Table of Contents
- 1 Diagnosing joint pain with a guide to Arthritis and coping with Arthritis
- 1.1 Why do you need a guide to Arthritis?
- 1.1.1 Guide to Arthritis: Osteoarthritis
- 1.1.2 Guide to Arthritis: Rheumatoid arthritis
- 1.1.3 Guide to Arthritis: Psoriatic arthritis
- 1.1.4 Guide to Arthritis: Gout
- 1.1 Why do you need a guide to Arthritis?
- 2 Consult a Specialist!
Diagnosing joint pain with a guide to Arthritis and coping with Arthritis
Why is a guide to Arthritis useful? Joint pain can be associated with more than 50 kinds of arthritis — but it also can be caused by conditions that are not arthritis at all. So when a joint aches, how do you know whether you have arthritis or something else? And if you have
arthritis, how do you know which kind you have?
Getting the right diagnosis is critical. Treatment for joint pain differs widely, depending on the cause. The right diagnosis and early treatment can arrest joint damage and return you to your previous level of activity. The wrong treatment — or avoiding treatment — may mean joint deterioration, poor function and compromised mobility.
Read the guide to Arthritis below to learn more about the three most common types of arthritis. You’ll understand which symptoms are important to communicate to your doctor so that, together, you can arrive at the right diagnosis and treatment sooner.
Why do you need a guide to Arthritis?
Arthritis means “joint inflammation” — redness and warmth within the joint. Because inflammation is painful, arthritis limits movement. The four most common types of arthritis are:
• Rheumatoid arthritis
• Psoriatic arthritis
As indicated in the guide to Arthritis below, the causes, symptoms and risk factors for each of these forms of arthritis may differ. You may suffer from more than one type of arthritis — for example, gout and osteoarthritis.
Guide to Arthritis: Osteoarthritis
Osteoarthritis, or OA, is the most common type of arthritis, affecting up to 27 million Americans. OA, the “wear-and tear
arthritis,” is also called degenerative joint disease. It usually develops after age 45 and progresses slowly, often over a decade. Typically, the hips, hands, knees, lower back and/or neck are affected.
In OA, cartilage within the joint gradually thins and wears away. Osteophytes (bone overgrowth) may develop when the ends of the bone touch each other, and the joint can eventually become deformed. When cartilage wears away, allowing bone to touch bone completely, advanced or end-stage OA is diagnosed.
Depending on the joint affected, you may experience:
• Stiffness (especially after periods of inactivity)
• Osteophytes (bony enlargement over the joint)
• Crepitus (crackling sound with joint movement)
• Excess weight
• A previous injury or surgery that damages the cartilage in a joint
• Repeated overuse of joints (at work, in daily activities, on the playing field)
• A sedentary lifestyle
• Older age
• Being female
• Congenital problems (bone deformities at birth)
• Having associated diseases such as Paget’s disease, hypermobility, gout, etc.
OA is diagnosed with a thorough history and physical exam. X-rays or magnetic resonance imaging (MRI) can help determine the cause of joint pain and the extent of the damage. If fluid is present in the joint, your doctor may also aspirate (drain the fluid from) a swollen joint to evaluate it in the laboratory.
If you are overweight or obese, weight loss will significantly reduce pressure on painful joints.
Regular, joint-friendly exercise such as walking, swimming or guided weight training is a good complement to healthy eating habits. Exercise improves both overall fitness and joint health. (Seek your doctor’s approval before you start an exercise regimen).
Sometimes inflamed arthritic joints need a short rest with a gradual return to activity. Applying ice to ease joint inflammation can be helpful.
Physical therapists can create a plan that strengthens muscles around the joints and increases your flexibility and endurance. This ensures proper body mechanics so that you avoid overloading your joints, and helps maintain good range of motion.
Braces used by physical and occupational therapists can alleviate pressure on painful joints. Braces typically used for people with arthritis include a soft knee sleeve to support the joint and a hinged brace to take pressure off the joint.
