What Is Arthritis?
Table of Contents
Osteoarthritis affects approximately 27 million people in the United States, making it the most common form of arthritis. Osteoarthritis is a degenerative disease that results when the cartilage surrounding the joints begins to wear down. The degeneration of the cartilage causes the bones to rub against each other, leading to joint pain, stiffness, and other issues within the affected joint. The cause of osteoarthritis is not fully understood; however certain risk factors that are associated with an increased risk of developing osteoarthritis have been identified, including increasing age, obesity, previous joint injuries, overuse of a joint, weak musculature, and certain genetic factors. Osteoarthritis can affect any joint in the body however it most commonly affects the joints in the hands, knees, hips, and spine.
The symptoms associated with osteoarthritis tend to develop gradually and usually include joint pain and stiffness that occurs after rest and improves with physical activity. Osteoarthritis is sometimes referred to as a progressive, degenerative joint disease as it is a disease that worsens over time. In the early stages of osteoarthritis, the pain may be moderate and intermittent, and may not have a negative impact on an individuals’ daily functioning. While some patients may not progress past the early stage of the disease, other patients progress to later and more debilitating stages of the disease. In the later stages of the disease the joint pain and stiffness worsens. For individuals with severe cases of osteoarthritis, normal activities such as walking, climbing stairs, and even sleeping can become difficult. At the present time there is no cure for osteoarthritis but maintaining a healthy weight, staying active, and other treatment options may help to reduce pain, improve joint functioning, and slow the progression of the disease.
Rheumatoid arthritis is another common type of arthritis, affecting approximately 1.5 million people in the United States. Women are three times more likely than men to develop this disease. Women are usually affected by rheumatoid arthritis between the ages of 30 and 60, while men are usually affected later in life. Rheumatoid arthritis is a chronic inflammatory disorder that is the result of inflammation of the membranes that make up the joint tissue lining. Rheumatoid arthritis causes joint pain, swelling, stiffness, and the joints are often warm to the touch. Rheumatoid arthritis can often lead to severe joint damage. Rheumatoid arthritis is commonly seen bilaterally, meaning that if a joint on one side of the body is affected by inflammation, the same joint on the other side of the body is usually affected as well. The severity of the symptoms associated with rheumatoid arthritis varies and can also change from day to day. However, if symptoms suddenly increase it is called a flare. When a flare occurs, it can last for several days to months.
Rheumatoid arthritis is considered an autoimmune disease. Under normal circumstances the body’s immune system acts to protect the body by attacking and destroying foreign substances, including bacteria and viruses. However, in patients who suffer with rheumatoid arthritis, the body’s immune system mistakenly attacks joint tissue. This abnormal immune system reaction results in inflammation that cannot only result in joint damage, but in organ damage as well. Early diagnosis of rheumatoid arthritis is essential in order to prevent severe joint damage and organ damage.
Juvenile arthritis is a term that is used to describe various inflammatory and autoimmune diseases that can develop in children below the age of 16. Juvenile idiopathic arthritis is the most common type of juvenile arthritis. In order to be diagnosed with this condition, the child must be experiencing the initial stages of swelling in at least one joint, for at least six weeks. At the present time there is no known cause of juvenile arthritis. Furthermore, there is no evidence to support the idea that certain foods, toxins, or allergies can cause children to develop juvenile arthritis. However, there is some evidence to suggest that there may be a genetic predisposition to developing this disease. An accurate diagnosis of juvenile arthritis is essential for proper treatment.
Epidemiology And Impact Of ArthritisApproximately 50 million individuals in the United States are affected by arthritis, making it a serious health concern in the country. While many people think that arthritis only affects the elderly, it can affect individuals of any age. It has been reported that two-thirds of individuals who suffer with arthritis are under the age of 65. Moreover, approximately 300,000 children are afflicted by this painful condition. It has been estimated that the prevalence of arthritis will continue to rise over the next two decades. By 2030 it is estimated that approximately 67 million individuals in the United States will develop arthritis.
Of the individuals affected by arthritis, approximately 36 million are Caucasian American, 4.6 million are African American, and 2.9 million are Latin American or Hispanic. Arthritis is also the leading cause of disability in the U.S. and results in more mobility issues than heart disease, cancer, or diabetes.
