Arthritis refers to inflammation of a joint. The inflammation may cause pain, swelling, stiffness, and damage.
What are the causes and risks of the condition?
There are many types of arthritis, with a host of different causes, such as:
- ankylosing spondylitis, which affects the spine and other joints
- arthritis caused by mechanical problems, such as a bone fracture or dislocation
- gout, caused by an accumulation of uric acid crystals in the joint
- infectious arthritis, caused by infections such as Staphylococcus, Streptococcus,Lyme disease or gonorrhea
- osteoarthritis, a degenerative process also known as wear-and-tear or degenerative arthritis
- pseudogout, caused by an accumulation of calcium pyrophosphate crystals in the joint
- psoriatic arthritis, an autoimmune disorder that is related to and often accompanies a skin condition of the same cause called psoriasis
- reactive arthritis, which may develop after an infection of the urinary tract, bowel, or other organs
- rheumatoid arthritis (RA), an autoimmune disorder in which the body makes antibodies to its own tissues
- lupus, an autoimmune disorder which often includes arthritis and rash and may include heart, lung, kidney, and brain involvement
Some of the risk factors for arthritis are as follows:
- aging changes in the bones and joints
- bodywide infections that affect the joints
- genetic or hereditary tendency to arthritis
- immunodeficiency disorders, such as HIV
- injury to the joints
- menopause, which increases a woman's risk for osteoarthritis
- overweight or obesity
- smoking, which doubles a woman's risk for RA
What can be done to prevent the condition?
Reducing repetitive strain on muscles and joints may help prevent arthritis. Be on the lookout for any chronic aches and strains caused by work, hobby, or recreation-related activities. For example, if you think your work is causing joint symptoms, you may want to see about changing tasks or modifying your workstation.
Regular exercise that does not abuse your joints may prevent arthritis as it creates healthier and more flexible joints.The exercise doesn't have to be strenuous. Just, just regular.
And, being evaluated for sprained joints is recommended. For example, a severe ankle sprain that is not properly splinted may lead to osteoarthritis.
Being overweight or obese increases your risk for osteoarthritis, particularly in the weight-bearing joints. Maintaining a normal weight may be one of the most important arthritis preventatives. Overweight and obese individuals are at far greater risk for osteoarthritis, particularly in the weight-bearing joints. Losing weight, or maintaining a normal weight, cuts your risk for arthritis.
Some infections, left untreated, may lead to infectious arthritis.
Early treatment of RA may prevent worsening of the disease.
How is the condition diagnosed?
Diagnosis of arthritis starts with a medical history and physical examination. Joint X-rays may be normal at first, perhaps showing some swelling.
Later the X-rays may show narrowing of the joint space, roughness of the joint surface, or poor alignment of the joint. Bone spurs, which are calcium deposits at the edge of the joint, may also be seen.
Blood tests, including a complete blood count, or CBC, rheumatoid factor, and antinuclear antibody can help detect some types of arthritis.
Joint aspiration, which means removing joint fluid with a needle under local anesthesia, can sometimes provide useful information. Rarely, a magnetic resonance imaging, or MRI, is needed to determine the cause or extent of the arthritis.
Long Term Effects
What are the long-term effects of the condition?
If the arthritis progresses, joint function may keep declining. The person will have more joint pain, stiffness, and swelling. The amount and rate of decline depend on the type of arthritis and how well the available treatments work.
What are the risks to others?
Arthritis is not contagious. It poses no risk to others. If the arthritis is caused by an infection, such as gonorrhea, the infection may be contagious.
What are the treatments for the condition?
Treatment varies depending on the type of arthritis, the severity of symptoms, and the degree to which the condition has progressed. The age, general health, and activity level of the person also are factors to consider.
Education about the disease can help bring about improved daily self-management and coping skills.
Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (i.e., Advil, Motrin) naproxen (i.e., Aleve, Anaprox, Naprosyn) and aspirin, are often used to treat early symptoms of arthritis. NSAIDs come in over-the-counter and prescription varieties. In addition, some patients find acetaminophen (i.e., Tylenol) to be helpful.
Two prescription COX-2 specific inhibitors, rofecoxib (Vioxx) and valdecoxib ( Bextra), were withdrawn from the U.S market because they may increase the risk of serious and potentially fatal cardiovascular events in some patients. One COX-2 specific inhibitor, Celecoxib (i.e., Celebrex), remains on the market.
At the present time, all NSAIDs carry a black box warning about the possibility of increased cardiovascular risks.
For some forms of arthritis, corticosteroids such as prednisone can work very well. Corticosteroids can be taken by mouth or injected into the joint. Depression and sleep disorders may be treated with low doses of antidepressant medicines, such as amitriptyline (i.e., Elavil).
