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Arthritis

What is arthritis?

Arthritis is a very common condition characterized by inflammation of one or more joints.

The key symptoms of arthritis include pain, stiffness and swelling. Arthritis can be localized to one joint or it can affect many joints, and can affect different structures inside a joint, such as the synovium (joint lining), bones, cartilage, or supporting tissues. The symptoms can also vary in severity and frequency. Some forms of arthritis are short term conditions, while others are long-term, and may permanently damage joint function.

According to the Centers for Disease Control, about one in four adults in the U.S. have arthritis (54 million).[1] Many forms of arthritis tend to predominantly affect older people, though it can affect people at any age and there are some conditions, generally rare, that cause arthritis in children and teenagers.

There are many possible causes of arthritis, such as age-related wear and tear, autoimmune conditions, infections, injuries and others. Each type of arthritis tends to be characterized by which joints are affected and the usual age at which people are affected.

A range of treatment options are available for arthritis, with the chosen option dependent on the type of arthritis and its causes. Some types of arthritis respond well to treatment, while other types are more hard to control.

Different types of arthritis and symptoms, causes and treatment

There are many different types of arthritis – some sources estimate over 200 – with differing causes and symptoms.[2]

Most, though not all, types of arthritis can be sorted by cause into two overarching categories:

Inflammatory arthritis: All arthritis is characterized by inflammation, which is part of the body’s healing process. However, in the case of inflammatory arthritis, inflammation generally occurs for no obvious reason. This is known as an autoimmune condition. The most common form of inflammatory arthritis is rheumatoid arthritis. Types of inflammatory arthritis generally causes stiffness in the joints following rest, such as just after getting out of bed in the morning.

Degenerative or mechanical arthritis covers types of arthritis in which there is damage to the joints through wear and tear. The most common form of degenerative arthritis is osteoarthritis. Types of degenerative arthritis tend to worsen with movement and weight bearing and be relieved by rest. They also tend to be more common in older people. Types of degenerative arthritis tend to affect joints asymmetrically, meaning they don't appear in the same joints on both sides of the body.

Doctors categorize arthritis by whether the symptoms are symmetric (same joints on both sides of the body) or asymmetric, and by the number of joints affected.

The most common types of arthritis include:

Osteoarthritis

Osteoarthritis is the most common type of arthritis, with more than 30 million adults in the U.S affected by the condition.[3] It is a degenerative arthritis, most often occurring in the hands, hips and knees.

The main symptoms of osteoarthritis are deep, achy joint pain that worsens with activity, decreased range of movement and stiffness during rest, known as gelling. It generally affects several joints. It is most common in women leading up to and after menopause.[4] Athletes are also at increased risk of osteoarthritis, due to repeated use of particular joints.

The condition is caused by damage to or breakdown of joint cartilage, a connective tissue that covers the ends of long bones at the joints, as well as other areas of the joint organ.[5] In normal joints, cartilage acts as a shock absorber and allows bones to slide over one another. Osteoarthritis damage may occur as a result of joint injury or overuse.

Treatment includes regular exercise, hot or cold compresses, working towards a healthy weight if overweight, physical and occupational therapy, and pain medication. In severe cases, surgery may repair, strengthen or replace a damaged joint.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is the second most common type of arthritis and the most common type of inflammatory arthritis.

Symptoms of RA occur in flare-ups, when symptoms of pain and swelling are worse, and periods of improved or no symptoms. It usually affects the hands, feet and wrists. Usually the joints are affected symmetrically, and many joints may be inflamed. Rheumatoid arthritis can also cause inflammation in other parts of the body, such as the lungs, heart and eyes. Other common symptoms include symptoms such as fever, fatigue and weight loss.

Rheumatoid arthritis is especially common in women and in smokers.[4] The age of onset for rheumatoid arthritis is usually after 35 years old, however, it becomes more common with age, and most people are diagnosed in their 60s.[6] The condition can, however occur at any age and normally worsens with time.

