Learning how your joints function and what happens when your arthritis symptoms flare up can help you to understand your condition and make it easier to live with.

We have already seen how arthritis is a disease that causes pain and inflammation in the joints. It doesn’t matter which type of arthritis you have been diagnosed with, if it is not managed properly you will usually end up in a certain amount of pain and may have problems getting around and doing certain things. That said, the two major types of arthritis, osteoarthritis and rheumatoid arthritis, are actually quite different in terms of:

  • their symptosm
  • the rate at which they develop
  • the people they affect
  • the way in which they are treated

These differences arise because what’s actually going on in the joints is very different. Although both conditions involve the breakdown of cartilage in the joint, osteoarthritis is due to age related changes in which the cartilage becomes thinner in some joints, and the joint becomes less cushioned, whereas rheumatoid arthritis is related to a problem with the body’s own immune system.

Osteoarthritis occurs when the cartilage starts to disappear and the lubricating (synovial) fluid loses its protective cushioning properties.

Osteoarthritis

Osteoarthritis is also known as degenerative arthritis, because the cartilage that protects the bone gradually gets worn away (or degenerates). If the cartilage wears away completely then the ends of the bones can end up rubbing together, which can be extremely painful.

At one stage, scientists believed that osteoarthritis was a natural (and inevitable) consequence of getting older, but we now know this to be untrue. The real story is probably much more complicated. Although it is true that the older you get, the more worn out your joints become, not everyone of a certain age automatically develops arthritis. It is more likely that osteoarthritis can be put down to changes taking place in the miscroscopic structure of the joints. These changes may start with the cells that make cartilage. The changes that go on in your joint(s) if you have osteoarthritis usually happen in a certain order.

  • The cartilage in the joint roughens and becomes worn down (and may disappear altogether).
  • Tiny cracks may start to appear in the cartilage.
  • Extra bone is laid down to replace the damaged or lost cartilage. The bone underneath the cartilage thickens and grows outwards.
  • The amount of bone laid down far exceeds the quantity that is actually needed to replace the damage cartilage.
  • Bony outgrowths (called osteophytes) start to form along the damaged joint.
  • Fragments of bone may break off into the joint, which cause the joint to become inflamed and swollen (and painful_.
  • The synovium starts to produce more synovial fluid than usual, which adds to the swelling in the joint.
  • The loss of cartilage, the wearing of bone and the bony outgrowths can all start to change the shape of the joint. This forces the bones out of their normal position and causes deformities.

Rheumatoid Arthritis

A case of mistaken identity

Rheumatoid arthritis can be traced back to a malfunction in the immune system. The body produces antibodies that attach the cells of the joint lining (the synovium) because it mistakes it for a foreign invader, making it painful, unstable and deformed.

At the moment, no-one knows exactly what causes them but the more we understand autoimmune diseases, the easier they will be to treat and even prevent. At the moment, however, there are some gaps in what we know.

The immune response

So what are antibodies and what do they do? Antibodies are made by white blood cells called B-lymphocytes. They can be thought as Y-shaped structures, with a special region at the tip that recognises and attaches to specific foreign substances, called antigens. Once it has bound to  the antibody, the antigen is neutralised so that it is no longer harmful. This process is known as immune response.

Of course, if the immune response is triggered inappropriately, perfectly healthy and harmless cells may become damaged. This is what happens in the joints when autoantibodies are made in people with rheumatoid arthritis.

Our blood is made up of three types of cell: white blood cells, red blood cells (which help to form blood clots). White blood cells are a key part of the body’s defence mechanism against infection.

How does autoimmunity cause inflammation and pain?

Rheumatoid arthritis usually progresses in three distinct stages:

  1. The synovium swells up and becomes inflamed as so-called inflammatory cells in the blood (specialised cells that are responsible for controlling inflammation) flock to the place where they are needed (i.e. the joint). This causes pain, warmth, redness and stiffness.
  2. The inflammatory cells in the synovium grow very rapidly, which causes the synovium to thicken and swell together.
  3. The inflamed cells then start to break down the bone and cartilage of the joint, often causing the joint to lose its shape and become unstable to move as it once did.

Call +65 6471 2674 (24 Hour) to make an appointment with our doctor to treat arthritis today.

