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100-528: Arthritis is a term often used to mean any disorder that affects joints . Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling , and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden. There are over 100 types of arthritis. The most common forms are osteoarthritis (degenerative joint disease) and rheumatoid arthritis . Osteoarthritis usually occurs with age and affects

200-486: A decreased appetite and decreased nutritional intake. A change in condition that deviates from baseline, such as moaning with movement or when manipulating a body part, and limited range of motion are also potential pain indicators. In patients who possess language but are incapable of expressing themselves effectively, such as those with dementia, an increase in confusion or display of aggressive behaviors or agitation may signal that discomfort exists, and further assessment

300-576: A 28-year-old resident physician at Salpêtrière Asylum in France was the first person to describe the symptoms of rheumatoid arthritis. Though Landré-Beauvais' classification of rheumatoid arthritis as a relative of gout was inaccurate, his dissertation encouraged others to further study the disease. The term is derived from arthr- (from Ancient Greek : ἄρθρον , romanized :  árthron , lit.   'joint') and -itis (from -ῖτις , -îtis , lit.   ' pertaining to ' ),

400-488: A credible and convincing signal of the need for relief, help, and care. Idiopathic pain (pain that persists after the trauma or pathology has healed, or that arises without any apparent cause) may be an exception to the idea that pain is helpful to survival, although some psychodynamic psychologists argue that such pain is psychogenic, enlisted as a protective distraction to keep dangerous emotions unconscious. In pain science, thresholds are measured by gradually increasing

500-431: A damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves once the noxious stimulus is removed and the body has healed, but it may persist despite removal of the stimulus and apparent healing of the body. Sometimes pain arises in the absence of any detectable stimulus, damage or disease. Pain is the most common reason for physician consultation in most developed countries. It

600-525: A higher risk of being stigmatized, leading to less urgent treatment of women based on social expectations of their ability to accurately report it. This has been postulated to lead to extended emergency room wait times for women and frequent dismissal of their ability to accurately report pain. Pain is a symptom of many medical conditions. Knowing the time of onset, location, intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and relieving factors, and quality (burning, sharp, etc.) of

700-475: A joint is strained. Damaging the cartilage of joints ( articular cartilage ) or the bones and muscles that stabilize the joints can lead to joint dislocations and osteoarthritis. Swimming is a great way to exercise the joints with minimal damage. A joint disorder is termed arthropathy , and when involving inflammation of one or more joints the disorder is called arthritis . Most joint disorders involve arthritis, but joint damage by external physical trauma

800-445: A key in a lock or opening jars, as these activities can be cumbersome and painful. There are adaptive aids or assistive devices (ADs) available to help with these tasks, but they are generally more costly than conventional products with the same function. It is now possible to 3-D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help arthritis patients and

900-408: A multifaceted approach, including physical therapy, medications, lifestyle changes, and, in severe cases, surgical interventions. Preventive care, such as regular exercise, a balanced diet, and avoiding excessive strain, is critical for maintaining joint health, preventing disorders, and improving overall quality of life. The number of joints depends on if sesamoids are included, age of the human and

1000-454: A non-communicative person, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding (trying to protect part of the body from being bumped or touched) indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes. Patients experiencing pain may exhibit withdrawn social behavior and possibly experience

1100-449: A person has "arthritis" it means that they have one of these diseases, which include: Joint pain can also be a symptom of other diseases. In this case, the arthritis is considered to be secondary to the main disease; these include: An undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease . Pain, which can vary in severity,

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1200-618: A person to move around and/or exercise, which can lead to secondary effects, such as: These changes, in addition to the primary symptoms, can have a huge impact on quality of life. Arthritis is the most common cause of disability in the United States. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis can make it difficult for individuals to be physically active and some become home bound. It

1300-556: A reduction in negative affect . Across studies, participants that were subjected to acute physical pain in the laboratory subsequently reported feeling better than those in non-painful control conditions, a finding which was also reflected in physiological parameters. A potential mechanism to explain this effect is provided by the opponent-process theory . Before the relatively recent discovery of neurons and their role in pain, various body functions were proposed to account for pain. There were several competing early theories of pain among

