Arthritis

Definition

Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).

Risk Factors/Causes

• A reduction in the normal amount of this cartilage tissue cause some forms of arthritis.
• Normal wear and tear causes OA, one of the most common forms of arthritis.
• An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue.
• Can be hereditary

Symptoms

• Joint pain, stiffness, and swelling are the most common symptoms of arthritis.
• Your range of motion may also decrease, and you may experience redness of the skin around the joint.
• In the case of RA, you may feel tired or experience a loss of appetite due to the inflammation that immune system activity causes.
• You may also become anemic — meaning your red blood cell count decreases — or have a slight fever. Severe RA can cause joint deformity if left untreated.

Diagnosis

• Your doctor will performing a physical exam. During the exam, your doctor will check for fluid around the joints, warm or red joints, and limited range of motion in the joints.
• Extracting and analyzing inflammation levels in your blood and joint fluids can help your doctor determine what kind of arthritis you have.
• Doctors commonly use imaging scans such as X-ray, MRI, and CT scans to produce an image of your bones and cartilage.

Treatment

A number of different types of medication treat arthritis.

They include:

  • analgesics, e.g., hydrocodone (Vicodin) or acetaminophen (Tylenol): effective for pain management, but don’t help decrease inflammation
    nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen: help control pain and inflammation
  • menthol or capsaicin creams: block the transmission of pain signals from your joints.
  • If you have RA, your doctor may put you on corticosteroids or disease-modifying antirheumatic drugs (DMARDs), which suppress your immune system.
  • Surgery to replace your joint (knees and hips)
  • Joint Fusion
  • Physical therapy

How to Prevent Arthritis:

• Maintaining a healthy weight can reduce the risk of developing OA, and can reduce symptoms if you already have it.
• Eating a healthy diet of food rich in antioxidants can help reduce inflammation.
• Stay active and exercise regularly will keep joints flexible.

Osteoarthritis is the most common type of arthritis. When the cartilage – the slick, cushioning surface on the ends of bones – wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic. Risk factors include excess weight, family history, age and previous injury (an anterior cruciate ligament, or ACL tear, for example).

When the joint symptoms of arthritis are mild or moderate, they can be managed by:

  • Balancing activity with rest
  • Using hot and cold therapies
  • Regular physical activity
  • Maintaining a healthy weight
  • Strengthening the muscles around the joint for added support
  • Using assistive devices
  • Taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines
  • Avoiding excessive repetitive movements

If joint symptoms are severe, causing limited mobility and affecting quality of life, some of the above management strategies may be helpful, but joint replacement may be necessary.

Osteoarthritis can be prevented by staying active, maintaining a healthy weight, and avoiding injury and repetitive movements.

A healthy immune system is protective. It generates internal inflammation to get rid of infection and prevent disease. But the immune system can go awry, mistakenly attacking the joints with uncontrolled inflammation, potentially causing joint erosion and may damage internal organs, eyes and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. Researchers believe that a combination of genetics and environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor that can trigger rheumatoid arthritis in people with certain genes.

With autoimmune and inflammatory types of arthritis, early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage. Remission is the goal and may be achieved through the use of one or more medications known as disease-modifying antirheumatic drugs (DMARDs). The goal of treatment is to reduce pain, improve function, and prevent further joint damage.

A bacterium, virus or fungus can enter the joint and trigger inflammation. Examples of organisms that can infect joints are salmonella and shigella (food poisoning or contamination), chlamydia and gonorrhea (sexually transmitted diseases) and hepatitis C (a blood-to-blood infection, often through shared needles or transfusions). In many cases, timely treatment with antibiotics may clear the joint infection, but sometimes the arthritis becomes chronic.

Uric acid is formed as the body breaks down purines, a substance found in human cells and in many foods. Some people have high levels of uric acid because they naturally produce more than is needed or the body can’t get rid of the uric acid quickly enough. In some people the uric acid builds up and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain, or a gout attack. Gout can come and go in episodes or, if uric acid levels aren’t reduced, it can become chronic, causing ongoing pain and disability.

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

Alternative Names

RA; Arthritis – rheumatoid

Causes

The cause of RA is unknown. It is considered an autoimmune disease. The body’s immune system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune system confuses healthy tissue for foreign substances. As a result, the body attacks itself.

RA can occur at any age. Women are affected more often than men.

RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected. The course and the severity of the illness can vary considerably. Infection, genes, and hormones may contribute to the disease.

Symptoms

The disease often begins slowly, with symptoms that are seen in many other illnesses:

  • Fatigue
  • Loss of appetite
  • Low fever
  • Swollen glands
  • Weakness
  • Eventually, joint pain appears.

Morning stiffness, which lasts more than 1 hour, is common. Joints can even become warm, tender, and stiff when not used for as little as an hour. Joint pain is often felt on both sides of the body. The fingers (but not the fingertips), wrists, elbows, shoulders, hips, knees, ankles, toes, jaw, and neck may be affected.
The joints are often swollen and feel warm and boggy (or spongy) to the touch.
Over time, joints lose their range of motion and may become deformed.
Other symptoms include:

  • Chest pain when taking a breath (pleurisy)
  • Eye burning, itching, and discharge
  • Nodules under the skin (usually a sign of more severe disease)
  • Numbness, tingling, or burning in the hands and feet
  • Joint destruction may occur within 1 – 2 years after the disease appears.

