Arthritis

Joint inflammation

Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. There are over 100 different types of arthritis.

See also: Joint pain

Causes, incidence, and risk factors

Arthritis involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

Joint inflammation may result from:

  • An autoimmune disease (the body's immune system mistakenly attacks healthy tissue)

  • Broken bone

  • General "wear and tear" on joints

  • Infection, usually by bacteria or virus

Usually the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type. See: Osteoarthritis


About Osteoarthritis, How it Develops, How it effects the knee
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Often called "wear and tear" arthritis, osteoarthritis (OA) is the most common form of arthritis in the U.S. In most cases, over time, cartilage in joints breaks down, and OA symptoms begin to occur. OA is most commonly found in the:

  • Knees
  • Hips
  • Hands and fingers
  • Spine

Wrists, elbows, shoulders, and ankles can also be affected by OA, but this occurs less frequently. When OA is found in these joints, there may have been a history of injury or stress to that joint.

The symptoms of osteoarthritis

Typically, OA comes on slowly. For many, the first signs are joints that ache after physical work or exercise. As the disease progresses, other most common symptoms include:

  • Pain in a joint
  • Swelling or tenderness in one or more joints
  • Stiffness after periods of inactivity, such as sleeping or sitting
  • Flare-ups of pain and inflammation after use of the affected joint
  • Crunching feeling or sound of bone rubbing on bone (called crepitus) when the joint is used

If you are experiencing any of these symptoms, it's important to talk to your doctor to find out if you have OA.

Where do symptoms of osteoarthritis typically appear?

OA most often occurs in the following areas:

Knees
Because knees are primarily weight-bearing joints, they are very commonly affected by OA. If you have OA in your knees, you may feel that these joints are stiff, swollen, and painful, making it hard to walk, climb, and get in and out of chairs and bathtubs.

Hips
OA in the hip can cause pain, stiffness, and severe disability. Hips both support the weight of the body and enable movement of your lower body. When you have OA in your hips, you may also feel the pain in your groin, inner thigh, or knees. OA in the hip can lead to difficulty moving, bending, and walking.

Fingers and Hands
When OA occurs in hands and fingers, the base of the thumb joint is commonly affected and people experience stiffness, numbness, and aching. Other symptoms of hand and finger OA include:

  • Heberden's nodes: small bony knobs that appear on the end joints of fingers
  • Bouchards's nodes: small bony knobs that appear on the middle joints of fingers

Spine
If you have OA of the spine, you may experience stiffness and pain in the neck or in the lower back. Sometimes arthritis-related changes in the spine can put pressure on the nerves, causing weakness or numbness in your arms or legs.

What causes osteoarthritis?

While the exact cause of OA is unknown, joint damage can be due to repetitive movement (also known as "wear and tear"). It can also begin as the result of an injury. Either way, with OA there's erosion of the cartilage, the part of the joint that covers the ends of the bones.

  • Cartilage acts as a shock absorber, allowing the joint to move smoothly.
  • As cartilage breaks down, the ends of the bones thicken and the joint may lose its normal shape.
  • With further cartilage breakdown, the ends of the bones may begin to rub together, causing pain.
  • In addition, damaged joint tissue can cause the release of certain substances called prostaglandins, which can also contribute to the pain and swelling characteristic of the disease.

Here are some factors that may increase your risk of developing OA:

Age
Age is the strongest risk factor for OA. Although OA can start in young adulthood, in these cases, it is often due to joint injury.

Gender
OA affects both men and women. However, before age 45, OA occurs more frequently in men; after age 45, OA is more common in women.

Joint injury or overuse caused by physical labor or sports
Traumatic injury to a joint increases your risk of developing OA in that joint. Joints that are used repeatedly in certain jobs may be more likely to develop OA because of injury or overuse.

Obesity
The chances of getting OA generally increase with the amount of weight the body’s joints have to bear. The knee is particularly affected because it is a major weight-bearing joint.

Joint Alignment
People with joints that don’t move or fit together correctly, like bowlegs, dislocated hips, or double-jointedness, are more likely to develop OA in those joints.

Heredity
An inherited defect in one of the genes responsible for manufacturing cartilage may be a contributing factor in developing OA.

Osteoarthritis diagnosis

If you experience joint pain, stiffness, and/or swelling that won't go away, you should make an appointment to see your doctor. Your doctor will be able to determine if you have arthritis and, if so, what type.