1400-512: A response to numerous factors, including fear of worsening symptoms. There are common risk factors that increase a person's chance of developing arthritis later in adulthood. Some of these are modifiable while others are not. Smoking has been linked to an increased susceptibility of developing arthritis, particularly rheumatoid arthritis. Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on

1500-707: A result of decreased sensation. A much smaller number of people are insensitive to pain due to an inborn abnormality of the nervous system, known as " congenital insensitivity to pain ". Children with this condition incur carelessly-repeated damage to their tongues, eyes, joints, skin, and muscles. Some die before adulthood, and others have a reduced life expectancy. Most people with congenital insensitivity to pain have one of five hereditary sensory and autonomic neuropathies (which includes familial dysautonomia and congenital insensitivity to pain with anhidrosis ). These conditions feature decreased sensitivity to pain together with other neurological abnormalities, particularly of

1600-424: A sedentary lifestyle. Rheumatoid arthritis (RA) is a disorder in which the body's own immune system starts to attack body tissues . The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. RA often affects joints in the fingers, wrists, knees and elbows,

1700-771: A skin rash, extreme photosensitivity , hair loss , kidney problems, lung fibrosis and constant joint pain. Gout is caused by deposition of uric acid crystals in the joints, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout . In the early stages, the gouty arthritis usually occurs in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function. Gouty arthritis can become particularly painful and potentially debilitating when gout cannot successfully be treated. When uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease

1800-448: A state known as pain asymbolia, described as intense pain devoid of unpleasantness, with morphine injection or psychosurgery . Such patients report that they have pain but are not bothered by it; they recognize the sensation of pain but suffer little, or not at all. Indifference to pain can also rarely be present from birth; these people have normal nerves on medical investigations, and find pain unpleasant, but do not avoid repetition of

1900-476: A wide variety of viruses . The virus SARS-CoV-2 , which causes Covid-19 has been added to the list of viruses which can cause infections arthritis. SARS-CoV-2 causes reactive arthritis . Psoriasis can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are continuous joint pains, stiffness and swelling. The disease does recur with periods of remission but there

2000-432: Is "pain that extends beyond the expected period of healing". Chronic pain may be classified as " cancer-related " or "benign." Allodynia is pain experienced in response to a normally painless stimulus. It has no biological function and is classified by characteristics of the stimuli as cold, heat, touch, pressure or a pinprick. Phantom pain is pain felt in a part of the body that has been amputated , or from which

2100-443: Is a common symptom in virtually all types of arthritis. Other symptoms include swelling , joint stiffness , redness, and aching around the joint(s). Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. Symptoms may include: It is common in advanced arthritis for significant secondary changes to occur. For example, arthritic symptoms might make it difficult for

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2200-696: Is a common, reproducible tool in the assessment of pain and pain relief. The scale is a continuous line anchored by verbal descriptors, one for each extreme of pain where a higher score indicates greater pain intensity. It is usually 10 cm in length with no intermediate descriptors as to avoid marking of scores around a preferred numeric value. When applied as a pain descriptor, these anchors are often 'no pain' and 'worst imaginable pain". Cut-offs for pain classification have been recommended as no pain (0–4mm), mild pain (5–44mm), moderate pain (45–74mm) and severe pain (75–100mm). The Multidimensional Pain Inventory (MPI)

2300-642: Is a major symptom in many medical conditions, and can interfere with a person's quality of life and general functioning. People in pain experience impaired concentration, working memory , mental flexibility , problem solving and information processing speed, and are more likely to experience irritability, depression, and anxiety. Simple pain medications are useful in 20% to 70% of cases. Psychological factors such as social support , cognitive behavioral therapy , excitement, or distraction can affect pain's intensity or unpleasantness. First attested in English in 1297,

2400-493: Is a questionnaire designed to assess the psychosocial state of a person with chronic pain. Combining the MPI characterization of the person with their IASP five-category pain profile is recommended for deriving the most useful case description. Non-verbal people cannot use words to tell others that they are experiencing pain. However, they may be able to communicate through other means, such as blinking, pointing, or nodding. With

2500-491: Is a tool used to aid a person's disability by reducing their physical barriers by improving the use of their damaged body part, typically after an amputation. Assistive technology devices can be customized to the patient or bought commercially. There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective. Depending on

