Arthritis

What is Arthritis?

Arthritis means joint inflammation, but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. It is a rheumatic condition. The most common form of arthritis is osteoarthritis.

What Are The Symptoms?

Arthritis most commonly involves joints. However, depending on the type of arthritis you have, your signs and symptoms can differ and could include:

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

Types of arthritis.

Osteoarthritis

The most common. It is caused from gradual wear and tear of the cartilage in joints. Facet joint arthritis occurs in the facet joints of the spine which can develop after injury or from wear-and-tear.

Rheumatoid arthritis (RA)

RA is a disease in which the immune system attacks the joints, beginning with the lining of joints. This autoimmune destruction causes inflammation, pain and joint deterioration.

Psoriatic arthritis

Another type of autoimmune, inflammatory arthritis that occurs most often in people with psoriasis.

Ankylosing spondylitis
Gout arthritis (GA)

GA can occur in patients with too much uric acid in their blood resulting in the formation of uric acid crystals. These can be deposited in joints causing inflammation and pain.

Septic arthritis (infection)

What Are The Causes?

The two main types of arthritis — osteoarthritis and rheumatoid arthritis — damage joints in different ways.

Osteoarthritis

The most common type of arthritis, osteoarthritis involves wear-and-tear damage to your joint’s cartilage — the hard, slick coating on the ends of bones where they form a joint. Cartilage cushions the ends of the bones and allows nearly frictionless joint motion, but enough damage can result in bone grinding directly on bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can be hastened by a joint injury or infection.

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

Rheumatoid arthritis

In rheumatoid arthritis, the body’s immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining (synovial membrane) becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint.

Risk factors

Risk factors for arthritis include:

  • Family history. Some types of arthritis run in families, so you may be more likely to develop it if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger the problem.
  • Age. The risk of many types this condition— including osteoarthritis, rheumatoid arthritis and gout — increases with age.
  • Your sex. Women are more likely than men to develop rheumatoid arthritis, while most of the people who have gout, another type, are men.
  • Previous joint injury. People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
  • Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. People with obesity have a higher risk of developing this condition.

Diagnosis

The history and physical exam are important evaluation tools for diagnosing arthritis. Your doctor will check your joints for swelling, redness and warmth, and they will want to see how well you can move your joints.

Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.

Laboratory Tests

The analysis of different types of body fluids — such as blood, urine and joint fluid — can help pinpoint the type of arthritis you may be suffering from. Your doctor will discuss with you what laboratory tests may be needed for your arthritis.

Imaging

These types of tests can help visually detect problems within your joint.

  • X-rays. X-rays use low levels of radiation to visualize bone to show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but they are often used to track progression and severity of the disease.

  • Computerized tomography (CT). CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues.

  • Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRI can produce more detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments without exposing patients to radiation.

  • Ultrasound. This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid-containing structures near the joints (bursae). Ultrasound is also used to guide needle placement for joint aspirations and injections.

What Are The Treatments?

Treatments vary depending on the type of arthritis. The main goals of arthritis treatments are to reduce symptoms and improve quality of life. Currently there is no definitive cure; however, regenerative medicine procedures have shown to improve and sometimes reverse some peoples’ arthritis.

Exercise

Consistent, low-impact exercise is the best way to maintain overall health and minimize the impact of this condition. Movement keeps your joints flexible, fluid, and extended through their fullest possible range of motion.

Walking, yoga, and swimming are among the best exercises for those who suffer from arthritis as these activities are low-impact. The side benefit of exercise can be weight loss (or maintaining a healthy weight), which decreases stress on the joints.

Medications

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

Painkillers.

These medications help reduce pain, but have no effect on inflammation. An over-the-counter option includes acetaminophen (Tylenol, others).

For more-severe pain, opioids might be prescribed, such as tramadol (Ultram, ConZip), oxycodone (OxyContin, Roxicodone, others) or hydrocodone (Hysingla, Zohydro ER). Opioids act on the central nervous system to relieve pain. When opioids are used for a long time, they may become habit-forming, causing mental or physical dependence.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Some types of NSAIDs are available only by prescription.
Oral NSAIDs can cause stomach irritation and may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.