Exams and Tests

A specific blood test is available for diagnosing RA and distinguishing it from other types of arthritis. It is called the anti-CCP antibody test. Other tests that may be done include:

  • Complete blood count
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Joint ultrasound or MRI
  • Joint x-rays
  • Rheumatoid factor test (positive in about 75% of people with symptoms)
  • Synovial fluid analysis
  • Regular blood or urine tests should be done to determine how well medications are working and whether drugs are causing any side effects.

Treatment

RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.

Medications

Disease modifying antirheumatic drugs (DMARDs): These drugs are the current standard of care for RA, in addition to rest, strengthening exercises, and anti-inflammatory drugs.

  • Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) may be substituted for methotrexate.
  • These drugs may have serious side effects, so you will need frequent blood tests when taking them.

Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

  • Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems.
  • Celecoxib (Celebrex) is another anti-inflammatory drug, but it is labeled with strong warnings about heart disease and stroke. Talk to your doctor about whether COX-2 inhibitors are right for you.

Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine), and is usually used along with methotrexate. It may be weeks or months before you see any benefit from these medications.

Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of long-term side effects, corticosteroids should be taken only for a short time and in low doses when possible.

Biologic Agents: Biologic drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.

They may be given when other medicines for rheumatoid arthritis have not worked. At times, your doctor will start biologic drugs sooner, along with other rheumatoid arthritis drugs.

Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). There are different types of biologic agents:

  • White blood cell modulators include: abatacept (Orencia) and rituximab (Rituxan)
  • Tumor necrosis factor (TNF) inhibitors include: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certolizumab (Cimzia)
  • Interleukin-6 (IL-6) inhibitors: tocilizumab (Actemra)

Biologic Agents: can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:

  • Infections from bacteria, viruses, and fungi
  • Leukemia
  • Possibly psoriasis

Surgery

Occasionally, surgery is needed to correct severely affected joints. Surgeries can relieve joint pain and deformities.

The first surgical treatment may be a synovectomy, which is the removal of the joint lining (synovium).

At some point, total joint replacement is needed. In extreme cases, total knee, hip replacement, ankle replacement, shoulder replacement, and others may be done. These surgeries can mean the difference between being totally dependent on others and having an independent life at home.

Physical Therapy

Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function.

Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.

Sometimes therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint mobility.

Occupational therapists can create splints for the hand and wrist, and teach how to best protect and use joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations caused by RA.

Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.

Outlook (Prognosis)

The course of rheumatoid arthritis differs from person to person. For some patients, the disease becomes less aggressive over time and symptoms may improve.

Other people develop a more severe form of the disease.

People with rheumatoid factor, the anti-CCP antibody, or subcutaneous nodules seem to have a more severe form of the disease. People who develop RA at younger ages also seem to get worse more quickly.

Treatment for rheumatoid arthritis has improved. Many people with RA work full-time. However, after many years, about 10% of those with RA are severely disabled, and unable to do simple daily living tasks such as washing, dressing, and eating.

Possible Complications

Rheumatoid arthritis is not only a disease of joint destruction. It can involve almost all organs.

Problems that may occur include:

  • Anemia due to failure of the bone marrow to produce enough new red blood cells
  • Damage to the lung tissue (rheumatoid lung)
  • Injury to the spinal cord when the cervical spine (neck bones) becomes unstable as a result of RA
  • Rheumatoid vasculitis (inflammation of the blood vessels), which can lead to skin ulcers and infections, bleeding stomach ulcers, and nerve problems that cause pain, numbness, or tingling. Vasculitis may also affect the brain, nerves, and heart, which can cause stroke, heart attack, or heart failure.
  • Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis). Both of these conditions can lead to congestive heart failure.
  • Sjogren syndrome

The treatments for RA can also cause serious side effects. If you experience any side effects, immediately tell your health care provider.

When to Contact a Medical Professional

Call your health care provider if you think you have symptoms of rheumatoid arthritis.

Prevention

Rheumatoid arthritis has no known prevention. However, it is often possible to prevent further damage to the joints with proper early treatment.

References

Yazici Y. Treatment of rheumatoid arthritis: we are getting there. Lancet. 2009;374:178-180.

Deighton C, O’Mahony R, Tosh J, Turner C, Rudolf M; Guideline Development Group. Management of rheumatoid arthritis: summary of NICE guidelines. BMJ. 2009;338:b702.

Harris ED Jr, Firestein GS. Clinical features of rheumatoid arthritis. In: Firestein GS, Budd RC, Harris ED Jr, et al., eds. Kelley’s Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 66.

How Can We Help You Today?


Find a Provider Request An Appointment

"They saved my life."

Laura Getty, a patient of one of our clinical programs, is grateful for the quick thinking of our exceptional surgeons and the innovative treatment that she received.

View Her Story

Call Us: (864) 455-7070