Arthritis can be treated if presented early

World Arthritis Day has come and gone, but Nigerians have been advised to always visit rheumatologists for proper treatment of the ailment.

The disease, said to be an infection or injury to the joints, can exacerbate natural breakdown of cartilage tissue. The risk of developing osteoarthritis (OA) may be higher, if a patient has a family history of the disease. Another common form of arthritis, rheumatic arthritis (RA) is an autoimmune disorder, which occurs, when the body’s immune system attacks tissues of the body.

Rheumatologists have explained that there are more than 100 types of arthritis, with different treatments. The public is, therefore, advised to go for screening at least once in a year, as there are misconceptions and myths that the ailment is caused by ‘juju’ or spiritual attack. However, it is treatable if presented early.

Femi Adelowo, a professor of medicine and Consultant Rheumatologist at Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, who is also President, African League of Associations of Rheumatology (AFLAR) and Chairman, executive committee of World Body of Rheumatology (ILAR), said this year’s World Arthritis Day titled: ‘It is in your hands take action’ is to urge patients to go for treatments and screening.

Adelowo explained that arthritis is not a spiritual attack, and that patients should avoid self-medication; rather, they should seek specialists’ intervention for proper treatment.He said: “Patients shouldn’t treat it at home, as they might not know the type of arthritis they suffer from. There are about 30 percent Nigerians going about their normal businesses, but who are having one type of arthritis or the other.”

Adelowo said avoiding lifting of heavy objects is one of the ways to prevent commonest types of arthritis, which include, rheumatoid, psoriatic and fibromyalgia.He said: “People should avoid activities that could lead to damage of back bone, because lifting a heavy object must definitely cause back pains. Gout is not a common type of arthritis, which is mainly caused by excessive intake of alcohol.”

He stated that osteoarthritis (OA) is the most prevalent musculoskeletal disease and a leading cause of disability globally. The impact of OA across the globe has been described as immense, as it affects 40 per cent of individuals over the age of 70, and is a major cause of pain, associated with an increased risk of morbidity and death.

The commonest OA site is the knee, affecting one in five people over the age of 45. The health economic burden of OA is rising, commensurate with longevity and obesity rates. Adelowo said: “There is currently no treatment, as management of the disease targets main symptoms of pain and loss of function and culminates in joint replacement surgery. Thus, there is a large unmet need for therapeutic interventions to alter natural history of the disease. This review will outline established and emerging pathways to improving understanding of the disease’s aetiopathology through genetics and genomics studies.”

He explained that synovial joint is a complex structure, comprising articular cartilage, subchondral bone, synovial lining membrane, fibrous joint capsule and supporting ligaments. The articular cartilage, calcified cartilage and subchondral bone form the osteochondral unit, a bio composite that is uniquely adapted to transferring loads during weight bearing and joint motion.

The osteochondral unit provides tensile strength, compressive resilience and a low-friction articulating surface through the collagen network, proteoglycan aggregates and layer of lubricants.

“Chondrocytes are the only cell type in articular cartilage, which is avascular and aneural. Under normal physiological conditions, the synovial membrane consists of a thin layer of cells with phenotypic features of macrophages and fibroblasts, and serves to produce synovial fluid that is responsible for maintaining nutrition and lubrication of the articular cartilage.

“The subchondral bone adapts its structural and functional architecture in response to its local mechanical environment through remodelling, regulated by osteocytes via interactions with osteoclasts and osteoblasts.

“OA is a disease characterised by a gradual process of tissue destruction and remodelling that affects all of the structures of the synovial joint, with degeneration of articular cartilage, remodelling of the underlying bone, and synovitis as its hallmarks.

“The initiating signals that trigger development of OA remain poorly understood. However, established clinical risk factors include increasing age, female sex, obesity, occupational exposure to high levels of joint loading activity, previous joint injury and deformity, smoking status and family history of OA”.

“Histological changes in OA include synovial hypertrophy and hyperplasia, with macrophage and lymphocyte recruitment, angiogenesis, and fibroblast proliferation. Those within the osteochondral unit include loss of chondrocytes in the superficial zone with proliferation in deeper zones; loss of extracellular matrix; vascularisation and neuronal ingrowth across the tidemark between calcified and non-calcified cartilage; and remodelling of subchondral bone, resulting in sclerosis, cysts and osteophyte formation.”