Arthritis Overview

What is arthritis?

Arthritis is a condition that causes pain and stiffness of the joints. Sometimes it also causes redness, swelling, and warmth. In severe cases, joints may become misshapen.

There are different kinds of arthritis. Two common forms are osteoarthritis and rheumatoid arthritis (RA). Both of these forms of arthritis are more common in women than in men.

Examples of other forms of arthritis include gout, ankylosing spondylitis, and arthritis that happens after an injury or with some infections such as gonorrhea.

How does it occur?

Osteoarthritis is a disease in which the cartilage in joints breaks down. Cartilage is the joint's cushion. It covers the ends of bones and allows free movement. If cartilage becomes rough, frays, or wears away, bones grind against each other. As a result, the joint becomes irritated and swollen (inflamed). Sometimes the irritation causes abnormal bone growths, called spurs. Bone spurs increase swelling. Osteoarthritis normally affects the feet, knees, lower back, hips, and fingers. Symptoms of the disease start to appear by middle age. Most people over age 60 have some osteoarthritis, but they may not have symptoms.

Rheumatoid arthritis (RA) affects the lining of the joints. It is an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue. Rheumatoid arthritis causes redness and swelling, stiffness, and misshapen joints. It usually affects the joints of the hands, arms, and feet. RA usually starts in early adulthood or middle age.

What are the symptoms?

Possible symptoms of arthritis are:

• mild to severe pain in joints
• red, swollen joints
• stiffness and limited movement, especially in the morning
• misshapen joints.

Some types of arthritis make your feel tired.

How is it diagnosed?

Your healthcare provider will review your medical history and examine you. You may have blood tests and X-rays of the joints that are bothering you.

How is it treated?

There are many ways to treat arthritis. The goal of treatment is to keep the joints working properly by:

• relieving pain and stiffness
• reducing swelling
• stopping or slowing down damage to the joints.

Medicine can control pain and reduce inflammation. Most of the time, acetaminophen is the best medicine to use to relieve pain because it has fewer side effects than other pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can help relieve pain and inflammation. Adults age 65 and older should not take NSAIDs for more than 7 days without their healthcare provider's approval. NSAIDs help reduce pain and swelling but can cause kidney and stomach problems.

COX-2 inhibitors such as celecoxib (Celebrex) are prescription NSAIDs. COX-2 inhibitors can help arthritis symptoms, but they have been linked to a greater risk of heart attack and stroke. Talk with your healthcare provider to learn more about taking NSAIDs.

When NSAIDs do not relieve symptoms, several other kinds of medicines may be used, such as:

• disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (Rheumatrex or Trexall) for people with rheumatoid arthritis
• biological response modifiers, such as Humira or Remicade, to help reduce inflammation in the joints caused by rheumatoid arthritis
• steroids such as prednisone or cortisone, which can be taken by mouth or injected into a joint.

Treatment with these medicines must be watched carefully by your provider to avoid serious side effects.

Three types of exercise are best for people with arthritis:

• Range-of-motion. These are gentle stretching exercises that help you move each joint as far as possible. Examples include tai chi and yoga. This type of exercise helps maintain or increase flexibility and relieve stiffness.
• Strengthening. Exercises such as weight training help increase muscle strength. Strong muscles help to support joints and help you to move more easily and with less pain.
• Aerobic or endurance. Exercises such as walking or bicycle riding improve overall health and help control weight. Extra weight puts extra strain on many joints. A healthy diet is also important to help you control body weight and stay healthy.

Talk with your healthcare provider before you start an exercise program. Too much too soon or even at the wrong time of day may make arthritis worse. Your provider may refer you to a physical therapist to design a program that is right for you.

Your healthcare provider may suggest using heat or cold therapy, depending on the type of arthritis you have. Sometimes a splint or brace is used to let the joint rest and protect it from injury.

Transcutaneous electrical nerve stimulation (TENS) may relieve some types of arthritis pain. TENS directs mild electric pulses through the skin to the nerves in the painful area.

If you have arthritis in your knee, hyaluronic acid can be injected into the knee to act as a lubricant. It helps the knee to move without pain.

If your joints are severely damaged, surgery may be necessary. Possible surgeries are:

• synovectomy to remove the inflamed joint tissue
• osteotomy to realign a joint
• joint replacement to replace a damaged joint with an artificial joint.

How long will the effects last?

If you have arthritis, you will probably have it for the rest of your life. How often you have symptoms of arthritis depends, at least in part, on the type of arthritis you have. You might be reminded of the arthritis every time you use the affected joints. Or there may be times when you have symptoms and times when you do not. Times when you do not have symptoms are called remissions.

How can I take care of myself?

• Take the medicine your healthcare provider recommends.
• Follow your provider's advice for weight control if you are overweight.
• Do the exercises recommended by your provider or physical therapist.
• Keep your body healthy by eating a healthy diet.

How can I help prevent arthritis?

No one knows how to prevent arthritis. However, it is a condition that can usually be managed by taking medicine and keeping the joints mobile.