2600-475: Is also associated with increased depression, anxiety, fear, and anger. If I have matters right, the consequences of pain will include direct physical distress, unemployment, financial difficulties, marital disharmony, and difficulties in concentration and attention… Although pain is considered to be aversive and unpleasant and is therefore usually avoided, a meta-analysis which summarized and evaluated numerous studies from various psychological disciplines, found

2700-446: Is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation. Additionally, there is a less common form of gout that is caused by the formation of rhomboidal-shaped crystals of calcium pyrophosphate . This form of gout is known as pseudogout . Temporomandibular joint syndrome (TMJ) involves the jaw joints and can cause facial pain, clicking sounds in

2800-663: Is derived from Latin articulatio . Humans have also developed lighter, more fragile joint bones over time due to the decrease in physical activity compared to thousands of years ago. Pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." Pain motivates organisms to withdraw from damaging situations, to protect

2900-547: Is distinctly located also activates the primary and secondary somatosensory cortex . Spinal cord fibers dedicated to carrying A-delta fiber pain signals and others that carry both A-delta and C fiber pain signals to the thalamus have been identified. Other spinal cord fibers, known as wide dynamic range neurons , respond to A-delta and C fibers and the much larger, more heavily myelinated A-beta fibers that carry touch, pressure, and vibration signals. Ronald Melzack and Patrick Wall introduced their gate control theory in

3000-470: Is essential for protection from injury, and recognition of the presence of injury. Episodic analgesia may occur under special circumstances, such as in the excitement of sport or war: a soldier on the battlefield may feel no pain for many hours from a traumatic amputation or other severe injury. Although unpleasantness is an essential part of the IASP definition of pain, it is possible in some patients to induce

3100-565: Is estimated that the total cost of arthritis cases is close to $ 100 billion of which almost 50% is from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers. Decreased mobility, in combination with the above symptoms, can make it difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease . People with arthritis are also at increased risk of depression , which may be

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3200-410: Is expected to increase. Adults with co-morbid conditions, such as heart disease, diabetes, and obesity, were seen to have a higher than average prevalence of doctor-diagnosed arthritis (49.3%, 47.1%, and 30.6% respectively). Disability due to musculoskeletal disorders increased by 45% from 1990 to 2010. Of these, osteoarthritis is the fastest increasing major health condition. Among the many reports on

3300-403: Is initially described as burning or tingling but may evolve into severe crushing or pinching pain, or the sensation of fire running down the legs or of a knife twisting in the flesh. Onset may be immediate or may not occur until years after the disabling injury. Surgical treatment rarely provides lasting relief. Breakthrough pain is transitory pain that comes on suddenly and is not alleviated by

3400-507: Is necessary. Changes in behavior may be noticed by caregivers who are familiar with the person's normal behavior. Infants do feel pain , but lack the language needed to report it, and so communicate distress by crying. A non-verbal pain assessment should be conducted involving the parents, who will notice changes in the infant which may not be obvious to the health care provider. Pre-term babies are more sensitive to painful stimuli than those carried to full term. Another approach, when pain

3500-607: Is no known cure for the disorder. A small percentage develop a severely painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function. There is no known cure for arthritis and rheumatic diseases. Treatment options vary depending on the type of arthritis and include physical therapy , exercise and diet, orthopedic bracing , and oral and topical medications. Joint replacement surgery may be required to repair damage, restore function, or relieve pain. In general, studies have shown that physical exercise of

3600-548: Is now Olathe, Kansas . Evidence of arthritis has been found throughout history, from Ötzi , a mummy ( c.  3000 BC ) found along the border of modern Italy and Austria , to the Egyptian mummies c.  2590 BC . In 1715, William Musgrave published the second edition of his most important medical work, De arthritide symptomatica , which concerned arthritis and its effects. Augustin Jacob Landré-Beauvais,

3700-421: Is often described as shooting, crushing, burning or cramping. If the pain is continuous for a long period, parts of the intact body may become sensitized, so that touching them evokes pain in the phantom limb. Phantom limb pain may accompany urination or defecation . Local anesthetic injections into the nerves or sensitive areas of the stump may relieve pain for days, weeks, or sometimes permanently, despite

3800-412: Is suspected, is to give the person treatment for pain, and then watch to see whether the suspected indicators of pain subside. The way in which one experiences and responds to pain is related to sociocultural characteristics, such as gender, ethnicity, and age. An aging adult may not respond to pain in the same way that a younger person might. Their ability to recognize pain may be blunted by illness or