Arthritis has begun to place a burden on the economic and healthcare systems in the U.S. Arthritis is responsible for approximately 44 million physician appointments and over 900,000 hospitalizations each year. Reports investigated patients between 2003 and 2010 and found that certain surgical procedures that are used for the treatment of arthritis are associated with longer hospital stays, especially when they are performed on patients with later stages of the disease. These results may be due to the fact that patients in the later stages of the disease waited too long to seek out treatment, or that they suffered from certain types of arthritis. When arthritis is diagnosed and treated in the early stages of the disease, if surgery is required, it may be done as a day surgery procedure or require a one-day stay as opposed to requiring a hospital stay of a longer duration. Longer hospitalization times result in an increased need for healthcare personnel and equipment, and therefore higher medical costs.
In particular, for patients aged 18 to 64 who suffer from rheumatoid arthritis reports have shown that between 2002 and 2011 there has been a considerable increase in costs for these patients. An increase in prescription medications combined with a decrease in hospitalizations, as well as an increase in other costs such as sick leave and disability may be responsible for the increased costs. Additionally, since 2009 there has been an increase in the cost of medications used to treat rheumatoid arthritis, which may also contribute to the rising costs associated with this particular subset of arthritis patients.
Causes Of ArthritisThere are a variety of factors that can influence an individuals’ susceptibility for developing arthritis. In order to understand how arthritis often develops, understanding the way a joint works is beneficial. Joints are areas where bones intercept and the ligaments within the joints hold the bones together. Ligaments are comprised of tissue that contracts and expands, similar to elastic. Ligaments help to keep bones in place. Conversely, surrounding muscles contract and relax to allow for movement of the joint. Cartilage is another type of tissue that covers the surface of bones and helps to prevent bones from rubbing against each other and becoming damaged. Synovial fluid fills that space within the joint and helps to encourage mobility by nourishing the cartilage and the joint.
The various components of the joint are all susceptible to damage from wear and tear from everyday use as well as from injury or acute traumatic events. When an individual is diagnosed with arthritis it may be indicative of a problem with the cartilage, synovial fluid, or immune system. The type of arthritis that an individual is diagnosed with provides an idea as to whether cartilage has worn away, synovial fluid has deceased, an abnormal immune response has occurred, that an infection is present, or that a combination of these activities has occurred.
Osteoarthritis is a chronic disease that involves damage to the cartilage located within the joint. The cartilage damage may be the result of wear and tear over time or may be the result of an injury. When the cartilage is damaged, it is unable to provide cushioning for the joint. If there is enough damage to the cartilage, there is a significant risk of bone rubbing against bone. This can lead to significant pain, especially with physical activity, in addition to a loss of joint flexibility.
On the other hand, rheumatoid arthritis is characterized by an abnormal immune response within the body to the joints. In particular, the immune system begins to attack the synovial membrane that lines that joint capsule and encloses the structures of the joint. As a result of this abnormal immune response, the synovial membrane becomes inflamed and swollen. If rheumatoid arthritis is left untreated it can progress from mild joint damage to serious organ damage.
While wear and tear, injury, trauma, and abnormal immune responses can lead to arthritis, research has shown that arthritis is often caused by a combination of various factors. The factors that have been associated with an increased risk of developing arthritis, include:
- Weak muscles
- Genetic predisposition
- Overuse of a joint
- Certain autoimmune conditions
- Increasing age
- Female sex
- Certain allergic reactions or infections
- Previous joint injury
- Physically demanding occupation
- Repetitive heavy lifting
- Certain foods
Symptoms Of ArthritisTypically, patients suffering from arthritis will report joint pain and stiffness. These symptoms tend to get worse with age or as the disease progresses. Other relatively common symptoms of arthritis include:
- Joint pain or stiffness during or after physical activity
- Joint pain or stiffness after prolonged rest
- Joint tenderness
- Morning joint stiffness
- Decreased range of motion
- Grinding sound or sensation within the joint
- Redness around the joint
- Swelling of the joint
- Warmth of the joint
- Weight loss
Symptoms that are common in patients who suffer from osteoarthritis include:
- Joint pain or stiffness (especially in the lumbar spine, hips, and knees)
- Joint pain or stiffness that increases with rest or overuse
- Joint pain or stiffness after rest that begins to resolve with movement
- Joint pain or stiffness that worsens during or after physical activity or at the end of the day
Symptoms that are common in patients who suffer from rheumatoid arthritis include:
- Chronic joint pain
- Warmth of the joint
- Swollen and red joints
- Prolonged morning joint stiffness
- Inflammation of the joints of the hand and wrist
Symptoms that are common in patients who suffer from juvenile arthritis include:
- Chronic joint pain
- Morning joint stiffness
- Joint swelling
- Joint tenderness
- Eye pain, eye redness, or blurred vision
- Fever (persistent)
In patients who are very young, it may seem that the child cannot perform motor skills and activities that they were previously able to perform.
