What is arthritis?
The word “arthritis” simply means “joint inflammation.” Inflammation involves pain, swelling, and stiffness of the joint area. When arthritis occurs, these symptoms tend to last for a long periods of time or reoccur over time.
Arthritis is very common, and most cases of arthritis lead to tissue damage. It has been estimated that as many as 70 million Americans (or one out of three people) have some form of arthritis or joint pain. Arthritis can affect persons of all ages but it is more commonly seen in older adults.
A joint is where two or more bones join together. Some major joints of the body include the hip, knee, elbow, and ankle joints. Joint surfaces are covered with a spongy, smooth material known as cartilage. This material cushions the bones and allows the joint to move freely and without pain. Joints are lined by a thin film of tissue known as the synovium. This tissue’s lining produces a slippery fluid called synovial fluid and it nourishes the joint and helps reduce friction.
Ligaments are the strong bands of tissue that connect the bones and keep the joint stable and strong. Further support of the joint comes from the muscles and tendons of the body and these allow us to move around. When a person has arthritis, the area in or around one or more of the joints becomes inflamed. When this inflammation occurs, there is pain, stiffness, and difficulty with movement.
What are the types of arthritis?
According to medical experts, there are more than one hundred different types of arthritis. The three most common types are osteoarthritis, rheumatoid arthritis, and gouty arthritis.
This is the most commonly occurring type of arthritis. Osteoarthritis occurs when the cartilage that covers the end of the bone gradually wears away. When this protection is gone, the bones rub against each other and this friction leads to pain and swelling. Osteoarthritis mainly affects the weight-bearing joints (knee, hip, and spine) and the hands. This type of arthritis is known as the ‘wear and tear arthritis’ because it occurs as we age. Other causes include previous injuries, obesity, and heredity. The symptoms of osteoarthritis include creaky joints, swollen joint areas, pain, stiffness, and immobility or difficulty with movement.
Rheumatoid arthritis is a long-term disease that affects joints in any part of the body except the lower back. This type of arthritis most commonly involves the hands, wrists, and knees. With this autoimmune disorder, the immune system mistakenly attacks itself and leads to the swelling of the joint lining. This inflammation not only affects the joint area, but it spreads to the surrounding structures damaging the tissues, cartilage, and bone in some cases. People with severe cases of rheumatoid arthritis may have involvement of their lungs, nerves, eyes, and skin as well.
Gouty arthritis is often referred to as ‘gout’. Gout is a painful medical condition that occurs when the body cannot eliminate uric acid from the body or it produces too much uric acid. Uric acid is a natural substance that we all have in small amounts. People with gouty arthritis have a build-up of this uric acid, and the excess uric acid forms needle-like crystals in the joints that lead to swelling and severe pain. The joints most commonly affected are the big toe, the knee, and the wrist.
What causes arthritis?
Medical experts do not know the exact cause of most types of arthritis. While exact causes elude researchers, they have identified several risk factors for arthritis. These include:
Age – The risk of developing arthritis, especially osteoarthritis, increases with age.
Obesity – When a person is overweight, this puts extra stress on weight-bearing joints, increasing wear-and-tear, and increasing the risk of arthritis, especially osteoarthritis.
Gender – For reasons unknown, arthritis occurs more frequently in women than in men.
Work Factors – Certain jobs that require repetitive movements or heavy lifting can stress the joints and lead an injury, which can cause arthritis, particularly osteoarthritis.
How is arthritis diagnosed?
Osteoarthritis is generally diagnosed with a complete medical history and imaging techniques like X-Rays or magnetic resonance imaging (MRI). These diagnostic tests can sometimes be used to show the condition of the joints. If other types of arthritis are suspected, lab tests on blood, urine, and joint fluid may be helpful in determining the type of arthritis like gout and rheumatoid arthritis. These tests also can help rule out other diseases as the cause of your symptoms, too.
Can arthritis be prevented?