If you have arthritis, or are caring for someone with the condition, you are certainly not alone. Arthritis is the single biggest cause of physical disability in Singapore.

How Common is Arthritis?

The answer is ‘very common indeed’. Of the two major types of arthritis (osteo- and rheumatoid arthritis), osteoarthritis is by far the most common.

  • Osteoarthritis is more common in people over the age of 60 and as the population of the UK gets older, the number of people who suffer from osteoarthritis will also increase.
  • In contrast, rheumatoid arthritis can affect people of any age, and is usually first picked between your 30s and 50s. About one in every hundred people is affected by rheumatoid arthritis, with women up to three times more likely to suffer than men.

Osteoarthritis is much more common than rheumatoid arthritis and tends to affect older people.

How did I end up with Osteoarthritis?

In the past, osteoarthritis was wrongly considered to be an unavoidable consequence of wear and tear on the joints. We no know that joints don’t just wear out with age, so if you do develop osteoarthritis, it can usually be traced back to at least one (and possibly a few) of the causes listed below.

Arthritis

Growing older

The chances of getting osteoarthritis seem to increase with age.

Being overweight

Carrying extra weight can put joints (especially the knees and hips) under unnecessary stress and can damage them, leading to osteoarthritis.

Injury

Sustaining an injury to a joint (like a fracture) can make you more likely to develop osteoarthritis in the future. Some professional athletes can injure the same joints over and over again.

Your occupation

Performing certain tasks on a regular basis can put your joints under strain. Farmers often develop osteoarthritis in their hips and people who operate machinery like pneumatic drills can develop arthritis in their hands or elbows.

Damage from another joint disease

Suffering from a joint-damaging disease like rheumatoid arthritis can make you more likely to develop osteoarthritis in later years.

Your family history

Some forms of osteoarthritis do run in families, especially those cases that affect the small joints of fingers. But in general, heredity is not a major reason for developing osteoarthritis.

Rheumatoid Arthritis Hand

Your gender

In most joints, especially the knees and hands, osteoarthritis is more common and severe in women.

Your anatomy

Being born with abnormal anatomy (like having one leg slightly longer than the other) can make you more susceptible to developing osteoarthritis. This is called a congenital abnormality, because you are born with it.

How did I end up with Rheumatoid Arthritis?

Unlike osteoarthritis, if you develop rheumatoid arthritis in all probability there would have been very little you could have done to prevent it. In many cases the actual cause of rheumatoid arthritis is unknown. Scientists simply do not know enough about the condition to point the finger at any one particular factor, but some of those listed below may contribute.

Genetic factor

We have seen that rheumatoid arthritis is an autoimmune disease that occurs when the body’s own immune system starts attacking the tissues of the body’s own joints. Our genetic make-up is determined before we are born, and with it, our susceptibility to developing rheumatoid arthritis.

Infection

Some scientists believe that it is possible that being exposed to or infected with a particular bacteria or a virus could trigger the autoimmune response and ultimately lead to rheumatoid arthritis (although nobody has been able to show exactly what this infecting agent is).

Hormones

Rheumatoid arthritis is more common in women that in men, and this may be linked to different levels of different hormones. Furthermore, the disease can go into remission during pregnancy, only to relapse afterwards. There is also some evidence that those women who take the contracetive pill are at less risk of developing rheumatoid arthritis.

Call +65 6471 2674 (24 Hour) to make an appointment to see our doctor regarding arthritis today.

Arthritis is the name given to diseases that bring about pain in our joints. Diseases that affect our joints also govern how mobile we are and therefore how independent we are. Managing arthritis effectively is all about controlling pain and stiffness and staying as active as possible.

What is Arthritis and Why is it a Problem?

Arthritis is a collection of distinct diseases that all cause pain in the joints. It is usually accompanied by swelling and sometimes changes in the structure of the joint.

People who have arthritis often have trouble moving and experience some loss of function (for example, trouble with fastening clothing or performing simple household chores or other everyday tasks). This has a number of knock-on effects, to the extent that (if it is not managed properly) arthritis can end up compromising your:

  • Moblity
  • Independence
  • Self-confidence
  • Sense of well-being
  • Family life

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis and rheumatoid arthritis are the two most common types of arthritis.