3900-462: Is symmetrical (appears on both sides of the body), and can lead to severe deformity in a few years if not treated. RA occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash , fever , pain , disability, and limitations in daily activities. With earlier diagnosis and aggressive treatment, many individuals can lead a better quality of life than if going undiagnosed for long after RA's onset. The risk factors with

4000-405: Is the most common form of arthritis. It affects humans and other animals, notably dogs, but also occurs in cats and horses. It can affect both the larger and the smaller joints of the body. In humans, this includes the hands, wrists , feet, back, hip, and knee. In dogs, this includes the elbow, hip, stifle (knee), shoulder, and back. The disease is essentially one acquired from daily wear and tear of

4100-459: Is typically not termed arthritis. Arthropathies are called polyarticular (multiarticular) when involving many joints and monoarticular when involving only a single joint. Arthritis is the leading cause of disability in people over the age of 55. There are many different forms of arthritis, each of which has a different cause. The most common form of arthritis, osteoarthritis (also known as degenerative joint disease), occurs following trauma to

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4200-525: The autoimmune nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called disease-modifying antirheumatic drugs (DMARDs). csDMARDs, TNF biologics and tsDMARDs are specific kinds of DMARDs that are recommended for treatment. Treatment with DMARDs is designed to slow down the progression of RA by initiating an adaptive immune response , in part by CD4+ T helper (Th) cells, specifically Th17 cells. Th17 cells are present in higher quantities at

4300-523: The autonomic nervous system . A very rare syndrome with isolated congenital insensitivity to pain has been linked with mutations in the SCN9A gene, which codes for a sodium channel ( Na v 1.7 ) necessary in conducting pain nerve stimuli. Experimental subjects challenged by acute pain and patients in chronic pain experience impairments in attention control, working memory capacity , mental flexibility , problem solving, and information processing speed. Pain

4400-405: The medial , paleospinothalamic tract . The neospinothalamic tract carries the fast, sharp A-delta signal to the ventral posterolateral nucleus of the thalamus . The paleospinothalamic tract carries the slow, dull C fiber pain signal. Some of the paleospinothalamic fibers peel off in the brain stem—connecting with the reticular formation or midbrain periaqueductal gray—and the remainder terminate in

4500-467: The 1965 Science article "Pain Mechanisms: A New Theory". The authors proposed that the thin C and A-delta (pain) and large diameter A-beta (touch, pressure, vibration) nerve fibers carry information from the site of injury to two destinations in the dorsal horn of the spinal cord, and that A-beta fiber signals acting on inhibitory cells in the dorsal horn can reduce the intensity of pain signals sent to

4600-447: The 19th-century development of specificity theory . Specificity theory saw pain as "a specific sensation, with its own sensory apparatus independent of touch and other senses". Another theory that came to prominence in the 18th and 19th centuries was intensive theory , which conceived of pain not as a unique sensory modality, but an emotional state produced by stronger than normal stimuli such as intense light, pressure or temperature. By

4700-415: The C fibers. These A-delta and C fibers enter the spinal cord via Lissauer's tract and connect with spinal cord nerve fibers in the central gelatinous substance of the spinal cord . These spinal cord fibers then cross the cord via the anterior white commissure and ascend in the spinothalamic tract . Before reaching the brain, the spinothalamic tract splits into the lateral , neospinothalamic tract and

4800-408: The United States more than 20% have a type of arthritis. Overall the disease becomes more common with age. Arthritis is a common reason that people miss work and can result in a decreased quality of life. The term is derived from arthr- (meaning 'joint') and -itis (meaning 'inflammation'). There are several diseases where joint pain is primary, and is considered the main feature. Generally when

4900-465: The affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person. Individuals with arthritis can benefit from both physical and occupational therapy . In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay

5000-429: The affective-motivational dimension. Thus, excitement in games or war appears to block both the sensory-discriminative and affective-motivational dimensions of pain, while suggestion and placebos may modulate only the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed. (p. 432) The paper ends with a call to action: "Pain can be treated not only by trying to cut down