When you see your doctor about your symptoms, he or she may ask questions about when and how you started experiencing them. The doctor will probably give you a physical examination to check your general health, and examine the joints that are bothering you.

You may also need other tests to help confirm the diagnosis of OA and determine the extent and severity of joint damage. Some of these may include:

  • X-rays. X-rays can help the doctor determine whether you have OA or rheumatoid arthritis (RA). A series of X-rays obtained over time can show how fast joint damage is progressing. X-rays of the affected joints can show cartilage loss, bone damage, and extra bone growth (known as bone spurs) that can develop on the surface of normal bones.
  • Joint Aspiration. If your doctor is still uncertain about the diagnosis or suspects that you may have an infection, he or she may perform joint aspiration. In this procedure, your doctor withdraws and examines synovial fluid (a liquid that lubricates the joint) from affected joints using a needle.

If you are experiencing some of these symptoms, the sooner you talk to your doctor, the sooner you may get diagnosed and get treatment.

http://www.arthritis.com/osteoarthritis_symptoms.aspx

What is Rheumatoid arthritis?

rheumatoid arthritis progression in the hand, joint inflammation and damage
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Rheumatoid arthritis (RA) is an autoimmune disease where the body's immune system attacks normal joint tissues, causing inflammation of the joint lining.

This inflammation of the joint lining (called the synovium) can cause pain, stiffness, swelling, warmth, and redness. The affected joint may also lose its shape, resulting in loss of normal movement. RA is an ongoing disease, with active periods of pain and inflammation, known as flares, alternating with periods of remission, when pain and inflammation disappear.

RA can affect many different joints. In some people, it can even affect parts of the body other than the joints, including the eyes, blood, the lungs, and the heart.

Symptoms of Rheumatoid Arthritis

Although RA is often a chronic disease, the severity and duration of symptoms may unpredictably come and go. With RA, people experience periods of increased disease activity, called flare-ups or flares, alternating with periods when the symptoms fade or disappear, called remission.

If you experience some of these symptoms, you may want to talk to your doctor:

  • Pain and stiffness lasting for more than 1 hour in the morning or after a long rest
  • Joint inflammation in the joints closest to the hand, such as wrist and fingers, although the neck, shoulders, elbows, hips, knees, ankles, and feet can also be affected
  • Symmetrical pattern of inflammation, meaning both sides of the body are usually affected at the same time
  • Fatigue, an occasional fever, and a general sense of not feeling well (called malaise)

As RA progresses, about 25% of people with the disease develop small lumps of tissue under the skin, called rheumatoid nodules, which can vary in size. Usually, they are not painful.

If you are experiencing any of the symptoms described above, it is important to find out from a doctor if you have RA.

What causes rheumatoid arthritis?

The exact causes of RA are unknown. But research has shown that several factors may contribute to the development of RA:

  • Genetic. Certain genes play a role in the immune system — for some people, genetic factors may be involved in determining whether they will develop RA.
  • Environmental. In people who have inherited a genetic tendency for the disease, RA can be triggered by an infection. However, RA is not contagious — you can't "catch it" from anyone.

Effects of rheumatoid arthritis

Rheumatoid arthritis can cause joint inflammation, which can affect the ability to go about your daily activities. If left untreated, RA can worsen and destroy joints. After the onset of the disease, some of the effects of RA are as follows:

  • Tendons become inflamed and may rupture (tear apart).
  • Swelling can severely damage or destroy ligaments that hold joints together. It can also damage joint cartilage and bone.
  • Erosion of the bones of the joint can occur, causing pain and deformity.

Rheumatoid arthritis diagnosis

If you have persistent discomfort and swelling in multiple joints on both sides of your body, make an appointment to see your doctor. Early diagnosis and treatment can help slow disease progression.

When you see your doctor about your symptoms, he or she may ask questions about your medical history and examine the joints that are bothering you. Your doctor will also decide if you need other tests to help confirm the diagnosis of RA and determine the extent and severity of joint damage. These may include:

Blood Tests

  • One of the tests looks for an antibody called rheumatoid factor. About 70% to 90% of people with RA have this antibody. However, it is also possible to have the rheumatoid factor in your blood and not have RA.
  • Another test measures your erythrocyte sedimentation rate (or sed rate), which will indicate the presence of an inflammatory process in your body. People with RA tend to have abnormally high sed rates.

X-rays

  • X-rays of all your joints can determine the extent of damage in the joints that are affected. A sequence of X-rays obtained over time can show the progression of RA.