Osteoarthritis

Occurs when the cushioning of the joint (from the cartilage and synovial fluid) starts to wear down and disappear. The two bones of the joint start to rub together when the joint moves, which can be very painful.

Knee Osteoarthritis

Rheumatoid Arthritis

Occurs when the joint as a whole becomes inflamed and swollen as a result of underlying autoimmune disease.

People with rheumatoid arthritis can often end up developing osteoarthritis eventually, because once a joint has been damaged (e.g. by rheumatoid arthritis) it becomes more susceptible to developing what is known as ‘secondary osteoarthritis‘.

Rheumatoid Arthritis to the Fingers

Rheumatoid Arthritis is an Autoimmune Disease

Our immune system protects us from foreign invaders (such as bacteria and viruses) by destroying them with specially tailored substances called antibodies.

Under normal circumstances our immune system helps to protect us against infection and without it we would not survive. However, if you have an autoimmune disease, your body mistakes healthy cells, organs, or tissues in the body for foreign invaders and starts attacking them.

If you have rheumatoid arthritis, your immune system mistakes one or more of your joints for a foreign invader and attacks it. This causes inflammation, and it is the inflammation that damages the joint and brings about the symptoms of arthritis.

What’s the Difference Between Osteoarthritis and Rheumatoid Arthritis?

Although they share a name and have many symptoms in common, osteoarthritis and rheumatoid arthritis are in fact very different diseases.

  • They are caused by different things. Although both conditions involve the breakdoen of cartilage in the joint, osteoarthritis is largely due to age-related changes in which the cartilage becomes thinner in some joints, whereas rheumatoid arthritis is related to a problem with the body’s own immune system.
  • They affect people of different ages. Osteoarthritis tends to affect people as they get older and rarely occurs before the age of 40, but rheumatoid arthritis can occur at any age (and usually tends to affect people between the ages of 30 and 50 but can sometimes even start during childhood).
  • They can affect different joints. Osteoarthritis mostly affects the weight-bearing joints (like the knees and the hips) whilst rheumatoid arthritis tends to affect the smaller joints (such as those in the hands, wrist or elbows). Rheumatoid arthritis is a symmetrical disease. This means that if one wrist is affected then it is likely that the other one will be too, but this is not always the case in osteoarthritis.
  • They develop at different rates. Whilst osteoarthritis can take many years to develop, rheumatoid arthritis can come on over a period of months.
  • They look different in X-rays. Bones affected by osteoarthritis cans how bony lumps and other deformities, whereas bones affected by rheumatoid arthritis can look thin and the joints may show signs of damage (‘erosions’) due to the inflammation.

The Symptoms of Osteoarthritis

The major symptoms of osteoarthritis are:

  • Pain (that gets worse after exercising or towards the end of the day)
  • Stiffness (that is usually worse in the mornings and after long periods of sitting down).

They symptoms of osteoarthritis usually come on gradually and you may only end up noticing them at certain times of the day (e.g. in the morning when you first get up) or after doing certain activities (e.g. weight-bearing exercises like walking or jogging). You may start to notice that your joints aren’t as flexible as they used to be and that your range of movement is impaired (i.e. you can’t straighten your leg out in front of you as far as you used to be able to). Performing certain activities like bending down, kneeling, gardening or climbing stairs may also start to become more difficult.

As osteoarthritis becomes more advanced, you may start to notice other symptoms like:

  • muscle weakness
  • swelling around the joints
  • a crunching feeling in the joints
  • pain during the night that keeps you awake
  • changes in the the outward appearance of the joint, for example they may start to look knobbly.

Deformed Knees due to Osteoarthritis

Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis tends to follow a different course in different people and symptoms can even vary from one day to the next. Given the right treatment, the symptoms of rheumatoid arthritis can disappear altogether, but this is not always the case and some people’s symptoms will continue to get steadily worse, even when they are receviing treatment.

Rheumatoid arthritis can affect any synovial joint (but tends to affect the smaller joints like the wrists, elbows and fingers) and interestingly enough, is usually symmetrical (if one wrist is affected, it is more likely that the other one will be too).

