Arthritis

What is arthritis?

Arthritis and other rheumatic diseases are more common in women than men.  They are also often linked with old age. But they affect people of all ages.

The 2 most common forms of arthritis are:

• Osteoarthritis. This is the most common type of arthritis. It is a chronic disease of the joints, especially the weight-bearing joints of the knee, hip, and spine. It destroys the coating on the ends of bones (cartilage) and narrows the joint space. It can also cause bone overgrowth, bone spurs, and reduced function. It occurs in most people as they age. It may also occur in young people because of an injury or overuse.
• Rheumatoid arthritis. This is an inflammatory disease of the joint linings. The inflammation may affect all of the joints. It can also affect organs such as the heart or lungs.

Other forms of arthritis or related disorders include:

• Gout. This condition causes uric acid crystals to build up in small joints, such as the big toe. It causes pain and inflammation.
• Lupus. This is a chronic autoimmune disorder. It causes periods of inflammation and damage in joints, tendons, and organs.
• Scleroderma. This autoimmune disease causes thickening and hardening of the skin and other connective tissue in the body.
• Ankylosing spondylitis. This disease causes the bones of the spine to grow together. It can also cause inflammation in other parts of the body. It can affect the shoulders, hips, ribs, and the small joints of the hands and feet.
• Juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA). This is a form of arthritis in children that causes inflammation and joint stiffness. Children often outgrow JRA. But it can affect bone development in a growing child.

What causes arthritis?

The cause depends on the type of arthritis. Osteoarthritis is caused by the wear and tear of the joint over time or because of overuse. Rheumatoid arthritis, lupus, and scleroderma are caused by the body’s immune system attacking the body’s own tissues. Gout is caused by the buildup of crystals in the joints. Some forms of arthritis can be linked to genes. People with genetic marker HLA-B27 have a higher risk of ankylosing spondylitis. For some other forms of arthritis, the cause is not known.

Who is at risk for arthritis?

Some risk factors for arthritis that can’t be avoided or changed include:

• Age. The older you are, the more likely you are to have arthritis.
• Gender. Women are more likely to have arthritis than men.
• Heredity. Some types of arthritis are linked to certain genes.

Risk factors that may be avoided or changed include:

• Weight. Being overweight or obese can damage your knee joints. This can make them more likely to develop osteoarthritis.
• Injury. A joint that has been damaged by an injury is more likely to develop arthritis at some point.
• Infection. Reactive arthritis can affect joints after an infection.
• Your job. Work that involves repeated bending or squatting can lead to knee arthritis.

What are the symptoms of arthritis?

Each person’s symptoms may vary. The most common symptoms include:

• Pain in 1 or more joints that doesn’t go away, or comes back
• Warmth and redness in 1 or more joints
• Swelling in 1 or more joints
• Stiffness in 1 or more joints
• Trouble moving 1 or more joints in a normal way

These symptoms can look like other health conditions. Always see your healthcare provider for a diagnosis.

How is arthritis diagnosed?

Your healthcare provider will take your medical history and give you a physical exam. Tests may also be done. These include blood tests such as:

• Antinuclear antibody (ANA) test. This checks antibody levels in the blood.
• Complete blood count (CBC). This checks if your white blood cell, red blood cell, and platelet levels are normal.
• Creatinine. This test checks for kidney disease.
• Sedimentation rate. This test can find inflammation.
• Hematocrit. This test measures the number of red blood cells.
• RF (rheumatoid factor) and CCP (cyclic citrullinated peptide) antibody tests. These can help diagnose rheumatoid arthritis. They can also assess how severe the disease is.
• White blood cell count. This checks the level of white blood cells in your blood.
• Uric acid. This helps diagnose gout.

Other tests may be done, such as:

• Joint aspiration (arthrocentesis). A small sample of synovial fluid is taken from a joint. It's tested to see if crystals, bacteria, or viruses are present.
• X-rays or other imaging tests. These can tell how damaged a joint is.
• Urine test. This checks for protein and different kinds of blood cells.
• HLA tissue typing. This looks for genetic markers of ankylosing spondylitis.
• Skin biopsy. Tiny tissue samples are removed and checked under a microscope. This test helps to diagnose a type of arthritis that involves the skin, such as lupus or psoriatic arthritis.
• Muscle biopsy. Tiny tissue samples are removed and checked under a microscope. This test helps to diagnose conditions that affect muscles.

