Joints
connect the components of the skeletal system together. They give flexibility
and move bones in different directions thanks to muscles. Joints can be structural or functional. There
are three basic structural (fibrous, cartilaginous and synovial joints) and functional
(synarthroses, amphiarthroses and diarthroses
) classifications for joints.
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Structural
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Functional
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Fibrous Joints- allow
very little movement, and are composed of fibrous (dense) connective tissue;
e.g. the skull sutures and syndesmoses such as
the connection between the tibia and fibula
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Synarthroses -
immovable joints; these joints are common where protection of delicate
internal structures (such as the brain and spinal cord) is important.
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Cartilaginous Joints-
allow very little or no movement, and are characterized by a connection
between adjoining bones made of cartilage;
e.g. the pubic
symphysis, intervertebral joints and connection between the first rib and
sternum ;
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Amphiarthroses -slightly
movable joints; these joints are common where protection of delicate internal
structures (such as the brain and spinal cord) is important.
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Synovial joints - are
the most complex of the joint types; They are characterized by articular
(hyaline) cartilage covering the ends of bones, a fibrous articular capsule
(composed of fibrous connective tissue) lined with synovial membrane, a joint
cavity containing synovial fluid and reinforcing ligaments to hold the bones
together. Synovial joints are found in between the bones of the limbs, and
are freely movable.
Synovial joints are
also associated with bursae, which are flattened fibrous sacs lined with
synovial membrane that develop in areas of friction. Tendon sheaths are
special bursae that wrap around tendons in areas of friction.
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Diarthroses- freely
movable joints; these joints dominate in the limbs and areas of the body
where movement is important.
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Osteoarthritis and Rheumatoid Arthritis similarities and differences
“Arthritis” literally means joint inflammation. Although joint inflammation is a symptom or sign rather than a specific diagnosis, the term arthritis is often used to refer to any disorder that affects the joints.
There are approximately 400,000 people with RA in the UK, which means that yearly around 12,000 people developing RA in the UK. Although it usually affects women (two to four times greater than men), the peak age for both genders is the 70s. Main aims of drugs are to relieve symptoms. RA can result in a wide range of complications. Approximately one third of people stop work because of the disease within 2 years of onset, and this prevalence increases thereafter.
From the other hand, osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis, and one of the leading causes of pain and disability worldwide. Pain, reduced function and effects on a person's ability to carry out their day-to-day activities can be important consequences of osteoarthritis. Osteoarthritis is not caused by ageing and does not necessarily deteriorate. Osteoarthritis is characterized pathologically by localized loss of cartilage, remodeling of adjacent bone and associated inflammation. A variety of traumas may trigger the need for a joint to repair itself. Osteoarthritis includes a slow but efficient repair process that often compensates for the initial trauma, resulting in a structurally altered but symptom-free joint.
According to the research of Lo G et al. Arthritis Care& Research 2017 (http://onlonelibrary.wiley.com/doi/10.1002/acr.23246/abstract/) ‘noisy’ knees maybe an early sign of knee OA. The more often heard grating, cracking or popping sounds in or around knee joints, the more likely develop painful knees.
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Characteristic
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Rheumatoid Arthritis (RA)
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Osteoarthritis (OA)
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Age at
which the condition starts
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It may begin any time in life.
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It usually begins later in life.
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Speed of onset
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Relatively rapid, over weeks to months
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Slow, over years
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Joint symptoms
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Joints
are painful, hot, swollen, and stiff.
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Joints ache and may be tender but have little or no
swelling.
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Pattern of joints that are affected
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It often affects small and large joints on both sides of
the body (symmetrical), such as both hands, both wrists or elbows, or the
balls of both feet.
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Symptoms often begin on one side of the body and may
spread to the other side. Symptoms begin gradually and are often limited to
one set of joints, usually the finger joints closest to the fingernails or
the thumbs, large weight-bearing
joints (hips, knees),
or the spine.
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Duration of morning stiffness
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Morning stiffness usually lasts longer than 1 hour.
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Morning
stiffness usually lasts less than 30 minutes. Stiffness returns at the
end of the day or after periods of activity.
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Presence of symptoms affecting the whole body (systemic)
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Frequent fatigue and
a general feeling of being ill are present.
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Whole-body symptoms are not present.
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Physiotherapy
in OA and RA
According
to NICE guidelines, people with RA
should have access to specialist physiotherapy, with periodic review to:
- improve general fitness and encourage regular exercise;
- learn exercises for enhancing joint flexibility, muscle strength and managing other functional impairments;
- learn about the short-term pain relief provided by methods such as transcutaneous electrical nerve stimulators [TENS] and wax baths;
- Consider a tailored strengthening and stretching hand exercise programme for people with RA with pain and dysfunction of the hands or wrists if:
o
they
are not on a drug regimen for RA, or
o
they have been on a stable drug regimen for RA
for at least 3 months
People with
osteoarthritis should be advised to exercise as a core treatment irrespective
of age, comorbidity, pain severity or disability. Exercise should include:
- local muscle strengthening ;
- general aerobic fitness;
- self-management programmes, either individually or in groups;
- thermotherapy -the use of local heat or cold should be considered as an adjunct to core treatments.
- manipulation and stretching should be considered as an adjunct to core treatments, particularly for osteoarthritis of the hip;
- aids and devices : advice on appropriate footwear (including shock-absorbing properties for people with lower limb osteoarthritis; assessment for bracing/joint supports/insoles;
- assistive devices (for example, walking sticks and tap turners) should be considered for people with osteoarthritis who have specific problems with activities of daily living. If needed, seek expert advice in this context (for example, from occupational therapists or Disability Equipment Assessment Centres). (https://www.nice.org.uk/guidance/cg177/resources/osteoarthritis-care-and-management-pdf-35109757272517)
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