November 2002 Volume 83 Number 11 "serving the protectors"

Less to fear from Arthritis

Joints

As you get older, you will run the increased risk of suffering from the pain and stiffness of arthritis. Advances in treatment options should mean less pain, more mobility and fewer problems with your joints as you get older. And, hopefully, you will not end up too sore to enjoy your retirement (which, if you look after yourself, might be for 30 years or more).

Arthritis

Between the bones is a joint surface made up of cartilage, synovium and various connective tissues, and the movement of the joint occurs when the ligaments and tendons pull the joints that are stabilized by the ligaments.

The description or name used to describe arthritis (from “arthro”, meaning joint) is usually based around which part of the joint is affected by injury or damage. A damaged bursa will become swollen and be called bursitis. A damaged tendon will cause pain and be swollen and be called tendonitis, etc.

Treatment will be directed toward fixing the part that is damaged.

Cartilage

The cartilage acts like a piece of rubber between bones to lessen the impact of the two bones rubbing. The knee is an example in which the rubbing of bone on bone in a weight-bearing joint is protected by the cartilage.

Synovium

The synovium is the layer of cells lining any joint that produces small amounts of fluid that act as the lubrication to make the movement of the joints easier. The mechanical equivalent is the use of oil or grease to decrease the friction between the joints as they move against each other. By decreasing the friction, there is less wear and tear, so the joints will last longer.

Connective tissue

Connective tissue is the term used to describe the various bits of tissue that will join ligaments to bone, bone to bone, or muscles to other parts of the body. The name describes the job the tissue does to join various parts of the joints together.

Tendons

These are specialized connective tissue joining usually the muscle to a bone. They act like a rope to pull on a bone and move the joint. As they move over the joint, it behaves like a rope over a pulley.

Bursa

To stop the tendons from rubbing on the bones, the body puts lubricated pads between the tendons and the bones. These are lined by synovial fluid, will stop wear and tear of the tendons and are known as bursa.

Treatment with medication has changed in the last few years for most forms of arthritis, and ultrasound (US), computerized tomography (CT or CAT scans) and magnetic resonance imaging (MRI) mean that the diagnosis and management can usually be sorted out before treatment starts.

Rheumatoid arthritis is a form of arthritis in which the body attacks itself. It is known as an autoimmune disease, and the antibodies attack the lining of the joints to destroy the synovium, thus causing loss of any lubrication of the joints. Almost complete destruction of the joint will occur unless something can be done to stop the immune system. Twenty years ago, the only real treatment was the use of cortisone, particularly tablets of prednisolone. Today, the immune system can be modified by various medications, such as Plaquenil and methotrexate. The effect of these treatments is to arrest the disease almost completely.

Osteoarthritis is the term used to describe the wear-and-tear arthritis that comes from using or overusing the joints. Recently, the choice of medication was cortisone (prednisolone) known as steroids, or the conventional non-steroidal anti-inflammatory drugs (NSAIDs). A new form or of NSAIDs became available because the conventional NSAIDs, like aspirin, were associated with many side effects but, in particular, the risk of bleeding and stomach ulcers. Aspirin is a prostaglandin inhibitor, but the new NSAIDs (Celebrex,Vioxx and Mobic) are COX 2 inhibitors. Therefore, the choice of treatments is a lot wider and, even though the new medications are not perfect, it is important to rethink the use of medication if you have arthritis.

Other diagnosis and treatment options

Ultrasound is useful to look at joints as they are in use. Known as dynamic imaging, you can watch a joint, the tendons, ligaments and other tissue as they move. It is particularly good for looking at shoulders, as there are many different ways the joint works and lots of little things that can go wrong. Once the diagnosis is made, treatment can be directed at the specific part of the joint that is damaged. If an injection into the joint is needed, the ultrasound can be used to make sure the needle is in exactly the correct position, thus making treatment more targeted. Fibre-optic surgery (keyhole surgery) allows more to be done with less other damage to tissue around.

MRI is useful to assess damage to joints before surgery is done. Because of this, the surgeon has a better idea of what damage is done and what surgery may be needed, making better results possible, such as a knee reconstruction.

Joint replacement is becoming more sophisticated as new technology and materials are used. Hip surgery lasts longer than it did before, and second or third operations are more common. Sometimes, parts of the joint can be replaced rather than the whole joint. This gives a better chance of longer useful function of the joint after the surgery and, in later years, having more surgical options.

New medications and surgical options make arthritis less scary than it was before. It is still good to look after yourself and avoid damage if possible but, if you do need treatment, you can probably find something to help you keep mobile to enjoy the golden years as you get older.

Your questions answered

Dr Pearce will answer questions on any health issue important to you. For his response, write to or fax the Police Journal with your question. Those who write need not identify themselves.

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