Symptoms of arthritis can vary drastically among patients. Symptoms may be temporary for some patients while others will develop chronic arthritis symptoms. The severity of arthritis pain can range from relatively mild to debilitating, and may be intermittent or constant. At times patients with arthritis will report that they have some days that are better than others when it comes to their arthritis symptoms.
Diagnosis Of Arthritis
There are a number of types of arthritis, including osteoarthritis, that are usually diagnosed following a medical assessment by a physician. The assessment typically includes a detailed history of symptoms as well as a physical examination. Diagnostic imaging tests, such as X-ray or magnetic resonance imaging (MRI), may be utilized to visualize the affected joint. If certain types of arthritis, such as rheumatoid arthritis or juvenile arthritis, are suspected, lab testing of urine, blood, or synovial fluid may also be performed to help confirm the diagnosis. Furthermore, lab testing of these body fluids helps to rule out other conditions that may be contributing to a patient’s symptoms.
In regard to rheumatoid arthritis, blood tests that reveal specific markers are necessary to properly diagnosis this condition. The specific markers that are revealed by these tests include various antibodies that are present in about 70 to 90% of individuals who suffer from rheumatoid arthritis. These specific markers sometimes circulate in the blood of individuals who do not suffer from rheumatoid arthritis, however the specific markers are usually present in higher levels in individuals suffering from this painful condition. The results of the lab testing can be used in conjunction with the medical history, physical examination, and any imaging performed to make an accurate diagnosis.
In regards to juvenile arthritis, there is no single lab test that can exclusively confirm this disease. In many patients the lab testing that is used reveals the presence of inflammation or possibly an infection; however, these results do not generally provide a physician with information to help make a clear diagnosis. Therefore in order to make a proper diagnosis of juvenile arthritis a detailed medical history combined with a thorough physical examination that includes special imaging tests is essential.
Early diagnosis of arthritis is essential in order to receive treatment that may help to reverse or prevent disease progression. If arthritis is left untreated it can lead to permanent damage to the joints, ligaments, cartilage, and bones. This damage can result in deformity and decreased mobility that may be irreversible. Moreover, arthritis can damage other structures within the body, including vital organs. Early diagnosis of arthritis can also help to prevent the need for invasive types of treatment, including surgery.
Treatments For ArthritisAt the present time, no cure has been developed for arthritis so treatment focuses on providing pain relief and improving joint functioning. Treatment for arthritis initially includes pain medication and non-steroidal anti-inflammatory drugs (NSAIDs), protective devices (e.g. braces), cold and hot packs, and exercise. Many patients suffering from arthritis pain believe that they should avoid exercise. However, there is a significant amount of research that suggests that certain forms of endurance training and resistance exercises are actually beneficial for individuals suffering from the early stages of both osteoarthritis and rheumatoid arthritis.
There is also a body of evidence that has found that weight management, exercise, and avoiding injuries to joints helps to reduce the occurrence of osteoarthritis and may also help to avoid flare-ups of arthritis symptoms. It has been found that weight loss in individuals who are overweight is especially effective. For every pound of weight loss, there is four pounds of pressure being taken off the knees. This can help to prevent or reduce inflammation and joint injury.
