Different Types Of Arthritis

Types of Arthiritis seen in Chiropractic practice

Monika Dobrowalska – Chiropractor in Cheltenham talks through her experience with patients suffering from arthritis.

Arthritis is a very common condition and one that everyone has heard of. However, what has become apparent to me as a chiropractor, is that many people do not realise that there are different types of arthritis. When someone tells you they have arthritis, you usually assume that they mean the degenerative or “wear and tear” kind. However, arthritis can also be inflammatory and therefore present with different symptoms, and it is important for us as chiropractors to be able to distinguish between the certain types.

During your initial consultation with a chiropractor in Bristol or Cheltenham, I always ask about a patient’s past medical history as well as the family history. This can give us important that can help to diagnose certain conditions and to rule others out. Quite often, individuals are not sure about what type of arthritis somebody in their family has – whether it is psoriatic arthritis or rheumatoid arthritis, and quite commonly people get confused between osteoarthritis and osteoporosis (osteoporosis is not actually arthritis). It’s completely understandable why you would get confused with all these names and complex terms, so I hope this blog to give you a brief overview of the different types of arthritis and how they may present.

As a chiropractor, I see a variety of people in practice, with a number of different symptoms.

The first thing to understand with arthritis is that it is divided into three types:

1. Osteoarthritis
2. Inflammatory Arthritis
3. Septic Arthritis

Osteoarthritis (OA)

This is the most common form of arthritis and the one that I see most frequently as a chiropractor – it is also what most people mean when they say they have arthritis. It is usually abbreviated to OA. Osteoarthritis is more common in weight-bearing joints, such as ankles, knees, hips, low back and neck, but can also occur in heavily used joints, such as the hands.  It presents in middle-aged years, or because of an injury or in fact obesity.

Osteoarthritis is divided into two types:

1. Primary Osteoarthritis
2. Secondary Osteoarthritis

Primary osteoarthritis can be part of our normal ageing process. Our weight-bearing joints are surrounded by cartilage as well as fluid, which is present to lubricate our joints. This combination is what cushions our joints from forces as we move and go about our normal day-to-day activities. As we age, the cartilage gradually wears down, which also decreases the amount of fluid being secreted.

As I said, this is part of a normal ageing process, and by the time you are in your 50’s an x-ray will usually show some evidence of this degenerative change, even if only in a mild way. However, some people are more predisposed to a faster rate of degeneration than others, and we categorise these changes as either mild, moderate or severe, depending on how far the degeneration has progressed. A severely degenerative knee will often require a knee replacement at some stage, but a mildly degenerative joint may not even be apparent to us. Importantly, the amount of symptoms associated with osteoarthritis is not necessarily related to the degree of degenerative change.

Secondary Osteoarthritis occurs usually because of previous trauma. A common example is a severe acromioclavicular (AC) joint sprain. In this instance, ruptured ligaments lead to altered mechanics within the joint, which over time can cause degeneration of the surrounding cartilage and therefore leading to osteoarthritis.

Inflammatory Arthritis

This is a completely different sort of joint condition than osteoarthritis and the most common types of inflammatory arthritis are:

1. Rheumatoid Arthritis (RA)
2. Psoriatic Arthritis
3. Crystal Induced Arthritis
4. Ankylosing Spondylitis (AS)
5. Reactive Arthritis

Rheumatoid, Psoriatic Arthritis and Ankylosing Spondylitis all have strong genetic traits. Crystal Induced arthritis is linked to a poor diet, and reactive arthritis is due to an infection, most commonly the sexually transmitted disease, chlamydia.

Rheumatoid Arthritis (RA)

This is a chronic, long term auto-immune condition of unknown cause, however in 50% of cases, there is a genetic link.  Females tend to be affected more than males, and smoking is a risk factor for this condition. RA mainly affects the hands and feet and is characteristically symmetrical – i.e. the same joints on each hand effected. The condition has periods of flare ups, followed by remissions. Diagnosis of RA is usually confirmed with blood tests and possibly an x-ray of your hands and/or feet.

Early detection is key to helping with the long-term management of the condition, and so if, as a chiropractor, we suspect you may be experiencing such a condition, we will promptly refer you to your GP for further investigations.

In terms of managing rheumatoid arthritis, NICE guidelines suggest a range of options that can be divided into either pharmacological and non-pharmacological options.  Drug-related treatments can be discussed and implemented by your GP or specialist, depending on the individual case, but non pharmacological management can involve a range of the following:

• Education about the condition
• Access to a multi-disciplinary team (such as a nurse to coordinating patient care
• Physiotherapy
• Occupational therapy
• Hand exercise therapy (where indicated)
• Psychological interventions
• Dietary advice
• Other complementary therapies

Chiropractic management typically comes under the umbrella term complementary therapy, but chiropractors also utilise many of the same interventions as physiotherapists. Patients with rheumatoid arthritis are still able to consult a chiropractor for support and advice, as well as the for the management of other co-existing conditions such as back pain, neck pain or another musculoskeletal complaint.  This is a choice that a patient can make on an individual basis, and it is important to clarify that chiropractors can not actually treat or cure the condition itself.

