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ARTHRITIS REVIEW | Learn more about Arthritis

What is arthritis?

Arthritis is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. A joint is an area of the body where two different bones meet. A joint function is to move the body parts connected by its bones. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are many different forms of arthritis including those related to wear and tear of cartilage [osteoarthritis], and those associated with inflammation resulting from an over-active immune system [rheumatoid arthritis], abnormal metabolism [gout and pseudogout], ankylosing spondylitis, psoriatic arthritis, systemic lupus erythematosus. Arthritis is frequently accompanied by joint pain.

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What are the arthritis’ symptoms?

Symptoms of arthritis include pain and limited function of joints. Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth. Tenderness of the inflamed joint can be present. Many of the forms of arthritis may cause symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms in some patients with certain forms of arthritis can also include fever, gland swelling, weight loss, fatigue, feeling unwell, and even symptoms from abnormalities of organs such as the lungs, heart, or kidneys. Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness. Arthritis is classified as one of the rheumatic diseases. These are conditions that are different individual illnesses, with differing features, treatments, complications, and prognosis. They are similar in that they have a tendency to affect the joints, muscles, ligaments, cartilage, tendons, and many have the potential to affect internal body areas. You may have joint inflammation for a variety of reasons, including: • Broken bone • Infection (usually caused by bacteria or viruses) • An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign) • General "wear and tear" on joints.

Often, the inflammation goes away after the injury has healed, the disease is treated, or the infection has been cleared. With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:

• Being overweight • Previously injuring the affected joint • Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers, and construction workers are all at risk)

Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people. Other types or cause of arthritis include:

• Rheumatoid arthritis (in adults) • Juvenile rheumatoid arthritis (in children) • Systemic lupus erythematosus (SLE) • Gout • Scleroderma • Psoriatic arthritis • Ankylosing spondylitis • Reiter's syndrome (reactive arthritis) • Adult Still's disease • Viral arthritis • Gonococcal arthritis • Other bacterial infections (non-gonococcal bacterial arthritis ) • Tertiary Lyme disease (the late stage) • Tuberculous arthritis • Fungal infections such as blastomycosis

How is arthritis diagnosed?

The very first thing the patient has to do before making any conclusion himself is talking to his doctor. The doctor will explore the history of symptoms, examine the joints for inflammation and deformity, as well as ask questions about other parts of the body for inflammation or signs of diseases that can affect other body areas. In addition, certain blood, urine, joint fluid, and/or x-ray tests might be required. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and any blood and x-ray findings. Several visits may be necessary before the doctor can be sure of the diagnosis. Many forms of arthritis are more of an annoyance than serious. However, millions of patients suffer daily with pain and disability from arthritis or its complications. Prior and accurate diagnosis can help to prevent irretrievable damage and disability. Properly guided programs of exercise and rest, medications, physical therapy, and surgery options can idealize long-term outcomes for arthritis patients. Further communication with the treating doctor is highly important, so that he/she can be aware of the vagaries of the patient's symptoms as well as their tolerance to and acceptance of treatments. It is also essential from the standpoint of patient, so that he can be assured that he has an understanding of the diagnosis and how the condition does and might affect them. It is also crucial for the safe use of prescribed medications.

Who is a rheumatologist?

A rheumatologist is a medical doctor who specializes in the non-surgical treatment of rheumatic illnesses, especially arthritis. Rheumatologists have special interests in, rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still's disease, dermatomyositis, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch-Schonlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia and others.

Pediatric rheumatologists are physicians who specialize in providing comprehensive care to children (as well as their families) with rheumatic diseases, especially arthritis.

Arthritis Treatment

Treatment of arthritis depends on the particular cause, which joints are affected, severity, and how the condition affects your daily activities. Your age and occupation will also be taken into consideration when your doctor works with you to create a treatment plan. If possible, treatment will focus on eliminating the underlying cause of the arthritis. However, the cause is NOT necessarily curable, as with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at reducing your pain and discomfort and preventing further disability. It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications. In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to lifestyle changes. Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should be tailored to you as an individual. Work with a physical therapist to design an individualized program, which should include: range of motion exercises for flexibility, strength training for muscle tone, low-impact aerobic activity (also called endurance exercise)

A physical therapist can apply heat and cold treatments as needed and fit you for splints or orthotic (straightening) devices to support and align joints. This may be particularly necessary for rheumatoid arthritis. Your physical therapist may also consider water therapy, ice massage, or transcutaneous nerve stimulation (TENS). Rest is just as important as exercise. Sleeping 8 to 10 hours per night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent exacerbations. You should also:

- Avoid positions or movements that place extra stress on your affected joints.
- Avoid holding one position for too long.
- Reduce stress, which can aggravate your symptoms. Try meditation or guided imagery. And talk to your physical therapist about yoga or tai chi.
- Modify your home to make activities easier. For example, have grab bars in the shower, the tub, and near the toilet.

