Arthritis

What is arthritis?

The word “arthritis” means pain and stiffness of the joints. Sometimes you may also have redness, swelling, and warmth around the painful joint. In severe cases, joints may become misshapen.

The 2 most common arthritis conditions are:

• osteoarthritis
• rheumatoid arthritis

There are many other forms of arthritis that are less common, such as gout and arthritis that happens after an injury or with some infections such as Lyme disease.

What is the cause?

Osteoarthritis is a disease in which the cartilage in joints breaks down. Cartilage is the cushion in joints. It covers the ends of bones and allows free movement of joints. If cartilage gets rough, frays, or wears away, then the roughened cartilage or bone surfaces grind against each other. The joint gets irritated and swollen (inflamed). Sometimes the irritation causes abnormal bone growths, called spurs. 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 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. It usually starts in early adulthood or middle age.

What are the symptoms?

The symptoms depend on the type of arthritis you have. They may include:

• mild to severe pain in joints
• redness and warmth of the skin around a joint
• swollen joints
• stiffness and limited movement, especially in the morning
• misshapen joints
• tiredness

How is it diagnosed?

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

Tests may include:

• blood tests
• joint aspiration, which is a test of fluid from a joint
• X-rays
• MRI scan

How is it treated?

The goals of treatment are to:

• relieve pain and stiffness
• reduce swelling
• keep the joints working properly
• stop or slow down damage to the joints

There are many ways to treat arthritis, including medicine, exercise, various kinds of therapy, and sometimes surgery.

Medicine

Medicines can control pain and reduce inflammation. Pain relief medicines and anti-inflammatory medicines are used for all kinds of arthritis.

Most of the time, acetaminophen is the best medicine for pain relief because it has fewer side effects than other pain relievers. Acetaminophen can be taken with most other arthritis medicines. Large amounts can harm the liver. General advice is to take no more than 4000 milligrams (mg) a day. If you have any liver problems, take lots of other medicines, or just have concerns, ask your healthcare provider what a safe amount of acetaminophen is for you.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, can help relieve pain and inflammation. Several well-known NSAIDs may be bought with or without a prescription. Some others you can get only if your healthcare provider prescribes them. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.

Talk with your healthcare provider to learn more about taking NSAIDs.

Several other kinds of medicines may be used, such as:

• disease-modifying antirheumatic drugs (DMARDs) for people with rheumatoid arthritis
• steroids, such as prednisone or cortisone
• strong pain medicines, such as codeine or hydrocodone
• medicine patches put over painful joints
• hyaluronic acid injected into the knee to act as a lubricant and help the knee move without pain if you have arthritis in your knee

Some of the medicines may be taken at home, while others may be given as a shot or IV treatment at a clinic. Many of the drug treatments must be watched carefully by your healthcare provider to avoid serious side effects. For example, using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

Exercise

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 low-speed bike riding or special exercises like tai chi and yoga. This type of exercise helps you keep or improve your flexibility and helps relieve stiffness.
• Strengthening. Exercise such as weight training helps strengthen muscles and tendons. Strong muscles and tendons help to support joints. They help you move more easily and with less pain.
• Aerobic or endurance. Exercise at a moderate pace, such as walking or bicycle riding, improves your overall health and helps control weight.

Talk with your healthcare provider before you start an exercise program. Too much exercise 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.

Other treatments

Getting weight and stress off painful joints helps a lot to relieve pain and slow down or stop damage. Using a cane, crutches, or a walker can help you take weight off your hips, knees, and ankles. If you are overweight, losing some weight often lessens joint pain. Exercise and a healthy diet can help you control your weight and stay healthy.

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. Acupuncture and massage are other possible treatments.

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

If the joints are severely damaged, surgery may be done to remove inflamed joint tissue or realign or replace a joint.

How long will the effects last?

If you have arthritis, you will probably have it for the rest of your life. The pain and stiffness from arthritis will vary from day to day and week to week. How often you have symptoms depends, at least in part, on the type of arthritis you have. You might be reminded of the arthritis every time you use affected joints. Or there may be times when you have symptoms and times you don’t. Times when you don’t 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.
• Work with your healthcare provider or physical therapist to learn how to use your joints in ways that put less stress on them.

How can I help prevent arthritis?

Doctors don’t know how to prevent arthritis. However, it is a condition that can usually be managed by taking medicine and keeping the joints mobile.