5100-433: The anatomic classification, joints are subdivided into simple and compound , depending on the number of bones involved, and into complex and combination joints: The joints may be classified anatomically into the following groups: Unmyelinated nerve fibers are abundant in joint capsules and ligaments, as well as in the outer part of intra-articular menisci. These nerve fibers are responsible for pain perception when

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5200-407: The ancient Greeks: Hippocrates believed that it was due to an imbalance in vital fluids . In the 11th century, Avicenna theorized that there were a number of feeling senses, including touch, pain, and titillation. In 1644, René Descartes theorized that pain was a disturbance that passed along nerve fibers until the disturbance reached the brain. The work of Descartes and Avicenna prefigured

5300-471: The brain no longer receives signals. It is a type of neuropathic pain. The prevalence of phantom pain in upper limb amputees is nearly 82%, and in lower limb amputees is 54%. One study found that eight days after amputation, 72% of patients had phantom limb pain, and six months later, 67% reported it. Some amputees experience continuous pain that varies in intensity or quality; others experience several bouts of pain per day, or it may reoccur less often. It

5400-506: The brain. In 1968, Ronald Melzack and Kenneth Casey described chronic pain in terms of its three dimensions: They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but "higher" cognitive activities can influence perceived intensity and unpleasantness. Cognitive activities may affect both sensory and affective experience, or they may modify primarily

5500-412: The definition of joints. However, the number of sesamoids is the same in most people with variations being rare. Joints are mainly classified structurally and functionally. Structural classification is determined by how the bones connect to each other, while functional classification is determined by the degree of movement between the articulating bones. In practice, there is significant overlap between

5600-577: The diagnosis or may indicate systemic disease. Radiographs are often used to follow progression or help assess severity. Blood tests and X-rays of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: rheumatoid factor , antinuclear factor (ANF), extractable nuclear antigen , and specific antibodies. Rheumatoid arthritis patients often have high erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) levels, which indicates

5700-413: The drug wearing off in a matter of hours; and small injections of hypertonic saline into the soft tissue between vertebrae produces local pain that radiates into the phantom limb for ten minutes or so and may be followed by hours, weeks, or even longer of partial or total relief from phantom pain. Vigorous vibration or electrical stimulation of the stump, or current from electrodes surgically implanted onto

5800-411: The fingers, knees, and hips. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet. Other types include gout , lupus , fibromyalgia , and septic arthritis . They are all types of rheumatic disease . Treatment may include resting the joint and alternating between applying ice and heat. Weight loss and exercise may also be useful. Recommended medications may depend on

5900-481: The form of arthritis. These may include pain medications such as ibuprofen and paracetamol (acetaminophen). In some circumstances, a joint replacement may be useful. Osteoarthritis affects more than 3.8% of people, while rheumatoid arthritis affects about 0.24% of people. Gout affects about 1–2% of the Western population at some point in their lives. In Australia about 15% of people are affected by arthritis, while in

6000-481: The increased prevalence of musculoskeletal conditions, data from Africa are lacking and underestimated. A systematic review assessed the prevalence of arthritis in Africa and included twenty population-based and seven hospital-based studies. The majority of studies, twelve, were from South Africa. Nine studies were well-conducted, eleven studies were of moderate quality, and seven studies were conducted poorly. The results of

6100-400: The intensity of a stimulus in a procedure called quantitative sensory testing which involves such stimuli as electric current , thermal (heat or cold), mechanical (pressure, touch, vibration), ischemic , or chemical stimuli applied to the subject to evoke a response. The " pain perception threshold " is the point at which the subject begins to feel pain, and the "pain threshold intensity" is

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6200-400: The intralaminar nuclei of the thalamus. Pain-related activity in the thalamus spreads to the insular cortex (thought to embody, among other things, the feeling that distinguishes pain from other homeostatic emotions such as itch and nausea) and anterior cingulate cortex (thought to embody, among other things, the affective/motivational element, the unpleasantness of pain), and pain that

6300-497: The jaw, or limitation of jaw movement, to name a few symptoms. It is caused by psychological tension and misalignment of the jaw ( malocclusion ), and may be affecting as many as 75 million Americans. The English word joint is a past participle of the verb join , and can be read as joined . Joint is derived from Latin iunctus , past participle of the Latin verb iungere , join, unite, connect, attach. The English term articulation