For mild to moderate OA, doctors may recommend NSAIDs or inject steroids to relieve inflammation. Hyaluronan, a substance found in normal joint fluid, can be injected into arthritic knee joints. Use of this type of injectable medication, called viscosupplementation, may effectively alleviate pain and increase range of motion in some patients with OA of the knee.
Glucosamine supplements (with chondroitin) may or may not help with OA joint pain. Your doctor can advise you on whether supplementation will be worthwhile.
When cartilage damage is so profound that conservative measures no longer help, diseased joints can be replaced with artificial ones. For active individuals who are not yet ready for total joint replacement, less invasive options are available.
Joint resurfacing repairs cartilage damage while offering greater mobility and a shorter recovery time than total joint
replacement. Partial knee replacement may be an option when only one compartment of the knee joint is affected.
Guide to Arthritis: Rheumatoid arthritis
Rheumatoid arthritis (RA) is one of the inflammatory types of arthritis. While OA is confined to the joint(s), RA is systemic and can affect the entire body. RA can develop at any age but is most common between ages 30 and 60, or during childhood.
It commonly affects small joints, such as the fingers and toes, and can progress to large ones, such as the knees and shoulders. Typically, joints on both sides of the body are similarly affected, but RA can involve a single joint, anywhere in the body. In RA, the immune system loses its ability to distinguish between healthy joint cells and “foreign invaders.” The
immune system attacks healthy cells, causing inflammation in the joint. The inflamed joint then starts attracting more
immune cells, and swelling and fluid buildup ensue.
Exposure to bacterial or viral infections and increased stress can worsen RA. As the disease progresses, joint cartilage can wear away. Without treatment, joint destruction may occur quickly. Fortunately, the chances of maintaining joint function and mobility in RA are very good with early treatment. That is why understanding the guide to Arthritis is important.
• Morning stiffness
• Low-grade fevers
• Warm, tender, stiff joints
• Joints on both sides of the body affected (usually, but not always)
• Bumps under the skin (rheumatoid nodules)
• Family history of RA
• Age between 30 and 60
• Being female (70 percent of sufferers are women)
Obesity and prior joint injury will not increase your risk of developing RA.
Evaluation for RA involves a thorough history and physical exam, imaging studies and blood tests to detect antibodies. The two blood tests that are helpful in diagnosing RA check for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP).
The past decade has seen an explosion of new drug treatment options for rheumatoid arthritis patients.
Disease-modifying antirheumatic drugs (DMARDs), the standard treatment for RA, can slow the progression of mild disease. Tumor necrosis factor (TNF) inhibitors block a protein that triggers inflammation in moderate disease.
In severe disease, drugs that target white blood cells can modify faulty immune responses. Biologic agents work by mimicking substances that are part of our natural immune system.
Exercise and rest
Exercise is important to keep the bones as healthy as possible when you have RA. However, the joints should be rested during periods of painful inflammation.
At times, splints or canes may be used to support painful joints. Applying heat in the morning can relax the muscles needed to move stiff joints.
Guide to Arthritis: Psoriatic arthritis
Psoriatic arthritis (PsA) is a form of inflammatory arthritis. Up to 30 percent of people with psoriasis (a skin condition)
develop psoriatic arthritis. Both psoriasis and psoriatic arthritis are chronic autoimmune diseases –conditions in which certain cells attack other cells and tissues in your body.
There are five different types of psoriatic arthritis. The types differ by the joints involved, ranging from only affecting the hands or spine area to a severe, deforming type called arthritis mutilans.
Researchers don’t know what causes PsA, but they suspect that it develops from a combination of genetic (heredity) and environmental factors. They also think that immune system problems, infection and physical trauma play a role in determining who will develop the disorder.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor (TNF) in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with PsA.
Early diagnosis and treatment can relieve pain and inflammation and help prevent progressive joint involvement and damage. Without treatment, psoriatic arthritis can potentially be disabling and crippling. There is no cure for psoriatic arthritis. However, by understanding the disorder and knowing what to expect, you can learn new and different ways to cope. Once you understand and learn to predict the ways in which your body responds to the disease, you can use exercise and therapy to alleviate discomfort and reduce stress and fatigue.