Over time, the ongoing inflammation can cause damage to the bones of the joint, which in turn causes changes to the shape and alignment of the joint. This may lead to an inability to do activities which use the affected joints. However, rheumatoid arthritis inflammation can normally be well managed with medications to slow down the immune system, called disease-modifying antirheumatic drugs (DMARDS), as well as pain medications for relief of symptoms. Surgery is sometimes carried out in cases where a joint becomes badly damaged. There is currently no specific cure for rheumatoid arthritis.

Gout

Gout is an inflammatory arthritis causing attacks of pain and inflammation in one or more joints. It is a very common condition, which is more common in men and increasingly common with age.

Gout is caused by a chemical called uric acid in the blood. It is usually caused by having persistently high levels of uric acid in the blood. A sudden decrease in the uric acid level, as can be caused by uric acid-lowering medications, can sometimes also trigger an attack of symptoms.

This is often caused either by excess amounts of uric acid being produced, or not enough being excreted from the urine on a chronic basis. Any abrupt increase in the level of uric acid in the blood may also trigger an attack of podagra orand gout. Uric acid can crystallize and settle in one or more joints, which may initiate an immune response, causing the characteristic inflammation of gout.

Most people with elevated blood levels of uric acid will never develop podagra and gout, and gout is not always associated with elevated uric acid blood levels; the condition can also occur despite there being normal levels of uric acid at the point in time when blood levels are measured.[4]

Uric acid is a chemical increased in the body by eating some foods, especially oily fish, red meat, organ meats such as liver or kidneys, drinking alcohol, conditions such as high blood pressure or obesity, as well as taking certain medications.

Gout tends to start with severe pain in one joint, often that of the big toe, where it is known as podagra, before later beginning to affect other joints. People with gout may experience fever and fatigue. In cases of chronic, untreated gout, usually after about ten years, a person may develop tophi, which are uric acid crystal deposits appearing as firm, yellowish nodules on the joint.[7]

Treatment often involves avoiding foods that cause gout and taking medications to relieve pain and inflammation and decrease the amount of uric acid in the body. Many people are able to manage and avoid episodes of gout using these measures.[8]

Psoriatic arthritis

Psoriatic arthritis is a long-term inflammatory arthritis that is associated with psoriasis, a skin condition that causes red, flaky, crusty patches of skin with silvery scales, known as plaques. Some people also have symptoms in their fingernails or eyes. About one or two in every five people with psoriasis will develop psoriatic arthritis.[9] Some people with psoriatic arthritis, however, will never develop the skin condition.

Psoriatic arthritis is an autoimmune condition thought to be triggered by a combination of genetic, immune and environmental factors, such as certain infections and joint injury.[10]

The condition is progressive, damaging the joints over time. However, with medication it is possible to slow down the progression of the arthritis and minimize joint damage. The condition varies widely in severity and the number of joints affected. It tends to occur in flare-ups and periods of improved or no symptoms. There are different typical patterns of psoriatic arthritis, affecting certain groups of joints, most often the distal joints, the end joints of the fingers and toes. Most commonly, psoriatic arthritis is asymmetric, not affecting the same joints on both sides of the body, and causes symptoms in several joints at once.

Psoriatic arthritis is treated with medications which suppress the immune system, called disease-modifying antirheumatic drugs (DMARDS), as well as over-the-counter medications, such as ibuprofen, to reduce pain and swelling. Ideally, one medication should be taken to treat both psoriasis and psoriatic arthritis when both conditions are present together.

People with other types of arthritis, such as rheumatoid arthritis or osteoarthritis, may also have psoriasis without the two conditions being linked.

Septic arthritis

Septic arthritis is an infection in a joint, causing inflammation. It is usually caused by bacteria, though it may be caused by other microorganisms, such as a fungus.[11]

This condition can affect anyone, but most commonly occurs in association with prosthetic joints and other joint surgeries. It is caused by infectious agents reaching the joints, either directly, as in the case of surgery, or indirectly, reaching the joints via the bloodstream. Risk is increased in older people and those with diabetes or a suppressed immune system.

Symptoms involve severe pain, swelling, redness and heat in affected joints. They usually develop quickly, over a few hours or days. Many people with this condition also develop a fever. If the infection becomes widespread, affected people may also experience nausea, vomiting, dizziness or drowsiness.

