is inflammation of one or more joints, which results in pain, swelling,
stiffness, and limited movement. There are over 100 different types of
Arthritis involves the breakdown of cartilage. Cartilage normally protects
the joint, allowing for smooth movement. Cartilage also absorbs shock when
pressure is placed on the joint, like when you walk. Without the usual
amount of cartilage, the bones rub together, causing pain, swelling
(inflammation), and stiffness.
You may have joint inflammation for a variety of reasons, including:
1. An autoimmune disease (the body attacks itself because the immune system
believes a body part is foreign)
2. Broken bone
3. General "wear and tear" on joints
4. Infection (usually caused by bacteria or viruses)
the inflammation goes away after the injury has healed, the disease is
treated, or the infection has been cleared.
With some injuries and diseases, the inflammation does not go away or
destruction results in long-term pain and deformity. When this happens, you
have chronic arthritis. Osteoarthritis is the most common type and is more
likely to occur as you age. You may feel it in any of your joints, but most
commonly in your hips, knees or fingers. Risk factors for osteoarthritis
1. Being overweight
2. Previously injuring the affected joint
3. Using the affected joint in a repetitive action that puts stress on the
joint (baseball players, ballet dancers, and construction workers are all at
can occur in men and women of all ages. About 37 million people in America
have arthritis of some kind, which is almost 1 out of every 7 people.
Other types or cause of arthritis include:
1. Adult Still's disease
2. Ankylosing spondylitis
3. Fungal infections such as blastomycosis
4. Gonococcal arthritis
6. Juvenile rheumatoid arthritis (in children)
7. Other bacterial infections (nongonococcal bacterial arthritis)
8. Psoriatic arthritis
9. Reactive arthritis (Reiter syndrome)
10. Rheumatoid arthritis (in adults)
12. Systemic lupus erythematosus (SLE)
13. Tertiary Lyme disease
14. Tuberculous arthritis
15. Viral arthritis
If you have arthritis, you may experience:
1. Joint pain
2. Joint swelling
3. Reduced ability to move the joint
4. Redness of the skin around a joint
5. Stiffness, especially in the morning
6. Warmth around a joint
Exams and Tests
First, your doctor will take a detailed medical history to see if arthritis
or another musculoskeletal problem is the likely cause of your symptoms.
Next, a thorough physical examination may show that fluid is collecting in
the joint. (This is called an "effusion.") The joint may be tender when it
is gently pressed, and may be warm and red (especially in infectious
arthritis and autoimmune arthritis). It may be painful or difficult to
rotate the joints in some directions. This is known as "limited
In some autoimmune forms of arthritis, the joints may become deformed if the
disease is not treated. Such joint deformities are the hallmarks of severe,
untreated rheumatoid arthritis.
Tests vary depending on the suspected cause. They often include blood tests
and joint x-rays. To check for infection and other causes of arthritis (like
gout caused by crystals), joint fluid is removed from the joint with a
needle and examined under a microscope. See the specific types of arthritis
for further information.
Treatment of arthritis depends on the particular cause, which joints are
affected, severity, and how the condition affects your daily activities.
Your age and occupation will also be taken into consideration when your
doctor works with you to create a treatment plan.
If possible, treatment will focus on eliminating the underlying cause of the
arthritis. However, the cause is NOT necessarily curable, as with
osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at
reducing your pain and discomfort and preventing further disability.
It is possible to greatly improve your symptoms from osteoarthritis and
other long-term types of arthritis without medications. In fact, making
lifestyle changes without medications is preferable for osteoarthritis and
other forms of joint inflammation. If needed, medications should be used in
addition to lifestyle changes.
Exercise for arthritis is necessary to maintain healthy joints, relieve
stiffness, reduce pain and fatigue, and improve muscle and bone strength.
Your exercise program should be tailored to you as an individual. Work with
a physical therapist to design an individualized program, which should
1. Low-impact aerobic activity (also called endurance exercise)
2. Range of motion exercises for flexibility
3. Strength training for muscle tone
physical therapist can apply heat and cold treatments as needed and fit you
for splints or orthotic (straightening) devices to support and align joints.
This may be particularly necessary for rheumatoid arthritis. Your physical
therapist may also consider water therapy, ice massage, or transcutaneous
nerve stimulation (TENS).
Rest is just as important as exercise. Sleeping 8 to 10 hours per night and
taking naps during the day can help you recover from a flare-up more quickly
and may even help prevent exacerbations. You should also:
1. Avoid holding one position for too long.
2. Avoid positions or movements that place extra stress on your affected
3. Modify your home to make activities easier. For example, have grab bars
in the shower, the tub, and near the toilet.
4. Reduce stress, which can aggravate your symptoms. Try meditation or
guided imagery. And talk to your physical therapist about yoga or tai chi.
Other measures to try include:
1. Apply capsaicin cream (derived from hot chili peppers) to the skin over
your painful joints. You may feel improvement after applying the cream for
2. Eat a
diet rich in vitamins and minerals, especially antioxidants like vitamin E.
These are found in fruits and vegetables. Get selenium from Brewer's yeast,
wheat germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Get
omega-3 fatty acids from cold water fish (like salmon, mackerel, and
herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin
seeds, and walnuts.
glucosamine and chondroitin -- these form the building blocks of cartilage,
the substance that lines joints. These supplements are available at health
food stores or supermarkets. While some studies show such supplements may
reduce osteoarthritis symptoms, others show no benefit. However, since these
products are regarded as safe, they are reasonable to try and many patients
find their symptoms improve.
