From the ProHealth.com Arthritis site. For more information on arthritis symptoms, treatment modalities, and news & articles, go to http://www.prohealth.com/arthritis.
WHAT IS ARTHRITIS?
The word arthritis means joint inflammation – from the words “arthro,” meaning joint and “itis,” meaning inflammation (the body’s natural response to injury).
It typically consists of four symptoms: redness, swelling, heat and pain. Arthritis can occur at any joint in the body and can result from a variety of different disease processes including infection, gout, wear and tear, and even autoimmune conditions.
No matter the underlying cause of the arthritis, the basic symptoms are similar. When a joint becomes inflamed, the result is joint tenderness, pain, swelling, stiffness, and reduction in range of movement. If the inflammation persists over time, the joint begins to deteriorate. If the destruction is severe enough, the joint becomes destroyed and will need to be replaced to relieve pain and restore function.
The pain of arthritis can be temporary or constant; many people with arthritis experience “flare ups,” where the disease is much worse for a period of time and then returns to a lower amount of pain. Typically, the pain and destruction caused by arthritis is slow and tends to increase over time, although occasionally arthritis can occur suddenly. Sudden types of arthritis are usually caused by infection or an underlying condition such as gout.
By far, the two most common types of arthritis are osteoarthritis (also known as degenerative joint disease) and rheumatoid arthritis. Other common causes of arthritis include gout, pseudogout, and infection.
• Gout is a condition of high uric acid in the body; the uric acid becomes crystallized in certain joints and then the body attacks these crystals with inflammation.
• Pseudogout is very similar to gout, only the crystals that are formed are made up of calcium pyrophosphate and not uric acid.
• Occasionally joints will be attacked by infectious arthritis. The infection may be introduced in many different ways, but is generally the result of an infection moving through the blood and ending up in a joint. Infectious arthritis is usually found in only one joint and tends to come on quickly.
This disease is also known as degenerative joint disease.
• It is more common in people over age 65.
• It is mostly thought to be due to wear and tear of a joint.
• It strikes the joints that bear weight and are used often – such as the hips and knees.
The protective covering (cartilage) on the joints breaks down and eventually the bone rubs against bone. Bones rubbing against bones causes destruction of the bone; this destruction leads to inflammation as the entire joint breaks down.
This type of arthritis is a chronic inflammatory disease that is classified as an autoimmune disease. In autoimmune diseases, the body mistakenly attacks itself. In rheumatoid arthritis, the body is attacking the joints of the body, and this can result in inflammation and destruction of the joints.
• The most commonly affected joints in rheumatoid arthritis are those of the hands, feet and wrists, knees, elbows and ankles.
• Usually rheumatoid arthritis strikes both sides of the body at the same time: for example, both wrists or both ankles might be affected.
• Rheumatoid arthritis is considered a systemic disease. This means that the whole body can be affected, not just the joints.
• When the whole body is affected, people can have a wide range of symptoms including:
– Overall muscle weakness
– Fatigue or tiredness
– Infection-like symptoms such as fever and swollen lymph nodes
– Hair loss
– Chest pain
– Skin rashes
– Dry eyes and dry mouth (called sicca syndrome)
– Night sweats
– Weight loss.
• Rheumatoid arthritis can also attack any of the organs of the body. This condition is rare, but usually involves inflammation of the membranes surrounding the heart or inflammation of the blood vessels and results in a condition called vasculitis.
• Rheumatoid arthritis can have flare ups where the pain and inflammation are much worse and then have periods that are relatively pain-free.
• Occasionally, rheumatoid arthritis has been known to completely go away.
No matter the underlying cause of the arthritis, the basic symptoms of all types of arthritis are very similar:
• Typically, joints are painful, swell, are stiff, tender, and often warm and red.
• Certain types of arthritis cause people to experience whole-body effects such as fatigue, fever and a rash.
But remember that joint pain and whole-body effects may be early symptoms of many different diseases, making it hard to determine that the disease is actually arthritis.
Each type of arthritis also has its own unique symptoms.
Osteoarthritis (Degenerative Joint Disease)
• People with this type of degenerative arthritis are typically better with resting the joint and not using it for a while. They can be a bit stiff in the morning and get better once they start to move around.
• Osteoarthritis tends to strike the joints in the body that get the most use, such as elbows, shoulders, knees and hips.
• Osteoarthritis is much worse when the joint is used. Working in the garden, going on a long walk, or any over-use of the joint can make the symptoms much worse.
• Osteoarthritis tends to attack only one side of the body. For example, a left knee may have arthritis, but the right knee may not.