6400-410: The joint, following an infection of the joint or simply as a result of aging and the deterioration of articular cartilage. Furthermore, there is emerging evidence that abnormal anatomy may contribute to early development of osteoarthritis. Other forms of arthritis are rheumatoid arthritis and psoriatic arthritis , which are autoimmune diseases in which the body is attacking itself. Septic arthritis

6500-773: The joint; however, osteoarthritis can also occur as a result of injury. Osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other. The condition starts with minor pain during physical activity, but soon the pain can be continuous and even occur while in a state of rest. The pain can be debilitating and prevent one from doing some activities. In dogs, this pain can significantly affect quality of life and may include difficulty going up and down stairs, struggling to get up after lying down, trouble walking on slick floors, being unable to hop in and out of vehicles, difficulty jumping on and off furniture, and behavioral changes (e.g., aggression, difficulty squatting to toilet). Osteoarthritis typically affects

6600-582: The joints in rheumatoid arthritis is inflammation of the synovium , caused in part by the production of pro-inflammatory cytokines and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts. Osteoclast activity can be directly induced by osteoblasts through the RANK/RANKL mechanism. Lupus is a common collagen vascular disorder that can be present with severe arthritis. Other features of lupus include

6700-503: The joints, often resulting in swelling, pain, and potential deformity. Another prevalent condition, gout , arises from the accumulation of uric acid crystals in the joints, triggering severe pain and inflammation. Joints also hold diagnostic importance, as their condition can indicate underlying health issues. Symptoms such as joint pain and swelling may signal inflammatory diseases, infections, or metabolic disorders. Effective treatment and management of joint-related conditions often require

6800-578: The latter suffix having come to be associated with inflammation . The word arthritides is the plural form of arthritis, and denotes the collective group of arthritis-like conditions. Joint Joints play a vital role in the human body, contributing to movement, stability, and overall function. They are essential for mobility and flexibility, connecting bones and facilitating a wide range of motions, from simple bending and stretching to complex actions like running and jumping. Beyond enabling movement, joints provide structural support and stability to

6900-416: The likelihood of reporting pain. Patients may feel that certain treatments go against their religious beliefs. They may not report pain because they feel it is a sign that death is near. Many people fear the stigma of addiction, and avoid pain treatment so as not to be prescribed potentially addicting drugs. Many Asians do not want to lose respect in society by admitting they are in pain and need help, believing

7000-575: The mid-1890s, specificity was backed primarily by physiologists and physicians, and psychologists mostly backed the intensive theory . However, after a series of clinical observations by Henry Head and experiments by Max von Frey , the psychologists migrated to specificity almost en masse. By the century's end, most physiology and psychology textbooks presented pain specificity as fact. Some sensory fibers do not differentiate between noxious and non-noxious stimuli, while others (i.e., nociceptors ) respond only to noxious, high-intensity stimuli. At

7100-411: The need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities. Assistive technology

7200-480: The noxious stimulus is removed or the underlying damage or pathology has healed. But some painful conditions, such as rheumatoid arthritis , peripheral neuropathy , cancer , and idiopathic pain, may persist for years. Pain that lasts a long time is called " chronic " or "persistent", and pain that resolves quickly is called " acute ". Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time between onset and resolution;

7300-610: The number of axes of movement they allow, into nonaxial (gliding, as between the proximal ends of the ulna and radius), monoaxial (uniaxial), biaxial and multiaxial . Another classification is according to the degrees of freedom allowed, and distinguished between joints with one, two or three degrees of freedom. A further classification is according to the number and shapes of the articular surfaces: flat, concave and convex surfaces. Types of articular surfaces include trochlear surfaces. Joints can also be classified based on their anatomy or on their biomechanical properties. According to

7400-400: The pain should be borne in silence, while other cultures feel they should report pain immediately to receive immediate relief. Gender can also be a perceived factor in reporting pain. Gender differences can be the result of social and cultural expectations, with, in some cultures, women expected to be more emotional and show pain, and men to be more stoic. As a result, female pain may be at

7500-487: The pain stimulus. Insensitivity to pain may also result from abnormalities in the nervous system . This is usually the result of acquired damage to the nerves, such as spinal cord injury , diabetes mellitus ( diabetic neuropathy ), or leprosy in countries where that disease is prevalent. These individuals are at risk of tissue damage and infection due to undiscovered injuries. People with diabetes-related nerve damage, for instance, sustain poorly-healing foot ulcers as