Other measures to try include:

- Taking glucosamine and chondroitin. These form the building blocks of cartilage, the substance that lines joints. These supplements are available at health food stores or supermarkets. While some studies show such supplements may reduce osteoarthritis symptoms, others show no benefit. However, since these products are regarded as safe, they are reasonable to try and many patients find their symptoms improve.
- Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruits and vegetables. Get selenium from Brewer's yeast, wheat germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
- Apply capsaicin cream (derived from hot chili peppers) to the skin over your painful joints. You may feel improvement after applying the cream for 3-7 days.
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MEDICATIONS REVIEW

Your doctor will choose from a variety of medications as needed. Generally, the first drugs to try are available without a prescription. These include:

• Acetaminophen (Tylenol) is recommended by the American College of Rheumatology and the American Geriatrics Society as first-line treatment for osteoarthritis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can provide significant relief of arthritis pain without many of the side effects of prescription drugs. DO NOT exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol. These actions may damage your liver.

• Aspirin, ibuprofen, or naproxen nonsteroidal anti-inflammatory (NSAID) drugs are often effective in combating arthritis pain. However, they have many potential risks, especially if used for a long time. They should not be taken in any amount without consulting your doctor. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage. In 2005, the U.S. Food and Drug Administration (FDA) asked makers of NSAIDs to include a warning label on their product that alerts users of an increased risk for heart attack, stroke, and gastrointestinal bleeding. If you have kidney or liver disease, or a history of gastrointestinal bleeding, you should not take these medicines unless your doctor specifically recommends them.

• Cyclooxygenase-2 (COX-2) inhibitors block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Talk to your doctor about whether COX-2s are right for you.

• Corticosteroids ("steroids") suppress the immune system and symptoms of inflammation. They are commonly used in severe cases of osteoarthritis, and they can be given orally or by injection. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, high blood pressure, thinning of bones, cataracts, and increased infections. The risks are most pronounced when steroids are taken for long periods of time or at high doses. Close supervision by a physician is essential.

• Disease-modifying anti-rheumatic drugs have been traditionally used to treat rheumatoid arthritis and other autoimmune causes of arthritis. These drugs include gold salts, penicillamine, sulfasalazine, and hydroxychloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve your quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on the medication.

• Biologic s-- these are the most recent breakthrough for the treatment of rheumatoid arthritis. Such medications, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are administered by injection and can dramatically improve your quality of life. Newer biologics include Orencia (abatacept) and Rituxan (rituximab).

• Immunosuppressants -- these drugs, like azathioprine or cyclophosphamide, are used for serious cases of rheumatoid arthritis when other medications have failed.

It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, due to intolerable side effects), you should talk to your doctor.

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Expectations

A few arthritis-related disorders can be completely cured with treatment. Most are chronic (long-term) conditions, however, and the goal of treatment is to control the pain and minimize joint damage. Chronic arthritis frequently goes in and out of remission.

Prevention

If arthritis is diagnosed and treated early, you can prevent joint damage. Find out if you have a family history of arthritis and share this information with your doctor, even if you have no joint symptoms. Osteoarthritis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to overwork a damaged or sore joint. Similarly, avoid excessive repetitive motions. Excess weight also increases the risk for developing osteoarthritis in the knees, and possibly in the hips and hands. See the article on body mass index to learn whether your weight is healthy.

Arthritis related topics

Alkaptonuria (Ochronosis), Amyloidosis, Ankylosing Spondylitis, Antiphospholipid Syndrome, Arthritis Baker Cyst, Behcet's Syndrome, Bullous Pemphigoid, Bunions, Bursitis, Bursitis of the Knee, Calcific Bursitis, Chondromalacia Patella, Chronic Pain, Connective Tissue Disease, Costochondritis and Tietze Syndrome, De Quervain's Tenosynovitis, Diffuse Idiopathic Skeletal Hyperostosis (DISH), Dupuytren Contracture, Ehlers-Danlos Syndrome, Eosinophilic Esophagitis, Eosinophilic Fasciitis, Essential Mixed Cryoglobulinemia, Felty's Syndrome, Fibromyalgia, Ganglion, Gout, Henoch-Schonlein Purpura, Hip Bursitis, Hydroxyapatite Crystal Disease, Hypermobility Syndrome, Juvenile Arthritis (Juvenile Rheumatoid Arthritis), Kawasaki Disease, Lumbar Stenosis, Lupus, Lyme Disease, Mixed Connective Tissue Disease, Neck Pain, Osteoarthritis, Osteochondritis Dissecans, Osteoporosis, Paget's Disease, Polyarteritis Nodosa.

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Arthritis contents

• Learn more about Arthritis
• Prescribed medications
• What are the arthritis’ symptoms?
• How is arthitis diagnosed?
• Who is a rheumatologist?
• What is the Arthritis Foundation?
• Arthritis related topics

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Arthritis Facts

All over the world arthritis sufferers include men and women, children and adults. Approximately 350 million people worldwide have arthritis. Nearly 40 million persons in the United States are affected by arthritis, including over a quarter million children! More than 21 million Americans have osteoarthritis and about 2.1 million suffer from rheumatoid arthritis. More than half of those with arthritis are under 65 years of age. Nearly 60% of Americans with arthritis are women.

It has been also estimated that the total cost of the arthritis bill for the United States, in terms of hospitalization, doctor visits, medications, physical therapies, nursing home care, lost wages, early death, and family discord is over $50 billion dollars annually. This does not include the nearly $2 billion spent each year in the United States on unproven remedies by patients addressing their symptoms on their own.