A wide variety of medicines are used to treat RA:
- antibiotics, such as doxycycline (i.e., Adoxa, Doryx, Oracea, Periostat, Vibramycin) and minocycline (i.e., Minocin, Solodyn)
- non-steroidal anti-inflammatories (NSAIDs) or acetaminophen (i.e., Tylenol)
- corticosteroids, such as prednisone
- the COX-2 specific inhibitor Celecoxib (i.e., Celebrex)
- disease-modifying medicines may slow down the progression of the disease. The fastest acting, best tolerated and most commonly prescribed DMARD is methotrexate (MTX). Although often used alone, many studies have shown that the outcome of two or three of these medications used in combination, is more effective at managing the disease.
- Other DMARDs used on their own or in combination with MTX, include hydroxychloroquine (i.e., Plaquenil), sulfasalazine (i.e., Azulfidine), azathioprine (i.e., Imuran), and leflunomide (i.e., Arava).
- Older DMARDs, such as gold therapy (Myochrisine) and D-penicillamine are virtually never used anymore.
- another option for treating RA is a class of drugs called biological response modifiers (BRMs), or biologics. In people with RA, proteins called Tumor Necrosis Factor (TNF) and Interleukin-1 (IL-1) are present in the blood and joints in excessive amounts where they increase inflammation (pain, swelling, and stiffness).
- Biologics are specially engineered medications which block the effects of TNF or IL-1 and are used to treat moderate to severe RA. These medications work quickly to ease inflammation and are often used in combination with other DMARDs such as methotrexate.
- BMRs in the U.S. include infliximab (i.e., Remicade), etanercept (i.e., Enbrel), and adalimumab (i.e. Humira), which block the effects of TNF.
- Anakinra (i.e. Kineret) is an Il-1 receptor antagonist.
- newer treatments include abatacept (i.e., Orencia) and rituximab (i.e., Rituxan)
If there is a bacterial infection of the joint, antibiotics are critical. The joint may be drained by repeated aspiration or by open surgical drainage.
A change in diet may help some forms of arthritis. People who have arthritis might experience loss of appetite or anemia, which is a low red blood cell count. Frequent small feedings or protein supplements may be prescribed.
Some medicines, such as oral corticosteroids, can stimulate the appetite and lead to weight gain. Losing excess weight can help, especially when the leg joints and other weight-bearing joints are affected.
Foods high in protein, iron, and vitamins contribute to tissue building and repair.
Physical activity is important in the treatment of arthritis. Thirty minutes of moderate exercise a day can help to prevent complications of arthritis, as well as heart disease, stroke, and diabetes. Low impact aerobics and water aerobics are two exercises that minimize joint stress.
A recent study focused on adults with osteoarthritis who used tai chi, a form of Chinese exercise that uses slow, fluid movements. Study participants reported better management of their symptoms, along with improved physical and mental health.
Surgery may be indicated when pain cannot be controlled or function is lost. Several types of surgery may be done:
- arthroplasty, which is the partial or total replacement of a joint, such as knee joint replacement or a hip joint replacement
- arthroscopy, a procedure that uses a small scope and instruments to get inside the joint without opening it
- arthrotomy, which involves opening the joint through a larger incision
- osteotomy, or realignment of the bone next to the joint
- synovectomy, or removal of the lining of the joint
There has been a great deal of interest lately in the use of supplements in treating arthritis, especially for osteoarthritis. According to the Natural Medicines Comprehensive Database, several supplements are "likely effective" in treating osteoarthritis:
Glucosamine sulfate significantly improves symptoms of pain and functionality in patients with osteoarthritis of the knee in studies lasting up to three years. It seems to reduce pain scores by 28 to 41 percent and improve function by 21 to 46%. Glucosamine hydrochloride may not be as effective as glucosamine sulfate.
Chondroitin sulfate may also relieve the symptoms of osteoarthritis, but 2-4 months is required before significant improvement is experienced. Adding chondroitin sulfate to NSAIDs has been shown to be more effective than NSAIDs alone in osteoarthritis of the hip and knee and may allow lower doses or discontinuation of NSAIDs after 6-8 weeks of use.
- SAMe has been shown in several clinical trials to be superior to placebo and comparable to NSAIDs, including the COX-2 inhibitor celecoxib (i.e., Celebrex) for decreasing symptoms associated with osteoarthritis and is associated with fewer side effects than NSAIDs. Symptom relief with SAMe may require up to 30 days of treatment compared to 15 days with NSAIDs.
What are the side effects of the treatments?
Medicines used to treat arthritis may cause stomach upset, allergic reaction, and decreased resistance to infection. Surgery may cause bleeding, infection, or allergic reaction
What happens after treatment for the condition?
Most types of arthritis require lifelong treatment. Exercises to maintain range of motion and muscle strength are very important.
How is the condition monitored?
A healthcare provider will monitor the person's level of comfort and function of the joint. Any new or worsening symptoms should be reported to the healthcare provider.