• Discomfort, stiffness, pain, throbbing, swelling or tenderness in one or more joints
• Reduced range of motion in joints
• Joint stiffness and fatigue in the morning
• Tenderness, pain or swelling where tendons and ligaments attach to the bone (e.g., Achilles’ tendonitis)
• Inflammation of the eye (such as iritis)
• Silver or gray scaly spots on the scalp, elbows, knees and/or the lower spine
• Inflammation or stiffness in the lower back, wrists, knees or ankles, or swelling in the joints in the fingers and toes
• Pitting (small depressions) of the nails
• Detachment or lifting of fingernails or toenails
• Family history of skin or joint disease
• Between 30 and 50 years of age
Your doctor will perform a thorough history and physical exam, imaging studies and blood tests to determine if you
The type of treatment you receive will depend on the severity of your symptoms at the time of diagnosis. Some early
indicators of more severe disease include onset at a young age, multiple joint involvement and spinal involvement.
Good control of the skin may be valuable in the management of PsA. In many cases, you may be seen by two different
types of doctors – a rheumatologist and a dermatologist. The aim of treatment for PsA is to relieve symptoms. Treatment may include any combination of the following:
Medication and other drugs
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Cortisone injections
• Disease modifying anti-rheumatic drugs (DMARDs)
• Biologic agents like Enbrel® (etanercept), Humira® (adalimumab) and others
Moderate, regular exercise may relieve joint stiffness and pain. Range-of-motion and strengthening exercises combined with low-impact aerobics may be helpful.
Heat and cold therapy
Heat and cold therapy involves switching the use of moist heat and cold therapy on affected joints.
Joint protection and energy conservation
Perform your daily activities in ways that reduce excess stress and fatigue on joints. Positioning your body properly during
activity protects joints and conserves energy. People with PsA are encouraged to frequently change body position at work, at home and during leisure activities. Maintaining good posture is helpful for preserving function.
Your doctor may recommend splinting your joints to ease inflammation or problems with joint alignment or stability. However, to maintain movement in these joints, the splints should be removed occasionally, and gentle range-of-motion exercises should be performed.
Most people with psoriatic arthritis will never need surgery. However, severely damaged joints may require joint replacement surgery
Guide to Arthritis: Gout
Gout is an increasingly common form of arthritis in people over 40 years of age. It involves sudden, severe inflammation of a joint in which uric acid crystals have collected. Gout pain is described as being so intense that even placing a sheet over the affected joint seems intolerable.
Gout typically affects a single joint, such as the big toe, ankle or knee. Attacks may last from several days to two weeks and can recur if not treated. Gout may be caused by an inherited enzyme defect that prevents the body from eliminating uric acid. Uric acid deposits that accumulate can cause white bumps around the joint called tophi, usually in more advanced disease.
• Sudden onset of joint pain
• Warmth and swelling in the joint
• Affected area turns red or purple
• Usually just one joint affected
• Frequent alcohol consumption
• Use of certain medications (thiazide diuretics to control high blood pressure)
• Being male (gout is 10 times more common in men than in women)
• Certain medical conditions (metabolic syndrome — the combination of high blood pressure, high cholesterol, diabetes and obesity — or heart failure)
• A family history of gout
The diagnosis of gout is based on a thorough history and physical examination. To confirm the diagnosis, fluid may be aspirated from the joint and examined under a microscope for uric acid crystals.
NSAIDs can relieve the pain of gout attacks, but for more severe attacks, steroids are used to quickly decrease inflammation. Allopurinol and febuxostat are medications used to control uric acid levels and prevent or reduce the number of gout attacks. Probenecid, a medication used to prevent the formation of kidney stones from uric acid, may also be helpful. Colchicine may be used as well.
Drinking less alcohol and avoiding red meats, organ meats and other foods that are rich in uric acid can help ward off gout.
Consult a Specialist!
Joint pain can limit your ability to do the things you love — whether it’s knitting scarves or walking the dog — If you need further evaluation, please consult your doctor immediately (even if you have read the above guide to Arthritis!)