Arthritis

Arthritis and other rheumatic diseases are common conditions that cause pain, swelling and limited movement. They affect joints and connective tissues around the body. Millions of people in the U.S. have some form of arthritis.

Arthritis means redness and swelling (inflammation) of a joint. A joint is where two or more bones meet. There are more than 100 different arthritis diseases. Rheumatic diseases include any condition that causes pain, stiffness and swelling in joints, muscles, tendons, ligaments or bones. Arthritis is usually ongoing (chronic).

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 two 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 padding 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 from 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.

Post-traumatic arthritis. This type of arthritis is often the result of a physical injury or fracture to a joint, such as a hip, knee or ankle.

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 for ankylosing spondylitis. For some other forms of arthritis, the cause is not known.

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

• Age. The older you are, the more likely you are to have arthritis.

• Sex. Women are more likely to have arthritis than men.

• Heredity. Some types of arthritis are linked to certain genes.

Risk factors that may be changed include:

• Weight. Being overweight or obese increases load on all lower extremity joints, including the foot and ankle. 

• 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.

• Deformity. A deformity, such as a flat foot or a high arch, can cause an uneven loading of joints, leading to early arthritis.

Your job. Work that involves repeated bending or squatting can lead to knee arthritis.

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

• Pain in one or more joints that doesn’t go away, or comes back.

• Warmth and redness in one or more joints.

• Swelling in one or more joints.

• Stiffness in one or more joints.

• Trouble moving one or more joints in a normal way.

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

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.

• 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.

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

• Medicines. Short-term relief for pain and inflammation may include pain relievers such as acetaminophen, aspirin, ibuprofen or other nonsteroidal anti-inflammatory medicines (NSAIDs).

• 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 thin towel) on the joint.

• Joint immobilization. Using a splint or brace can help a joint rest and protect it from more injury.

• Massage. Lightly massaging painful muscles may increase blood flow and bring warmth to the muscle.

• Transcutaneous electrical nerve stimulation (TENS). Pain may be eased with 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 how you feel pain.

• Acupuncture. Thin needles are inserted at certain points in the body. It may help the release of natural pain-relieving chemicals made by the nervous system. The procedure is done by a licensed healthcare provider.

Long-term treatments include:

• Disease-modifying antirheumatic drugs (DMARDs). These prescription medicines may slow down the disease and treat any immune system problems linked to the disease. Examples of these medicines include methotrexate, hydroxychloroquine, sulfasalazine and chlorambucil.

• Corticosteroids. Corticosteroids reduce inflammation and swelling. These medicines, such as prednisone, can be taken by mouth (orally) or as a shot.

• 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 ease symptoms.

• Surgery. There are many types of surgery, depending on which joints are affected. Surgery may include arthroscopy, fusion or joint replacement. Full recovery after surgery takes up to six months. A rehabilitation program after surgery is an important part of the treatment.

Arthritis treatment can include a team of healthcare 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.

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.

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.

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