Counterirritants.

Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.

Disease-modifying antirheumatic drugs (DMARDs).

Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall, Rasuvo, others) and hydroxychloroquine (Plaquenil).

Biologic response modifiers.

Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response.

There are many types of biologic response modifiers. Tumor necrosis factor (TNF) inhibitors are commonly prescribed. Examples include etanercept (Enbrel, Erelzi, Eticovo) and infliximab (Remicade, Inflectra, others).

Other medications target other substances that play a role in inflammation, such as interleukin-1 (IL-1), interleukin-6 (IL-6), Janus kinase enzymes, and certain types of white blood cells known as B cells and T cells.

Corticosteroids.

This class of drugs, which includes prednisone (Prednisone Intensol, Rayos) and cortisone (Cortef), reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or can be injected directly into the painful joint.

Physical therapy 

Physical therapy sessions with a specially trained therapist can help develop exercises and stretching that are specifically tailored to your unique abilities and pain level.

This type of non-invasive therapy can be especially useful when you combine it with other treatments, such as surgery or joint injections.

Braces

Everyone needs a helping hand now and then, and braces and other accommodations or comforts for arthritis can help you get your life back. For example, when hands are cold, warming gloves can bring comfort and ease stiffness.

Arthritis aids may not relieve pain or improve your overall symptoms, but they can help with everything from getting dressed to making dinner.

Home Remedies

A variety of home remedies for arthritis can also provide relief and help with swelling and inflammation.

These include things like:

  • Transdermal magnesium

  • Essential oils

  • Heat therapy

  • Eating an anti-inflammatory diet

Acupuncture

Some patients find relief with acupuncture, a form of traditional Chinese medicine that stimulates the energy meridians of the body to promote healing.

There are virtually no side effects to this treatment, so even if you are skeptical it can be worth a try before moving to more invasive treatments.

Over-The-Counter Pain Relievers

The first-line of treatment for most forms of arthritis includes non-steroidal anti-inflammatory drugs, otherwise known as NSAIDs. This includes ibuprofen and naproxen sodium.

NSAIDs can alleviate chronic inflammation and pain. Typically you should use it only for short-term flare-ups of pain.

Joint Injections

Many arthritis patients have seen an improvement in their pain with joint injections.

These consist of a corticosteroid injection that may reduce inflammation and pain in the joint. In some cases, you’ll need a series of injections for relief.

Depending on the injection, the type of arthritis, and the severity, you can repeat joint injections to improve your range of motion in your joints. Combine these with physical therapy as well so you have the ability to undergo strengthening exercises with less pain.

Medial Branch Blocks (Facet Joint Arthritis)

Medial branch blocks may help those who suffer from back and neck pain due to this condition (including facet joint arthritis, one of the leading causes of lower back pain in adults).

A medial branch block effectively reduces inflammation and irritation in the joints of the spine, and relief from pain is often immediate. Your doctor can perform medial branch blocks multiple times to help manage your pain.

Joint Replacement

In severe cases and after exhausting more conservative options, you may find relief through full joint replacement.

By replacing the damaged joint with a plastic or metal prosthesis, you may experience a pain-free lifestyle, resuming activities that were previously impossible due to pain.

While knee and hip replacements are the most common, medical technology has advanced to allow for shoulder joint replacements, elbow joint replacements, and finger joint replacements.

While a replacement surgery may relieve pain, recovery time post-surgery is often long and can have complications that are non-existent with less invasive options. Because of this, it’s always best to try less invasive options before undergoing surgery.

Lateral Branch Blocks (Sacroiliac “SI” Joint Arthritis)
Genicular Nerve Blocks (Knee Joint Arthritis)
Femoral and Obturator Articular Nerve Branches Block (Hip Joint Arthritis)
Regenerative Medicine

Additional Resources