Many people will need to stay in hospital for two weeks or more to have pus drained from the joint and intravenous antibiotics. Surgery may be needed to further drain pus or to replace an infected joint prosthesis. With antibiotic treatment and proper management, most people will recover well. Without treatment, septic arthritis may lead to permanent joint damage and can be life-threatening.

Reactive arthritis

Reactive arthritis (ReA), formerly known as Reiter’s syndrome, Reiter’s disease or Reiter’s arthritis, is a relatively short-lived inflammatory arthritis. Reactive arthritis develops as a reaction to certain bacterial infections, most often genital tract or bowel infections. Reactive arthritis is not an infection of the joints. It is more common in younger people than other forms of arthritis.

Reactive arthritis generally begins one to four weeks after a bacterial infection and can last for up to six months. Some people experience repeated bouts of symptoms, and a few may develop chronic, usually mild arthritis.

Symptoms can range in severity from mild to severe, often appearing suddenly, lasting for several months and stopping within about six months. Symptoms often include asymmetric, oligoarticular inflammation of between two and five joints, red eyes and painful urination.

Typically, reactive arthritis is triggered by chlamydia, but can also be triggered by other infections, such as food poisoning.

There is no treatment specifically for reactive arthritis, but the condition normally stops on its own. Treatment involves antibiotics to treat the triggering infection and non-steroidal anti-inflammatory drugs (NSAIDs) to treat joint symptoms of inflammation and pain. Physiotherapy may be advised to keep the affected joints moving, in order to help retain flexibility and strength until symptoms subside.

Ankylosing spondylitis and other spondyloarthropathies

Ankylosing spondylitis is a lifelong inflammatory arthritis involving back pain. The word ankylosing means joining together or fusing, and spondylitis means inflammation of the spine. The condition causes the affected spine joints to fuse together into one bone. Inflammation causes the bone-making cells to grow bone within the ligaments, which then may form bony bridges between the vertebrae of the spine. The cause of the condition is unknown, but there is normally a genetic component. Smoking is known to make the disease more severe. The condition mainly affects the lower back, but can spread up the spine and also affect other joints.

Symptoms usually include back pain and stiffness, inflammation in other joints, and extreme tiredness. Onset normally occurs gradually in early adulthood, between the ages of 20 and 30.[12] Severity of symptoms varies widely. It is associated with a serious but treatable eye condition called uveitis.

Treatment involves physiotherapy and exercise, painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), and medication to suppress the immune system.

Secondary arthritis

Some conditions may commonly cause the symptoms of arthritis, although the condition does not predominantly affect the joints. These include:[13][14]

Systemic lupus erythematosus (SLE), also known as lupus, is a long-term autoimmune condition that may cause inflammation in almost every part of the body, commonly including joint pains, as well as skin rashes and tiredness.

Paget’s disease of bone is a condition in which the normal cycle of bone renewal is disrupted, which can weaken the bones and in some cases cause them to become deformed. Osteoarthritis is a common complication of Paget’s disease.

Viral arthritis is inflammation of a joint caused by a viral infection. Some viruses have a tendency to affect the joints, such as dengue fever and mumps. This type of arthritis is normally self-limiting and requires no specific intervention.

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA), previously known as juvenile rheumatoid arthritis or juvenile chronic arthritis, is a chronic inflammatory arthritis, that occurs in children under 16 years old. It is the most common autoimmune joint condition in children.

It is not known exactly what causes the autoimmune condition, but it is associated with inherited factors and may be triggered by infection.[15]

Juvenile idiopathic arthritis tends to affect children younger than 10 but does not generally affect those younger than 6 months old. Girls are more commonly affected than boys and tend to manifest symptoms at a younger age.

There are different types of juvenile arthritis, with varying symptoms. All types of JIA involve pain, swelling and stiffness of one or more joints. Many children will also experience fever with this condition.

Treatment often involves taking medications that dampen the immune system. Many children with this condition live well with treatment, and find that their symptoms improve over time. Many children will grow out of JIA, though it is not possible to accurately predict this.

