Arthritis

Overview

Arthritis isn't a single condition but a broad term for many conditions affecting the joints. Arthritis typically is associated with pain that affects the ability to move a joint. It causes swelling and tenderness of one or more joints. The main symptoms are joint pain and stiffness, which can impact daily activities and work. The most common types are osteoarthritis and rheumatoid arthritis.

Osteoarthritis happens when cartilage — the hard, slippery tissue that cushions the ends of bones at a joint — breaks down.

Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks the joints, beginning with the lining of joints. This leads to inflammation and tissue damage.

Another form of arthritis is gout. Gout is caused by uric acid crystals depositing in the joints due to high levels of uric acid in the blood. And infections or underlying conditions such as psoriasis or lupus also can cause other types of arthritis.

Treatment depends on the type of arthritis, but the main goals are to relieve symptoms and improve quality of life.

Causes

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

Osteoarthritis

Osteoarthritis is the most common type of arthritis. It is caused by damage to the cartilage in a joint. Healthy cartilage allows for nearly frictionless movement. But as cartilage wears down, bones may begin to grind against each other. This leads to pain and reduced mobility. This damage happens over time, but it can be hastened by a joint injury or an infection.

In addition to causing cartilage loss, osteoarthritis may lead to bone changes and the breakdown of connective tissues. Connective tissues support the joint by attaching muscles to bones to keep the joint stable. If cartilage and connective tissues in a joint are damaged, the joint lining may become inflamed and swollen, further increasing discomfort and stiffness.

Rheumatoid arthritis

In rheumatoid arthritis, the body's immune system mistakenly attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining is called the synovial membrane. It becomes inflamed and swollen. Over time, the ongoing immune response may lead to the destruction of cartilage and bone. This results in pain, stiffness and joint damage.

Complications

Advanced arthritis, especially in the hands or arms, can make everyday tasks challenging. When arthritis affects weight-bearing joints, it may cause difficulty walking or keeping proper posture. Over time, arthritis also may lead to changes in joint alignment and shape.

Treatment

Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments or combinations of treatments before you find what works best for you.

Medicines

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

• NSAIDs. Nonsteroidal anti-inflammatory drugs, also called NSAIDs, can relieve pain and reduce inflammation. Examples include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. NSAIDs you take by mouth can cause stomach irritation and may increase your risk of heart attack or stroke. They can affect liver and kidney function and need to be used with caution. NSAIDs also are available as creams or gels, which can be rubbed on joints.
• Counterirritants. Some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. When applied to the skin over a painful joint, these ingredients may help block pain signals, providing temporary relief.
• Steroids. Corticosteroid medicines, such as prednisone, reduce inflammation and pain. And they may slow joint damage. Corticosteroids may be given as a pill or as an injection into a painful joint. Side effects may include thinning of bones, weight gain and diabetes.
• Disease-modifying antirheumatic drugs, also called DMARDs. These medicines can slow the progression of rheumatoid arthritis and change the course of the condition. This may save the joints and other tissues from permanent damage. In addition to conventional DMARDs, there also are biologic agents and targeted synthetic DMARDs. Side effects vary, but most DMARDs increase your risk of infections.

Therapy

Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. Sometimes, splints or braces may be recommended for added support and stability.

Surgery

If medicines and therapy don't help, your healthcare professional may recommend surgery. Common surgeries to treat arthritis include:

• Joint repair. In some people, joint surfaces can be smoothed or aligned again to reduce pain and improve function. These procedures are often done arthroscopically, using small incisions over the joint.
• Joint replacement. This procedure removes the damaged joint and replaces it with an artificial implant. The most commonly replaced joints are hips and knees.
• Joint fusion. Typically used for smaller joints, such as those in the wrist, ankle and fingers, joint fusion removes the ends of two bones and fuses them together. This allows them to heal into a single, rigid unit to relieve pain.

Alternative medicine

Many people use alternative treatments for arthritis, but strong scientific evidence is lacking for many of these approaches. Talk with your healthcare professional about alternative treatments and how they may benefit you. The most common alternative remedies for arthritis include:

• Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce pain, including pain caused by certain types of arthritis.
• Glucosamine. Research results are mixed. Some studies have found that glucosamine works no better than a placebo. But both have been shown to relieve osteoarthritis pain better than taking nothing, particularly in people with moderate to severe knee pain.
• Chondroitin. Chondroitin may provide modest pain relief from osteoarthritis, although study results are mixed.
• Fish oil. Some preliminary studies have found that fish oil supplements may reduce the symptoms of certain types of arthritis. But fish oil can interfere with medicines, so talk with a healthcare professional before taking fish oil.
• Yoga and tai chi. These gentle, stretching-based practices may improve joint flexibility and range of motion.
• Massage. Light stroking and kneading of muscles may increase blood flow and warm affected joints, temporarily relieving pain. Be sure to tell your massage therapist which joints are affected by arthritis.