How is arthritis treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how what type of arthritis you have, and how severe the condition is. A treatment plan is tailored to each person with his or her health care provider.

There is no cure for arthritis. The goal of treatment is often to limit pain and inflammation, and help ensure joint function. Treatment plans often use both short-term and long-term methods.

Short-term treatments include:

• Medications. Short-term relief for pain and inflammation may include pain relievers such as acetaminophen, aspirin, ibuprofen, or other nonsteroidal anti-inflammatory medications.
• Heat and cold. Pain may be eased by using moist heat (warm bath or shower) or dry heat (heating pad) on the joint. Pain and swelling may be eased with cold (ice pack wrapped in a towel) on the joint.
• Joint immobilization. The use of a splint or brace can help a joint rest and protect it from further injury.
• Massage. The light massage of painful muscles may increase blood flow and bring warmth to the muscle.
• Transcutaneous electrical nerve stimulation (TENS). Pain may be reduced with the use of a TENS device. The device sends mild, electrical pulses to nerve endings in the painful area. This blocks pain signals to the brain and changes pain perception.
• Acupuncture. This is the use of thin needles that are inserted at specific points in the body. It may stimulate the release of natural, pain-relieving chemicals made by the nervous system. The procedure is done by a licensed health care provider.

Long-term treatments include:

• Disease-modifying antirheumatic drugs (DMARDs). These prescription medications may slow down the disease and treat any immune system problems linked to the disease. Examples of these medications include methotrexate, hydroxychloroquine, sulfasalazine, and chlorambucil.
• Corticosteroids. Corticosteroids reduce inflammation and swelling. These medications, such as prednisone, can be taken orally or as an injection.
• Hyaluronic acid therapy. This is a joint fluid that appears to break down in people with osteoarthritis. It can be injected into a joint, such as the knee, to help relieve symptoms.
• Surgery. There are many types of surgery, depending on which joints are affected. Surgery options may include arthroscopy, fusion, or joint replacement. Full recovery after surgery takes up to 6 months. A rehabilitation program after surgery is an important part of the treatment.

Arthritis treatment can include a team of health care providers, such as:

• Orthopedist/orthopedic surgeon
• Rheumatologist
• Physiatrist
• Primary care doctor (family medicine or internal medicine)
• Rehabilitation nurse
• Dietitian
• Physical therapist
• Occupational therapist
• Social worker
• Psychologist or psychiatrist
• Recreational therapist
• Vocational therapist

What are the complications of arthritis?

Because arthritis causes joints to worsen over time, it can cause disability. It can cause pain and movement problems. You may be less able to carry out normal daily activities and tasks.

Living with arthritis

There is no cure for arthritis. But it’s important to help keep joints working by reducing pain and inflammation. Work on a treatment plan with your healthcare provider that includes medicine and therapy. Work on lifestyle changes that can improve your quality of life. Lifestyle changes include:

• Weight loss. Extra weight puts more stress on weight-bearing joints, such as the hips and knees.
• Exercise. Some exercises may help reduce joint pain and stiffness. These include swimming, walking, low-impact aerobic exercise, and range-of-motion exercises. Stretching exercises may also help keep the joints flexible.
• Activity and rest. To reduce stress on your joints, switch between activity and rest. This can help protect your joints and lessen your symptoms.
• Using assistive devices. Canes, crutches, and walkers can help keep stress off certain joints and improve balance.
• Using adaptive equipment. Reachers and grabbers let you extend your reach and reduce straining. Dressing aids help you get dressed more easily.
• Managing use of medicines. Long-term use of some anti-inflammatory medicines can lead to stomach bleeding. Work with your healthcare provider to create a plan to reduce this risk.

When should I call my healthcare provider?

Call your provider if your symptoms get worse or you have new symptoms.

Key points about arthritis

• Arthritis and other rheumatic diseases cause pain, swelling, and limited movement in joints and connective tissues in the body.
• Arthritis and other rheumatic diseases can affect people of all ages. They are more common in women than men.
• Symptoms may include pain, stiffness, swelling, warmth, or redness in 1 or more joints.
• There is no cure for arthritis. The treatment goal is to limit pain and inflammation and preserve joint function.
• Treatment options include medicines, weight reduction, exercise, and surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.