Your doctor will choose from a variety of medications as needed. Generally,
the first drugs to try are available without a prescription. These include:
1. Acetaminophen (Tylenol) -- recommended by the American College of
Rheumatology and the American Geriatrics Society as first-line treatment for
osteoarthritis. Take up to 4 grams a day (two arthritis-strength Tylenol
every 8 hours). This can provide significant relief of arthritis pain
without many of the side effects of prescription drugs. DO NOT exceed the
recommended doses of acetaminophen or take the drug in combination with
large amounts of alcohol. These actions may damage your liver.
Aspirin, ibuprofen, or naproxen -- these nonsteroidal anti-inflammatory
drugs (NSAIDs) are often effective in combating arthritis pain. However,
they have many potential risks, especially if used for a long time. They
should not be taken in any amount without consulting your doctor. Potential
side effects include heart attack, stroke, stomach ulcers, bleeding from the
digestive tract, and kidney damage. In 2005, the U.S. Food and Drug
Administration (FDA) asked makers of NSAIDs to include a warning label on
their product that alerts users of an increased risk for heart attack,
stroke, and gastrointestinal bleeding. If you have kidney or liver disease,
or a history of gastrointestinal bleeding, you should not take these
medicines unless your doctor specifically recommends them.
Prescription medicines include:
1. Biologics-- these are the most recent breakthrough for the treatment of
rheumatoid arthritis. Such medications, including etanercept (Enbrel),
infliximab (Remicade) and adalimumab (Humira), are administered by injection
and can dramatically improve your quality of life. Newer biologics include
Orencia (abatacept) and Rituxan (rituximab).
Corticosteroids ("steroids") -- these are medications that suppress the
immune system and symptoms of inflammation. They are often injected into
painful osteoarthritic joints. Steroids are used to treat autoimmune forms
of arthritis but should be avoided in infectious arthritis. Steroids have
multiple side effects, including upset stomach and gastrointestinal
bleeding, high blood pressure, thinning of bones, cataracts, and increased
infections. The risks are most pronounced when steroids are taken for long
periods of time or at high doses. Close supervision by a physician is
Cyclooxygenase-2 (COX-2) inhibitors -- These drugs block an
inflammation-promoting enzyme called COX-2. This class of drugs was
initially believed to work as well as traditional NSAIDs, but with fewer
stomach problems. However, numerous reports of heart attacks and stroke have
prompted the FDA to re-evaluate the risks and benefits of the COX-2s.
Celecoxib (Celebrex) is still available, but labeled with strong warnings
and a recommendation that it be prescribed at the lowest possible dose for
the shortest duration possible. Talk to your doctor about whether COX-2s are
right for you.
Disease-modifying anti-rheumatic drugs -- these have been used traditionally
to treat rheumatoid arthritis and other autoimmune causes of arthritis.
These drugs include gold salts, penicillamine, sulfasalazine, and
hydroxychloroquine. More recently, methotrexate has been shown to slow the
progression of rheumatoid arthritis and improve your quality of life.
Methotrexate itself can be highly toxic and requires frequent blood tests
for patients on the medication.
Immunosuppressants -- these drugs, like azathioprine or cyclophosphamide,
are used for serious cases of rheumatoid arthritis when other medications
It is very important to take your medications as directed by your doctor. If
you are having difficulty doing so (for example, due to intolerable side
effects), you should talk to your doctor.
SURGERY AND OTHER APPROACHES
In some cases, surgery to rebuild the joint (arthroplasty) or to replace the
joint (such as a total knee joint replacement) may help maintain a more
normal lifestyle. The decision to perform joint replacement surgery is
normally made when other alternatives, such as lifestyle changes and
medications, are no longer effective.
Normal joints contain a lubricant called synovial fluid. In joints with
arthritis, this fluid is not produced in adequate amounts. In some cases, a
doctor may inject the arthritic joint with a manmade version of joint fluid.
The synthetic fluid may postpone the need for surgery at least temporarily
and improve the quality of life for persons with arthritis.
A few arthritis-related disorders can be completely cured with treatment.
Most are chronic (long-term) conditions, however, and the goal of treatment
is to control the pain and minimize joint damage. Chronic arthritis
frequently goes in and out of remission.
1. Chronic pain
2. Lifestyle restrictions or disability
When to Contact a Medical Professional
Call your doctor if:
1. Your joint pain persists beyond 3 days.
2. You have severe unexplained joint pain.
3. The affected joint is significantly swollen.
4. You have a hard time moving the joint.
5. Your skin around the joint is red or hot to the touch.
6. You have a fever or have lost weight unintentionally.
If arthritis is diagnosed and treated early, you can prevent joint damage.
Find out if you have a family history of arthritis and share this
information with your doctor, even if you have no joint symptoms.
Osteoarthritis may be more likely to develop if you abuse your joints
(injure them many times or over-use them while injured). Take care not to
overwork a damaged or sore joint. Similarly, avoid excessive repetitive
Excess weight also increases the risk for developing osteoarthritis in the
knees and possibly in the hips. See the article on body mass index to learn
whether your weight is healthy.
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