Arthritis Nodes: Symptoms, Diagnosis and Treatment

 

Arthritis is a term that refers to joint inflammation (pain, swelling, and stiffness). It is generally used to describe any disorder that affects the joints, tissues around the joints, as well as other connective tissues. Arthritis can affect either one joint or several joints at the same time, hence there are different types of arthritis, more than 100 of them.

Surveys have estimated that 58.5 million adults have one type of arthritis joint condition. It was also indicated that it affects adults 65 years and above. Although it is more common among women and the elderly, arthritis can affect everyone, children and young people alike. (1)

Types Of Arthritis

The common types of arthritis include:

  1. 1. Osteoarthritis:

Osteoarthritis is the most common form of arthritis and is reputed to have the most frequent number of visits to the hospital. Also known as Arthrosis or Wear-and-tear arthritis, it is a degenerative disease that affects the whole joint. It begins with the roughening and breaking down of the cartilage within a joint (commonly the knees, hands, hips, and spine).

In an attempt to make up for the wear and loss of cartilage, the body causes unwanted little bits of bone, called osteophytes to grow at the ends of the bone in the joint. Over time, the synovial fluid increases and may stretch the joint capsule, leading to difficult and painful movement. (2)

Arthritis joint damage incurred previously, such as joint inflammation or fracture can also cause osteoarthritis. Swelling of the joint is an attribute of joint inflammation, which occurs as a result of the thickening of the synovium. Studies suggest that, when the degraded cartilage pieces fall into the synovium, the synovial cells view them as foreign bodies and respond by releasing inflammatory mediators. (3)

Signs and symptoms of Osteoarthritis

  • – Swelling and tenderness: this is a result of inflammation.
  • – Pain: Intensity varies from one person to the other and increases with time if management is not commenced.
  • – Arthritis nodes are bony hard lumps at the joints of your finger. When arthritis nodes develop at the joint closest to your finger, they are referred to as Heberden’s nodes. When they develop at joints close to your hand, they are called Bouchard’s nodes.
  • – Stiffness
  • – Reduced movement
  • – Crunching sounds, like your bone is rubbing against each other.

What Age Is One Likely To Develop Osteoarthritis

About 250 million people in the world are affected by osteoarthritis, of which the majority are the elderly. Osteoarthritis is more likely to develop in women after the age of 45, while in men, it can develop before age 45. Due to bodily changes that occur as one age, such as weight gain, inability to heal faster and efficiently, and muscle weakness, it is common to develop osteoarthritis in your late forties. (4)

To differentiate arthritis versus arthrosis, the doctor can run physical tests to check for tenderness, swelling, and redness in the joints. He could also run some imaging tests such as X-rays and MRIs to view detailed images of the bones and soft tissues and determine cartilage loss. Although blood tests cant be used to diagnose osteoarthritis, the blood can be analyzed to rule out other likely causes of joint pain.

Management of Osteoarthritis

Several modalities have been postulated to help with the management of osteoarthritis. Some of them are:

  • – Hot and cold therapies
  • – Regular physical activity
  • – Over-the-counter medication
  • – Assistive devices like osteoarthritis unloader knee brace.

Osteoarthritis patients should avoid foods such as red meat and fried foods, sugars, dairy products, refined carbohydrates, alcohol, and tobacco. They irritate the joint tissue and can increase inflammation. Studies carried out by the American Academy of Orthopedic surgeons have identified osteoarthritis as the primary reason for discharge from active military service. Hence, veterans may receive a 10% arthritis VA rating if symptoms appear within one year of discharge.

  1. 2. Rheumatoid Arthritis: 

Rheumatoid arthritis is an autoimmune disease majorly characterized by inflammation. Naturally, our immune system causes inflammation as a defense mechanism against some bacteria, viruses, or other injuries like burns. However, in rheumatoid arthritis, the immune system becomes overactive, attacks healthy cells of the joints, and triggers inflammation. This results in an inflated lining of the joint and damaged joint tissue. Asides from worsening the pain in the arthritis joint, continuous inflammation can lead to permanent damage of the joints, lack of balance, deformity, and issues in other organs of the body. The common joints affected are the hands, wrists, and knees. At the onset of rheumatoid arthritis, one can experience elbow pain caused by uncontrolled inflammation in the elbow joint. Veterans may receive a 100% arthritis VA rating if they experience total incapacitation of the arthritis joint during constitutional manifestations.

Signs and symptoms of Rheumatoid Arthritis

  • – Swelling and tenderness in the joints
  • – Stiffness in the joints in the mornings
  • – Pain or ache in the joints
  • – Weakness
  • – Fatigue
  • – A general feeling of being unwell
  • – Fever

Rheumatoid Arthritis Versus Lupus

Oftentimes, some patients develop rheumatoid arthritis with lupus, or mistake the former for the latter. While they are both autoimmune diseases and share similar symptoms such as joint swelling, fatigue, and fever, there are several distinguishing features.

