ARTHRITIS

What is Arthritis

There are various forms of arthritis but the three most common are osteoarthritis, traumatic arthritis and rheumatoid arthritis. Less common forms include arthritis secondary to gout, psoriasis and systemic lupus erythematosus

What does someone with arthritis complain of?

This will depend on the form of arthritis. But pain, swelling, stiffness and deformities are common. Pain is made worse by movement and relieved by rest. However affected joints may have surprisingly little or no pain associated with movement. The type is often readily obvious during the consultation from the history and appearance of the hand. In other cases some blood investigations enable diagnosis.

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Osteoarthritis refers to the process of degeneration of the cartilaginous joint surfaces and hypertrophy (increase of prominence) of bone at the articular margins. It is also referred to as degenerative joint disease. 

The cause is unknown.

Surprisingly there may not be much inflammation when compared to the other common form of arthritis (rheumatoid arthritis)

This is common in females and there is often a family history of similar condition of the fingers.

As the normal ‘wear and tear’ with daily use gets worse with increasing age, this form of arthritis presents more in older patients. The distal or furthest joint in the finger and the base of the thumb are the most commonly affected.

Traumatic arthritis is very similar to osteoarthritis except that there is a history of a preceding injury specifically to the involved joint (s).

Rheumatoid arthritis is a systemic autoimmune (body fighting itself) disease of unknown cause. It is marked by painful, inflammatory reaction with destruction of the joint. It causes significant deformities of the hands. Younger patients (20 to 40 years) are predominantly affected.

It is more common in females. Many other important and inner structures such as the tendons, heart and lungs can also be affected

How is it treated?

The treatment varies with type. This usually involve a combination of non surgical and surgical methods.

Non surgical methods include rest, splintage, physiotherapy, analgesics and various medications depending on type (non steroidal anti-inflammatory agents, intra-articular steroid injections, disease modifying drugs)

Surgery depends on type of arthritis and aims to relieve intractable pain and improve function. The range include joint replacements, tendon repair or transfer, fusion, synovectomy (removal of the ‘flimsy gluey’ tissue around the tendons) etc. 

The necessary surgery will be discussed during the consultation.

Obviously the underlying condition such as psoriasis is also treated

Anaesthesia

This depends on the kind of surgery required. Local anaesthetics in form of injections to numb only the finger (ring block), the whole arm (regional anaesthesia or brachial block) and general anaesthesia are all used when necessary.