1. What is a ‘joint’?
A joint is a structure where bones and bones meet, allowing movement of various parts of the body, such as arms and legs. Some joints can only bend and unfold like elbows or knees, and others can move in different directions, such as shoulders and high joints.
The articular bone ends are covered with smooth cartilage. A very thin membrane called the synovial membrane surrounds it, and there is a very strong joint bag outside the synovial membrane. The synovial membrane secretes a slippery liquid called synovial fluid, which allows the joints to move smoothly. The muscles around the joints are connected to the bones by tendons, providing the power to move the joints, and the ligaments connect between the bones, allowing joint tissue to move as a mass.
2. What is ‘arthritis’?
I usually doubt if my limbs are sore that I have arthritis, but not all of my sore limbs are arthritis. Arthritis is a disease in which the synovial membrane surrounding the joint becomes inflamed or cartilage is damaged. Symptoms include joint pain and stiffness. Secondly, when the joint weakens and deformation occurs, the joint may rattle. This will make everyday life difficult, such as walking, climbing stairs, brushing teeth.
Also, I think arthritis is a disease that develops with age, but arthritis can occur at any age, and there are more than 100 types of arthritis. In some arthritis patients, in addition to joint symptoms, other organs in our body can also be affected, causing disease in the heart, lungs, kidneys, blood vessels, and skin.
3. What types of arthritis exist?
It is said that there are more than 100 diseases that cause arthritis, but only arthritis, which is common among them, is discussed here.
1) Osteoarthritis: This is the most common arthritis and increases with age.
Osteoarthritis is a condition in which cartilage at the end of the bone wears off and is the most common joint disease. It is also called degenerative arthritis because it increases with age. Generally, degenerative changes in the joints begin at age 40, and about 60% of people develop degenerative arthritis symptoms at age 60.
The exact cause of osteoarthritis is unknown, but old age, genetic and environmental factors work. Cartilage elasticity is lost and destroyed by various causes, and inflammation is caused by fragments of cartilage that have fallen off. If this process lasts for a long time, eventually the cartilage wears out and the bones are exposed, making joint movement difficult. In addition, a bone proliferation protrusion grows on the edge of the bone, and the joint protrudes and deforms. Osteoarthritis is particularly common on the finger joints, spine, and knee joints.
The main symptom of osteoarthritis is pain, which is exacerbated by the patient’s joint movements and improves when resting. When I wake up in the morning, my fists don’t hold well and there’s a stiff symptom, but unlike rheumatoid arthritis, it doesn’t last long and releases within 30 minutes. In the case of finger joints, the pain increases as the bones pop out gradually. In the case of the knee, it is difficult to climb up and down the stairs at first, but as the symptoms progress, the flat road becomes difficult to walk, and the legs may bend in an “O” shape.
Osteoarthritis symptoms and physical examination alone can be diagnosed, and a radiograph is done to see the progress of arthritis.
2) Rheumatoid arthritis: characterized by inflammation of the synovial membrane surrounding the joint
Rheumatoid arthritis is characterized by “inflammation” of the synovial membrane. Rheumatoid arthritis usually occurs in people in their 30s and 40s, and the ratio of women to men is 3 to 1. Rheumatoid arthritis is a typical disease of autoimmune disease, and the patient’s inflammatory cells attack the joint.
When rheumatoid arthritis develops, it is accompanied by fatigue, and the joint feels stiff in the morning. Mainly, the small joints of the hands and feet are well invaded, and the affected joints have a fever, swelling, and painful joint movement. Rheumatoid arthritis lasts for many years and invades several joints such as fingers, wrists, and elbows, eventually causing damage to the cartilage, bones, tendons, ligaments, etc. Rheumatoid arthritis is characterized by symmetrical involvement of the left and right joints. If the rheumatoid arthritis is severe, the appetite disappears, the body weight decreases, the fever and the whole body are sore, sore without pain, and there is no aura. In some patients, rheumatoid nodules appear, and sometimes the membranes surrounding the heart or lungs and the lungs themselves become inflamed. In addition, in some patients, the salivary glands and tear glands are inflamed, resulting in dry mouth and stiff eyes.
In the diagnosis of rheumatoid arthritis, symptoms and examination are the most important, and blood tests and radiographs may be needed. Blood tests often reveal anemia and rheumatoid factors, but rheumatoid factors can be positive even in healthy people or with other conditions. In some patients with rheumatoid arthritis, rheumatoid factor may be negative.
3) Ankylosing spondylitis: A young man may have back pain.
Ankylosing spondylitis is a joint disease that mainly affects the spine, causing inflammation in the joints or ligaments used to move and bend the lower back. Inflammation causes pain and stiffness, which usually begins in the lower back and can progress to the back, chest, and neck. Unlike other causes of low back pain, the pain is better when the patient is resting and when he is moving or exercising. Later, the joints and spine stick together, making the spine stiff and unable to bend. Other joints such as high joints, shoulders, knees, and ankles can also become inflamed.
The cause of ankylosing spondylitis is still unknown. However, with some genetic impact, the gene HLA-B27 appears in 90% of patients with ankylosing spondylitis. However, not all people with an HLA-B27 gene develop ankylosing spondylitis. Ankylosing spondylitis is common in young men aged 16-35. In women, it is relatively rare and the symptoms are not so severe that diagnosis is often difficult.
