Arthritis

The word arthritis actually means joint inflammation. The term arthritis is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Childhood Arthritis

Background

• There is much disagreement among experts about definitions of childhood arthritis. At least three clinical classification schemes exist—juvenile rheumatoid arthritis (JRA), juvenile chronic arthritis (JCA), and juvenile idiopathic arthritis (JIA). All three schemes do not include many of the conditions considered as arthritis and other rheumatic conditions in adults. Also, a case counted in one classification system may not be a case in another system; however, all schemes define childhood arthritis as occurring in people younger than 16 years.
   
• Because childhood arthritis is an umbrella term covering a number of types of arthritis and because there are a number of different clinical case definitions for childhood arthritis, there is a wide range of estimates of how much childhood arthritis exists and much difficulty in describing its epidemiology.
   
• The most common form of juvenile arthritis is JRA (the term and classification system used most commonly in the United States). JRA involves at least 6 weeks of persistent arthritis in a child younger than 16 years with no other type of childhood arthritis. JRA has three distinct subtypes: systemic (10%), polyarticular (40%) and pauciarticular (50%). Each type has a unique presentation and clinical course and immunogenetic association. For the latter two types, girls are more commonly affected (3–5:1). In all three types about 40–45% still have active disease after 10 years. For the systemic type, the peak age of onset is 1– to 6–years-old and about 50% of cases show very short stature in adulthood as a result. For the pauciarticular form, there are two distinct subtypes- early onset and late onset. Early onset is more common in girls, late onset is more common in boys. The genetics differ as do the clinical courses. In the polyarticular form, there are also two subtypes: rheumatoid factor (RF) positive and negative. RF positive usually affect girls with onset after 8 years of age and a poorer prognosis compared with RF negative children. (1)
   
• For adults, more than 150 conditions are counted as arthritis and other rheumatic conditions (AORC). Many of these conditions occur in children, although much more rarely.

Fibromyalgia

Fibromyalgia is a syndrome predominately characterized by widespread muscular pains and fatigue. The causes of fibromyalgia are unknown; however researchers hypothesize that genetics and physical and emotional stressors are possible contributory factors to the development of the illness. There are difficulties in diagnosing fibromyalgia, since its clinical picture can overlap other illnesses and there are no definitive diagnostic tests. Patient education, pharmacologic agents, and other nonpharmacologic therapies are used to treat fibromyalgia. Exercise has been found to improve outcomes for people with fibromyalgia.

Background

• Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as, 
•  
• Morning stiffness
• Tingling or numbness in hands and feet
• Headaches, including migraines
• Irritable bowel syndrome
• Problems with thinking and memory (sometimes called "fibro fog")
• Painful menstrual periods and other pain syndromes
   
• May often co-occur (up to 25-65%) with other rheumatic conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS). 

  Gout

  Gout is a rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process is caused by an overproduction or under excretion of uric acid. Certain common medications, alcohol, and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain. These acute gouty flare-ups respond well to treatment with oral anti-inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis.
  

  Background

• Gout is an ancient and common form of inflammatory arthritis, and is the most common inflammatory arthritis among men. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic.
   
• Gout is a chronic disease caused by an uncontrolled metabolic disorder, hyperuricemia, which leads to the deposition of monosodium urate crystals in tissue. Hyperuricemia means too much uric acid in the blood. Uric acid is a metabolic product resulting from the metabolism of purines (found in many foods and in human tissue). (1, 2)
   
• Hyperuricemia is caused by an imbalance in the production and excretion of urate, i.e., overproduction, underexcretion or both. Underexcretion is the most common cause, thought to account for 80–90% of hyperuricemia. (3)
   
• Hyperuricemia is not the same as gout. Asymptomatic hyperuricemia does not need to be treated.
   
• Risk factors for gout include being overweight or obese, having hypertension, alcohol intake (beer and spirits more than wine), diuretic use, and a diet rich in meat and seafood. (4,5,6)
   
• Weight loss lowers the risk for gout. (5,6)
   
• Gout can be viewed in four stages: 
•  
• Asymptomatic tissue deposition occurs when people have no overt symptoms of gout, but do have hyperuricemia and the asymptomatic deposition of crystals in tissues. The deposition of crystals, however, is causing damage.
• Acute flares occur when urate crystals in the joint(s) cause acute inflammation. A flare is characterized by pain, redness, swelling, and warmth lasting days to weeks. Pain may be mild or excruciating. Most initial attacks occur in lower extremities. The typical presentation in the metatarsophalageal joint of the great toe (podagra) is the presenting joint for 50% of people with gout. About 80% of people with gout do have podagra at some point. Uric acid levels may be normal in about half of patients with an acute flare. Gout may present differently in the elderly, with many joints affected.
• Intercritical segments occur after an acute flare has subsided, and a person may enter a stage with clinically inactive disease before the next flare. The person with gout continues to have hyperuricemia, which results in continued deposition of urate crystals in tissues and resulting damage. Intercritical segments become shorter as the disease progresses.
• Chronic gout is characterized by chronic arthritis, with soreness and aching of joints. People with gout may also get tophi (lumps of urate crystals deposited in soft tissue)—usually in cooler areas of the body (e.g., elbows, ears, distal finger joints). (7,8)
   
• Gout is also associated with an increased risk of kidney stones. (9,10)
   
• The gold standard for diagnosing gout is aspiration and microscopic analysis for urate crystals in joint fluid or a tophus. Urate crystals are negatively birefringent under polarized light. Infection must be ruled out. (7,11)
   
• The goals of treatment are to end the pain of acute flares, and to prevent future attacks and the formation of tophi and kidney stones. Therapy for acute flares consists of nonsteroidal anti-inflammatory drugs, steroids, and colchicine. Diet and lifestyle (weight loss, avoiding alcohol, reducing dietary purine intake) modifications may help prevent future attacks. Changing medications (e.g., stopping diuretics) associated with hyperuricemia may also help. Preventive therapy to lower blood uric acid levels in persons with recurrent acute flares or chronic gout usually involves allopurinol or a new drug (febuxostat)..
  
  
  Source: Centers for Disease Control and Prevention