Arthritis Types and Treatments

Arthritis is one of the most prevalent conditions in the U.S. population, affecting 1 in 4 adults and 1 in 250 children, according to the Arthritis Foundation. It strikes people of all ages and races it is most common in women. This article will not address childhood arthritis.

Approximately 100 different kinds of arthritis affect adults. Arthritis is defined as swelling, pain, stiffness, and diminished motion of the joints. The tendons that move the joints, as well as the covering of the joints, are also commonly painful and swollen, which may be the first signs of joint damage. Symptoms may come and go based on the weather, activity, illness, emotional stress, or diet. It may affect more than one part of the body, with pain varying from mild to severe. The hands are commonly afflicted. Given the number of joints in the hands as well as their visibility, they are the most often noted and examined body part in the diagnosis of arthritis. Shoulders, knees, the low back, hips, neck, and elbows are also commonly involved. What is not generally known, however, is that arthritis can progress past the joints and affect the heart, eyes, lungs, kidneys, and skin. Certain types of arthritis can become life threatening. The first step toward effective treatment is accurately diagnosing the type of arthritis.

Categories of arthritis

The most common type of arthritis is osteoarthritis, also known as “wear and tear” arthritis. The condition usually starts in adults over age 40. It produces “usage related pain” — that is, when the joint is used or overused the pain worsens and is accompanied by swelling and redness. Symptoms can improve with rest and elevation. Osteoarthritis commonly affects the hands, knees, hips, and spine, although shoulders, wrists, and ankles can also be affected.

Inflammatory arthritis, including rheumatoid arthritis (RA), occurs when there is a problem with the immune system. For reasons that remain unknown, the immune system believes the body is being “attacked” by a cancer or an infection. It floods the bloodstream with a high number of fighting cells that produce various chemicals. These chemicals are designed to destroy tumors, viruses, or bacteria, but in large numbers they begin to accumulate in the joints, kidneys, eyes, and even the heart. These chemicals then start to irritate and cause swelling in the joints and tendons. Left unchecked, inflammatory arthritis often produces joint and organ damage. Seventy percent of patients with inflammatory arthritis have RA while the remainder have a less common or even unknown form of the disease.

Infectious arthritis, another common condition, can occur at any age, although it tends to occur in the elderly or those who have had a skin infection or laceration or use intravenous drugs. The infection can occur because bacteria enter the joint through a cut in the skin, or spread through the bloodstream. Staphylococcus aureus, a normal skin bacterium, enters the joint and then grows.

The other major category, metabolic arthritis, occurs when the body incorrectly metabolizes calcium or proteins, which build up in the bloodstream, forming crystals in the joints. These crystals act like sand in a machine, irritating and inflaming the joints. This condition often runs in families.

Treatments

Effective treatment of arthritis relies on accurate diagnosis. For infectious arthritis, treatment typically involves antibiotics with or without surgery. The goal is to kill the bacteria or viruses and surgically relieve pressure that has built up from their growth, which is destroying the joint cartilage.

In metabolic arthritis, successful treatment requires correcting the problem that caused the crystals to build up in the system.

Osteoarthritis often begins with stiffness in any of the major joints, such as the knees, shoulders, or ankles, or with difficulty walking. The patient may not experience pain but rather muscle weakness and poor balance. As discussed, age produces more symptoms because more joints are involved and they are more swollen. Typically, patients feel best in the morning and the symptoms worsen as the day progresses, with the most intense pain striking in the late afternoon and evening. When the condition is severe, the pain can be constant and wake patients at night. Deformity begins as arthritis worsens — the hands develop nodules (bumps) or the knees and ankles become misaligned. Occasionally, the joints sublux, meaning they give way or buckle. People sometimes refer to this as a “trick knee” or “finger snapping”. Treatment involves gentle exercise that moves the joint through its full motion. The knees should go from completely extended (straightened out) to completely flexed (bent). Motion lubricates the joints, which reduces pain. Ice — as opposed to heat — is applied to prevent painful swelling or reduce swelling that has already started. Many patients, particularly those who are thin, find ice annoying, so the combination of heat and ice is helpful. Ice should not be applied directly to the skin because this can cause burns and pain. To prevent injury, use a cloth barrier between the ice and the skin.

Water exercise is often used to help patients who cannot fully move their joints because the body is weightless in water. In fact, the same conditions benefit astronauts in space, who do not experience joint pain because not pressure is being exerted on their joints. Sometimes a physical or occupational therapist is needed to help move the joint because the patient’s tendons or joint capsules are too swollen to do so without assistance.

Anti-inflammatory medications and steroids can also be very helpful because they reduce swelling and create an environment in which the joint can naturally lubricate itself. Determining the best arthritis medicine and dosage based on each individual’s body chemistry is crucial. This is where consultation with a nurse, physician’s assistant, or physician can be very helpful. Patients taking these medicines have their blood tested every six to 12 months to monitor for side effects.

Unlike with osteoarthritis, symptoms of inflammatory arthritis are typically at their worst in the morning and improve as the day progresses. While heat is typically more helpful than ice for inflammatory arthritis, other treatments are similar to those used for osteoarthritis. Both range of motion and water exercise are very useful, as are anti-inflammatory medications and steroids, which must be adjusted to the patient’s age, gender, and condition.

An arthritis combo

Many people have a combination of inflammatory arthritis and osteoarthritis, which is why they experience mixed symptoms. The explosion of blood tests to more accurately diagnose these conditions has considerably helped treatment. For this reason, a person who has joint inflammation for several weeks or inflammation involving many joints should seek medical help.

Want to learn more about rheumatoid arthritis? Read “Steps to Manage Rheumatoid Arthritis Flare-Ups” and “Managing Sleep Problems in RA.” Want to learn more about osteoarthritis? Read “Osteoarthritis: Who Gets It?” “Osteoarthritis: How Is It Treated?” “Osteoarthritis: Top 10 Self-Management Tips,” and “How Our Understanding of Osteoarthritis Is Changing.”

Dr. Callewart is an orthopedic spine surgeon who specializes in treating traumatic spine injuries and chronic pain.

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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