7600-400: The pain will help the examining physician to accurately diagnose the problem. For example, chest pain described as extreme heaviness may indicate myocardial infarction , while chest pain described as tearing may indicate aortic dissection . Functional magnetic resonance imaging brain scanning has been used to measure pain, and correlates well with self-reported pain. Nociceptive pain

7700-497: The patient's regular pain management . It is common in cancer patients who often have background pain that is generally well-controlled by medications, but who also sometimes experience bouts of severe pain that from time to time "breaks through" the medication. The characteristics of breakthrough cancer pain vary from person to person and according to the cause. Management of breakthrough pain can entail intensive use of opioids , including fentanyl . The ability to experience pain

7800-512: The peripheral end of the nociceptor, noxious stimuli generate currents that, above a given threshold, send signals along the nerve fiber to the spinal cord. The "specificity" (whether it responds to thermal, chemical, or mechanical features of its environment) of a nociceptor is determined by which ion channels it expresses at its peripheral end. So far, dozens of types of nociceptor ion channels have been identified, and their exact functions are still being determined. The pain signal travels from

7900-486: The periphery to the spinal cord along A-delta and C fibers. Because the A-delta fiber is thicker than the C fiber, and is thinly sheathed in an electrically insulating material ( myelin ), it carries its signal faster (5–30  m/s ) than the unmyelinated C fiber (0.5–2 m/s). Pain evoked by the A-delta fibers is described as sharp and is felt first. This is followed by a duller pain—often described as burning—carried by

8000-620: The presence of an inflammatory process in the body. Anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) are two more common blood tests. Positive results indicate the risk of rheumatoid arthritis, while negative results help rule out this autoimmune condition. Imaging tests like X-rays, MRI scans or Ultrasounds used to diagnose and monitor arthritis. Other imaging tests for rheumatoid arthritis that may be considered include computed tomography (CT) scanning, positron emission tomography (PET) scanning, bone scanning, and dual-energy X-ray absorptiometry (DEXA). Osteoarthritis

8100-542: The production of uric acid (e.g., allopurinol) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout. Infectious arthritis is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible joint damage. Only about 1% of cases of infectious arthritis are due to any of

8200-474: The question of why pain should have the quality of being painful. He describes the alternative as a mental raising of a "red flag". To argue why that red flag might be insufficient, Dawkins argues that drives must compete with one another within living beings. The most "fit" creature would be the one whose pains are well balanced. Those pains which mean certain death when ignored will become the most powerfully felt. The relative intensities of pain, then, may resemble

8300-537: The relative importance of that risk to our ancestors. This resemblance will not be perfect, however, because natural selection can be a poor designer . This may have maladaptive results such as supernormal stimuli . Pain, however, does not only wave a "red flag" within living beings but may also act as a warning sign and a call for help to other living beings. Especially in humans who readily helped each other in case of sickness or injury throughout their evolutionary history, pain might be shaped by natural selection to be

8400-654: The sensory input by anesthetic block, surgical intervention and the like, but also by influencing the motivational-affective and cognitive factors as well." (p. 435) Pain is part of the body's defense system, producing a reflexive retraction from the painful stimulus, and tendencies to protect the affected body part while it heals, and avoid that harmful situation in the future. It is an important part of animal life, vital to healthy survival. People with congenital insensitivity to pain have reduced life expectancy . In The Greatest Show on Earth: The Evidence for Evolution , biologist Richard Dawkins addresses

8500-495: The site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17). A number of rheumasurgical interventions have been incorporated in the treatment of arthritis since the 1950s. Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. People with hand arthritis can have trouble with simple activities of daily living tasks (ADLs), such as turning

8600-433: The skeleton, helping to maintain posture, balance, and the ability to bear weight during daily activities. The clinical significance of joints is highlighted by common disorders that affect their health and function. Osteoarthritis , a degenerative joint disease, involves the breakdown of cartilage, leading to pain, stiffness, and reduced mobility. Rheumatoid arthritis , an autoimmune disorder, causes chronic inflammation in

