk factors include breech birth and firstborns. In breech position the femoral head tends to get pushed out of the socket. A narrow uterus also facilitates hip joint dislocation during fetal development and birth.
Congenital
Some studies suggest a hormonal link. Specifically the hormone relaxin has been indicated.
A genetic factor is indicated by the trait running in families and increased occurrence in some ethnic populations (e.g. native Americans, Lapps / Sami people. A locus has been described on chromosome 13. Beukes familial dysplasia, on the other hand, was found to map to an 11-cM region on chromosome 4q35. With nonpenetrant carriers not affected.
Acquired
As an acquired condition it has often been linked to traditions of swaddling infants, use of overly restrictive baby seats, carriers and other methods of transporting babies, or use of a cradle board which locks the hip joint in an "adducted" position (pulling the knees together tends to pull the heads of the femur bone out of the sockets or acetabulae) for extended periods. Modern swaddling techniques allow some room for leg movement.
Further risk factors include breech birth and firstborns. In breech position the femoral head tends to get pushed out of the socket. A narrow uterus also facilitates hip joint dislocation during fetal development and birth.
Given the very real possibility of a limp, constant and/or debilitating pain, complicated treatment and impaired mobility later in life, careful developmental monitoring and early intervention are indicated. The worst possible consequence of non treatment is developing early arthritis, sometimes even during teenage years. All treatment aims to delay the onset of arthritis, but no treatment is fully successful in avoiding it.
Harnesses, casts, and traction
Early hip dysplasia can often be treated using a Pavlik harness (see photograph) or the Frejka pillow/splint in the first year of life with usually normal results. Cases of femoral head avascular necrosis have been reported with the use of the Pavlik harness, but whether these cases were due to improper application of the device or a complication encountered in the course of the disorder remains unresolved. Complications arise mainly because the sheet of the iliopsoas muscle pushes circumflex artery against the neck of the femur and decreases blood flow to the femoral head. That is the reason why the Frejka pillow is not indicated in all the forms of the developmental dysplasia of the hip.
Harnesses, casts, and traction
Early hip dysplasia can often be treated using a Pavlik harness (see photograph) or the Frejka pillow/splint in the first year of life with usually normal results. Cases of femoral head avascular necrosis have been reported with the use of the Pavlik harness, but whether these cases were due to improper application of the device or a complication encountered in the course of the disorder remains unresolved. Complications arise mainly because the sheet of the iliopsoas muscle pushes circumflex artery against the neck of the femur and decreases blood flow to the femoral head. That is the reason why the Frejka pillow is not indicated in all the forms of the developmental dysplasia of the hip.