Diagnosing arthritis

In order to receive appropriate treatment, it is important to fully describe the nature of joint pain to the doctor, making sure to include information such as:

  • How long you have been experiencing joint inflammation and pain
  • The location and severity of the pain
  • If any family members have experienced arthritis or autoimmune conditions
  • Whether there are other symptoms that occur besides the joint inflammation and pain

Following the investigation of a person’s medical history, a doctor will typically perform a physical exam to check for swollen joints or loss of motion, and use blood tests and X-rays to confirm a diagnosis and distinguish the type of arthritis.[16]

Treating arthritis

It is always important to seek prompt diagnosis and treatment of arthritis, as well as any other associated conditions, in order to prevent joint damage, which can lead to physical disability. Arthritis treatment will vary, depending on the type of arthritis, but generally may include:

  • Rest
  • Exercise
  • Medication
  • Occupational or physical therapy
  • In some cases, surgery

Arthritis FAQs

Q: How many types of arthritis exist?
A: Some sources estimate that there are over 200 different types of arthritis and related diseases. Arthritis can range from mild to severe. Causes are normally either degenerative “wear-and-tear” of cartilage, such as with osteoarthritis, or inflammatory conditions such as rheumatoid arthritis. Together all of these forms of arthritis make up the most chronic illness in the U.S. It is important to find out which type of arthritis is present, as each condition will have a different underlying cause, progression and treatment.

Q: Are there home remedies for arthritis?
A: Yes, there are a number of home remedies for arthritis, which may help to relieve symptoms, but will not have a significant impact on the progress of the disease. Some of the most regularly cited include:

  • Using heat pads or ice packs
  • Swimming
  • Omega-3, which is found in fish, canola oil and supplements

However, if arthritis is suspected, professional medical attention should always be sought.

Q: What are some risk factors for arthritis?
A: Although it depends on the type of arthritis, some factors increase the risks of several different types. Arthritis risk factors include:[17][18]

  • Smoking tobacco
  • Being overweight
  • Certain inherited traits, such as HLA-B27, a gene associated with autoimmune conditions
  • Increasing age
  • Joint injury or certain repetitive movements

  1. CDC. "Arthritis in America - Vital Signs." 7 March 2017. Accessed 5 June 2018.

  2. ScienceDirect Topics. "Arthritis - an overview." Accessed 5 June 2018.

  3. CDC. "Osteoarthritis (OA) | Basics | Arthritis." 3 April 2018. Accessed 5 June 2018.

  4. Taylor and Francis. "A diagnostic approach to the common arthritic conditions." Accessed 5 June 2018.

  5. Medscape eMedicine. "Osteoarthritis." 14 March 2018. Accessed 5 June 2018.

  6. CDC. "Rheumatoid Arthritis (RA) | Arthritis Basics | Arthritis Types." 3 April 2018. Accessed 5 June 2018.

  7. DermNet New Zealand. "Gout." Accessed 8 July 2018.

  8. Patient. "Gout | Causes and Treatment." Accessed 5 June 2018.

  9. NHS.UK "Psoriatic arthritis." Accessed 5 June 2018.

  10. UpToDate. "Patient education: Psoriatic arthritis (Beyond the Basics)." 5 February 2018. Accessed 5 June 2018.

  11. UpToDate. "Septic arthritis in adults."15 September 2017. Accessed 5 June 2018.

  12. UpToDate. "Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)." Accessed 5 June 2018.

  13. UpToDate. "Overview of the clinical manifestations of systemic lupus." 8 January 2018. Accessed 5 June 2018.

  14. Patient.info. "Fibromyalgia | Causes, Symptoms and Treatment | Patient." 17 April 2018. Accessed 5 June 2018.

  15. JIA-at-NRAS. "Juvenile Idiopathic Arthritis." Accessed 5 June 2018.

  16. WebMD. "Arthritis Diagnosis and Treatment." Accessed 5 June 2018.

  17. CDC. "Risk Factors | Arthritis." 2 July 2018. Accessed 14 July 2018.

  18. NCBI - NIH. "Characteristics and risk factors of rheumatoid arthritis in the United States." 24 November 2017. Accessed 14 July 2018.