Many Singaporean adults have some type of arthritis. It is a major cause of lost work time and serious disability for many people.

A joint is where the ends of two or more bones meet. For example, the knee joint is formed by a bone of the lower leg, called the shin or tibia and the thighbone. The hip is a ball and socket joint. It is formed by the upper end of the thighbone-the ball-fitting into the socket-part of the pelvis called the acetabulum.

The bone ends of a joint are covered with a smooth material called cartilage. The cartilage cushions the bone and allows the joint to move easily without pain. The synovium is a fibrous envelope which produces a fluid that helps to reduce friction and wear in a joint. Ligaments connect the bones and keep the joint stable. Muscles and tendons power the joint and enable it to move.

Inflammation is one of the body's normal reactions to injury or disease. In an injured or diseased joint, this results in swelling, pain, and stiffness. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability.

There are many different types of arthritis.

The most common type of arthritis is osteoarthritis. It is seen in many people as they age, although it may begin when they are younger as a result of injury or overuse. It is often more painful in weight bearing joints such as the knee, hip, and spine. All joints may be more affected if they are used extensively in work or sports, or if they have been damaged from fractures or other injuries.

In osteoarthritis, the cartilage covering the bone ends gradually wears away. In many cases, bone growths called "spurs" can develop in osteoarthritic joints. The joint inflammation causes pain and swelling. Continued use of the joint produces pain. Some relief may be possible through rest or modified activity.

Rheumatoid arthritis is a long-lasting disease that can affect many parts of the body, including the joints. In rheumatoid arthritis, one’s immune system has become sensitized and overactive, the joint lining swells, invading surrounding tissues, and producing chemical substances that attack and destroy the joint surface. This commonly occurs in joints in the hands and feet. Larger joints such as hips, knees, and elbows also may be involved. Swelling, pain, and stiffness are usually present even when the joint is not used. Rheumatoid arthritis can affect people of all ages, even children. However, more than 70 percent of people with this disease are over 30 years old. Many joints of the body may be involved at the same time.

Making a diagnosis of arthritis often includes evaluating symptoms, a physical examination, and X-rays, which are important to show the extent of damage to the joint. Blood tests and other laboratory tests may help to determine the type of arthritis

The goals of treatment are to provide pain relief, increase motion, and improve strength. There are several kinds of treatment:

Medications

Many medications, including arcoxia, celebrex (common anti-inflammatory drugs) may be used to effectively control pain and inflammation in arthritis. Ultracet (Paracetamol and Tramadol) may be used to effectively control pain. The physician chooses a medication by taking into account the type of arthritis, its severity, and the patient's general physical health. Patients with ulcers, asthma, kidney, or liver disease may not be able to safely take anti-inflammatory medications. Some immune modulating drugs can be used selectively with improved outcomes.

Injections

a. of cortisone directly into the joint may temporarily help to relieve pain and swelling.
b. Artificial lubricant (Synvisc) may increased the production of lubricant.
c. Pulsed radiofrequency stimulation may be helpful for some OA knees for longer term pain control.

Interventional Procedure for Arthritis knee or shoulders

Pulsed Radiofrequency Stimulation is likened to applying a laser on the sensitized nerves to stimulate recovery of the sensitized nerves. It does not generate any heat and is not harmful to nerves, when applied appropriately. The RFA is directed through a needle to the particular nerves or ganglion (nerve plexuses), under Xray guidance. It uses electro-motive forces to encourage increased nutrient transport and recovery of the sensitized nerves. Once accurate placement of the RF needle on the nerve, it allows for obliteration of pain and surrounding supporting structures (muscles) to recover. Once the pain cycle is broken, the original painful joint is rehabilitated under active physiotherapy.

There are occasions where RFA only partially reduces the pain, then the residual pain is usually coming from chronically damaged ligaments/tendons. Prolotherapy may be a helpful adjunct to therapy by strengthening ligaments/tendons and tightening the loosened or distorted joints. This then results in less pain and greater function.

Combined together with artificial lubricant addition to the knee joint will improve outcomes.

Joint protection

Joint protection - Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic joints. Learning methods of performing daily activities that are the less stressful to painful joints also may be helpful. Certain exercises and physical therapy (such as heat treatments) may be used to decrease stiffness and to strengthen the weakened muscles around the joint.

In most cases, persons with arthritis can continue to perform normal activities of daily living. Exercise programs, anti-inflammatory drugs, and weight reduction for obese persons are common measures to reduce pain, stiffness, and improve function.

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