Arthritis

Definition

Diagram of a normal joint and a joint affected by osteoarthritis
Diagram of a normal joint and a joint affected by osteoarthritis

Arthritis is inflammation of one or more of your joints, such as one or both knees or wrists, or a part of your spinal column.

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Joint pain and stiffness are the main symptoms of arthritis.

Less common types of arthritis may be associated with conditions that also affect other parts of your body. For example, lupus can affect the kidneys and lungs, in addition to joints, while psoriasis is primarily a skin disease that sometimes also affects joints.

Symptoms

The most common signs and symptoms of arthritis involve the joints. Depending on the type of arthritis you have, your joint symptoms may include:

  • Pain
  • Stiffness
  • Swelling
  • Redness
  • Decreased range of motion

Some types of arthritis are accompanied by signs and symptoms involving other parts of your body. These symptoms may include:

  • Fever
  • Fatigue
  • Rash
  • Weight loss
  • Breathing problems
  • Dry eyes and mouth
  • Night sweats

Causes

The pain associated with arthritis is caused by joint damage. Joints are made up of the following parts:

  • Cartilage. A hard, but slick, coating on the ends of bones, cartilage allows bones of the joint to slide smoothly over each other.
  • Joint capsule. This tough membrane encloses all the joint parts.
  • Synovium. This thin membrane lines the joint capsule and secretes synovial fluid, which lubricates the joint.

How arthritis damages joints


The two main types of arthritis damage joints in different ways.

  • Osteoarthritis. In osteoarthritis, wear-and-tear damage to cartilage can result in bone grinding directly on bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can be hastened by a joint injury or infection.
  • Rheumatoid arthritis. In rheumatoid arthritis, the body's immune system attacks joints and inflames the synovium, causing swelling, redness and pain. The disease can eventually destroy cartilage and bone within the joint.
Diagram of a knee with Osteoarthritis
Diagram of a knee with Osteoarthritis

Risk factors

Risk factors for arthritis include:

  • Family history. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. While your genes don't actually cause arthritis, they can make you more susceptible to environmental factors that may trigger arthritis.
  • Age. The risk of many types of arthritis — including osteoarthritis, rheumatoid arthritis and gout — increases with age.
  • Gender. Women are more likely than are men to develop rheumatoid arthritis, while most of the people who have gout are men.
  • Previous joint injury. People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
  • Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. Obese people have a higher risk of developing arthritis.

Complications

Severe arthritis, particularly if it affects your hands or arms, can make it difficult for you to take care of daily tasks. Arthritis of weight-bearing joints can keep you from walking comfortably or sitting up straight. In some cases, joints may become twisted and deformed.

Preparing for your appointment

While you might first discuss your symptoms with your family doctor, he or she may refer you to a rheumatologist — a doctor who specializes in the treatment of arthritis and other inflammatory conditions — for further evaluation.

Bring along information about yourself

It can be a great help for your doctor if you bring along the following information about yourself

  • A list of your medications, including the name and dosage.
  • Information about your medical problems and past treatment
  • Previous investigation results, such as xrays and blood tests.

Prepare a list of questions for your doctor


Because appointments can be brief, plan ahead and write a list that includes:

  • Detailed descriptions of your symptoms, including when they started and if anything makes them better or worse
  • Information about medical problems you've had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

What to expect from your doctor


During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also want to see how well you can move your joints.

Tests and diagnosis

Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.

Laboratory tests


The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include:

  • Blood
  • Urine
  • Joint fluid

To obtain a sample of your joint fluid, your doctor will cleanse and numb your skin, and then insert a needle into your joint space to withdraw some fluid.

Imaging


These types of tests can detect problems within your joint that may be causing your symptoms. Examples include:

  • X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but are often used to track progression of the disease.
  • Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRI can visualize soft tissues such as cartilage, tendons and ligaments as well as bone.

Arthroscopy


In some cases, your doctor may look for damage in your joint by inserting a small, flexible tube — called an arthroscope — through an incision near your joint. The arthroscope transmits images from inside the joint to a video screen.

Treatments and drugs

Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments, or combinations of treatments, before you determine what works best for you.

Medications


The medications used to treat arthritis vary, depending on the type of arthritis. Commonly used arthritis medications include:

  • Analgesics. These types of medications help reduce pain, but have no effect on inflammation. Examples include paracetamol, tramadol and narcotics like oxycodone .
  • Counterirritants. Some varieties of creams and ointments contain a substance such as menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include aspirin, ibuprofen and naproxen. Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.
  • Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
  • Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint.

Physiotherapy


Physiotherapycan be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.

Surgery


If more-conservative measures don't help, your doctor may suggest surgery, such as:

  • Synovium removal (synovectomy). Rheumatoid arthritis causes the joint capsule's lining, called the synovium, to swell — particularly in the wrists, hands and fingers. Removing the synovium may slow joint deterioration.
  • Joint replacement. This procedure removes your damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.
  • Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit.

Looking After Yourself

  • Weight loss. If you're obese, losing weight will reduce the stress on your weight-bearing joints. This may increase your mobility and limit future joint injury.
  • Exercise. Regular exercise can help keep your joints flexible. Swimming or water aerobics is often a good choice because the buoyancy of the water reduces stress on weight-bearing joints.
  • Heat and cold. Heating pads or ice packs may help relieve arthritis pain.
  • Assistive devices. Using canes, walkers, raised toilet seats and other assistive devices can help protect your joints and improve your ability to perform daily tasks.

Alternative Medicine

Many people use alternative remedies for arthritis, but there is little reliable evidence to support the use of many of these products. Some alternative remedies appear to reduce the symptoms of some types of arthritis but not others. The most promising alternative remedies for arthritis include:

  • Glucosamine. Although study results have been mixed, many experts now recommend this nutritional supplement as a first-line treatment for osteoarthritis.
  • Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce many types of pain, including that caused by some types of arthritis.
  • Transcutaneous electrical nerve stimulation (TENS). Using a small device that produces mild electrical pulses, TENS therapy stimulates nerves near the aching joint and may interfere with the transmission of pain signals to the brain.

Coping and support

The pain and disability associated with arthritis can be frustrating and depressing. In many cases, it may help to talk about your feelings with people who are facing the same problems.

Prevention

While there is no proven way to prevent arthritis, maintaining a healthy weight and exercising regularly may help reduce your risk.