Ask the Doctors February 2003 Issue

Ask Dr. Marks: 02/03

What causes joint inflammation? Can you develop arthritis in any joint?

Pain in a joint can be caused by inflammation or neuro-mechanical factors. Inflamma-tion is the primary cause of joint pain in rheumatoid arthritis (RA), while neuro-mechanical factors predominate in osteoarthritis (OA). When articular cartilage is worn away and bone is exposed, simple pressure on the bone surface will cause pain. This explains why joint pain is increased when an involved joint is placed in certain positions. The articular cartilage itself does not become inflamed, but instead the joint lining, or synovium, develops inflammation, which is called synovitus. Non-steroidal anti-inflammatory drugs (NSAIDs) are an effective treatment for joint inflammation and should be taken to relieve pain caused by synovitus. Arthritis can occur in any joint, from the smallest to the largest. Joints that are frequently traumatized, such as the knee, have a higher incidence of OA. It is believed that joint instability caused by trauma can predispose a joint to OA at an early age.

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Is there any truth to the notion that genes play a part in the onset of arthritis?

There is no direct genetic link, or “arthritis gene,” that causes osteoarthritis in the vast majority of arthritis suffers. There is, however a small subset of people with OA who have a genetically determined defect in Type II collagen production, leading to early OA. Genes do dictate many factors that play a role in the development of early arthritis. Body build and weight, to a certain extent, are influenced by an individual’s genetic makeup. It is believed that a more important factor in OA is an individual’s response to injury. One of the leading theories on the cause of OA is that cumulative trauma to a joint will over time lead to joint degeneration, or OA. Wound or trauma healing, to a degree, are genetically influenced. It is the organism’s ability to repair damage that will determine the extent of cumulative trauma suffered by a joint. It is by this mechanism that genes may exert an indirect influence on the development of OA.

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What’s the best treatment for arthritic flare-ups—heat or cold?

Flare-ups occur from time to time in all people suffering from arthritis. The arthritic joint becomes swollen and painful. When that happens, you need to put the joint at relative rest. That does not mean you need to go to bed, but instead decrease your overall activity and avoid those activities that you know increase your joint pain. The use of heat of cold is not as important as rest and medication for the treatment of arthritic flare-ups. A warm shower or hot-water bottle are the best home remedies for warming an arthritic joint. Caution must be used when using a heating pad, since it may become too hot and cause burns.