Psoriatic Arthritis

This is a chronic type of inflammatory arthritis found in individuals who have psoriasis, that typically affects the joint, or attachments of tendons and ligaments to the bones in specific locations around the body.  Patients with psoriatic arthritis can experience swelling, stiffness and painful joints, and the fingers are most affected.   They may also develop changes in their nails such as pitting or splinter haemorrhages. Diagnosis of psoriatic arthritis is determined by scoring at least 3 points on a list of common signs and symptoms, as well an x-ray of the hands and blood tests.

Again, early detection of this condition is important and if achieved early, progression can be slowed down, and joint damage and deformity can be prevented or minimised with the treatment.

As chiropractors at Skelian, we would routinely give consideration to this condition in patients with a history of psoriasis, in combination with either joint swelling, stiffness or pain.  Although less frequently affected than the fingers, we do sometimes observe this condition in patients presenting with lower back pain or pelvic pain.  It is important for us to be able to differentiate between patients with a common ‘mechanical’ lower back pain, and those with psoriatic arthritis that could be affecting the joints and connective tissues around the lower back.  To do so, all chiropractors at Skelian are able to liaise with your GP where we suspect conditions, such as psoriatic arthritis, could be present.

Crystal Induced Arthritis – AKA Calcium Pyrophosphate Crystal Deposition (CPPD)

This condition is commonly referred to as CPPD, as it is caused by calcium deposits. Calcium within the body is stored within bones, but due to certain conditions (such as hyperparathyroidism for example), excess calcium can be circulating in the bloodstream, which may then deposit in a joint such as the knee. This condition was previously referred to as pseudo-gout, as it can present similarly as gout (with painful swelling of the joint), however, gout is due to uric acid deposition rather than calcium. CPPD can also mimic the presentation that comes with an infection of a joint, therefore diagnosis is carried out by a blood test to rule out other conditions. Additionally, an x-ray can also show the calcium deposits within the joint.

Ankylosing Spondylitis (AS)

AS is a chronic, inflammatory condition of unknown cause that causes progressive stiffening of the spine. It can be difficult to diagnose, as it typically presents in people whilst in their 20s-30s and is typically experienced as a generalised dull ache in the lower back. As it is an inflammatory condition, it also has periods of relapse and remission.  Another clinical feature of this condition is noticeable back stiffness, especially in the morning, which then eases throughout the day. Diagnosis will include a process of elimination as well as obtaining radiographs of the spine and sacroiliac joints.

Management of the condition as recommended by the NHS includes exercise prescription, physiotherapy, as well as medication.  Seeing a chiropractor is not specifically recommended by the NHS as a way to manage this condition, however, chiropractors do possess a number of skills that both themselves and physiotherapists have in common, such as being able to give advise on posture, exercise programmes and more general lifestyle advice, as well as various massage techniques (that the NHS do advise). As a chiropractor, I do often direct patients that I see experiencing AS to the National Ankylosing Spondylitis Society (NASS), as a useful source for exercise options to support the management of the condition.

Reactive Arthritis AKA Reiter’s Arthritis

This is a form of arthritis which may cause a combination of: redness and pain of the eye, painful urination and swelling of multiple joints around the body. It is usually secondary to an infection (such as chlamydia and salmonella) and in the majority of cases, it clears up within a few months of treatment and has no long-term negative effects. Treatment for this condition involves a course of antibiotics and painkillers prescribed by your GP.

Septic Arthritis

Septic arthritis is a medical emergency and requires referral to A&E. It is usually caused by a staphylococcal infection, that has entered the body through a cut in the skin, which then makes its way to the inside of a joint. If any healthcare provider (including a chiropractor) is suspicious that Septic Arthritis is a possibility, this should be assumed until otherwise ruled out. The symptoms include:

• Sudden painful swelling of a joint (usually a single joint only)
• Change of colour around the joint, usually red or purple.
• You feel unwell, have a temperature, or feel hot/shivery.

Symptoms develop very quickly and progress over a few days. If you are ever concerned you can phone 111 or book an urgent GP appointment.

Summary

I hope this short summary has helped differentiate between the many different types of arthritis. In practice, we as chiropractors may see patients with these conditions, sometimes before a formal diagnosis has been made, and so it is important for us to be aware of how these conditions present in individuals.

If you have any questions about the type of treatment we provide and whether we could help you, please don’t hesitate to book an appointment and speak to one of our chiropractors at Skelian in Cheltenham or Bristol.