If there is no response to initial treatment methods, physical therapy may be recommended. Research has shown that physical therapy; in addition to regular physical activity is beneficial for arthritis sufferers. It has been found that individuals who suffer from arthritis often exercise less than the recommended amount to maintain a healthy lifestyle. Physical therapists often use techniques that alter normal behaviors to address both the biological and psychosocial aspects of an individual’s life. Patients are educated by their physical therapist on arthritis and the benefit of engaging in a healthy lifestyle that includes physical activity. Current statistics show that individuals who are in the later stages of arthritis, on disability, or that have strong familial and social support are more likely to receive the services of a physical therapist.
Often a combination of treatments provides arthritis symptom relief. However, for some individuals their arthritis symptoms fail to respond to treatment or serious damage has occurred and surgery is necessary.
In addition to a healthy lifestyle consisting of exercise and physical therapy, there is some evidence to suggest that a healthy, nutritious diet can help to minimize the complications that are associated with arthritis. In particular, certain foods including those that contain trans and saturated fats tend to increase inflammation in the body and should therefore be avoided.
It is suggested that the following foods should be limited in the diet or completely avoided:
- Fatty pork or beef
- Chicken skin
- Dairy foods (full fat)
- High sugar foods
- Baked goods (made with white flour)
- White rice
- White bread
- Foods that contain palm oil or palm-kernel oil
It is recommended that these foods be replaced by healthier food options, including:
- Lean cuts of pork and beef
- Skinless turkey and chicken
- Fat-free or reduced-fat dairy products
Certain types of fish and nuts contain omenga-3 fatty acids, which have been demonstrated to reduce arthritis symptoms, particularly rheumatoid arthritis symptoms. Furthermore, extra virgin olive oil contains high levels of a naturally occurring compound, oleocanthal, which helps to prevent and reduce inflammation associated with arthritis. Oleocanthal has also been shown to block the inflammatory pathways in the same manner that anti-inflammatory medications, including aspirin and ibuprofen do. Moreover, vitamin C, bioflavonoids, and carotenes are antioxidants that can help to protect the body from the negative effects of inflammatory compounds. Foods containing these antioxidants have the ability to help in the prevention of arthritis, slow the disease progression, and help to reduce pain.
It is recommended that the following healthy food options be added into the diet of individuals suffering with arthritis:
- Fish (e.g. herring, salmon, sardines, mackerel, rainbow trout, and anchovies)
- Flax seeds (ground)
- Chia seeds
- Vegetables and fruits with high levels of vitamin C (e.g. oranges, grapefruits, guava, strawberries, lemons, pineapples, bell peppers, broccoli, kale, sweet potatoes, Brussels sprouts, carrots, butternut squash, spinach, and sweet red peppers)
Alternative treatment options that are available for individuals suffering with arthritis include relaxation and guided imagery. Visualization, also referred to as mental imagery, is the act of an individual imagining themselves engaging in a certain action. It is also referred to as guided imagery as a professional trained in this technique often helps to guide an individual through the imagined activity.
Studies have shown that by mentally rehearsing an activity prior to actually executing the needed motor skills to complete the activity has the ability to improve future activity performance. The strength of visualization is dramatic, as research has shown that imagining an activity prior to engaging in it has a more significant effect on overall performance than by engaging in motor and strength exercises, when there is no history of guided imagery. Recent research also alludes to the fact that visualization is an effective technique that shows that the mind has the ability to transform mental imagery into improved physical activity performance.
Treatment With Medication
Over-the-counter medication may be recommended for patients suffering from mild to moderate pain due to their arthritis. However, prescription medication may be required for patients suffering with severe or chronic arthritis symptoms. Currently there are over 100 different types of medications available for the treatment of various forms of arthritis. The first-line treatment, from a pharmacological approach, are non-steroidal anti-inflammatory drugs (NSAIDs). Physicians usually recommend NSAIDs due to their ability to reduce joint inflammation, thereby helping to reduce pain. NSAIDs that can be taken orally are a very common prescription for the treatment of inflammation related to arthritis. Analgesic medication may also be recommended to treat pain that is related to arthritis; however, this type of medication does not offer the same anti-inflammatory effects that NSAIDs do.
