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Arthritis

Joint inflammation; Joint degeneration

 

Arthritis is inflammation of one or more joints. A joint is the area where 2 bones meet. There are more than 100 different types of arthritis.

Causes

 

Arthritis involves the breakdown of cartilage. Normal cartilage protects a joint and allows it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together. This causes swelling (inflammation), and stiffness.

Joint inflammation and damage may result from:

  • An autoimmune disease (the body's immune system mistakenly attacks healthy tissue)
  • Broken bone
  • General "wear and tear" on joints
  • Infection, most often by bacteria or virus
  • Crystals such as uric acid or calcium pyrophosphate dihydrate

In most cases, the joint inflammation goes away after the cause goes away or is treated. Sometimes, it does not. When this happens, you have long-term (chronic) arthritis.

Arthritis may occur in men or women. Osteoarthritis is the most common type.

Other, more common types of inflammatory arthritis include:

  • Ankylosing spondylitis
  • Crystal arthritis, gout, calcium pyrophosphate deposition disease
  • Juvenile rheumatoid arthritis (in children)
  • Bacterial infections
  • Psoriatic arthritis
  • Reactive arthritis
  • Rheumatoid arthritis (in adults)
  • Scleroderma
  • Systemic lupus erythematosus (SLE)

 

Symptoms

 

Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include:

  • Joint pain
  • Joint swelling
  • Reduced ability to move the joint
  • Redness and warmth of the skin around a joint
  • Joint stiffness, especially in the morning

 

Exams and Tests

 

The health care provider will perform a physical exam and ask about your medical history.

The physical exam may show:

  • Fluid around a joint
  • Warm, red, tender joints
  • Difficulty moving a joint (called "limited range of motion")

Some types of arthritis may cause joint deformity. This may be a sign of severe, untreated rheumatoid arthritis.

Blood tests and joint x-rays are often done to check for infection and other causes of arthritis.

The provider may also remove a sample of joint fluid with a needle and send it to a lab to be checked.

 

Treatment

 

The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.

LIFESTYLE CHANGES

Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint swelling. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you.

Exercise programs may include:

  • Low-impact aerobic activity (also called endurance exercise). Walking is a good example. 
  • Range of motion exercises for flexibility.
  • Strength training for muscle tone.

Your provider may suggest physical therapy. This might include:

  • Heat or ice
  • Splints or orthotics to support joints and help improve their position; this is often needed for rheumatoid arthritis
  • Water therapy
  • Massage

Other things you can do include:

  • Get plenty of sleep. Sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly, and may even help prevent flare-ups.
  • Avoid staying in one position for too long.
  • Avoid positions or movements that place extra stress on your sore joints.
  • Change your home to make activities easier. For example, install grab bars in the shower, the tub, and near the toilet.
  • Try stress-reducing activities, such as meditation, yoga, or tai chi.
  • Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E.
  • Eat foods rich in omega-3 fatty acids, such as cold water fish (salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
  • Avoid excessive alcohol and smoking.
  • Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3 to 7 days.
  • Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.

MEDICINES

Medicines may be prescribed along with lifestyle changes. All medicines have some risks. You should be closely followed by a doctor when taking arthritis medicines .

Over-the-counter medicines:

  • Acetaminophen (Tylenol) is often the first medicine tried. Take up to 3,000 mg a day (2 arthritis-strength Tylenol every 8 hours). To prevent damage to your liver, do not take more than the recommended dose. Since multiple medicines are available without a prescription that also contain acetaminophen, you will need to include them in the 3,000 mg per day maximum. Also, avoid alcohol when taking acetaminophen.
  • Aspirin, ibuprofen, or naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs) that can relieve arthritis pain. However, they can carry risks when used for a long time. Possible side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage.

