Arthritis

Arthritis, Osteoarthritis and Rheumatoid Arthritis

 View larger image

Arthritis describes inflammation of the joints.

It describes a symptom or sign rather than a specific diagnosis.

The primary symptoms of most types of arthritis include varying levels of pain, joint stiffness, and aches in the hands, feet, back, knees, hips, or neck.

Some arthritic conditions can also affect other organs in the body and produce additional symptoms. 

Arthritis is a leading cause of disability. Because joint pain makes it difficult for individuals to remain physically active, many people with arthritis also experience symptoms from reduced exercise, including high cholesterol, heart disease, obesity, and depression.

Arthritis can be a painful condition, but there are arthritis treatments that can help to reduce pain, reduce symptoms and improve a person's quality of life.

Types of Arthritis

Arthritis takes many forms. Some types of arthritis include:

  • Gout- Gout is a recurent inflammatory condition most often striking the joints in the big toe of the foot. It is thought to be associated with abnormally high levels of uric acid in the blood. When your body breaks down uric acid, it sometimes creates a byproduct that your immune system attacks, which causes inflammation and pain. 
  • Osteoarthritis- Osteoarthritis is the most common form of arthritis. This condition is usually associated with aging, and affects both the cartilage, which is the tissue that cushions the ends of bones within the joint, as well as the underlying bone. It most often affects the fingers, knees, and hips. It is thought to be caused by the degredation of tissues within the joints. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt her knee badly playing soccer. Then, years after the individual’s knee has apparently healed, she might get arthritis in her knee joint.
  • Psoriatic arthritis- Psoriatic arthritis is a type of arthritis associated with the chronic skin condition psoriasis. Psoriatic arthritis often affects the joints at the ends of the fingers and toes and is accompanied by changes in the fingernails and toenails. Back pain may occur if the spine is involved.
  • Reactive arthritis- Reactive arthritis is a form of arthritis that forms as a "reaction" to an infection elsewhere in the body. Besides joint inflammation, inflammation of the eyes (conjunctivitis) and urinary tract (urethritis) are also often associated with reactive arthritis.
  • Rheumatoid arthritis- Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks tissues in the joints. It first targets the synovium, or lining of the joint, resulting in pain, stiffness, swelling, joint damage, and loss of function of the joints. Inflammation most often affects joints of the hands and feet and tends to be symmetrical (occurring equally on both sides of the body). This symmetry helps distinguish rheumatoid arthritis from other forms of the disease.

Causes of Arthritis

Arthritis is generally believed to be caused by a combination of genetic and environmental factors. In other words, you may be born with a susceptibility to a disease, but it may take something in your environment to get the disease started.

Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. In rheumatoid arthritis and juvenile idiopathic arthritis, patients may have a variation in a gene that codes for an enzyme called protein tyrosine phosphatase nonreceptor 22 (PTPN22).

Certain viruses may trigger disease in genetically susceptible people.

Gender is another factor in some types of arthritis. Rheumatoid arthritis is more common among women. This indicates that hormones or other male-female differences may play a role in the development of this ­condition.

Arthritis Treatment

Arthritis treatments vary depending on the type of arthritis that you have. Unless you have a type of arthritis that is caused by an infection, there is no cure. Treatment focuses on reducing pain and improving your ability to cary out physical activity. 

Treatments for arthritis include rest and relaxation, exercise, proper diet, medication, and instruction about the proper use of joints and ways to conserve energy.

Other treatments include the use of pain relief methods and assistive devices, such as splints or braces. In severe cases, surgery may be necessary. You and your doctor develop a treatment plan that helps you maintain or improve his or her lifestyle. Treatment plans usually combine several types of treatment and vary depending on the condition and the patient.

Rest, Exercise, and Diet

People who have arthritis should develop a comfortable balance between rest and activity. One sign of arthritis fatigue. Patients must pay attention to signals from their bodies. For example, when experiencing pain or fatigue, it is important to take a break and rest. Too much rest, however, may cause muscles to become weak and joints to become stiff.

