Arthritis: What You Need to Know
What is arthritis?
Arthritis is a condition associated with swelling and inflammation of the joints, which often results in pain and restriction of movement. In osteoarthritis (OA), a breakdown of the cartilage in the joints leads to pain. Rheumatoid arthritis (RA) occurs when the body's immune system attacks its own organs (joints, bones, internal organs), and is considered an autoimmune disease.
Osteoarthritis (OA) affects one or more joints and can result in loss of cartilage, swelling and inflammation resulting in pain, stiffness, and trouble easily moving the joint. Osteoarthritis is the most common type of arthritis and is more likely to occur with advancing age. It can occur in any of the joints but is most common in the hips, knees, spine, and hands.
In rheumatoid arthritis (RA) an inflammation of the tissue lining the joints (synovium) occurs. In severe cases, inflammation of other body tissues can arise. An erosion of the bone and cartilage, pain, stiffness and limitations in the range of joint movement also occur with RA.
In the most simple terms, arthritis is a result of a breakdown in cartilage associated with inflammation. Cartilage protects joints and enables smooth movement by absorbing shock when pressure is placed on a joint. Without the usual amount of cartilage, the bones rub together to cause pain, swelling (inflammation), and stiffness.
Joint inflammation can occur for a variety of reasons, including:
- broken bones
- infections (usually caused by bacteria or viruses)
- an autoimmune disease (where the immune system attacks the body itself)
- general "wear and tear" on joints
In acute disease, the inflammation usually goes away once the injury has healed, the disease is treated, or once the infection has been cleared. However, with some injuries and diseases, the inflammation does not go away or the cartilage is destroyed and long-term pain and deformity results. When this happens, the disease is called chronic arthritis.
- overweight, obese
- age over 50 years
- having previously injured the affected joint, or a bone deformity
- using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers, and construction workers are all at risk)
- being female
- age between 40 and 60 years
- genetics or family history
- environmental exposures, such as silica or asbestos
Arthritis can occur in both men and women of any age. Some forms of arthritis also affect children, such as juvenile rheumatoid arthritis.
Types of arthritis
There are numerous forms of arthritis, including:
- rheumatoid arthritis
- systemic lupus erythematosus (SLE)
- psoriatic arthritis
- ankylosing spondylitis
- Reiter's syndrome (reactive arthritis)
- adult Still's disease
- infectious arthritis
- lyme disease arthritis
- tuberculous arthritis
- juvenile rheumatoid arthritis
Symptoms of arthritis
A person suffering from arthritis may experience any of the following:
- joint pain and swelling
- stiffness, especially in the morning, that may improve with movement
- warmth around a joint
- redness of the skin around a joint
- reduced ability to move the joint
- loss of a range-of-motion with joint use
Getting an accurate diagnosis is important. If arthritis is diagnosed and treated early, you can often prevent further joint damage.
At your appointment, the doctor will first note your symptoms and will then look at your medical history in detail to see if arthritis or another musculoskeletal problem is the likely cause of those symptoms.
Your doctor will then perform a thorough physical examination to see if there is any fluid collecting around the joint (an abnormal build up of fluid around a joint is called "joint effusion").
- The joint may be tender when gently pressed, and it may also be warm and red (especially if you have infectious arthritis or autoimmune arthritis).
- You may also find it painful or difficult to rotate the joints in some directions (this is known as "limited range-of-motion").
After this initial physical examination, your doctor may then ask you to undertake a number of different tests, depending on what they suspect to be the cause of your symptoms.
- Often, you will need to have a blood test and joint x-rays.
- You may also need to have a test where joint fluid is removed from the joint with a needle; the fluid will then be examined under a microscope to check for infection and for other causes of arthritis, such as crystals, which cause gout.
If you have a family history of arthritis, share this information with your doctor, even if you have no joint symptoms.
- In some autoimmune forms of arthritis, such as rheumatoid arthritis, the joints may become deformed if the disease is not treated.
- Osteoarthritis may be more likely to develop with over-use of your joints. Take care not to overwork a damaged or sore joint. Similarly, avoid excessive repetitive motions.
- Excess weight also increases the risk for developing osteoarthritis in the knees, and possibly in the hips and hands.
