'MAJORITY OF OLD PEOPLE WILL DEVELOP ARTHRITIS'
There are many myths surrounding arthritis disease. In this interview with Winifred Ogbebo, a consultant orthopaedic surgeon, Dr Christopher Uyimwen Otabor, sheds more light on the symptoms of arthritis and the class of people who suffer it the most.
What is arthritis?
Arthritis is a Greek word that is derived from two different words- the first is arthro which means joint; the second is athris which means inflammation. So arthritis simply refers to the inflammation of the joint. Almost any joint in the body can be affected. There are different types of arthritis. It can be classified depending on the pathology or the symptomathology. We have osteo-arthritis, which is actually the commonest form of arthritis. We have rheumatoid-arthritis, septic-arthritis and goiter-arthritis. There are several types of arthritis but these are the commonest ones. By far, the commonest type of arthritis is the osteo-arthritis which is the inflammation of the sinovia joint. A sinovia joint is the juncture of two or more bones and that juncture is covered by a sinovia membrane and the sinovia membrane is like a bag that contains sinovia fluid. That fluid helps to lubricate the joint. So if there is inflammation of that part of joint, it's called osteo-arthritis. Apart from that, we have rheumatoid arthritis which is what we call an auto immune disease. It is a situation in which the body now sees itself as a foreign body. Normally, the body has a defence mechanism that helps to fight foreign invasion; that helps to fight germs and anything that is foreign to the body but for one reason or the other, those defence mechanisms start attacking the body cells as though they are foreign and that leads to inflammation. That is the cause of rheumatoid arthritis.
We also have septic arthritis which is inflammation of a joint by reason of infection. The bacteria or virus or fungi in the joint state has been multiplied. It produces toxic materials and they invade the joint tissue and they lead to pain, swelling, and loss of function, as the case may be. So these are the most common types of arthritis that are prevalent in this environment. In the western world, there is soyatic arthritis and other forms of arthritis, like goiter which is becoming common here now because our lifestyle in Nigeria is mirroring that of the western world. Goitre arthritis means accumulation of uric acid within the joint and this leads to pain, swelling, redness and loss of function of the joint. There is another emerging type of arthritis now called tuberculosis arthritis. It's under infectious arthritis. It's tuberculosis of the joint which present as arthritis. The joint is damaged.
What is the spread and incidence of arthritis in Nigeria?
Arthritis by and large is commoner in older people especially osteo-arthritis, a disease that results from a breach in the normal integrity of the joint. It can result from old age because as we grow older, there is wear and tear of the joints. Our joints are like machines. As we grow older, the tendency is that we have used the joint for a longer period of time and over time, there is a gradual wearing away of the cartilage that covers the joint and that can lead to arthritis. So age is one of the strongest factors in the emergence of osteo-arthritis. Another common cause of osteo-arthritis is trauma to the joint. If a joint has been traumatized either from a fall or from a road traffic accident or for whatever reason a joint was involved in an injury; the injury may have been treated but arthritis tend to result after some three, four years and above. So those that have been traumatized have a very high tendency to end up with arthritis.
We also have infection. If a joint was infested and treated but not properly treated, that joint stands the risk of developing osteo-arthritis in future. Those are the commonest causes of osteo- arthritis. Another important cause is weight. Arthritis generally is commoner in women than in men. We are not sure exactly why but we know that women tend to have more weight compared to their height than men; that is the body mass index. So that may be a factor in their predisposition to osteo-arthritis. There was a study done in America that shows that about 70 per cent of women over 65 years old have osteo- arthritis. So women have a higher predisposition to osteo-arthritis. Weight is one of the causes. It's been found that when women lose weight, the symptoms of arthritis also abate. It is also commoner in the old people compared to the young people.
Do the young people have it at all?
Yes they do if they are involved in an accident and maybe the accident is not properly treated or the young has infection in the joint and it's not properly treated. Both situations can predispose the young person to arthritis but for rheumatoid arthritis, it is commoner in middle age especially as from the age of 40 unlike the osteo-arthritis that is commoner in the elderly.
Septic arthritis, which occurs as a result of infection not properly treated, can occur at early age, right from infancy to old age.