  • – Where Rheumatoid arthritis affects majorly the joints, lupus affects majorly the internal organs and skin, in addition to the joints.
  • – RA can cause deformities of the joints while lupus doesn’t.
  • – RA doesn’t lead to life-threatening conditions like seizure and kidney damage while lupus can cause complications.
  • – Pain caused by RA worsens in the morning and gets better during the day while pain caused by lupus is often consistent. (5)

Rheumatoid Arthritis vs Gout

Gout is another condition that shares a few similarities with Rheumatoid Arthritis which can lead to mistaking one for the other. When comparing arthritis vs gout, there are a few notable differences.

  • – Gout is not an autoimmune disease whereas RA is an autoimmune disease.
  • – Gout is caused by the presence of high levels of uric acid in the body while RA is caused by a default in the body’s immune system.
  • – Gout primarily affects only one joint (the big toe) whereas RA affects majorly the knee, hand, and wrist joints.

What is Rheumatoid factor?

Rheumatoid arthritis can be diagnosed by running a rheumatoid factor test with your blood sample. It involves looking for rheumatoid factor (antibodies made by the immune system) in the sample. Sometimes, these antibodies accidentally attack healthy cells. High levels of rheumatoid factor can indicate an autoimmune disorder like rheumatoid arthritis, or certain types of cancer. This is used with other tests to diagnose rheumatoid arthritis. (6)

Also, an imaging test can be conducted to diagnose and monitor the progression of rheumatoid arthritis. An arthritis Xray hand scan will show ulnar deviation of the metacarpophalangeal joints, subchondral cysts, ulnar translocation, swan neck deformities, scapholunate dissociation, hitchhiker’s thumb deformity, ankylosis and arthritis bumps on fingers. (7)

  1. 3. Spondyloarthritis

This refers to some conditions that affect the joints of the spine and sacroiliac area, causing pain and swelling. It involves inflammation of the joints, ligaments, tendons, and other connective tissues. It is a type of arthritis that results from degeneration of the joints and discs of the spine.

It is further divided into the following types:

  • – Ankylosing Spondylitis

Refers to a type of spondyloarthritis that primarily affects the spine. It is a chronic joint inflammation in which there is a fusion of the spinal vertebrae, leading to stiffness and limited movement in the spine. The term “ankylosis means stiffness of the joint as a result of injury. This is caused by the presence of extra mineral calcium in the spine, formed when the body responds to inflammation. New bits of bones grow in the spine, resulting in painful and stiff joints. Arthritis upper back pain can also result from this.Ankylosing Spondylitis can start during the teenage years, but is more common in early adulthood, from 20 to 30 years.

Although the exact cause of AS is not known, it has been discovered that 90% of those who develop AS carry the human leukocyte antigen B27 gene (HLA-B27). Having this gene does not mean that the carrier will develop the condition. It is estimated that 8 out of every 100 carriers do not have ankylosing spondylitis. (8)

Symptoms include:

  • – Arthritis upper back pain.
  • – Stiffness
  • – Swelling accompanied by pain in other areas of the body like the upper back.
  • – Fatigue
  • – Juvenile spondyloarthritis

This refers to arthritis in children and the most common form is Juvenile Idiopathic Arthritis. It is also termed as arthritis young age chronic condition. Any inflammatory arthritis diagnosed on or before 16 years of age is termed Juvenile spondyloarthritis. It involves inflammation of the regions where tendons and ligaments connect to the bone. The leg joints are commonly affected. This arthritis young age condition must be diagnosed early in people to avoid permanent physical damage to the joints. Symptoms include:

  • – Pain and tenderness in the joints
  • – Bowel inflammation
  • – Fatigue
  • – Arthritis eyes inflammation
  • – Loss of appetite
  1. 4. Metabolic Spondylitis

Also known as gout, this is a condition that results from the buildup of uric acid crystals in the joints. Usually, the body eliminates excess uric acid. However, when one eats too many foods like red meats, some seafood, alcohol, and dairy products, the body may produce more uric acid than it can get rid of. This causes buildup in the blood, causing hyperuricemia.

Accumulation of uric acid crystals in the joints can lead to inflammation in the joints, resulting in the formation of lumps in the affected joints and surrounding tissues, especially in the big toe. Gout is accompanied by sudden and extreme bouts of pain.

  • – Psoriatic arthritis

This is an inflammatory condition that is chronic in nature. It affects the joints and regions where tendons and ligaments are connected to the bone. Here, the body’s immune system causes painful swelling and stiffness around the joints. This disease condition is associated with an inflammatory disease known as psoriasis, characterized by a red scaly skin rash. The rash can occur on several parts of the body such as the upper back, buttocks, knees, scalp, and elbow.

Psoriatic arthritis is common among adults 30 to 50 years of age. It is also common to have severe tiredness, otherwise known as fatigue.