• The pain from osteoarthritis can be mild or very severe, and this often does not correlate with the amount of destruction seen on X-rays.
• People with rheumatoid arthritis (autoimmune) are often much worse with resting and when they are not using the affected joints. They typically wake up in the morning very sore and find that their pain increases when they sit or lie down for more than an hour.
• The disease often attacks the same joints on both sides of the body, especially hands wrists, elbows feet, ankles, knees and neck.
• Rheumatoid arthritis develops slowly over time, although juvenile rheumatoid arthritis can occasionally appear suddenly with no warning.
• People with rheumatoid arthritis are more likely to have whole body symptoms. [See Whole-Body Symptoms for more detail.]
• Gout typically strikes the big toe, but can strike any joint in the body. It typically only occurs in one toe, but it can happen on both sides of the body.
• Pseudogout often causes pain in the knees and has symptoms similar to osteoarthritis (Degenerative Joint Disease).
• Infectious arthritis is more likely to occur in the larger joints of the body such as the hips and the knees.
WHO IS AT RISK?
Each type of arthritis carries its own risk factors. Gout is an obvious risk for gouty arthritis, and some injuries where the skin is pierced are a risk for infectious arthritis. Here are more risks for the two most common types or arthritis:
Osteoarthritis (Degenerative Joint Disease)
• Age: It is estimated that 80 percent of people over 70 years of age have the degenerative type of arthritis, known as osteoarthritis.
• Weight: The risk for osteoarthritis increases with the amount of weight that a person carries. This makes sense, as more weight adds more stress to the joints of the body, especially the hips, knees and ankles.
• Repetitive motion: Working in a job that requires repetitive motions tends to increase risk for osteoarthritis, as do any job-related injuries.
• Exercise: Exercise is also thought to cause certain types of arthritis such as osteoarthritis (Degenerative Joint Disease), but it is complicated to determine the risk. Some exercise may be protective, like swimming, cycling and walking. Other exercise, like running very long distances, may be harmful; but this is not necessarily true, as not all long distance runners have osteoarthritis. To add to the confusion, there seems to be a genetic component to osteoarthritis, with around 30 to 50 percent of twins having the same amount of osteoarthritis.
• Sex: Women are 2 to 3 times more likely to have rheumatoid arthritis (autoimmune).
• Age: It generally strikes people between the ages of 40 and 60 years, but there is also a juvenile version that affects youngsters.
• Family: There is a strong genetic component to rheumatoid arthritis, as it tends to run in families.
HOW IS ARTHRITIS DIAGNOSED?
Diagnosis depends on the type of arthritis suspected by the doctor. Most of the time, the testing is very similar:
• No matter which type of arthritis is suspected, a patient will have a complete medical exam that includes personal, medical, and family history.
• Functional tests are often performed to determine the range of motion of the affected joint.
• Diagnosis will be helped with the use of X-rays, computerized tomography (CT) and magnetic resonance imaging (MRI).
• A blood test, called the erythrocyte sedimentation rate (ESR), can help to determine if there is inflammation in the whole body. ESR is nonspecific test and may point to many types of arthritis.
After the general tests, more specific tests may be used to help make the diagnosis:
• General blood tests are often performed and can show the presence of an infection, suggesting an infectious arthritis.
• Gout is determined by testing the uric acid level in blood.
• Pseudogout is unique in that it requires a test where some of the fluid of the joint is extracted and examined under a microscope.
• Further testing may be performed if rheumatoid arthritis is suspected. The two blood tests typically performed are called rheumatoid factor (RF) and antinuclear antibody (ANA). The tricky part of rheumatoid arthritis is that not everyone with rheumatoid arthritis has positive results from these tests.
The underlying causes for many types of arthritis are unknown. For some types of arthritis, such as gout and pseudogout, the underlying causes are easy to determine: uric acid crystals in the case of gout, and calcium pyrophosphate crystals in the case of pseudogout. Infectious arthritis can also be determined by the presence of bacteria, viruses, or even a fungus.
Genetics seem to play a large role in many types of arthritis, including gouty, rheumatoid, and osteoarthritis (degenerative joint disease). If a close family member has or had a certain type of arthritis, you are more likely to have it.
As with many diseases, no single cause for arthritis may ever be found; it may be the result of a combination of factors. Lifestyle factors play an important role in all types of arthritis. (See
Treatment Modalities for more detail.) Good diet and exercise can be helpful in fighting the onset of arthritis, whereas smoking, alcohol use, obesity and more all appear to have a great impact on whether an individual will have arthritis, especially the types that are chronic in nature.