8700-535: The spinal cord, all produce relief in some patients. Mirror box therapy produces the illusion of movement and touch in a phantom limb which in turn may cause a reduction in pain. Paraplegia , the loss of sensation and voluntary motor control after serious spinal cord damage, may be accompanied by girdle pain at the level of the spinal cord damage, visceral pain evoked by a filling bladder or bowel, or, in five to ten percent of paraplegics, phantom body pain in areas of complete sensory loss. This phantom body pain

8800-408: The stimulus intensity at which the stimulus begins to hurt. The " pain tolerance threshold" is reached when the subject acts to stop the pain. A person's self-report is the most reliable measure of pain. Some health care professionals may underestimate pain severity. A definition of pain widely employed in nursing, emphasizing its subjective nature and the importance of believing patient reports,

8900-425: The strongest association for developing rheumatoid arthritis are the female sex, a family history of rheumatoid arthritis, age, obesity, previous joint damage from an injury, and exposure to tobacco smoke. Bone erosion is a central feature of rheumatoid arthritis. Bone continuously undergoes remodeling by actions of bone resorbing osteoclasts and bone forming osteoblasts . One of the main triggers of bone erosion in

9000-462: The systematic review were as follows: Evidence of osteoarthritis and potentially inflammatory arthritis has been discovered in dinosaurs. The first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples. It was noted in skeletal remains of Native Americans found in Tennessee and parts of what

9100-655: The treatment of arthritis. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions. Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. In the United States a CDC survey based on data from 2013 to 2015 showed 54.4 million (22.7%) adults had self-reported doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number

9200-460: The two most commonly used markers being 3 months and 6 months since the onset of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply "acute" to pain that lasts less than 30 days, "chronic" to pain of more than six months' duration, and "subacute" to pain that lasts from one to six months. A popular alternative definition of "chronic pain", involving no arbitrarily fixed duration,

9300-450: The two types of classifications. Structural classification names and divides joints according to the type of binding tissue that connects the bones to each other. There are four structural classifications of joints: Joints can also be classified functionally according to the type and degree of movement they allow: Joint movements are described with reference to the basic anatomical planes . Joints can also be classified, according to

9400-644: The type of arthritis, the medications that are given may be different. For example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen . Opioids and NSAIDs may be less well tolerated. However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular corticosteroid injections may also be considered. The drugs to treat rheumatoid arthritis (RA) range from corticosteroids to monoclonal antibodies given intravenously . Due to

9500-724: The type of suspected arthritis. All arthritides potentially feature pain . Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness lasting over 30 minutes. Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. It may include checking joints, observing movements, examination of skin for rashes or nodules and symptoms of pulmonary inflammation. Physical examination may confirm

9600-410: The use of medication . Depression may also keep older adult from reporting they are in pain. Decline in self-care may also indicate the older adult is experiencing pain. They may be reluctant to report pain because they do not want to be perceived as weak, or may feel it is impolite or shameful to complain, or they may feel the pain is a form of deserved punishment. Cultural barriers may also affect

9700-550: The vast majority of those with arthritis need and use them. Further research is required to determine if transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis is effective for controlling pain. Low level laser therapy may be considered for relief of pain and stiffness associated with arthritis. Evidence of benefit is tentative. Pulsed electromagnetic field therapy (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis. The FDA has not approved PEMFT for

9800-465: The weight-bearing joints, such as the back, knee and hip. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. The strongest predictor of osteoarthritis is increased age, likely due to the declining ability of chondrocytes to maintain the structural integrity of cartilage. More than 30 percent of women have some degree of osteoarthritis by age 65. Other risk factors for osteoarthritis include prior joint trauma, obesity, and

9900-542: The word peyn comes from the Old French peine , in turn from Latin poena meaning "punishment, penalty" (also meaning "torment, hardship, suffering" in Late Latin) and that from Greek ποινή ( poine ), generally meaning "price paid, penalty, punishment". The International Association for the Study of Pain recommends using specific features to describe a patient's pain: Pain is usually transitory, lasting only until

10000-542: Was introduced by Margo McCaffery in 1968: "Pain is whatever the experiencing person says it is, existing whenever he says it does". To assess intensity, the patient may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10 the worst pain they have ever felt. Quality can be established by having the patient complete the McGill Pain Questionnaire indicating which words best describe their pain. The visual analogue scale

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