- Exercise and physical therapy may still be important components of your care, so be sure to discuss this with your doctor.
The treatment of arthritis depends on the particular cause of the disease, which joints are affected, the severity of the disorder, and the effect it has on your daily activities. Your age and occupation will also be taken into consideration when your doctor works with you to create a treatment plan.
- If possible, treatment will focus on eliminating the underlying cause of the arthritis. However, sometimes the cause is not curable, as with osteoarthritis and rheumatoid arthritis. In this case, the aim of treatment will be to reduce pain and discomfort and prevent further disability.
- Symptoms of osteoarthritis and other long-term types of arthritis can often be improved without medications. Making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation.
- If needed, medications should be used in addition to lifestyle changes, such as exercise, therapy, and weight loss.
Your doctor will select the most appropriate medication for your form of arthritis based on your medical history and preferences.
The most common types of medications used for treatment of osteoarthritis include:
- acetaminophen (Tylenol, others)
- NSAIDs (Non-steroidal anti-inflammatory drugs)
- COX-2 inhibitors
- topical pain relief agents
- corticosteroids and intra-articular corticosteroid injections
- non-prescription herbal and dietary supplements
- artificial joint fluid (viscosupplementation agents)
Effective agents available for controlling rheumatoid arthritis include:
TNF alfa inhibitors for rheumatoid arthritis include brand agents and biosimilars that lessen inflammation such as:
- Cimzia (certolizumab)
- Enbrel, Erelzi, Eticovo (etanercept and biosimilars)
- Humira, Hadlima, Abrilada, Amjevita, Hulio, Cyltezo, Hyrimoz (adalimumab and biosimilars)
- Remicade, Inflectra, Ixifi, Renflexis, Avsola (infliximab and biosimilars)
- Simponi (golimumab)
Other options include:
Rinvoq (upadacitinib): In August 2019 , Rinvoq, a once a day Janus kinase (JAK) inhibitor was approved to treat adults with moderate-to-severe rheumatoid arthritis (RA) who have had an inadequate response or intolerance to methotrexate (MTX-IR).
Olumiant (baricitinib): In June 2018, the FDA cleared Olumiant, a once-daily oral medicine for adults with moderate-to-severe RA and an inadequate response to TNF inhibitors. Like Xeljanz (tofacitinib), Olumiant is a Janus kinase (JAK) inhibitor. Olumiant may be used alone or in combination with methotrexate or other non-biologic DMARDs.
Kevzara (sarilumab): Approved in May 2017, Kevzara is an interleukin-6 receptor (IL-6R) antagonist for the treatment of patients with moderate-to-severe rheumatoid arthritis who have had an inadequate response or cannot tolerate one or more disease-modifying antirheumatic drugs (DMARDs). Kevzara may be used alone or in combination with methotrexate (MTX) or other conventional DMARDs.
For more treatment options, see: Rheumatoid Arthritis: Overview and Treatments
Non-drug treatment is also important and may be used in conjunction with medications. It is important to make lifestyle changes to help ease symptoms of pain. In fact, for some patients, physical therapy and regular exercise may control pain without medications.
- Exercise helps maintain joint and overall mobility. Ask your health care provider to recommend an appropriate home exercise routine.
- Water exercises, such as swimming, are especially helpful. You also need to balance rest with activity. Non-drug pain relief techniques may help to control pain.
- Heat and cold treatments, protection of the joints and the use of self-help devices are recommended.
- Good nutrition and careful weight control are important. Weight loss for overweight individuals will reduce the strain placed on the knee, spine and ankle joints.
- Physical therapy sessions
- Braces or orthotics
- Surgery or joint replacement is usually used only when other options have failed.
See your doctor if:
- Your joint pain persists beyond 3 days.
- You have severe unexplained joint pain.
- The affected joint is significantly swollen.
- You have a fever.
- You have a hard time moving the joint.
- Your skin around the joint is red or hot to the touch.
- You have lost weight unintentionally.
- Fact or Fiction? The Top 15 Osteoarthritis Myths
- Drug Treatments for Rheumatoid Arthritis: What Are Your Options?
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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.