Sunday, December 11, 2005


arthritis; See also OSTEOARTHRITIS.

arthritis, infectious (septic) Infectious arthritis has always been common among children and adolescents. However, in the last two decades an increasing number of cases have been found in the elderly. The usual symptoms of infectious arthritis are fever, pain, redness, swelling and effusion in the involved joint. In the elderly, however, the symptoms are less acute and may occur in the same joints previously involved in rheumatoid arthritis or osteoarthritis. The hip or knee is the most common site affected. Leucocytosis (excessive white blood cells), anemia, and an elevated erthrocyte sedimentation rate (rapidity with which red cells sink in drawn blood) are the most frequent abnormalities found in laboratory tests. The diagnosis is made by joint aspiration, which usually reveals purulent fluid. Once the diagnosis is made treatment is begun on the basis of either a Gram stain or culture results. The most frequent causative organism of infectious arthritis in the elderly is Staphylococcus aureus, although various streptococci, Mycobacterium tuberculosis, and gram negative bacilli may occasionally be the causative agent.
If treatment is initiated before the cartilage is destroyed, full return of function may be expected. Because of limited blood supply, late therapy of septic arthritis of the hip may result in avascular necrosis (death of tissue). Degenerative arthritis and decreased range of motion may complicate a poor result. In the elderly it is not uncommon for limitation of motion to persist even though the joint may not be severely damaged.
Covington, T., and Walker, J. Current Geriatric Therapy. Philadelphia: W. B. Saunders, 1984.

arthritis, rheumatoid Rheumatoid arthritis is a chronic progressive disease with marked inflammatory changes and atrophy of the tissue to the joints. The disease may begin at any age but is more predominant between the ages of 20 and 60, peaking at ages 35 to 45. Women are affected two to three times more often than men, and there is often a family history of the disease. Onset of the disease is usually insidious with stiffness and aching joints followed by gradual swelling, warmth, redness, and tenderness with limitation of motion. In most patients, the small joints of the hands and feet are commonly involved. Other affected joints are the wrists, knees, elbows, ankles, shoulders, hips, and, rarely, the cervical spine. The muscles of affected extremities may become severely weakened and atrophied to a greater degree than would be expected to result from disuse alone.
Symptoms include fatigue, malaise, low-grade fever, TACHYCARDIA, weakness, weight loss, ANEMIA, and joint deformities. Subcutaneous nodules may appear over pressure joints, especially the elbow. People with rheumatoid arthritis appear to be more susceptible to peptic ulcers, and this tendency is increased when the patient takes drugs such as aspirin, ibuprofen, indomethacin (Indocin), phenylbutazone, (Butazolidin) and corticosteroids (Prednisone).
The basic treatment for rheumatoid arthritis consists of rest, physical therapy, and anti-inflammatory drugs. Surgery is only necessary in a small number of people. A proper balance of rest and exercise should be part of the person's daily program. Heat, particularly moist heat, is helpful as a muscle relaxant. Therapeutic exercise is best done after the application of heat when the person is comfortable and muscle spasm is reduced. The person must be encouraged and motivated to make the most of his or her capabilities.
The elderly are especially prone to depression and passivity and benefit from a trusting, caring relationship with their physician and family. Local chapters of the Arthritis Foundation can provide assistance in directing people to self-help devices and rehabilitative facilities.
For additional information write or call:
National Arthritis Foundation
1314 Spring Street, N. W. # 103
Atlanta, GA 30309
Reichel, W. M. Clinical Aspects of Aging. Baltimore: The Williams & Wilkins Co., 1979.


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