When inflammation occurs, harmful fluids that contain enzymes that cause pain typically build up. NSAIDs help to reduce the buildup of these pain-inducing enzymes. These medications also help to block the release of pain-inducing enzymes, which enhance inflammatory reactions.
Many patients consider more invasive types of treatment for their arthritis symptoms. There is some evidence that suggests that corticosteroid injections can help reduce the degree of inflammation, in addition to providing pain relief for arthritis sufferers. Corticosteroids, including cortisone and prednisone, may be recommended in an effort to reduce inflammation, and in some cases to suppress an individual’s immune system. This is particularly true in cases where the immune system has begun to attack the joints of the body, as is seen in individuals affected by rheumatoid arthritis. There are a variety of corticosteroid injections and treatment plan regimens that are available that usually involve multiple injections for optimal pain relief.
Joint injections are a common procedure that is often recommended for patients suffering with arthritis. This procedure involves injecting medication directly into a joint, which helps to relieve inflammation and pain. Joint injections usually involve injecting an anesthetic combined with a corticosteroid into the affected area. The anesthetic helps to reduce pain while the corticosteroid helps to reduce inflammation. This procedure is relatively quick and simple to perform and some patients have reported immediate relief of pain symptoms. Joint injections can be repeated multiple times in order to enhance symptom relief. Various studies have shown that patients who receive joint injections report significant pain relief, increased range of motion, and improved quality of life.
Medial branch blocks are another type of treatment that can be offered to patients suffering with arthritis pain. A medial branch block involves injecting medication into the facet joints, which are structures that connect the vertebrae within the spinal column. Within the facet joint are networks of medial branch nerves that are responsible for the transmission of pain signals to the brain when nerve tissue is damaged or inflamed. When an individual begins to experience chronic arthritic pain, a medial branch block is usually recommended to help destroy the medial branch nerves, thereby blocking the transmission of pain signals to the brain. This results in a reduction, or elimination of pain. The use of medial branch blocks to relieve pain associated with arthritis has been well documented as an effective treatment option. The use of medial branch blocks has been shown to provide significant pain relief and improved mobility.
Joint injections and medial branch blocks may be used in cases where the physician suspects that surgery may be necessary. These treatment options may be used to provide some pain relief to these patients but can also provide physicians with information regarding how the body and nerves may react to certain surgical procedures. Diagnostic injections usually involve nerve blocks where a needle is inserted into the spinal column at specific areas where the affected spinal nerves are located. Fluoroscopy, or X-ray guidance, is used to ensure proper needle placement. Once proper placement is confirmed, a catheter is inserted through the needle to deliver pain medication directly to the spinal nerves that are believed to be responsible for the arthritic pain. An anesthetic and corticosteroid, or a substance that disintegrates nerve tissue, is injected to provide pain relief. This procedure leads to prolonged pain relief by blocking pain signal transmission.
Diagnostic nerve blocks provide the physician with an idea of whether a particular surgery will be effective for reducing arthritic pain for periods longer than the nerve block itself. A diagnostic nerve block is usually performed a minimum of two times. If the patient experiences greater pain relief with repeated injections, there is an increased probability that they will experience positive surgical outcomes. Prior to recommending surgery for arthritic pain, physicians usually like to observe the results of at least two diagnostic nerve blocks.
Osteoarthritis TreatmentMedication can be taken as needed for patients who are suffering from pain that is associated with the early stages of osteoarthritis. If the disease begins to progress, the physician may recommend occupational therapy or physical therapy to help maintain muscle strength and joint functioning. When the pain becomes severe, mobility becomes limited, or the patient becomes unable to perform daily activities, physicians may recommend more aggressive treatment options, including surgery.
Patients suffering with osteoarthritis are advised to engage in regular physical activity and maintain a healthy lifestyle. If patients follow these recommendations in the early stages of the disease, it may help to prevent the disease from progressing. Patients who limit their physical activity due to pain may end up with weak joints and increased joint stiffness which can add to the pain that they are experiencing. Engaging in regular physical activity helps to strengthen muscles, which helps to protect the joints. Additionally, avoiding excessive weight gain is also important for patients who suffer with osteoarthritis as extra weight places added pressure and stress on the joints of the body. Other aspects of osteoarthritis management include eating a healthy diet, maintaining a good sleep schedule, and maintaining good mental health.