If you have joint pain, stiffness, and/or swelling that won't go away, you may have arthritis. Talk with your doctor about your symptoms.

http://www.arthritis.com/rheumatoid_arthritis_symptoms.aspx


Other, more common types of arthritis include:

Symptoms

Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include:

  • Joint pain

  • Joint swelling

  • Reduced ability to move the joint

  • Redness of the skin around a joint

  • Stiffness, especially in the morning

  • Warmth around a joint

Signs and tests

The health care provider will perform a physical exam and ask questions about your medical history.

The physical exam may show:

  • Fluid around a joint

  • Warm, red, tender joints

  • Difficulty moving a joint (called "limited range of motion")

Some types of arthritis may cause joint deformity. This may be a sign of severe, untreated rheumatoid arthritis.

Blood tests and joint x-rays are often done to check for infection and other causes of arthritis.

Your doctor may also remove a sample of joint fluid with a needle and send it to a lab for examination.

Arthritis Symptoms Checklist

Right now, you're taking an active role in discovering more about arthritis. That's a great step. This Arthritis Symptoms Checklist can help you and your doctor determine if arthritis could be the cause of your symptoms. Simply answer the questions, print out the checklist, and take it to your doctor to discuss the results.

Do you have pain in one or more of your joints?

Do you have swelling in one or more joints?

Do you have stiffness in your joints, especially after not moving for an extended period of time (e.g., moving in the morning)?

Do you have pain or discomfort in a joint that has a history of injury?

Treatment

The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause cannot usually be cured.

LIFESTYLE CHANGES

Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint inflammation. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you.

Exercise programs may include:

  • Low-impact aerobic activity (also called endurance exercise)

  • Range of motion exercises for flexibility

  • Strength training for muscle tone

Physical therapy may be recommended. This might include:

  • Heat or ice

  • Splints or orthotics to support joints and help improve their position; this is often needed for rheumatoid arthritis

  • Water therapy

  • Massage

Other recommendations:

  • Get plenty of sleep. Sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent flare ups.

  • Avoid staying in one position for too long.

  • Avoid positions or movements that place extra stress on your sore joints.

  • Change your home to make activities easier. For example, install grab bars in the shower, the tub, and near the toilet.

  • Try stress-reducing activities, such as meditation, yoga, or tai chi.

  • Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E.

  • Eat foods rich in omega-3 fatty acides, such as cold water fish (salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.

  • Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3-7 days.

  • Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.

MEDICATIONS

Medications may be prescribed along with lifestyle changes. All medications have risks, some more than others. It is important that you are closely monitored by a doctor when taking arthritis medications.

Generally, over-the-counter medications are recommended first:

  • Acetaminophen (Tylenol) is usually tried first. Take up to 4 grams a day (two arthritis-strength Tylenol every 8 hours). Do not take more than the recommended dose or take the drug along with a lot of alcohol. Doing so may damage your your liver.

  • Aspirin, ibuprofen, or naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs) that can relieve arthritis pain. However, they have many potential risks, especially if used for a long time. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage.

Prescription medicines include:

  • Biologics are used for the treatment of autoimmune arthritis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), rituximab (Rituxan), golimumab (Simponi), certolizumab (Cimzia), and tocilizumab (Actemra). These drugs can improve the quality of life for many patients, but can have serious side effects.

  • Corticosteroids ("steroids") help reduce inflammation. They may be injected into painful joints or given by mouth.

  • Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, gold salts, penicillamine, sulfasalazine, and hydroxychloroquine.

  • Immunosuppressants such as azathioprine or cyclophosphamide are used to treat patients with rheumatoid arthritis when other medications have not worked.

It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, because of side effects), you should talk to your doctor. Also make sure your doctor knows about all the medicines you are taking, including vitamins and supplements bought without a prescription.

SURGERY AND OTHER TREATMENTS

In some cases, surgery may be done if other treatments have not worked. This may include:

Expectations (prognosis)

A few arthritis-related disorders can be completely cured with proper treatment.

Most forms of arthritis however are long-term (chronic) conditions.

Complications

Complications of arthritis include:

  • Long-term (chronic) pain

  • Disablity

  • Difficulty performing daily activities

Calling your health care provider

Call your doctor if:

  • Your joint pain persists beyond 3 days.

  • You have severe unexplained joint pain.

  • The affected joint is significantly swollen.

  • You have a hard time moving the joint.

  • Your skin around the joint is red or hot to the touch.

  • You have a fever or have lost weight unintentionally.