In contrast to osteoarthritis, the symptoms of rheumatoid arthritis can affect the whole body rather than just the joint in question. The main symptoms of rheumatoid arthritis are:

  • pain
  • stiffness
  • swelling around the joints
  • warmness and redness around the joints
  • lumps under the skin (called rheumatoid nodules)
  • tiredness
  • loss of appetite

Diagnosis Arthritis

Depending on the type of arthritis, your symptoms can develop over a matter of weeks or it may take many months before they start to bother you to the extent that you go and see your doctor for advice. If you suspect that you may have a form of arthritis, it is important that you seek medical advice as soon as you can.

Managing Arthritis

If your arthritis is causing you pain, your doctor may suggest some pain management strategies. These may include:

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There are different types of cartilage found in the body and each is adapted to its specific function. In the knee, two different types of cartilage function side-by-side.

The knee is no different from most other joints in that it is lined by hyaline cartilage. This cartilage serves to provide a smooth gliding surface for joint motion, and is called articular cartilage. Articular cartilage does not have a blood supply and as such, it has poor intrinsic ability for healing and regeneration. Thus, injuries to articular cartilage, especially in the knee, are a significant cause of pain and disability.

Knee Structure

The meniscus is a piece of “C” shaped cartilage. It is tough and rubbery and made up of fibrocartilage. There are two menisci in each knee and they have multiple functions. First, they act as shock absorbers to lower the stress transmitted to articular cartilage. They also help to evenly distribute forces acting through the knee joint and help the ligaments with joint stability. Menisci derive their blood supply from blood vessels that enter them from the periphery. The central area of the meniscus is devoid of blood supply and has poor healing potential, unlike the peripheral zone.

Meniscus Injuries

Knee Meniscus Tear

Meniscus tears can be a result of injury (traumatic tear) or associated with routine wear and tear and early arthritis (degenerate tear).

Traumatic tears of the meniscus often result from twisting injuries of the knee sustained during sport. It is often seen in association with knee ligament injuries but also can also exist in isolation. With a meniscus tear of this nature, there is a precipitating incident followed by pain and knee swelling. The swelling often subsides, leaving residual knee pain and, depending on the configuration of the meniscus, the knee can also experience locking episodes where there is a block to normal range of motion because the torn fragment of the meniscus is trapped within the joint. Occasionally, a torn meniscus can result in a locked knee from the outset (at the point of injury).

In a degenerative meniscus tear, the precipitating incident can be very minor. The tear results because the meniscus is already degenerated and fragile so does not require a significant force to tear. Due to the relatively low forces involved, concurrent ligament injuries are uncommon. Symptoms are similar to that of a traumatic meniscus tear.

In the assessment of a suspected meniscus tear, your doctor will perform a physical examination after obtaining a history of the injury. A MRI scan may also be performed to visualise the internal structure of the knee and to confirm the meniscus tear as well as to study the tear configuration.

Types of Meniscus Tear

Initial treatment of symptoms is with rest, ice and anti-inflammatory medications. Surgery may be required in some cases. The decision whether surgery is needed largely depends on extent of symptoms, configuration and location of the tear.

Blood Supply Zones of the Meniscus

In order to understand the rationale behind how meniscus tears are managed, it is important to know how the meniscus is supplied with blood. Blood supply is critical for healing as blood brings with it healing cells and healing factors. Blood vessels enter each meniscus from the periphery and as a consequence, the meniscus has a good blood supply in the peripheral zone (red zone). A tear in this zone has a fairly good chance of healing. More centrally, the meniscus has a progressively poorer healing potential due to diminishing blood supply. As a consequence, a tear in the red-white zone has a fair potential for healing while a tear involving the white zone will not heal.

Based on the different configurations of a meniscus tear and taking into account the blood supply, some tears do well with repairs while others have to have the torn portion trimmed off. An example of a tear which can be repaired is a bucket handle tear through the red zone. Parrot beak tears, radial tears and complex tears are not repairable.

“Whether the meniscus is to be trimmed or repaired, surgery is performed arthroscopically (keyhole surgery).”

Articular Cartilage Injuries

Articular cartilage injuries can be localised or generalised. Localised damage is usually related to injury while generalised cartilage damage is related to arthritis.

A patient with significant damage to articular cartilage would, most commonly, have recurrent knee pain and swelling. Occasionally, cartilage flaps or loose pieces of cartilage can cause locking symptoms.