Rheumatoid Arthritis Treatment
The goals of treatment for rheumatoid arthritis are to reduce pain and inflammation, and slow disease progression. Over-the-counter pain medications and prescriptions medication are often quite effective for reducing rheumatoid arthritis symptoms. Medication that specifically works to suppress abnormal immune system responses are also effective for the management of rheumatoid arthritis and may help to lead to a state of remission. This means that the inflammation associated with this disease completely ceases or is extremely low. Even if a patient experiences a state of remission they will still be monitored for inflammatory markers with regular lab testing as well as a physical examinations. Monitoring these patients at regular intervals will help to determine how well the treatment is working for their condition. Additionally, if the symptoms of rheumatoid arthritis begin to re-occur, the physician may adjust the medication dosage or prescribe a new type of medication.
Patients suffering with rheumatoid arthritis are also advised to remain physically active as this will help to keep their joints flexible. Additionally, it is advisable that these patients also receive physical therapy in order to learn appropriate types of exercises that they should perform in addition to learning proper techniques of the exercises to avoid potential injuries. In addition to exercise and physical therapy, patients with rheumatoid arthritis are encouraged to consume a nutritious diet and maintain a healthy weight. Patients that follow these recommendations may notice a dramatic improvement in their pain levels.
Juvenile Arthritis TreatmentThe goal of treatment for juvenile arthritis is to reduce inflammation and pain in an effort to improve a child’s quality of life. A combination of a healthy diet, physical activity, medication, and eye care is usually recommended. The treatment plan for a child with juvenile arthritis is developed specifically for their case and often involves multiple healthcare practitioners. The healthcare team may include an ophthalmologist, dentist, pediatric rheumatologist, nurse practitioner, and physical therapist. The healthcare team will evaluate and monitor a child’s condition and adjust the treatment plan as needed. This is vital as each child responds differently to arthritis treatment.
Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesic medications as well as disease-modifying anti-rheumatic drugs (DMARDs) are the two types of medications that are commonly used to treat juvenile arthritis. NSAIDs and analgesic medication are used due to the fact that these medications help to relieve pain and inflammation. Disease-modifying anti-rheumatic drugs are used because they may cause the disease to go into a remission state, thereby helping to prevent joint damage. In rare cases medication doses or different types of medications may be prescribed until the child begins to respond positively to treatment. Certain medications that are prescribed to children affected by juvenile arthritis affect the immune system and/or cause undesirable side effects; therefore these children are monitored closely for adverse reactions.
ConclusionArthritis is a term that is used to describe over 100 conditions and diseases that affect individuals of all ages. The three most common types of arthritis are osteoarthritis, rheumatoid arthritis, and juvenile arthritis. Common symptoms of all of these conditions include joint pain, swelling, stiffness, and weakness. Osteoarthritis is caused by degeneration that may be the result of normal wear and tear of the joint or by an acute traumatic event. Rheumatoid arthritis is caused by an abnormal immune response, whereby the body begins to attack the joints of the body. The cause of juvenile arthritis is unknown, although most children who develop this disease are genetically predisposed to this condition.
There is currently no cure for arthritis, but a variety of treatment options exist to help manage the pain and inflammation associated with this condition. Typically, conservative treatment methods including medication, exercise, physical therapy, and hot and cold compresses are recommended. Patients with more severe or chronic symptoms may be advised to undergo more invasive treatment options including corticosteroid injections, medial branch blocks, and possibly surgery.
Most cases of early stage arthritis can be successfully managed with conservative treatment options. Early diagnosis and treatment of arthritis is essential for optimal treatment outcomes. Receiving early treatment is particularly important for patients with rheumatoid arthritis as it can help to prevent deformities, disability, and organ damage. Symptoms of chronic pain and inflammation should not be ignored; patients are encouraged to speak with their physicians if they begin to experience any joint pain or stiffness as they may be suffering from the early stages of this painful condition.
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