People with arthritis can participate in a variety of sports and exercise programs. Physical exercise can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. Exercise also can result in weight loss, which in turn reduces stress on painful joints and contributes to an improved sense of well-being. Before starting any exercise program, people with arthritis should talk with their doctor.

Another important part of a treatment program is a well-balanced diet. Along with exercise, a well-balanced diet helps people manage their body weight and stay healthy. Diet is especially important for people who have gout. People with gout should avoid alcohol and foods that are high in purines, such as organ meats (liver, kidney), sardines, anchovies, and gravy.

Medications for Arthritis

A variety of medications are used to treat arthritis. The type of medication recommended depends on the type of arthritis and on the individual patient.

Medications commonly used to treat arthritis provide relief from pain and inflammation. In some cases, especially when a person has rheumatoid arthritis or another type of inflammatory arthritis, the medication may slow the course of the disease and prevent further damage to joints or other parts of the body.

The doctor may delay using medications until a definite diagnosis is made because medications can hide important symptoms or signs (such as fever and swelling) and thereby interfere with diagnosis. Patients taking any medication, either ­prescription or over the counter, should always follow the doctor’s instructions. The doctor should be notified immediately if the medicine is making the symptoms worse or causing other problems, such as upset stomach, nausea, or headache. The doctor may be able to change the dosage or medicine to reduce these side effects.

Some of the types of medications commonly used in the treatment of arthritis include:

Analgesics – Analgesics (pain relievers) such as acetaminophen are often used to reduce the pain caused by many types of arthritis. For severe pain or pain following surgery or a fracture, doctors may prescribe stronger prescription or narcotic analgesics.

Topical analgesics – People who cannot take oral pain relievers or who continue to have some pain after taking them may find topical analgesics helpful. These creams or ointments are rubbed into the skin over sore muscles or joints and relieve pain through one or more active ingredients. These are the most common:

  • Counterirritants – These ingredients, such as menthol, oil of wintergreen, eucalyptus oil, or camphor, work by irritating the nerve endings in the skin. This distracts the brain from the deeper source of pain.
  • Salicylates – This ingredient works like aspirin, by blocking chemicals in the body that contribute to pain.
  • Capsaicin – This natural ingredient found in cayenne peppers is an effective pain reliever for many.

Nonsteroidal anti-inflammatory drugs (NSAIDS) – A large class of medications useful against both pain and inflammation, NSAIDs are staples in arthritis treatment. A number of NSAIDs – such as ibuprofen, naproxen sodium, and ketoprofen are available over the counter. More than two dozen others, including a subclass of NSAIDs called COX-2 inhibitors, are available only with a prescription.

Disease-modifying antirheumatic drugs (DMARDs) – A family of medicines that are used to treat inflammatory arthritis and rheumatoid arthritis, DMARDs may be able to slow or stop the immune system from attacking the joints. This in turn decreases pain and swelling. DMARDs typically require regular blood tests to monitor side effects, which may include increased risk of infection. In addition to relieving signs and symptoms, DMARDs may help to retard or even stop joint damage from progressing. However, DMARDs cannot fix joint damage that has already occurred. Some of the most commonly prescribed DMARDs are methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide.

Biologic response modifiers – Biologic response modifiers, or biologics, are a new family of genetically engineered drugs that block specific molecular pathways of the immune system that are involved in the inflammatory process. They are often prescribed in combination with DMARDs such as methotrexate. Because biologics work by suppressing the immune system, they could be problematic for patients who are prone to frequent infection. They are typically administered by injection at home or by intravenous infusion at a clinic. Some commonly prescribed biologics include etanercept, adalimumab, infliximab, abatacept, and rituximab.

Corticosteroids – Corticosteroids, such as prednisone, cortisone, solumedrol, and hydrocortisone, are used to treat some types of arthritis because they decrease inflammation and suppress the immune system. The dosage of these medications as well as their method of administration will vary depending on the diagnosis and the patient.

