Elbow

Joint swelling

Arthritis is is a group of chronic diseases which entail damage, deformation and limitation of joint movements, while their distinctive symptoms are joint swelling, pain and stiff joint. This group of diseases is mostly composed of autoimmune inflammations which force the patient’s organism to generate anti-bodies that damage joint structures. If untreated, the inflammation most often leads to irreversible changes – destroyed joints and in effect disability. Early diagnosis and adoption of a suitable treatment hinders the progress of the disease, prevents consequences and allows normal living.

Many patients who suffer from joint swelling and experience pain first visit the orthopedist who identifies the problem as other than orthopedic and thus refers the patient to a family doctor or rheumatologist.

Joint swelling – causes

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Patients most frequently visit the orthopedist because of pain and/or joint effusion, that is symptoms visible to human’s eye – joint swelling. It may result from an injury, overloading or accompany the joint degenerative disease. Sometimes such swelling of one or many joints (which must be considered serious) may be an inflammatory disease. Every joint may be swollen but it is mostly located in the knee joint, ankle joint, shoulder joint, wrist joint, as well as minor palm and feet joints.

What should be an alarming signal to the orthopedist is a symmetry of joints in question, that is swelling of both ankle joints at a time, and in particular when both wrists or minor palm or feet joints are swollen. This may suggest an inflammatory joint disease, rather than injury or overloading.

PhD Paweł Rybak, a Rehasport Clinic orthopedist in Gdańsk, says that such typical cases of being non-orthopedic happen about three times a month. It is not a lot. Most frequently these patients have swollen knees but also minor palm and feet joints.

 Arthritis is afflicted by persons of any age, both women and men.

Joint swelling – symptoms

The main symptoms are swollen joint, stiff joint in the morning and symmetry of joints in question. The aforesaid symptoms are accompanied by pain of various intensity. In the case of arthritis, pain usually occurs at night and in the morning; often eases throughout the day and after warm-up. However, when you wake up and do not feel any pain, but it emerges later during the day, after workout, you most often deal with joint degenerative disease.

Joint swelling – diagnostics

To diagnose the problem well, it is necessary to take a medical history and conduct a physical examination, says PhD Kinga Kozicka-Kąkol from Rehasport Clinic in Gdańsk. Changes are often obvious and it is enough to make a proper diagnosis. Yet sometimes we have to make use of additional examinations: laboratory and radiological. If joint inflammation is suspected, doctors request the patient to take blood tests: morphology, inflammatory parameters (OB and CRP), rhematoid factor (RF), anti-bodies anti-CCP. At present there are increasingly-popular genetic examinations. In nearly all laboratories we can mark HLA-B27 antigen which should be marked for patients suspected to have some kind of joint inflammation.

In rheumatology a considerable emphasis is placed on genetics. This is why a family history is so important. If the patient suspects joint inflammation, a doctor always asks if other family members had any joint or connective tissue diseases (that is parents, siblings, grandparents, children…). It is important that the doctor learns if the patient or patient’s family suffered from other autoimmune diseases, e.g. psoriasis, inflammatory bowel disease).

There is also post-infection arthritis. In this case the major cause is evident (cause and effect relation). The inflammation may be generated by bacteria, viruses or other pathogens. It is the so-called reactive arthritis.  It may be bacteria which lead to inflammation of the urogenital system.

Joint swelling – treatment

Arthritis is always treated comprehensively, adds PhD Kinga Kozicka-Kąkol. The key is to make sure the patient cooperates closely with a rheumatologist, physiotherapist, and often psychologist. After understanding the problem and establishing a need to have a long-term therapy (often lasting many years), a solid treatment plan can be developed. To treat arthritis, we use medicament intended for a specific kind of disease. At present we can use a wide range of therapies, starting from non-steroid anti-inflammatory drugs, through immuno-suppressive medicine (blocking/modifying immune system), ending up with biological drugs which are becoming more and more accessible. For arthritis, locally-applied drugs (steroids) are also used. These are the so-called joint blockades.

A patient with arthritis must move! Movement cannot treat the disease but is crucial. In some cases it can be as much effective as drugs. The joint which does not move leads to contracture and freezes. People react to pain in the way that they want to „rest until they relieve” – wait until it goes away. Speaking of arthritis, it must be the other way round. If it hurts, you must move. It is important that this movement is aimed at specific joints – conscious rehabilitation conducted by an experienced physiotherapist.

Unfortunately it is impossible to cure patients of the arthritis for good; we can only partially heal the disease. Our priority is to assure remission or low disease activity. It is an ideal target which must be achieved to make sure the patient enters remission, which may be a long-lasting process. It is not always possible but the sooner the diagnosis is made, the earlier a suitable treatment can be adopted and more likely to have a long-term remission.

If you afflict an inflammatory joint disease, you have to deal with it for the rest of your life. You just need to „make friends” with it. It is very important that the patient accepts his/her condition, then he/she can understand the problem and cooperate with doctors, and assure better treatment results. Sadly arthritis may recur, get more intensive, and this happens when patients are highly stressed or undergo infections. This is what autoimmune diseases are like. Although remission lasts a couple of years, a strong stimulus, e.g. stress, makes a patient wake up due to pain, swollen joints and… the disease comes back.

In the last couple of years the situation in Poland has changed. Speaking of arthritis treatment, we are no longer in the shadow. We have the same guidelines, treatment standards and we have the same drugs as western Europe’s.

Joint swelling – doing sports

If you have arthritis, there are no contraindications against doing sports. Quite the opposite, the more physical activity, the better. We need to emphasize however that it is more about recreational activities than professional sport, for instance weight training which entails considerable overloads. Rheumatologists recommend such activities as swimming which engages virtually all joints, but they are supported by water. The second recommended activity is cycling which contrary to running does not overload knees and hips.

Note: If you notice any joint swelling and pain which do not arise from any injury or overload, you should visit a doctor.

Joint swelling – rehabilitation

Rehabilitation depends on the condition of your joint, on whether swelling is substantial and whether the joint is contractured or stiff, says MA Michał Młotkowski, a Rehasport Clinic physiotherapist from Gdańsk. We do not focus on any special rheumatological exercises. They are very similar to the ones we recommend to orthopedic patients, e.g. arthroscopy where the knee is swollen and its movements are limited. Sadly rheumatic-based diseases may require a considerably longer rehabilitation. The conspicuous results can be expected a way later than in the case of orthopedic patient.

A patient who has a swollen joint tries not to use it due to pain. Such joint freezes and loses its mobility. A task of the physiotherapist is to eliminate swelling as much as possible, restore a full range of movements in the joint, and finally introduce strengthening and stabilizing exercises, depending on which joint is in question. The patient must undergo rehabilitation sessions once or twice a week, including everyday home workout. Rheumatic patients feel the so-called morning stiffness and for this reason they need about half an hour of „morning warm-up” every day. It is all about exercises aimed at a specific joint to make sure it warms up and the patient can function better throughout the day. Everyday systematic workout is very important and can slower or even stop the progress of the disease.

Joint swelling – examples of exercises:

The article has been prepared in cooperation with PhD Kinga Kozicka-Kąkol (a Rehasport Clinic general practitioner and rheumatologist), PhD Paweł Rybak (an orthopedist) and MA Michał Młotkowski (a physiotherapist).