Prescription medicines:

  • Corticosteroids ("steroids") help reduce inflammation. They may be injected into painful joints or given by mouth.
  • Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide.
  • Biologics are used for the treatment of autoimmune arthritis especially rheumatoid arthritis (RA). They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), rituximab (Rituxan), golimumab (Simponi), certolizumab (Cimzia), and tocilizumab (Actemra). These drugs can improve the quality of life for many people, but can have serious side effects.
  • Other drugs for RA -- Janus kinase inhibitor: Tofacitinib (Xeljanz). This is a medicine taken by mouth that is now approved for treating RA.
  • For gout, allopurinol (Zyloprim), febuxostat (Uloric) or probenecid (Benemid) may be used to lower uric acid.

It is very important to take your medicines as directed by your provider. If you are having problems doing so (for example, because of side effects), you should talk to your provider. Also make sure your provider knows about your all the medicines you are taking, including vitamins and supplements bought without a prescription.

SURGERY AND OTHER TREATMENTS

In some cases, surgery may be done if other treatments have not worked. This may include:

  • Joint replacement, such as a total knee joint replacement

 

Outlook (Prognosis)

 

A few arthritis-related disorders can be completely cured with proper treatment.

Most forms of arthritis however are long-term (chronic) conditions.

 

Possible Complications

 

Complications of arthritis include:

  • Long-term (chronic) pain
  • Disability
  • Difficulty performing daily activities

 

When to Contact a Medical Professional

 

Call your provider if:

  • Your joint pain persists beyond 3 days.
  • You have severe unexplained joint pain.
  • The affected joint is significantly swollen.
  • You have a hard time moving the joint.
  • Your skin around the joint is red or hot to the touch.
  • You have a fever or have lost weight unintentionally.

 

Prevention

 

Early diagnosis and treatment can help prevent joint damage. If you have a family history of arthritis, tell your provider , even if you do not have joint pain.

Avoiding excessive, repeated motions may help protect you against osteoarthritis.

 

 

Open References

References

Bope ET, Kellerman RD. Rheumatology and the musculoskeletal system. In: Bope ET, Kellerman RD, eds.  Conn's Current Therapy 2016 . Philadelphia, PA: Elsevier Saunders; 2016:chap 9.

Davis JM, Matteson EL, American College of Rheumatology, European League Against Rheumatism. My treatment approach to rheumatoid arthritis.  Mayo Clin Proc . 2012;87(7): 659-673. PMID: 22766086  www.ncbi.nlm.nih.gov/pubmed/22766086 .

Khanna D, Khanna PP, Fitzgerald JD, Singh MK, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and anti-inflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447-1461. PMID: 23024029  www.ncbi.nlm.nih.gov/pubmed/ 23024029 .

Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64:625-639. PMID: 22473917  www.ncbi.nlm.nih.gov/pubmed/22473917 .

 
  • Arthritis

    Arthritis

    Animation

    •  

    Arthritis - Animation

    Arthritis, inflammation of one or more joints, is the most common cause of disability in the United States, limiting the activities of millions of adults. So, what causes arthritis? Cartilage, which is the tough but flexible tissue that covers the ends of your bones, normally protects and cushions a joint, allowing it to move smoothly. When this covering starts to break down, your bones rub together, causing pain, swelling, and stiffness. This is arthritis. Joint inflammation may result from an autoimmune disease like rheumatoid arthritis, which is when your immune system mistakenly attacks health tissue, or a broken bone, or general wear and tear on joints from osteoarthritis, or an infection from bacteria or a virus. If you have arthritis, you'll probably know it before you see your doctor. You may have joint pain, joint swelling, a reduced ability to move your joint, redness of the skin around your joint, and stiffness, especially in the morning. So, what do you do about arthritis? Your doctor will give you a physical exam and ask questions about your symptoms. Your doctor might find that you have fluid around a joint, warm, red, tender joints, and trouble moving your joints. You may have blood tests and x-rays to check for infection or other arthritis causes. Your doctor may take a sample of joint fluid with a needle and send it to a lab for examination. Once your doctor confirms that you have arthritis, your treatment will focus on reducing your pain, improving your mobility, and limiting further joint damage. Lifestyle changes are a big part of the treatment for arthritis. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you. Physical therapy may also be very helpful. You may use treatments like heat or ice, splints or orthotics to support your joints, water therapy, and even massage. You can take other steps to ease your pain. For example, sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly, and may even help prevent them. Avoid staying in one position for too long, and avoid positions or movements that place extra stress on your joints. Install grab bars in the shower, tub, and near the toilet, to help you get around easier. Try stress reducing activities, such as meditation, yoga, or tai chi. Get more fruits, vegetables, cold water fish, and nuts into your diet. Weight loss through dieting and exercise can also take pressure off your joints. After lifestyle factors, medicine can help relieve your arthritis pain. If over-the-counter medicines like acetaminophen, ibuprofen, or aspirin are not enough, your doctor may prescribe stronger medicines. Most forms of arthritis are long-term, and life-long, conditions. But if you make lifestyle changes, and work with your health care team to manage your pain, you should be able to move more freely and hopefully feel less pain.