Although it probably is not be possible to prevent arthritis completely, there are steps to take to reduce your risk of developing the disease too soon. These steps will slow or prevent permanent joint damage as well.
Maintaining a healthy weight – Excess weight puts strain on your joints, which can lead to arthritis.
Exercising – Keeping your muscles and supporting structures strong can help protect and support your joints.
Using joint-protecting devices and techniques at work – Proper lifting and posture can help protect your muscles and joints of your back, knees, and hips.
Eating a healthy diet – A well balanced diet can help strengthen your bones and muscles and this will in turn prevent joint break down.
How is arthritis treated?
A careful examination of the duration, location, and character of the joint symptoms and the appearance of the joints will help your doctor diagnose and treat your arthritis. A person with osteoarthritis has bony enlargement of the joints from spur formation. Once a diagnosis is made, the orthopedic specialist can perform further testing and treatment of the arthritis.
Exercise is one of the best things you can do to relieve joint pain with osteoarthritis. Strength-training, stretching, and low impact aerobic exercises all are therapeutic for arthritis. Physical therapy is a part of the treatment for certain types of arthritis, too. Another great thing about exercises is that it helps you to maintain a healthy weight, which benefits osteoarthritis sufferers.
A class of drugs that is used in the treatment of arthritis is the Nonsteroidal Anti-Infammatory Drugs (NSAIDS). These medications interfere with the prostaglandins in the body to allow for inflammation and pain relief. These drugs include ibuprofen (Advil and Motrin), naproxen (Aleve), and aspirin. There are many prescription only NSAIDS, also. Another medication option for osteoarthritis is Tylenol (acetaminophen). This medicine not only relieves pain, but researchers now have found that it has anti-inflammatory properties.
There are creams and gels you can rub on your affected joints that relieve pain, too. These include capsaicin, camphor, eucalyptus oil, and menthol. Disease-Modifying Anti-Rheumatic Drugs (DMARDS) will actually slow the joint damage in people with rheumatoid arthritis and psoriatic arthritis. These drugs stop the progression of the disease process. These include Azulfidine, Plaquenil, Arava, Trexall, and Rheumatrex. If other drug therapies fail, your orthopedic specialist may prescribe corticosteroids. These drugs dampen the immune response to help reduce inflammation. They can be taken by mouth, by injection into a muscle, or direct injection into the joint space.
Joints have a natural lubricant known as hyaluronic acid to keep them moving smoothly. If you have osteoarthritis, you have less of this substance than normal. Doctors now have hyaluronic acid injection products they can inject into the joint to improve mobility and relieve pain. These include Synvisc, Supartz, Orthovisc, Hyalgan, and Euflexxa.
Surgery for Arthritis
Arthrocentesis is done to analyze joint fluid. During this procedure, joint fluid is removed with a small needle and sent to the lab for evaluation. This allows health care professionals to exclude gout, infection, and other causes of arthritis. During this procedure, the doctor can inject corticosteroids into the joints to help relieve inflammation, pain, and swelling.
Another surgical technique that can be done is arthroscopy. This is where the orthopedic doctor inserts a viewing instrument directly into the joint space to assess for abnormalities and damage of the cartilage and ligaments. This procedure is more helpful for addressing the meniscus tears and ligament injuries than for the treatment of arthritis.
If the damage to the joint is severe and there is considerable pain, your orthopedic specialist may suggest surgery to replace the joint to improve function and relieve pain. Joint replacement, also called arthroplasty, is done using a man-made plastic and metal ‘joint’ that is placed inside the affected area.
Another procedure is joint fusion. This is rarely performed when arthroplasty fails. The joint is completely removed and the bones are held together with screws, pins, or plates. It is called fusion because over time, the bones fuse together. If you are fairly young and active, your surgeon may suggest a joint-preserving procedure called osteotomy. This surgery involves cutting and removing a wedge of the bone to improve joint alignment, essentially shifting the weight bearing from the worst area in the joint to the more normal side of the joint.