COMMON TYPES OF ARTHRITIS
Osteoarthritis or degenerative joint disease affects 86% of persons over 70 years
of age, although symptoms may start in the fifth or sixth decade of life. This com-
mon form of arthritis is the result of deformation or mismatched joint surfaces,
rather than an inflammatory disease. Symptoms include joint stiffness that usually
lasts only a few minutes after initiating movement and perhaps an aching pain in
weight-bearing joints. Early disease stages may respond to local heat and nonpre-
scription analgesics. Later stages may require orthopedic or other interventions.
Rheumatoid arthritis usually occurs between 30 to 70 years of age and occurs
more often in women than in men. Early symptoms may include feelings of
fatigue and weakness, joint pain and stiffness, and, joint swelling several weeks
later. Joints are inflamed (warm, red, swollen) and often are limited in range of
motion. This is a progressive disease that leads to joint deformity. Aspirin and
aspirin-type products (NSAIDs) and Disease Modifying Anti-Rheumatic Drugs
(DEMARDs) are usually necessary to reduce the inflammation around the joints
and inhibit the progression of the disease. Heat therapy, weight control, and
exercise may also be helpful.
A list of drugs utilized in the treatment of arthritis is provided in the Appendix.
Detailed tables show doses, recommendations, expectations, side effects, contra-
indications, and more; available on the book’s Web site (see URL in Appendix).
Gout has been called the “disease of Kings” because in the past, royalty ate
rich foods and drank wine and alcohol and suffered from gout. However, it is not
just for the “rich and famous.” Gout is an inflammatory condition that attacks
joints, tendons, and other tissues. The most common site of acute gouty inflam-
mation is at the joint of the big toe. It may also be referred to as gouty arthritis.
It is characterized by a uric acid metabolism disorder and a defect in purine
(products of certain proteins) metabolism, resulting in an increase in urates (uric
acid salts) and an accumulation of uric acid (hyperuricemia) or an ineffective
clearance of uric acid in the kidneys. Uric acid solubility is poor in acid urine
and urate crystals may form, causing urate calculi (stones). Gout may appear as
bumps or “tophi” in the subcutaneous tissue of earlobes, elbows, hands, and the
base of the large toe. The complications of untreated or prolonged periods of
gout include tophi, gouty arthritis, urinary calculi, and gouty nephropathy.
Fluid intake should be increased while taking antigout drugs and the urine
should be alkaline. Foods rich in purine, including wine, alcohol, organ meats,
sardines, salmon, and gravy should be avoided.
A list of drugs utilized in the treatment of gout is provided in the Appendix.
Detailed tables show doses, recommendations, expectations, side effects, contra-
indications, and more; available on the book’s Web site (see URL in Appendix).(^200) CHAPTER 12 Inflammation