Arthritis is inflammation
of one or more of your joints, such as one or both knees or wrists, or a
part of your spinal column. The two most common types of arthritis are
osteoarthritis and rheumatoid arthritis. Joint pain and stiffness are
the main symptoms of arthritis.
Less common types of arthritis may be associated with conditions that
also affect other parts of your body. For example, lupus can affect the
kidneys and lungs, in addition to joints, while psoriasis is primarily a
skin disease that sometimes also affects joints.
The most common signs and symptoms of arthritis involve the joints.
Depending on the type of arthritis you have, your joint symptoms may
* Decreased range of motion
Some types of arthritis are accompanied by signs and symptoms involving other parts of your body. These symptoms may include:
* Weight loss
* Breathing problems
* Dry eyes and mouth
* Night sweats
The pain associated with arthritis is caused by joint damage. Joints are made up of the following parts:
* Cartilage. A hard, but slick, coating on the ends of bones,
cartilage allows bones of the joint to slide smoothly over each other.
* Joint capsule. This tough membrane encloses all the joint parts.
* Synovium. This thin membrane lines the joint capsule and secretes synovial fluid, which lubricates the joint.
How arthritis damages joints
The two main types of arthritis damage joints in different ways.
* Osteoarthritis. In osteoarthritis, wear-and-tear damage to
cartilage 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.
* Rheumatoid arthritis. In rheumatoid arthritis, the body's immune
system attacks joints and inflames the synovium, causing swelling,
redness and pain. The disease can eventually destroy cartilage and bone
within the joint.
Risk factors for arthritis include:
* Family history. Some types of arthritis run in families, so you
may be more likely to develop arthritis if your parents or siblings have
the disorder. While your genes don't actually cause arthritis, they can
make you more susceptible to environmental factors that may trigger
* Age. The risk of many types of arthritis — including osteoarthritis, rheumatoid arthritis and gout — increases with age.
* Sex. Women are more likely than are men to develop rheumatoid arthritis, while most of the people who have gout 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. Obese people have a higher risk
of developing arthritis.
Severe arthritis, particularly if it affects your hands or arms, can
make it difficult for you to take care of daily tasks. Arthritis of
weight-bearing joints can keep you from walking comfortably or sitting
up straight. In some cases, joints may become twisted and deformed.
Preparing for your appointment
While you might first discuss your symptoms with your family doctor, he
or she may refer you to a rheumatologist — a doctor who specializes in
the treatment of arthritis and other inflammatory conditions — for
What you can do
Because appointments can be brief, plan ahead and write a list that includes:
* Detailed descriptions of your symptoms, including when they started and if anything makes them better or worse
* Information about medical problems you've had in the past
* Information about the medical problems of your parents or siblings
* All the medications and dietary supplements you take
* Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor will check your joints for
swelling, redness and warmth. He or she will also want to see how well
you can move your joints.
Tests and diagnosis
Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.
The analysis of different types of body fluids can help pinpoint the
type of arthritis you may have. Fluids commonly analyzed include:
* Joint fluid
To obtain a sample of your joint fluid, your doctor will cleanse and
numb your skin, and then insert a needle into your joint space to
withdraw some fluid.
These types of tests can detect problems within your joint that may be causing your symptoms. Examples include:
* X-rays. Using low levels of radiation to visualize bone, X-rays
can show cartilage loss, bone damage and bone spurs. X-rays may not
reveal early arthritic damage, but are often used to track progression
of the disease.
* Magnetic resonance imaging (MRI). Combining radio waves with a
strong magnetic field, MRI can visualize soft tissues such as cartilage,
tendons and ligaments as well as bone.
In some cases, your doctor may look for damage in your joint by
inserting a small, flexible tube — called an arthroscope — through an
incision near your joint. The arthroscope transmits images from inside
the joint to a video screen.
Treatments and drugs
Arthritis treatment focuses on relieving symptoms and improving joint
function. You may need to try several different treatments, or
combinations of treatments, before you determine what works best for
The medications used to treat arthritis vary, depending on the type of arthritis. Commonly used arthritis medications include:
* Analgesics. These types of medications help reduce pain, but have
no effect on inflammation. Examples include acetaminophen (Tylenol,
others), tramadol (Ultram) and narcotics like oxycodone (Percocet) and
* Counterirritants. Some varieties of creams and ointments contain a
substance such as 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
* Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both
pain and inflammation. Over-the-counter NSAIDs include aspirin,
ibuprofen and naproxen. Some types of NSAIDs are available only by
prescription. Oral NSAIDs can cause stomach irritation, and some may
increase your risk of heart attack or stroke. Some NSAIDs are also
available as creams or gels, which can be rubbed on joints.
* 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) and
* Biologics. Typically used in conjunction with DMARDs, biologic
response modifiers are genetically engineered drugs that suppress the
immune system. Examples include TNF blockers such as etanercept (Enbrel)
and infliximab (Remicade).
* Corticosteroids. This class of drug, which includes prednisone and
cortisone, reduces inflammation and suppresses the immune system.
Corticosteroids can be taken orally or be injected directly into the
Physical therapy can be helpful for some types of arthritis. Exercises
can improve range of motion and strengthen the muscles surrounding
joints. In some cases, splints or braces may be warranted.
If more-conservative measures don't help, your doctor may suggest surgery, such as:
* Synovium removal (synovectomy). Rheumatoid arthritis causes the
joint capsule's lining, called the synovium, to swell — particularly in
the wrists, hands and fingers. Removing the synovium may slow joint
* Joint replacement. This procedure removes your damaged joint and
replaces it with an artificial one. Joints most commonly replaced are
hips and knees.
* Joint fusion. This procedure is more often used for smaller
joints, such as those in the wrist, ankle and fingers. It removes the
ends of the two bones in the joint and then locks those ends together
until they heal into one rigid unit.
Lifestyle and home remedies
* Weight loss. If you're obese, losing weight will reduce the stress
on your weight-bearing joints. This may increase your mobility and
limit future joint injury.
* Exercise. Regular exercise can help keep your joints flexible.
Swimming or water aerobics is often a good choice because the buoyancy
of the water reduces stress on weight-bearing joints.
* Heat and cold. Heating pads or ice packs may help relieve arthritis pain.
* Assistive devices. Using canes, walkers, raised toilet seats and
other assistive devices can help protect your joints and improve your
ability to perform daily tasks.
Many people use alternative remedies for arthritis, but there is little
reliable evidence to support the use of many of these products. Some
alternative remedies appear to reduce the symptoms of some types of
arthritis but not others. The most promising alternative remedies for
* Glucosamine. Although study results have been mixed, many experts
now recommend this nutritional supplement as a first-line treatment for
* Acupuncture. This therapy uses fine needles inserted at specific
points on the skin to reduce many types of pain, including that caused
by some types of arthritis.
* Transcutaneous electrical nerve stimulation (TENS). Using a small
device that produces mild electrical pulses, TENS therapy stimulates
nerves near the aching joint and may interfere with the transmission of
pain signals to the brain.
Coping and support
The pain and disability associated with arthritis can be frustrating and
depressing. In many cases, it may help to talk about your feelings with
people who are facing the same problems.
While there is no proven way to prevent arthritis, maintaining a healthy
weight and exercising regularly may help reduce your risk.
People who have gout should avoid:
* Organ meats, such as liver and kidney