Arthritis

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Arthritis is a general term for approximately 100 diseases that produce either INFLAMMATION of connective tissues, particularly in joints, or noninflammatory degeneration of these tissues. The word means "joint inflammation," but because other structures are also affected, the diseases are often called connective tissue diseases. The terms rheumatism and rheumatic diseases are also used. Besides conditions so named, the diseases include gout, lupus erythematosus, ankylosing spondylitis, degenerative joint disease, and many others, among them the more recently identified LYME DISEASE.

Causes of these disorders include immune-system reactions and the wear and tear of aging, while research indicates that the nervous system may often be equally involved. About one out of seven Americans exhibit some form of arthritis. INFLAMMATORY CONNECTIVE TISSUE DISEASES This varied group of diseases produces inflammation in the connective tissues, particularly in the joints. The signs of inflammation--warmth, redness, swelling, and pain--may be apparent. Microscopic examination of the lesions reveals prominent blood vessels, abnormal accumulations of white blood cells, and varying degrees of wound healing with scarring.

In some diseases, the inflammation is clearly an immune reaction, the body's defense against invading microorganisms. In others, the cause is different or unknown. Infectious Arthritis This disease is most common in young adults. Infection in a joint is usually caused by bacteria or other microorganisms that invade the joint from its blood vessels.

Within hours or a few days the joint, usually the knee or elbow, becomes inflamed. There is an abnormal accumulation of synovial, or joint, fluid, which may be cloudy and contain large numbers of white blood cells. Gonococcal arthritis, a complication of gonorrhea, is the most common form of infectious arthritis. Treatment with antibiotics and aspiration of synovial fluid is usually promptly effective, and only minor residual damage is done to the joint. Occasionally the infection is prolonged and produces joint destruction and requires surgery. Rheumatic Fever This is a form of infectious arthritis caused by hemolytic streptococcus, a bacterium.

Unlike typical infectious arthritis, however, the disease is most common in children aged 5 to 15 years, begins weeks after the onset of the streptococc...

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... certain adrenal cortical steroids are powerful inhibitors of inflammation, toxic side effects limit their usefulness. Similarly, drugs that inhibit proliferation of cells in the inflammatory masses have potentially severe side effects. Drugs that inhibit undesirable inflammation may also inhibit desired inflammatory responses.

A result is a high frequency of secondary infections. More specific therapy, for example, allopurinol and colchicine in gout, is dependent on knowledge of the precise biochemical mechanisms of disease pathogenesis. Researchers are also studying the use of drugs that act on the nervous system. Despite the wear-and-tear origin of degenerative joint disease, it, too, may respond well to so-called anti-inflammatory drugs. Perhaps they are primarily acting as analgesics (pain-killers), or they may act by decreasing the secondary inflammation that follows joint trauma. Franklin Mullinax

Bibliography: Arthritis Foundation, Understanding Arthritis (1986); Kelley, William N., et al., eds., Textbook of Rheumatology, 2d ed., (1985); McCarty, Daniel F., ed., Arthritis and Allied Conditions, 11th ed. (1988); Moll, J. M. H., Rheumatology in Clinical Practice (1987).

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