Arthritis

What is arthritis?

Arthritis is a condition that causes pain and stiffness of the joints. Sometimes it also causes redness, swelling, and warmth. In severe cases, joints may become misshapen.

There are different kinds of arthritis – “wear and tear” and “inflammatory” types. The 2 most common forms are osteoarthritis (a “wear and tear” type) and rheumatoid arthritis (an inflammatory type). Both of these forms of arthritis are more common in women than in men.

Other forms of arthritis are less common. They include gout, ankylosing spondylitis, and arthritis that happens after an injury or with some infections such as Lyme disease.

How does it occur?

Osteoarthritis is a disease in which the cartilage in joints breaks down. Cartilage is the joint's cushion. It covers the ends of bones and allows free movement of joints. If cartilage gets rough, frays, or wears away, then the roughened cartilage or bone surfaces grind against each other. As a result, the joint becomes irritated and swollen (inflamed). Sometimes the irritation causes abnormal bone growths, called spurs. Osteoarthritis normally affects the feet, knees, lower back, hips, and fingers. Symptoms of the disease start to appear by middle age. Most people over age 60 have some osteoarthritis, but they may not have symptoms.

Rheumatoid arthritis (RA) affects the lining of the joints. It is an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue. Rheumatoid arthritis causes redness and swelling, stiffness, and misshapen joints. It usually affects the joints of the hands, arms, and feet. RA usually starts in early adulthood or middle age.

What are the symptoms?

Possible symptoms of arthritis are:

• mild to severe pain in joints
• redness and warmth of the skin around a joint
• swollen joints
• stiffness and limited movement, especially in the morning
• misshapen joints.

Some types of arthritis make you feel tired.

How is it diagnosed?

Your healthcare provider will review your medical history and examine you. You may have blood tests and X-rays of the joints that are bothering you.

Most blood tests are normal if you have osteoarthritis. If you have rheumatoid arthritis, blood tests may be abnormal and show inflammation. Sometimes, tests of a sample of fluid from a joint helps sort out what kind of arthritis you have. The test is called joint aspiration. It can be done in most physician offices.

Plain X-rays show most types of arthritis. An MRI scan sometimes helps show what’s happening to the bone and tendons around a joint. MRI usually is not needed if your history, exam, basic blood tests, and X-rays suggest osteoarthritis or rheumatoid arthritis.

How is it treated?

There are many ways to treat arthritis. The 2 main goals of treatment are to relieve pain and to keep the joints working properly. Treatments work by:

• relieving pain and stiffness
• reducing swelling
• stopping or slowing down damage to the joints.

Medicine

Medicines can control pain and reduce inflammation. Pain relieving medicines and anti-inflammatory medicines are used for all kinds of arthritis. Some special types of medicines are used mostly to treat rheumatoid arthritis, such as the disease-modifying anti-rheumatic drugs (DMARDs) and several new drugs called biological response modifiers.

Most of the time, acetaminophen is the best medicine to use to relieve pain because it has fewer side effects than other pain relievers. Acetaminophen can be taken with most other arthritis medicines. Large amounts can harm the liver. General advice is to take no more than 4000 milligrams (mg) a day. If you have any liver problems, take lots of other medicines, or just have concerns, ask your healthcare provider what is a safe amount of acetaminophen for you.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, and many others, can help relieve pain and inflammation. However, NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.

COX-2 inhibitors such as celecoxib (Celebrex) are prescription NSAIDs. COX-2 inhibitors can help arthritis symptoms, but they have been linked to a greater risk of heart attack and stroke. Talk with your healthcare provider to learn more about taking NSAIDs.

Several other kinds of medicines may be used, such as:

• disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (Rheumatrex or Trexall) for people with rheumatoid arthritis
• biological response modifiers, such as Enbrel, Humira, or Remicade, to help reduce inflammation in the joints caused by rheumatoid arthritis
• steroids such as prednisone or cortisone, which can be taken by mouth or injected into a joint
• strong pain medicines, such as codeine or hydrocodone
• steroids injected into the joint
• medicine patches put over painful joints
• hyaluronic acid injected into the knee to act as a lubricant and help the knee move without pain if you have arthritis in your knee.

Many of the drug treatments must be watched carefully by your provider to avoid serious side effects. For example, using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

Exercise

Three types of exercise are best for people with arthritis:

• Range-of-motion. These are gentle stretching exercises that help you move each joint as far as possible. Examples include simple, low-speed bike riding or special exercises like tai chi and yoga. These types of exercise help maintain or increase flexibility and relieve stiffness.
• Strengthening. Exercises such as weight training help strengthen muscles and tendons. Strong muscles and tendons help to support joints and help you move more easily and with less pain.
• Aerobic or endurance. Exercises such as walking or bicycle riding (at higher speeds or with more resistance to pedaling) improve overall health and help control weight.

Talk with your healthcare provider before you start an exercise program. Too much too soon or even at the wrong time of day may make arthritis worse. Your provider may refer you to a physical therapist to design a program that is right for you.

Other treatments

Getting weight and stress off painful joints helps a lot to relieve pain and slow down or stop damage. Using a cane, crutches, or a walker helps you take weight off your hips, knees, and ankles. If you are heavy for your age (overweight or obese), losing some weight often reduces joint pain. Exercise and a healthy diet can help you control your weight and stay healthy.

Your healthcare provider may suggest using heat or cold therapy, depending on the type of arthritis you have. Sometimes a splint or brace is used to let the joint rest and protect it from injury. Acupuncture and massage are other possible treatments.

Transcutaneous electrical nerve stimulation (TENS) may relieve some types of arthritis pain. TENS directs mild electric pulses through the skin to the nerves in the painful area.

If your joints are severely damaged, surgery may be needed. Possible surgeries are:

• synovectomy to remove the inflamed joint tissue
• osteotomy to realign a joint
• joint replacement to replace a damaged joint with an artificial joint.

How long will the effects last?

If you have arthritis, you will probably have it for the rest of your life. The pain and stiffness from arthritis will vary from day to day and week to week. How often you have symptoms depends, at least in part, on the type of arthritis you have. You might be reminded of the arthritis every time you use affected joints. Or there may be times you have symptoms and times you don’t. Times when you don’t have symptoms are called remissions.

How can I take care of myself?

• Take the medicine your healthcare provider recommends.
• Follow your provider's advice for weight control if you are overweight.
• Do the exercises recommended by your provider or physical therapist.
• Keep your body healthy by eating a healthy diet.
• Work with your healthcare provider or physical therapist to learn how to use your joints in ways that put less stress on them.

How can I help prevent arthritis?

No one knows how to prevent arthritis. However, it is a condition that can usually be managed by taking medicine and keeping the joints mobile.