Symptoms

Symptoms can develop after some years of having psoriasis. While some people experience arthritis before or without having psoriasis at all.

  • – Arthritis eyes pain and redness
  • – Pain and stiff joint (s)
  • – Dactylitis, which appears as swollen bumps in the fingers and toes.
  • – Fatigue
  • – Decreased flexibility

 

  • – Infectious Arthritis

This is a type of inflammatory arthritis that develops when there is a sudden and severe infection of the joint. It could be of bacterial, fungal, or viral origin. It is characterized by pain, fever, and swelling that often subsides on treatment with antibiotics and antifungals. There could also be tissue damage. Infectious arthritis affects both young people and adults and should be diagnosed on time to avoid spreading from one joint to another.

Another form of infectious arthritis is Reactive Arthritis. It occurs when an infection from another part of the body spreads to a joint, especially the knee. It could also be a result of the body’s response to an infection in some part of the body, leading to joint inflammation.

  • – Lupus

Commonly known as systemic lupus erythematosus (SLE), this is a chronic autoimmune inflammatory condition that affects and damages many parts of the body such as the joints, skin, brain, kidneys, etc. It is characterized by joint aches, chest pain, headaches, fatigue, fever, rash, and sensitivity to light. Lupus causes intense inflammation and damage to the tissue in the affected regions. It is very common to see patients arthritis with lupus at the same time.

Diagnosis of Arthritis

The general practitioner first performs a physical test to check for the presence of fluid in the joints and determine if it’s inflamed. He also employs the use of imaging scans like X-rays, MRIs, and CT scan to have a detailed view of your bones. This also helps to determine if the joint pain is caused by arthritis vs bursitis, temporary inflammation of the bursa (fluid-filled sacs that cushion the bones).

How is Arthritis Treated?

The main goal of arthritis treatment is to relieve symptoms, improve joint function and prevent further damage to the joints or surrounding tissues. When considering treatment options, factors such as age, symptoms, and severity should be considered. Also, the type of arthritis, like arthritis versus arthrosis is noted. It could be short-termed or long-termed and may involve more than one treatment type. They include:

  1. 1. Medications such as:
  2. A. Non-Steroidal AntiInflammatory Drugs (NSAIDs): They help to relieve pain and reduce inflammation. Eg is Ibuprofen
  3. B. Steroids: They reduce pain and inflammation as well as slow joint damage. Eg is Prednisolone
  4. C. Disease Modifying Antirheumatoid Drugs (DMARDs): They slow the progression of rheumatoid arthritis. Also, they prevent permanent damage to the joints. Eg Methotrexate.
  5. D. Counterirritants: They are topical drugs that help in pain relief when applied to the affected joint.
  6. E. Hydroxychloroquine: this has been found useful in the treatment of arthritis when pregnant.
  7. 2. Cold and Hot Therapy: This involves the application of a cold compress such as an ice pack, moist heat such as a warm bath, or dry heat such as a heating pad on the joint to reduce pain and inflammation. This is equally a good alternative for managing arthritis when pregnant and arthritis bumps on fingers.
  8. 3. Massage: Massaging the affected joints may help to stimulate blood flow and relieve pain.
  9. 4. Acupuncture: This involves the insertion of thin needles at strategic points in the body to relieve pain.
  10. 5. Transcutaneous Electrical Nerve Stimulation (TENS): This makes use of a device to transmit mild electrical pulses to the nerve endings in the affected areas which stops the patient from feeling pain. (10)
  11. 6. Surgery: This is a long-term treatment and is dependent on the type of arthritis one has. It includes joint fusion, arthroscopy (joint repair), and total joint replacement. In a few cases, complications of arthritis arise and may involve conditions such as carpal tunnel syndrome (a nerve condition where the median nerve that runs along the wrist is squeezed, pinched, or damaged). An arthritis Xray hand scan can be used to distinguish if it’s only arthritis or carpal tunnel.

Since arthritis is not curative, it is recommended that lifestyle measures are taken to improve quality of life. These measures regular exercises, use of assistive devices like osteoarthritis unloader knee brace to improve balance, weight loss if obese, and quality sleep.

 

REFERENCES

  1. 1. https://www.medicalnewstoday.com/articles/7621
  2. 2. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
  3. 3. https://www.hindawi.com/journals/mi/2020/8293921/
  4. 4. https://www.nia.nih.gov/health/osteoarthritis
  5. 5. https://www.healthline.com/health/lupus-and-ra
  6. 6. https://medlineplus.gov/lab-tests/rheumatoid-factor-rf-test/
  7. 7. https://www.wikidoc.org/index.php/Rheumatoid_arthritis_x_ray
  8. 8. https://www.medicalnewstoday.com/articles/spondylitis#types
  9. 9. https://www.medicalnewstoday.com/articles/323049#infectious-vs-reactive-arthritis
  10. 10. https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis