Arthritis

Arthritis is a common condition that causes pain and inflammation in a joint, which is where two or more bones meet. People of all ages, races, and sexes can develop arthritis, and it is the leading cause of disability in the United States.

Arthritis can affect one or multiple joints throughout the body. However, the parts of the body most commonly affected are the knees, hands, hips, and back.

There are over 100 different types of arthritis, with the most common being osteoarthritis and rheumatoid arthritis. Osteoarthritis is the most common type of arthritis and it typically affects older adults. It is a disease that affects your whole joint, not just cartilage. Bones in the affected joints become weaker, the connective tissue that holds the joint together deteriorates and inflammation damages the joint lining. Rheumatoid arthritis is an autoimmune disorder where the immune system mistakenly attacks the joints, leading to inflammation. This can cause damage to the joint tissue, resulting in chronic pain, swelling, and potentially, loss of function.

Other types include gout, which is caused by a buildup of uric acid crystals in the joints, and psoriatic arthritis, which can occur in people with psoriasis.

Symptoms of arthritis may include joint pain, stiffness, swelling, and reduced range of motion. These symptoms can be severe and may come and go. Treatment often focuses on relieving symptoms and improving joint function and quality of life. Options include medication, physical therapy, lifestyle changes, and in severe cases, surgery.

The causes of arthritis depend on the form of arthritis you have. Some of the most common forms and their causes include:

• Osteoarthritis: This type is typically caused by wear and tear on the joints over time. As the cartilage that cushions the ends of bones wears away, they may rub directly against each other, causing pain and restricted movement. Risk factors include aging, joint injury, overuse of the joint, and obesity, which places extra stress on the joints. This is the most common form of arthritis.

• Rheumatoid arthritis (RA): RA is an autoimmune disease where your body's immune system attacks the joint tissue. This can lead to inflammation and severe joint damage. The exact cause of RA is not fully understood but is believed to involve a combination of genetic and environmental factors such as smoking and possibly infections.

• Gout: This type of arthritis is caused by a buildup of uric acid crystals in your joints, most commonly in your big toe. Uric acid is a substance that forms when the body breaks down purines, which are found in your cells and many foods. When uric acid levels build up, it can form sharp, needle-like crystals in a joint or surrounding tissue, causing intense pain and swelling.
• Psoriatic arthritis: This type can occur if you have psoriasis, which is a chronic skin condition. Psoriatic arthritis involves inflammation of the skin (psoriasis) and joints (arthritis). It is also thought to be an autoimmune condition, where your immune system attacks your body’s own cells, both in the skin and in the joints.
• Ankylosing Spondylitis: This type of arthritis primarily affects your spine, although other joints can become involved. It is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together, making your spine less flexible.

• Juvenile Idiopathic Arthritis: The most common type of childhood arthritis is juvenile idiopathic arthritis (JIA). It can cause permanent physical damage to joints, which can result in disability.

The symptoms of arthritis can vary depending on the type you have and how severe it is. Some common signs and symptoms may include:

• Joint pain: This is often the most noticeable symptom, which can range from mild to severe and may worsen after activity or towards the end of the day.
• Stiffness: Your joints may feel stiff, especially after periods of inactivity or in the morning.

• Swelling: Fluid may accumulate in your joint, causing it to feel swollen and tender.

• Redness and warmth: The skin around the affected joint may be red and warm to the touch.

• Decreased range of motion: Movement of your joint may become reduced due to pain, swelling, or stiffness.
• Fatigue: Especially in inflammatory types of arthritis like rheumatoid arthritis, fatigue can be a common symptom.
• Joint deformity: As some types of arthritis progress, joints can become enlarged and out of shape due to swelling, loose ligaments, loss of cartilage, and changes to your bones.
• Grating sensation: If you have osteoarthritis, you may hear or feel a grating sensation when you use the joint.

Diagnosing arthritis involves a combination of clinical evaluation, medical history, and diagnostic tests. Some common tests your healthcare provider may perform include:

• Medical History: Your healthcare provider will ask about your symptoms, their duration, and any family history of arthritis or other autoimmune diseases. Information about lifestyle, occupation, and previous injuries is also important.
• Physical Exam: Your healthcare provider will examine the affected joints for redness, swelling, warmth, and tenderness. They will also check your range of motion in the joints.

• Blood Tests: These can help identify inflammation markers and specific antibodies, including:

  • Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are often present in rheumatoid arthritis.

  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, which can indicate there is inflammation occurring, although it is not specific.

• Imaging Tests: These tests are used to look at your joints and see if there is any damage:

  • X-rays: They can show bone damage, bone spurs, and cartilage loss and are particularly useful in diagnosing osteoarthritis and monitoring any long-term changes.

  • MRI and Ultrasound: These imaging methods provide more detailed images of your cartilage, ligaments, and tendons. They help diagnose conditions like rheumatoid arthritis and other types of inflammatory arthritis.
• Joint Fluid Analysis (Arthrocentesis): In some cases, your healthcare provider may use a needle to draw fluid from an inflamed joint for analysis. This can help to rule out gout or infectious arthritis by looking for uric acid crystals or bacteria in the joint fluid.

Arthritis treatment can help reduce symptoms, improve joint function, and prevent further damage. The treatment approach varies depending on the type of arthritis, its severity, and your specific symptoms. Some common treatment options that are used to treat arthritis pain include:

• Medications:

  • Pain relievers: Over-the-counter (OTC) pain relievers such as Tylenol (acetaminophen) can help manage pain but do not treat inflammation.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as Advil (ibuprofen), Anaprox (naproxen), and Celebrex (celecoxib), reduce both pain and inflammation.
  • Corticosteroids: These can be administered orally or as injections directly into the joint to quickly reduce inflammation and pain.
  • Disease-modifying antirheumatic drugs (DMARDs): Used primarily in rheumatoid arthritis, these drugs can slow the progression of the disease. Trexall (methotrexate) is the most commonly used DMARD, but others include Arava (leflunomide), Plaquenil (hydroxychloroquine), Azulfidine (sulfasalazine), Xeljanz (tofacitinib), and Olumiant (baricitinib)
  • Biologic response modifiers: These are newer, typically injectable treatments that target specific parts of your immune system to reduce inflammation. Some examples include Enbrel (etanercept), Rituxan (rituximab), Humira (adalimumab), Orencia (abatacept), Simponi (golimumab), and Actemra (tocilizumab).
  • Physical Therapy: A physical therapist can help develop an exercise program to keep your joints flexible and strengthen the muscles around your joints. This can improve mobility and reduce pain.
  • Occupational Therapy: Occupational therapists can teach you how to modify your home and workplace environments and your routines to reduce strain on your joints during daily tasks.
  • Joint replacement: Surgery can be performed where damaged parts of your joint are removed and replaced with artificial ones. This is most commonly performed if you have severe arthritis in your hip or knee.
  • Joint fusion: This is typically used in smaller joints, such as those in the wrist, ankle, and fingers. A surgeon will remove the ends of the two bones in the joint and then fuse them together, eliminating the joint.

• Lifestyle Changes:

  • Diet and Nutrition: Eating a diet rich in antioxidants, like fresh fruits, vegetables, and herbs, can help reduce inflammation. You may find that making dietary changes, such as reducing processed and fatty foods, helps improve your symptoms.

  • Weight management: Maintaining a healthy weight can reduce the stress in your joints, which can be helpful in weight-bearing joints like your hips and knees.
  • Exercise: Regular physical activity can help maintain joint function and reduce stiffness. Low-impact exercises, such as swimming or cycling, can be helpful.
  • Alternative Therapies: You may find relief with acupuncture, massage, or the use of supplements like glucosamine and chondroitin sulfate, although the evidence supporting these treatments varies.
  • Use Assistive Devices: Using shoe inserts, canes, raised toilet seats, walkers, or other assistive devices can help protect your joints while you do daily tasks.

Sources:

• What is Arthritis? Arthritis Foundation. Accessed May 13, 2024.

• Arthritis: An Overview. American Academy of Orthopaedic Surgeons. Accessed May 13, 2024.

• Arthritis and Rheumatic Diseases. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Accessed May 13, 2024.
• Rheumatoid Arthritis. American College of Rheumatology. Accessed May 13, 2024.
• Arthritis. National Library of Medicine. Accessed May 13, 2024.
• Arthritis types. Centers for Disease Prevention and Control. Accessed May 13, 2024.