Generally, ankylosing spondylitis is diagnosed by symptoms and X-rays. In some cases, ankylosing spondylitis is known as a very severe disease in which the body hardens without treatment, but this is different from the fact, and pain and stiffness are controlled by early diagnosis and proper treatment. It can reduce the strain caused by ankylosing spondylitis and prevent it to some extent.
4) Gout: Arthritis caused by uric acid common in middle-aged men
Gout is a disease in which severe pain occurs when the joint suddenly swells. Gout is caused by uric acid, which is made from a substance called purine that comes out when the cells of our body die. People with gout have too much uric acid in their blood, which accumulates in joints or tissues, and this uric acid crystal causes inflammation in the joints. This disease usually involves only one joint at a time, but the joints of the big toe are often affected. However, the joints of the knee, ankle, instep, hand, wrist, and elbow may be affected. Gout can occur at any age, but usually the first seizures occur well in men between the ages of 40 and 50.
Gout is divided into three stages: (1) acute gouty arthritis, (2) no symptoms between acute gout attacks, and (3) chronic gout.
Gout is not a curable disease, but it is a highly regulated disease as a drug. Therefore, if the patient is properly treated, acute attacks of gout or subsequent joint damage can be prevented. Occasionally, a healthy person suspects gout due to an increased uric acid level at the screening, but even if the uric acid level is increased on a blood test, it is not gout. This is called “asymptomatic hyperuricemia,” and even if the uric acid level is increased, only about 20% of people develop gout. Therefore, no treatment is required in this case.
5) Recurrent rheumatism or recurrent arthritis: a disease where joints become inflamed occasionally
Recurrent rheumatism is an intermittent inflammation of the joints or joints. This disease is a relatively common disease, but it is not well known to people. It occurs similarly to men and women, and the symptoms suddenly swell and redden around one joint or joint without other symptoms, and the inflammation improves within hours or two days without treatment. If there are no symptoms, nothing goes wrong. Symptoms are repeated in about half of patients, and in about one third of patients, they may progress to rheumatoid arthritis.
Arthritis or joint pain also occurs when a patient has systemic rheumatic disease, such as systemic lupus erythematosus. Arthritis can occur intermittently even in Behcet’s disease.
4. A disease with symptoms similar to arthritis
Among the patients who visit the hospital, there are some cases of arthritis because of a sore joint around the joint, and in fact, patients with other diseases are not arthritis. Here, I would like to introduce these diseases.
1) Fibromyalgia: Patients who are sick all over the body for no particular reason.
Fibromyalgia is a disease that makes the body sick and tired. It is a disease that is still confusing and misunderstood, as the cause of the disease is unknown and the same symptoms are common in other diseases. Sometimes people with fibromyalgia think they have arthritis, but the actual fibromyalgia is not arthritis and is considered a rheumatism of soft tissue. “Rheumatism” refers to the pain and stiffness associated with arthritis, diseases of the joints, muscles, and bones. The fibromyalgia becomes sensitive to the peripheral nerves, causing symptoms that cause pain even with mild irritation. Fibromyalgia is a more common disease than expected, occurring 7 to 10 times better in women than in men, and more likely in women of gestational age.
Pain is the most important symptom of fibromyalgia. It starts at the neck or shoulders at first, but over time, the body spreads throughout the body and becomes sick. Some patients complain of extreme pain. If the doctor does a physical examination, most of them appear to be fine, but a closer examination reveals a very tender pain spot in a special spot. This tenderness is characteristic of fibromyalgia. Nine out of every 10 patients with fibromyalgia have no energy, are very tired and complain of reduced endurance, lack of sleep, aura, and exhausted feeling. Sometimes tiredness is more difficult than pain. In general, I feel tired from the morning despite sleeping all night. They also do not sleep deeply and sometimes wake up on the way. According to scholars, patients with fibromyalgia have abnormal sleep patterns, especially during sleep.
Fibromyalgia can interfere with the daily life of patients with this disease, so an accurate diagnosis and understanding of the disease is very important. With proper treatment, most patients can improve their symptoms and cope with the disease. In the future, it is thought that better treatments and preventive measures will be developed if the causes and exacerbations of the disease are identified.
2) Climacteric disorder: joints are stiff and painful before and after menopause
Women get menopause as they get older. A few years before menopause comes, the face is burning and the heart is beating. In addition, the joints become stiff and joint pain appears. However, it is not real arthritis, it is just pain. The severity of these symptoms varies depending on the race and country.
3) Pain caused by excessive joint use
Even if a healthy person uses too many joints, pain appears. Repeated damage can damage the muscles, tendons, and nerves in the arms and legs. In severe cases, refraining from using joints improves symptoms. In severe cases, tendonitis, fasciitis, bursitis, and carpal tunnel syndrome occur.
If the wrist is used excessively, the pain may appear in the elbow rather than the wrist. Depending on the wrist posture that a person takes a lot, the inside or outside bone of the elbow hurts and the outside bone is called a tennis elbow. This reduces wrist use and sometimes requires physical therapy or injections.
Trigger finger refers to the tendency of the tendon to bend the finger when the finger is used a lot, and contracts to the thin film surrounding the tendon so that the finger does not move freely. In this case, the fingers are “sticky,” bent or stretched, and pain appears. When the doctor touches it, there is a painful palm in the palm of his hand. If these symptoms occur simultaneously on the patient’s multiple finger tendons, it is very difficult to use the hands and the pain is severe. However, treatment is relatively easy with topical injections or simple surgery.