Arthritis

DISCLAIMER: The following information is a summary for informational purposes and does not replace advice from your doctor regarding arthritis. You should always talk to a health care professional regarding any medical concerns or questions about medications you may have.

Overview

Arthritis is the name for the tenderness or swelling of one or more of your joints. The main symptoms of arthritis are joint stiffness and pain. These will usually get worse with age. The most common kind of arthritis are rheumatoid arthritis and osteoarthritis. 

Rheumatoid arthritis is a disease where the immune system attacks the joints, beginning with the joint lining. Osteoarthritis causes cartilage – the hard and slippery tissue covering the ends of bones where a joint forms – to break down. 

Uric acid crystals which form when there is an excess amount of uric acid in your blood, can cause gout. Underlying diseases or infections, such as lupus or psoriasis, can cause other kinds of arthritis. 

Treatment options will vary depending on the type of arthritis. The main goals of arthritis treatments are the reduction of symptoms to improve quality of life. 

Symptoms

The most common symptoms of arthritis involve the joints. Depending on the kind of arthritis you have, your signs and symptoms can include: 

  • Stiffness
  • Decreased range of motion
  • Pain
  • Redness
  • Swelling 

Causes

The two main kinds of arthritis – rheumatoid arthritis and osteoarthritis – damage joints in different ways. 

Osteoarthritis

The most common variety of arthritis, osteoarthritis, involves wear-and-tear damage to the cartilage of the joints. Cartilage acts as a cushion to the ends of the bones and allows nearly frictionless joint motion. Enough damage to the cartilage can result in bones grinding against each other which causes pain and restricted movement. This wear and tear can occur over many years, or it can be quickened by a joint injury. 

Osteoarthritis affects the entire joint. It causes changes in the bones and a deterioration of the connective tissues that attach bone to muscle and hold the joint together. It also causes inflammation to the lining of the joint. 

Rheumatoid arthritis

In rheumatoid arthritis, the immune system attacks the joint capsule lining. This lining becomes inflamed and swollen. The disease process eventually can destroy bone and cartilage within the joint. 

Diagnosis

During a physical exam, your doctor will check your joints for swelling, warmth, and redness. They will also need to see how well you can move your joints. 

Depending on the kind of arthritis suspected, your doctor might suggest one or more of the following tests. 

Laboratory tests

The analysis of different kinds of body fluids can help pinpoint the type of arthritis you could have. Fluids that are commonly analyzed include urine, blood, and joint fluid. In order to obtain a sample of joint fluid, your doctor will numb and cleanse the area before inserting a needle in your joint space to withdraw some fluid. 

Imaging

These kinds of tests can detect problems within your joint that could be causing your symptoms. Examples include: 

  • X-rays. Using low levels of radiation to visualize bones, x-rays can show bone spurs, cartilage loss, and bone damage. X-rays are usually used to track progression of the disease and may not detect early arthritic damage. 
  • Computerized tomography (CT). A CT scan takes x-rays from many angles and combines the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding tissues. 
  • Magnetic resonance imaging (MRI). Combining radio waves using a strong magnetic field, MRI can produce more-detailed cross-sectional images of soft tissues such as tendons, cartilage, and ligaments. 
  • Ultrasound. This technology uses high-frequency sound waves to image cartilage, soft tissues, and fluid-containing structures near the joints (bursae). Ultrasound is also used to help guide needle placements for injections and joint aspirations. 

Treatment

Treatment for arthritis is focused mainly on improving joint function and relieving symptoms. You may need to try several different kinds of treatment or combinations of different treatments, before determining what works best for you. 

Medications

The medications commonly used for arthritis treatment vary depending on the kind of arthritis. Normally used arthritis medications include: 

  • Painkillers. These medications are to help reduce pain, though they have no effect on joint inflammation. You can get over the counter options like acetaminophen.
    For more severe pain, you may be prescribed an opioid such as tramadol, oxycodone, or hydrocodone. Opioids act on the central nervous system to help to relieve pain. When opioids are used for a long time, they can become habit-forming, causing physical or mental dependence. 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both inflammation and pain. There are over-the-counter NSAIDs including naproxen and ibuprofen. Some kinds of NSAIDs are available by prescription only.
    Oral NSAIDs can cause stomach irritation and have been known to increase the risk of stroke or heart attack. Some NSAIDs may also be available as creams or gels to be rubbed on joints. 
  • Counterirritants. Some varieties of ointments and creams contain capsaicin or menthol, the ingredients that make hot peppers spicy. Rubbing these preparations over an aching joint can interfere with the transmission of pain signals from the joint itself. 
  • Disease-modifying antirheumatic drugs (DMARDs). Often used in the treatment of rheumatoid arthritis, DMARDs slow or even stop your immune system form attacking your joints. Examples include hydroxychloroquine (Plaquenil) or methotrexate (Rasuvo, Trexall, others). 
  • Biologic response modifiers. Usually used in conjunction with DMARDs, biologic response modifiers are genetically engineered medications that target various protein molecules that are involved in the immune response.
    There are various types of biologic response modifiers. Tumor necrosis factor (TNF) inhibitors are prescribed commonly. Examples include etanercept (Erezil, Enbrel, Eticovo) and infliximab (Inflectra, Remicade, and others).
    Other medications target other substances that contribute to inflammation such as interleukin-1, interleukin-6, Janus kinase enzymes, and some types of white blood cells known as T cells and B cells. 
  • Corticosteroids. This class of medications which includes prednisone (Rayos, Prednisone Intensol) and cortisone (Cortef), suppresses the immune system and reduces inflammation. Corticosteroids can be injected directly into the affected joints, or taken orally. 

Therapy

For some kinds of arthritis, physical therapy can be helpful. Exercises can improve the range of motion and strengthen the muscles surrounding the joints. In some cases, braces or splints may be warranted. 

Surgery

If more conservative measures aren’t any help, your doctor may suggest a surgery such as: 

  • Joint repair. In some cases, joint surfaces can be realigned or smoothed in order to reduce pain and improve their function. These kinds of procedures can usually be performed arthroscopically (through small incisions over the joint).
  • Joint replacement. This kind of procedure removes the damaged joint and replaces it with an artificial one. The most common joints that get replaced are hips and knees. 
  • Joint fusion. This is a procedure commonly used for smaller joints like those in the ankle, wrist, or fingers. It removes the ends of the two bones in the joint and locks the ends together until they heal into one rigid unit.