Effects of Aging on the Joints

Effects of Aging on the Joints

Aging takes a heavy toll on the body’s joints. Conditions such as arthritis and rheumatism are among the most prevalent complaints of elderly people. These conditions involve pain and stiffness in the joints, which may lead to immobility. Causes of arthritis include bacterial or viral infections, joint injuries, severe physical stress, and metabolic conditions.

Arthritis

Arthritis is a term that signifies more than 100 inflammatory or degenerative diseases, all of which damage the joints. Arthritis is the most common disease that results in crippling of movement in the United States, affecting one in five people. Acute arthritis usually develops from bacterial infections, whereas chronic arthritis includes the forms known as osteoarthritis, rheumatoid arthritis, and gouty arthritis. Rheumatoid arthritis is an autoimmune disorder that primarily affects the small joints of the hands, causing pain, stiffness, and deformity (FIGURE 8 -11 ). Gouty arthritis, known also as gout, is caused by accumulation of uric acid and primarily affects the joints of the great toe, but can also involve the joints of the fingers (FIGURE 8-12), wrists, knees, and ankles. It is much more common in men over the age of 30.

Gouty Arthritis

Gouty arthritis is a condition based on excessive, abnormal levels of uric acid deposited as needle-like urate crystals in soft tissues of joints. An inflamma-tory response is triggered and an extremely painful gouty arthritis occurs. Usually, the joint at the base of the great toe is first affected (FIGURE 8-13). Men experience gouty arthritis much more than women because of their naturally higher blood levels of uric acid. The condition may be genetically linked and often runs in families. If untreated, the articulating bone ends fuse to immobilize the joint. Medications include nonsteroidal anti-inflammatory drugs, col-chicine, glucosteroids, and others. Dietary changes include increased water intake, avoiding alcoholic beverages, and avoiding foods such as kidneys, liver, or sardines, which are high in purine-containing nucleic acids.

Osteoarthritis

Osteoarthritis is the most common chronic form of arthritis. Degeneration of joints, via ­enzymatic activity occurs due to aging in most patients (FIGURE­ 8-14). Degenerative joint disease occurs more commonly in women, usually affecting the knees and other weight-bearing joints and the distal finger joints. Nearly half of all adults develop osteoarthritis by age 85, and women are more commonly affected than men. In peo-ple with osteoarthritis, more cartilage is destroyed than can be normally replaced. Poorly aligned or overused joints are most likely to evelop osteoarthritis. Exposed bone tissue becomes thicker over time, forming bony osteophytes (spurs). These enlarge bone ends, restrict-ing joint movement. Affected joints may “crunch,” a condition known as crepitus. Most commonly, the joints of the cervical or lumbar spine, fingers,­ knuckles, knees, and hips are affected. Osteoarthritis develops slowly, is irreversible, and causes pain, joint stiffness, and inflam-mation. Treatments include pain relievers, moder-ate activity, capsaicin, and ­nutritional ­supplements.

Continuous­ passive motion helps an injured joint to repair by improving circulation of synovial fluid. This is often performed by a machine or physical therapist working with the patient.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that usually appears between the ages of 30 and 50. It is less common than osteoarthritis and affects women three times more often than men. Initially, joint tender-ness and stiffness are common. It usually manifests in the fingers, wrists, ankles, and feet, on a bilateral basis. All of the rheumatic diseases that affect synovial joints are known as rheumatoid arthritis; which is marked by exacerbations and remissions. These may include anemia, muscle weakness, osteoporosis, and cardiovascular­ abnormalities. Rheumatoid arthritis is an autoimmune disease, in which the immune system attacks its own tissues. Although cause is not completely understood, it may be related to various bacteria and viruses. The synovitis (synovial membrane) of an affected joint becomes inflamed first Lymphocytes, macrophages, and other inflammatory cells move to the joint cavity and release inflammatory chemicals. Over time, a pannus develops, which is a thickened, abnormal tissue that grasps to articular cartilages. The pannus erodes cartilage and bone, forming scar tissue and connecting bone ends together. When this scar tissue ossifies and the bone ends fuse, the joint becomes immobile. Ankylosis­ is the “end” condition, in which the affected areas become bent and deformed. Although ankylosis does not always develop, rheumatoid arthritis consistently results in restricted joint movement and intense pain. Treatment is aimed at disrupting the autoimmune destruction of the joints. Medications include steroidal and nonsteroidal anti-inflammatory drugs, immune suppressants, and biologic agents. Surgery may be used to replace affected joints with artificial prostheses.

Bursitis

Bursitis is inflammation of the bursae, which is often caused by trauma or friction. Examples of bursitis include conditions known as water on the knee and student’s elbow. If severe, common treatments include injection of anti-inflammatory drugs into the bursae or removal of excessive fluid via needle aspiration.

Tendonitis

Tendonitis is inflammation of tendon sheaths, which is usually caused by excessive wear. This condition has similar symptoms to bursitis, which include pain and swelling. Treatment of tendonitis includes ice, rest, and anti-inflammatory drugs.

Lyme Disease

Lyme disease may also affect the joints and is caused by spirochete bacteria. It is transmitted by ticks that infest deer or mice. Lyme disease may cause joint (often knee) pain, arthritis, skin rash, flu-like symptoms, and impaired cognition. Untreated Lyme disease results in neurological and cardiovascular problems. It is very difficult to diagnose and usually requires a long course of antibiotics.