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from "wear and tear" on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.

    Osteoarthritis

    illustration

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is associated with the aging process and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing bone to rub against bone. Bony spurs develop on the unprotected bones causing pain and inflammation.

    Osteoarthritis

    illustration

  • Rheumatoid arthritis

    Rheumatoid arthritis - illustration

    Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints affected is usually symmetrical, involves the hands and other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body organs, whereas osteoarthritis is limited to the joints. Over time, both forms of arthritis can be crippling.

    Rheumatoid arthritis

    illustration

  • Rheumatoid arthritis

    Rheumatoid arthritis - illustration

    The affect of rheumatoid arthritis can progress to the degree that it is crippling. Deformities distinctive to late-stage rheumatoid arthritis such as ulnar deviation of the bones of the hands, or swan-neck deviation of the fingers occur because muscles and tendons on one side of the joint may overpower those on the other side, pulling the bones out of alignment.

    Rheumatoid arthritis

    illustration

  • Osteoarthritis vs. rheumatoid arthritis

    Osteoarthritis vs. rheumatoid arthritis - illustration

    Osteoarthritis is a deterioration of cartilage and overgrowth of bone often due to "wear and tear". Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage.

    Osteoarthritis vs. rheumatoid arthritis

    illustration

  • Arthritis in hip

    Arthritis in hip - illustration

    Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when walking. Arthritis involves the breakdown of cartilage. Without the usual amount of cartilage, the bones of the joint rub together, causing pain, swelling and stiffness.

    Arthritis in hip

    illustration

  • Rheumatoid arthritis

    Rheumatoid arthritis - illustration

    Rheumatoid arthritis is another form of arthritis. The body’s own immune system attacks a joint’s synovial membrane, which secretes fluid and lines the joint. The synovium becomes inflamed, produces excess fluid, and the cartilage becomes rough and pitted.    

