Preventive measures for the Degenerative Joint Diseases- Rheumatoid arthritis

Secondary preventive measures are directed at reducing the strain on affected joints by weight reduction, use of back braces, abdominal support for sagging abdomen (to take strain off the back), neck braces, and adequate rest. Pain-relieving medication and local heat applications are useful. Steroid injections of affected joints may be used in some cases. Usually these measures work very well. In cases not adequately helped by them, the arthritis may cause distortion of joint structure and may necessitate such tertiary measures as replacement of a joint by a metal pros- thesis or surgical removal of restricting diseased tissue.

 In some cases of DJD, bony over- growths may cause pressure on nerves. When this happens in the neck region -a common site for DJD-it may cause pain and weakness in the hands and fingers. Surgical removal of the bony spurs is the only effective treatment. Gout is a disease thought lightly of by all except those who suffer from it. Books are replete with cartoons of obese aristocrats suffering from painful gouty toe, and the implication is that "high living"-overindulgence in food and drink and lack of gainful work-is responsible for the disease. In reality, gout is an inherited ailment related to abnormal metabolism of certain important compounds, called purines, in foods.

As a result of the abnormal metabolism, an in- creased level of a purine breakdown product, uric acid, builds up in blood and body tissues. When excess uric acid is deposited in joints it may lead to inflammatory reaction by the joint tissues. This produces severe pain, swelling, and stiffness. The joints usually affected are those of the lower extremities, particularly the great toe, but any other joint in the body can be involved. The arthritis of gout can be severe and disabling if untreated and may lead to permanent deformity.

 Also, changes leading to impairment of vital organs such as the kidney may occur. Not everyone with gout develops the chief clinical symptom of arthritis; by far the great majority of cases are without symptoms. People in sedentary work are more likely than manual laborers to have clinical gout. 

The physician suspects gout particularly when a middle-aged man-goutyarthritis is predominantly a disease of men- complains of pain and swelling in one or occasionally two joints which are extremely sensitive to the slightest pressure. He will confirm the suspicion by a test which measures the amount of uric acid in the blood. The outlook is for recurrent arthritic attacks involving great pain and leading to joint deformity unless adequate treatment is instituted, in which case the patient can be free of all symptoms of the disease.

The physician will perform tests to evaluate the function of the kidneys, because uric acid can cause kidney stones and in other ways can damage the kidneys. Kidney failure is a dreaded complication of gout and fortunately an uncommon one that can be prevented. The physician also will be alert for high blood pressure and heart disease, since, for unknown reasons, many people with gout also have these ailments. Finally, he may ask blood relatives to have their uric acid levels checked, since gout is an inherited disorder. Because it is well known that stress or injury to joints can precipitate an attack of gouty arthritis, the obese patient will be advised to reduce weight. 

Rheumatoid Arthritis - preventive care and treatment

The joints may be stiffer and sorer in the morning than after exercise. In some cases, small hard nodules may appear under the skin, especially in pressure areas. In many instances, the hand affected by RA begins to deviate outward (toward the little finger). To confirm the diagnosis, x-ray studies may reveal characteristic changes of bones and joints. Blood tests may be used, including one for an unusual protein that appears in the blood of patients with RA, although it may sometimes be related to other diseases. 

Once RA is diagnosed, the physician can envision two possible scenarios for the disease. In one form of RA, there is severe joint inflammation, with pain, swelling, fairly rapidly developing deformities. Fever and prostration often accompany this type of RA; and if the disease is untreated, not only may there be rapid development of deformities, but the deformities may become crippling. In the second and more common type, the arthritic pains and swelling are not as severe and disabling, and there may be intervals during which few, if any, symptoms are experienced.

However, gradually over many years and often after several attacks of more severe joint pain, the joints may become deformed and impaired. Although medical science is learning more and more about rheumatoid arthritis, much remains to be revealed about the cause. The latest findings seem to indicate that an unusual type of bacterium or virus may cause the disease.

Meanwhile, lacking means of primary prevention, the physician must rely on methods of secondary and tertiary prevention to counter the ill effects of RA-joint deformity and disability. For secondary prevention, a many-pronged approach is used. Bed rest is important for acutely inflamed joints. In severe cases, this may mean hospitalization. In less severe cases, adequate sleep and avoidance not only of excessive fatigue but also of coldness and dampness may serve. It's important; too, that inflamed joints be maintained in non-deforming positions.

Swollen, inflamed joints are most comfortable when slightly bent, but if they freeze in this position they become of limited usefulness. Therefore every effort must be made to keep the joints extended or straight. This may require that splints and braces be worn at night and, in some cases, during the day as well. It may also call for use of a non-sagging mattress with a small pillow under the head to help keep the back straight; chairs with firm seats and straight backs; avoidance of tightly drawn sheets; use of cane or crutch to avoid excess weight on sensitive joints; and proper shoes with straight last. 

Exercise is important as part of the program to keep joints from stiffening. Special exercises may be needed to increase or maintain muscle power or to relieve any deformities that may have begun to develop. Local heat-from heating pad, lamp, etc.-helps relieve muscle spasm and pain. Pain-relieving medications also are essential for the arthritic.