Similar to meniscus injuries, localised articular cartilage injuries can be confirmed with a MRI scan. More advanced generalised cartilage loss (as seen in arthritis) can be diagnosed with a simple X-ray.

The initial treatment for either localised or generalised cartilage injuries is rest and anti-inflammatory medications.

Failing non-operative treatment for localised cartilage injuries, operative strategies may need to be employed. One option is stimulating cartilage growth by removing damaged cartilage and creating bleeding points from the underlying bone either by drilling or punching holes in the bone (microfracture). Another option is covering the damaged area with cartilage plugs harvested from other parts of the knee (mosaicplasty) or with cartilage cells grown in a lab (autologous chondrocyte implantation). The choice of procedure is determined primarily by the size of the damaged area and associated damage to the underlying bone.

“For generalised cartilage damage, if simple measures fail, options include joint injections and replacement surgery.”

Conclusion

Cartilage injuries of the knee are common. They cause significant pain and disability. Do consult your doctor if your knee pain does not resolve with rest and anti-inflammatory medications. It is usually easier to deal with these injuries earlier rather than later.

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Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. Some people have spines that also curve slightly inward. Some people have spines that also curve from side to side. Unlike poor posture, these curves cannot be corrected simply by learning to stand straight.

This condition of side-to-side spinal curves is called a scoliosis. On an X-ray, the spine of an individual with scoliosis looks more like an “S” or a “C” than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.

Curved Spine

Who gets a Crooked Back?

Scoliosis affects approximately 2% of the population. If someone in a family has scoliosis, however, the likelihood of an incidence is much higher approximately 20%. If anyone in your family has curvature of the spine, you should be examined for scoliosis.

Scolioisis in Children

Most scoliosis is “idiopathic,” meaning its cause is unknown. It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys. Although scoliosis can occur in children with cerebral palsy, muscular dystrophy, spina bifida, and other miscellaneous conditions, most scoliosis is found in otherwise healthy youngsters.

Scolioisis in Adults

Scoliosis usually develops during childhood, but it also can occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, and was not diagnosed or treated while the person was still growing. What could have started out as a slight or moderate curve may have progressed in the absence of treatment.

Adult Scoliosis

Adult scoliosis can also be caused by the degenerative changes of the spine. Other spinal deformities such as kyphosis or round back are associated with the common problem of osteporosis (bone softening), As more people in Singapore reach the age of 65 years or older, the incidence of scoliosis and kyphosis is expected to increase. A sudden fall in an older person can result in a spine fracture causing sudden kyphosis. This may require urgent treatment using small needles to introduce a medication to repair the spine fracture. This can be done without open surgery as a day procedure.

If allowed to progress, severe instances of adult scoliosis can lead to chronic severe back pain, deformity, and difficulty in breathing. This may require spine surgery to correct and to prevent nerve damage.

The Importance of Early Detection – Tips for Parents

“Idiopathic scoliosis can go unnoticed in a child because it is rarely painful in the formative years.”

Therefore, parents should watch for the following warning signs of scoliosis when their child is about eight years of age:

  • Uneven shoulders
  • Prominent shoulder blade or shoulder blades
  • Uneven waist
  • Elevated hips
  • Leaning to one side

Any one of these signs warrants an examination by an orthopaedic specialist.

Some schools sponsor scoliosis screenings. Although only a physician can accurately diagnose scoliosis, school screenings can help alert parents to the presence of the warning signs in their child.

Treatment for Scoliosis

In planning treatment for each child, an orthopaedic expert will carefully consider a variety of factors, including the history of scoliosis in the family, the age of the child when the curve began, and the location and severity of the curve.

Most spine curves in children with scoliosis will  remain small and need only be periodically assessed for any sign of progression. If a curve does progress, physiotherapy can be done to prevent it from getting worse.

If a scoliotic curve is severe when it is first seen, surgery may be necessary. In this instance, surgery has been found to be highly effective and safe treatment for scoliosis and massage therapy or manipulations has not been shown to be effective.

Summary

Scoliosis is a common problem that usually requires only observation with repeated examination in the growing years. Early detection is important to make sure the curve does not progress. In the relatively small number of patients who require medical intervention, advances in modern spine techniques have made scoliosis a highly manageable condition.

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