We don't really have statistics about arthritis in our environment but it is very common. Apart from low back pain, it's probably the most common second cause of presentation of adults in the orthopaedic clinic. It has a huge burden on our healthcare. The majority of elderly people will end up having arthritis. As one gets older, there is wear and tear and it leads to arthritis.
What are the signs and symptoms of arthritis?
The commonest symptom that brings patients to hospital when they have arthritis is pain. Initially the pain starts as mild and it progresses to become severe as the disease advances. Also, patients can also present with stiffness of the joints. It's difficult to move the joints through all the range of motion depending also on the type of arthritis. In osteo-arthritis, which I said is the commonest and is also commoner in the more elderly women. The pain of osteo-arthritis increases as the day progresses but the pain of rheumatoid arthritis reduces as the day progresses. So it's vice versa. That's the differentiation between osteo-arthritis and rheumatoid arthritis. Another symptom of arthritis apart from pain is stiffness, then deformity. Sometimes you find people who have knocked knee, what we call genuvalgum or bow legs, which is genuvaltum. Many of those people with such deformity, especially in elderly people are suffering from arthritis.
Other symptoms of arthritis will depend on other circumstances of the disease and the other causes of the diseases. By and large, pain, stiffness, deformity and loss of function are very important. The patient may not be able to walk as he used to. So with these five symptoms, namely pains, stiffness, swelling, deformity and loss of function, you're almost sure of making the diagnosis of arthritis, coupled with investigation. The investigation involves blood investigation like full blood count, erythrocyte segmentation rate (ESR), x-ray and other investigations that will help clinch the suspected cause of the arthritis. For infectious arthritis like septic arthritis, we may want to do blood culture to be able to get the bacteria that is causing it and fluid from the joint for the test. X-ray is very important for osteo-arthritis and rheumatoid arthritis. You can also diagnose goitre arthritis.
How do you treat arthritis?
It is a multidisciplinary approach. No one particular person has all the answers to treatment of arthritis because it is a huge medical burden. In the early stage of arthritis, the physiotherapist has a huge role to play. The physiotherapists help in strengthening the muscles around the joints and help to put the joint through a wide range of exercise and that helps to reduce the stiffness and the pain.
Medication is important. Sometimes the pain gets so bad that you have to reduce it by means of painkillers and you can start with the common paracetamol, but if the pain gets worse then anti- inflammatory drug is used. But that also has its own side effect. We've treated a lot of patients with osteo-arthritis and they ended up with stomach ulcer and peptic ulcer because those non- anti inflammatory drugs have side effect like peptic ulcer disease. So you have to be under the care of a doctor who will put you through the treatment because the drugs are like a double- edged sword. Apart from ulcer, it can also damage the kidney if it's used for a long time. Don't forget, osteo-arthritis is a disease that stays for a long period of time. So you need to discuss treatment with an orthopaedic surgeon who will guide you on what to do, it's not just enough to buy drugs and keep taking.
For rheumatoid arthritis, some other medications have been designed. Medications that help reduce the inflammation, the tendency for the body to attack itself.
For very advanced cases of arthritis where the joint has been deformed and the patient is not able to work, and the lifestyle has been affected terribly, surgery has a role to play. There are some surgeries that are done on the bone to realign the position of the bone when the deformity is so much. There are some situations in which the joint is badly damaged and you just have to do a joint replacement surgery. We do total hip replacement for hip arthritis. We do knee replacement for knee arthritis, shoulder replacement for shoulder arthritis and elbow replacement for elbow arthritis.
For women who have excess weight, weight loss is recommended. If you lose weight significantly, the symptoms of arthritis drastically reduce.
How do we prevent arthritis at old age?
Yes. The way you use your body now always tells on us in life in future. So it's good to eat healthy, maintain healthy lifestyle, avoid alcohol, and smoking. Regular exercise helps to strengthen the bones and muscles. Then avoid over exertion. Accidents are not avoidable but avoid traumatic events. If you have any problem, present early to the hospital so that the doctor can quickly arrest it because some of the things that lead to arthritis are things that are not adequately catered for. For example, somebody had an accident and instead of going to see the doctor, he goes to the traditional bone setter and by the time he's leaving that place, he's already primed for arthritis.There are also some situations one cannot help. They just come.