ACHES, PAINS AND ARTHRITIS
Aches and pains of body parts or stiffness of bones and joints are common problems noticed by almost everyone from time to time. Fortunately, the vast majority recover after a few days. However, there are instances when the problem lingers long as a chronic discomfort, requiring medical attention. Most common are discomforts involving upper and lower extremities and back pain. All such painful conditions are lumped together as arthritis in colloquial language.
Musculoskeletal sprains occur from sporting injuries, falls, slips, lifting heavy objects, sudden jerky movements, accidents, bad sleeping postures or from intentional injuries. The area gets swollen, may develop bruises or discolorations, along with difficulty in moving the affected body part associated with pain. They require rest, ice packs, immobilization or splinting, elevation and pain medications such as ibuprofen. Recovery is usually expected within a week.
Similar aches and pains can occur because of infections, particularly viral infections such as Covid-19. Dengue fever and chikungunya are well-known in this category and are nick-named as bone-breaking diseases. Several bacterial infections can cause septic arthritis. Most common infection of this type is staphylococcal arthritis. Bacteria can settle in from another part of the body or as a complication of previous joint surgery.
Two widespread types of arthritis affecting older people are osteoporosis and osteoarthritis. Often, they are named as arthritis of old age.
In osteoporosis, the bone becomes brittle and thin and can easily break resulting in fractures. Calcium, which is the strengthening chemical, is lost from bones resulting in demineralization. Conditions such as deficiency of Vitamin D, diabetes mellitus, alcoholism, post-menopausal state in women, hyperparathyroidism, renal failure, poor diet, malabsorption and multiple myeloma are some of the causes. Even minimal pressure, body turn, or slip can result in fracture of hip or compression of vertebrae. Vigorous coughing can lead to fractures of ribs. They need to be evaluated by a physician since they may require certain medications or hormone replacements. Food items that are rich in calcium such as milk and dairy products, green leafy vegetables and variety of fruits are encouraged. One may take Vitamin D supplements. Morning walks in sunlight are helpful along with mild non-weight bearing exercises.
Osteoarthritis is an age-related arthritis of joints. The cartilage in the joints that act as a cushion between bones gets worn out and cell proliferation occurs in and around the joint leading to swelling, contractures, pain and limitation of joint movements. X-rays show loss of joint space, osteophyte formation and sclerosis at edges of the bones. Slowly, it becomes more and more disabling with pain and inability to ambulate. Initial treatment is with non-steroidal pain medications, physiotherapy, non-weight bearing exercises and control of obesity. Injection of certain medications or cortisone into the joint area is tried for temporary relief. Finally, they may end up requiring surgical procedures from simple arthroscopic procedures to total joint replacements.
Rheumatoid arthritis is an autoimmune disorder that affects small joints, causing pain, swelling, deformity, nodule formation, along with general symptoms such as malaise, anorexia, weight loss, anemia, eosinophilia, splenic enlargement, vasculitis, keratoconjunctivitis, interstitial fibrosis and amyloidosis. Blood tests show elevated ESR and positive rheumatoid factors. Initial treatment is with simple medications and physiotherapy. Advanced cases will require special immunosuppressive medications, steroid injections or surgical corrections.
Gout is related to excess amount of uric acid in the blood. It could be due to overproduction of urates or underexcretion of urates. Excess uric acid leads to crystal formation and deposition of white powdery chalk like material in the tissues in and around the joints. This results in inflammation, swelling and formation of localized lumpy mass, along with episodes of excruciating severe pain. Patients are advised to avoid high purine food items such as shellfish, meat items and alcohol. Hydration is recommended. They may require medications for pain, inflammation and reduction of uric acid levels.
Upper limb musculoskeletal disorders can be painful and disabling. These include conditions such as rotator cuff problems, biceps tendon rupture, olecranon bursitis, tennis elbow, carpal tunnel syndrome, Dupuytren’s contracture, and adhesive capsulitis, otherwise called as frozen shoulder. The causes can be related to repeated minor trauma, genetic or inflammatory. Initial treatments are with medications, physiotherapy or steroid injections. Many will end up requiring surgery.
Hip fracture is likely to affect older individuals and almost always requires surgery. Common causes are osteoporosis, poor vision, balancing problems and accidents resulting in falls. Patients experience severe pain and inability to ambulate. It is more frequent among women. The fracture often leads to further complications such as blood clots in lungs or legs, bedsores, pneumonia, depression and loss of strength, eventually leading to death. Precautionary measures should be taken to avoid falls in the house and to reduce the incidence of osteoporosis.
Back pain is mostly due to muscle sprain or lifting excessive weight. It can also be caused by intervertebral disc prolapse pinching on nerves. Other rare causes are cancer, obesity or ruptured aortic aneurysm. Acute musculoskeletal problems recover with pain medications, physiotherapy and rest. Persistent back pain, especially those associated with neurological deficits, needs evaluation with MRI scans. Some may require surgical interventions.
There are several other types of arthritic conditions, less common in incidence. All patients with severe or persistent pain should undergo physical examination. Prompt evaluation and treatment will help.