One of the more common illnesses that I am constantly encountering as a general primary care physican is the debilitating affects that arthritis may have on our senior citizens or elderly patients. Because of a number of reasons, people are living longer, and thus, are dealing with diseases that may be related to our aging process.
Loved ones are being called upon to take active roles in helping elderly family members deal with the stresses of arthritis that may be related to limited physical mobility, the mental stress with taking untold numbers of medications to ease arthritic pain, or limiting further destruction of joints caused by the inflammation within the joints. Still those elderly patients who may not be so fortunate to have a loved one’s support will be limited to self support or relying on home health nurse/assistant to help them. So, I would like to shed light on how either the patient or the patient’s loved one can help in dealing with arthritis that may be due primarily to the aging process.
With that, let’s start with some basic concepts about arthritis. Arthritis simply means inflammation in the joints. There are numerous types of joints within the body, some are mobile, others are fused (without movement), and still others are associated with slight movements (i.e. sliding movement). The ones that are geneally associated with pain as caused by arthritis are those which are associated with movements, also known as synovial joints. Synovial joints are comprised essentially of connective tissues. Connective tissues are the supportive structures of the body, which include fibrous tissue, cartilage and bone. These different types of connective tissue around joints are lined by special cells called synovial epithelial cells, that supply nutrients to the connective tissue, as well as make lubricants and other fluids that keep the joints working smoothly. As we age, the ability of the synovial cells to produce those fluids and nutrients become reduced. In fact, the connective tissue becomes less stretchable or flexable, and arthritis sets in. Sometimes our body create immune defense cells to attack and destroy our joints. With that destruction, other inflammatory cells come in to the joint space to resolve the destroyed cells, and by doing so cause release of certain chemicals that result in pain, and even recruitment of more acute inflammatory cells, giving rise to even more intense pain. Often times, the arthritic pain is noticed more so in the morning than at night because of the lack of mobility of the joints that take place while we are sleeping, and thus the joints become stiffer. So during the next morning when we become more active with movements, the environment of the cells to be subjected to destruction sets up the scenario for arthritic pain as described above. Now during the rest of the day with increasing motion of our joints, the pain and inflammation generally goes away.
Now for the most part there are two major types of arthritis. One is rheumatoid arthritis where our immune system attacks our joints, even sometimes associated with other immune disease complexes such as lupus, sorgrens, mixed connective tissue disease, etc. The second type of arthritis is osteoarthritis, where the cartilage between bones that move against the other gets destroyed for whatever reason, principally one reason being due to overweight or chronic stresses on the bones, thus resulting in bone to bone articulation or movement (grinding and friction) which causes destruction of bone directly and severe pain.
Now the symptoms and signs of arthritis are primarily revealed in the form of pain related to movement of the joints. The skin over the joints may become red in color, warm to touch, and there may be “rheumatoid nodules” which are accumulation of destroyed and degenerated connective tissue from years of arthritic diseases. X-rays, other imaging studies, and a variety of laboratory tests are done to give the doctor an idea regarding the type of arthritis as well as just how severely the joints may be damaged to begin a treatment strategy. Often times with osteoarthritis, because of severe bone to bone destruction, surgery may be the only main stain of treatment. However, with rheumatoid related arthritis, medication is the principle method for resolving both the pain as well as the destruction that the inflammatory cells may contribute to the deformation of the bone or joints.
Now, here is to address the point of living with arthritis. We all will eventually experience arthritis as we age. So to the elderly patients who are experiencing arthritis, you want to know what can you do to minimize the affects of arthritis and live with it in an amenable way. Well, I say for one communication about the frequency of symptoms to either your primary health care provider or your home health nurse/assistant is one way of getting a handle on the painful destruction that arthritis have on us as we age. That way, the various types of medications that block the inflammation, as well as reduction in pain can be done before the joints are beyond repair by medicine, and thus limiting us from a mobile standpoint, in that generally arthritis affects many joints of our body, and not just one. If one joint is affected particularly with fever associated, then septic (infectious) arthritis should be considered.
Now for those of you who are in more advanced stages of arthritis where mobility is highly restricted, there are mobile medical devices that can help you matriculate during your daily activity, thus allowing one to be as functionally mobile as possible, motion wise, without reducing normal activity. I recently had an elderly patient who lives in an independent living facility for the elderly, and whom I evaluated medically. This patient over 30 years ago had undergone surgery repair for osteoarthritis of both knee joints, and developed complications from the metal medical devices that were implanted into both of her knee joints. This operation left this patient thirty years later without the ability to stand and move her knees because of severe osteoarthritic pain as a complication from the failed metal medical implanted devices. We are, now, able to manage her arthritic pain succesfully, as well as she has a mobile medical device to get around her apartment without limitation. Even she has other mobile medical equipments to assist her in getting in and out of bed, and this has helped this patient tremendously. She is now living comfortably with arthritis.
I write to say, life with arthritis can be managed effectively if elderly patients or their loved ones or those who visit elderly patients for home care, can become partners with the patient’s health care providers in making a difference in minimizing or limiting the debilitating and mind-stressful causes that arthritis may place on elderly patients.