Hyaluronic acid substitutes – Hyaluronic acid products mimic a naturally occurring body substance that serves to lubricate joints and is believed to be deficient in joints with osteoarthritis. Depending on the particular product, patients receive a series of three to five injections, which are administered directly into the affected knee(s) or hip(s) to help provide temporary relief of pain and flexible joint movement.

Medical Devices for Arthritis

A number of devices may be used to treat some types of arthritis. For example, transcutaneous electrical nerve stimulation (TENS) has been found effective in modifying pain perception. TENS blocks pain messages to the brain with a small device that directs mild electric pulses to nerve endings that lie beneath the painful area of the skin.

Some health care facilities use a blood-filtering device called the Prosorba Column to filter out harmful antibodies in people with severe rheumatoid arthritis.

Heat and Cold Therapies

Heat and cold can both be used to reduce the pain and inflammation of arthritis. The patient and doctor can de­termine which one works best.

Heat therapy increases blood flow, tolerance for pain, and flexibility. Heat therapy can involve treatment with paraffin wax, microwaves, ultrasound, or moist heat. Physical therapists are needed for some of these therapies, such as microwave or ultrasound therapy, but patients can apply moist heat themselves. Some ways to apply moist heat include placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower.

Cold therapy numbs the nerves around the joint (which reduces pain) and may relieve inflammation and muscle spasms. Cold therapy can involve cold packs, ice massage, soaking in cold water, or over-the-counter sprays and ointments that cool the skin and joints.

Hydrotherapy, Mobilization Therapy, and Relaxation Therapy

Hydrotherapy involves exercising or relaxing in warm water. The water takes some weight off painful joints, making it easier to exercise. It helps relax tense muscles and relieve pain.

Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation. (Someone other than the patient moves stiff joints through their normal range of motion.) When done by a trained professional, these methods can help control pain, increase joint motion, and improve muscle and tendon flexibility.

Relaxation therapy helps reduce pain by teaching people ­various ways to release muscle tension throughout the body. In one method of relaxation therapy, known as progressive relaxation, the patient tightens a muscle group and then slowly releases the tension. Doctors and physical therapists can teach patients a variety of relaxation techniques.

Splints and Braces

Splints and braces are used to support weakened joints or allow them to rest. Some prevent the joint from moving; others allow some movement. A splint or brace should be used only when recommended by a doctor or therapist, who will explain to the patient when and for how long the device should be worn. The doctor or therapist also will demonstrate the correct way to put it on and will ensure that it fits properly. The incorrect use of a splint or brace can cause joint damage, stiffness, and pain.

Assistive Devices

A person with arthritis can use many kinds of devices to ease the pain. For example, using a cane when walking can reduce some of the weight placed on a knee or hip affected by arthritis. A shoe insert (orthotic) can ease the pain of walking caused by arthritis of the foot or knee. Other devices can help with activities such as opening jars, closing zippers, and holding pencils.

Surgery for Arthritis

Surgery may be required to repair damage to a joint after injury or to restore function or relieve pain in a joint damaged by arthritis. Many types of surgery are performed for arthritis. These include:

  • Anthroscopic surgery – surgery to view the joint using a thin lighted scope inserted through a small incision over the joint. If repair is needed, tools may be inserted through additional small incisions.
  • Bone fusion – surgery in which joint surfaces are removed from the ends of two bones that form a joint. The bones are then held together with screws until they grow together forming one rigid unit.
  • Osteotomy – a surgery in which a section of bone is removed to improve the positioning of a joint.
  • Arthroplasty – also known as total joint replacement. This procedure removes and replaces the damaged joint with an artificial one.

___________________________________________________

© 2010 Vivacare. Last updated January 16, 2012.

Reference: National Institute of Arthritis and Musculoskeletal and Skin Diseases

All rights reserved. Any redistribution or reproduction of part or all of the contents in any form is prohibited. You may not, except with our express written permission, distribute, reproduce, or commercially exploit the content.

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

From Your Doctor service powered by Vivacare.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.
View Content Policy