Osteoarthritis (Degenerative Joint Disease)
The cause of osteoarthritis was once thought to be simply degenerative. The more you use a joint, the more it’s subject to wear and tear. This appears not to be the case, as many long distance runners are no more likely to have osteoarthritis than the rest of the population.
Scientists now think that there might be some genetic component to osteoarthritis, as siblings and twins are more likely to share the disease. The loss of the cartilage cushion between bones is the main feature of the disease, but determining just why some people lose that cushion and others don’t is a bit of a mystery and may be determined by future research.
The destruction of the joint in rheumatoid arthritis (autoimmune) is the result of the body attacking itself. The immune system is designed to attack foreign invaders in the body. For reasons not completely clear, when someone has rheumatoid arthritis the body thinks the joints are foreign invaders. When the body attacks its own joints, the result is pain and inflammation. This inflammation eventually leads to the destruction of the joint.
Like many autoimmune diseases, rheumatoid arthritis tends to run in families. This suggests that genetics play a role in the development of the disease.
No matter the type of arthritis, there is a general medical treatment approach employing medications designed to reduce pain and inflammation. Once this is done, a doctor will focus on the underlying cause of the disease and use specific treatments for each condition:
• Infectious arthritis is often treated with antibiotics.
• There are anti-gout medications and pseudogout treatments.
• Osteoarthritis (Degenerative Joint Disease) is treated using anti-inflammatory medications and sometimes, direct injections into the joint.
• Rheumatoid arthritis has a wide variety of treatments, all designed to calm inflammation and lessen the body’s self-attacks.
(See “Pharmaceutical Treatment Modalities” for details on the general and condition-specific options.)
Physical therapy is often employed in chronic types of arthritis, and generally involves keeping the joint limber by moving the joint through its whole range of motion, sometimes in water.
A wide range of natural supplements including herbs and other nutrients have been shown to be very successful in supporting the reduction of pain and inflammation, and the destruction of the joints in arthritis.
Acupuncture has also been used with some success.
CHOOSING A DOCTOR
Often the best place to start when you suspect you have arthritis is your primary care physician or other health care provider with whom you’ve established a good rapport.
• If the type of arthritis you have is acute (meaning it is only temporary), you probably need look no further than your local health care provider.
• If you are diagnosed with a more chronic condition such as osteoarthritis, gout, pseudogout, or especially rheumatoid arthritis, then seeing a specialist in these diseases may be important.
As with any chronic illness, navigating your way within the medical world will require you to be your own advocate. This means being proactive about your care, staying informed, and being organized about your needs during each appointment. This is not an easy road, and balancing the medical, insurance and care aspects of your health is going to require clarity and work on your part.
How Do You Choose a Doctor?
While you can use you primary care physician for advice in treating arthritis, you might want to consider consulting a specialist. You should consider the following types of physicians when are attempting to choose a doctor:
• Rheumatologists are doctors who specialize in treating diseases of the joints and connective tissue. They deal with all types of arthritis and keep up on the latest research. Since many diseases mimic arthritis, they are often the best professional to turn to if there is a question about diagnosis.
• Pain Specialists may be consulted if the pain you are suffering from becomes unbearable. Pain specialists often use a variety of techniques and medications in order to help people with chronic diseases.
If you need help choosing a doctor or researching your condition, there are associations that can help you:
American College of Rheumatology
1800 Century Place,Suite 250
Atlanta, GA 30345-4300
P.O. Box 7669
Atlanta, GA 30357-0669
Many other diseases mimic the symptoms of arthritis. In addition, it might be hard to determine exactly which type of arthritis you have. Depending on the situation, it may be difficult to determine if arthritis of the ankle is caused by osteoarthritis, rheumatoid arthritis, infectious, gout, or other types of arthritis.
There is also the possibility of having more than one type of arthritis, for example: you might have osteoarthritis of the knee and gout in your big toe.
People who suffer from arthritis – especially the types of arthritis that are autoimmune – can experience a wide range of other conditions, including:
• Overall muscle weakness
• Fatigue or tiredness
• Infection-like symptoms such as fever and swollen lymph nodes
• Hair loss
• Chest Pain
• Skin rashes
• Dry eyes and dry mouth (called sicca syndrome)
• Night sweats
• Weight loss
People with arthritis often have more trouble losing weight and tend toward being overweight or obese. This is often owing to the difficulty of exercising with painful joints.
Depression is another common side-effect of chronic arthritis, as the pain and lack of exercise contribute to depression.
And importantly, many other types of diseases may present with painful joints and muscles, such as lupus, fibromyalgia, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Lyme disease, osteoporosis, and others.
Note: This information has not been evaluated by the FDA. It is not meant to diagnose, prevent, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.