    Rheumatoid arthritis

    illustration

  • Knee joint replacement - Series

    Knee joint replacement - Series

    Presentation

    •  
  • Hip joint replacement - Series

    Hip joint replacement - Series

    Presentation

    •  

  • Arthritis

    Animation

    •  

    Arthritis - Animation

    Arthritis, inflammation of one or more joints, is the most common cause of disability in the United States, limiting the activities of millions of adults. So, what causes arthritis? Cartilage, which is the tough but flexible tissue that covers the ends of your bones, normally protects and cushions a joint, allowing it to move smoothly. When this covering starts to break down, your bones rub together, causing pain, swelling, and stiffness. This is arthritis. Joint inflammation may result from an autoimmune disease like rheumatoid arthritis, which is when your immune system mistakenly attacks health tissue, or a broken bone, or general wear and tear on joints from osteoarthritis, or an infection from bacteria or a virus. If you have arthritis, you'll probably know it before you see your doctor. You may have joint pain, joint swelling, a reduced ability to move your joint, redness of the skin around your joint, and stiffness, especially in the morning. So, what do you do about arthritis? Your doctor will give you a physical exam and ask questions about your symptoms. Your doctor might find that you have fluid around a joint, warm, red, tender joints, and trouble moving your joints. You may have blood tests and x-rays to check for infection or other arthritis causes. Your doctor may take a sample of joint fluid with a needle and send it to a lab for examination. Once your doctor confirms that you have arthritis, your treatment will focus on reducing your pain, improving your mobility, and limiting further joint damage. Lifestyle changes are a big part of the treatment for arthritis. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you. Physical therapy may also be very helpful. You may use treatments like heat or ice, splints or orthotics to support your joints, water therapy, and even massage. You can take other steps to ease your pain. For example, sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly, and may even help prevent them. Avoid staying in one position for too long, and avoid positions or movements that place extra stress on your joints. Install grab bars in the shower, tub, and near the toilet, to help you get around easier. Try stress reducing activities, such as meditation, yoga, or tai chi. Get more fruits, vegetables, cold water fish, and nuts into your diet. Weight loss through dieting and exercise can also take pressure off your joints. After lifestyle factors, medicine can help relieve your arthritis pain. If over-the-counter medicines like acetaminophen, ibuprofen, or aspirin are not enough, your doctor may prescribe stronger medicines. Most forms of arthritis are long-term, and life-long, conditions. But if you make lifestyle changes, and work with your health care team to manage your pain, you should be able to move more freely and hopefully feel less pain.

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from "wear and tear" on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.

    Osteoarthritis

    illustration

  • Osteoarthritis

    Osteoarthritis - illustration

    Osteoarthritis is associated with the aging process and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing bone to rub against bone. Bony spurs develop on the unprotected bones causing pain and inflammation.

    Osteoarthritis

    illustration

  • Rheumatoid arthritis

    Rheumatoid arthritis - illustration

    Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints affected is usually symmetrical, involves the hands and other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body organs, whereas osteoarthritis is limited to the joints. Over time, both forms of arthritis can be crippling.

    Rheumatoid arthritis

    illustration

  • Rheumatoid arthritis

    Rheumatoid arthritis - illustration

    The affect of rheumatoid arthritis can progress to the degree that it is crippling. Deformities distinctive to late-stage rheumatoid arthritis such as ulnar deviation of the bones of the hands, or swan-neck deviation of the fingers occur because muscles and tendons on one side of the joint may overpower those on the other side, pulling the bones out of alignment.

    Rheumatoid arthritis

    illustration

  • Osteoarthritis vs. rheumatoid arthritis

    Osteoarthritis vs. rheumatoid arthritis - illustration

    Osteoarthritis is a deterioration of cartilage and overgrowth of bone often due to "wear and tear". Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage.

    Osteoarthritis vs. rheumatoid arthritis

    illustration

  • Arthritis in hip

    Arthritis in hip - illustration

    Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when walking. Arthritis involves the breakdown of cartilage. Without the usual amount of cartilage, the bones of the joint rub together, causing pain, swelling and stiffness.

    Arthritis in hip

    illustration

  • Rheumatoid arthritis

    Rheumatoid arthritis - illustration

    Rheumatoid arthritis is another form of arthritis. The body’s own immune system attacks a joint’s synovial membrane, which secretes fluid and lines the joint. The synovium becomes inflamed, produces excess fluid, and the cartilage becomes rough and pitted.    

    Rheumatoid arthritis

    illustration

  •   Knee joint replacement - Series

    Knee joint replacement - Series

    Presentation

    •  
  •   Hip joint replacement - Series

    Hip joint replacement - Series

    Presentation

    •  

A Closer Look

 

Talking to your MD

 

    Self Care

     

    Tests for Arthritis

     
       

      Review Date: 10/18/2015

      Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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