Arthritis: What You Need to Know
Medically reviewed by L. Anderson, PharmD Last updated on Nov 25, 2018.
What is arthritis?
Arthritis is a condition associated with swelling and inflammation of the joints, which often results in pain and restriction of movement.
Osteoarthritis (OA) is a breakdown of the cartilage in the joints leads to pain. One or more joints may be involved. Loss of cartilage, swelling and inflammation may occur, 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.
- Learn More: Osteoarthritis: Overview and Treatment Options
Rheumatoid arthritis (RA) occurs when the body's immune system starts attacking it's own organs (joints, bones, internal organs) -- and is considered an autoimmune disease. In rheumatoid arthritis an inflammation of the tissue lining the joints (synovium) and in severe cases inflammation of other body tissues occurs. 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 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 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.
- Being overweight
- 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, 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
- Viral arthritis
- Lyme 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.
He or she 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 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 including:
- Cimzia (certolizumab)
- Enbrel, Erelzi (etanercept)
- Humira, Amjevita (adalimumab)
- Remicade, Inflectra, Ixifi, Renflexis (infliximab)
- Simponi (golimumab)
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?
- Singh JA, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research 2016;68:1-25. Accessed Nov. 24, 2018 at http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf
- FDA Approves Ixifi. Drugs.com. Accessed Nov. 25, 2018 at https://www.drugs.com/newdrugs/fda-approves-ixifi-infliximab-qbtx-biosimilar-remicade-4659.html
- FDA Approves Renflexis. Accessed Nov. 25, 2018 at https://www.drugs.com/newdrugs/fda-approves-renflexis-infliximab-abda-biosimilar-remicade-4519.html
- Drugs.com Rheumatoid Arthritis. Accessed Nov. 25, 2018 at https://www.drugs.com/rheumatoid-arthritis.html
- Up To Date. Patient Information: Rheumatoid Arthritis symptoms and diagnosis (Beyond the Basics). Accessed Nov. 25, 2018 at uptodate.com/homeindexcontents/rheumatoid-arthritis-treatment-beyond-the-basics
- Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip and Knee. Arthritis Care Res 2012;64:465-74. DOI 10.1002/acr.21596.
- Arthritis Foundation. Disease Center. Osteoarthritis. Accessed June 23, 2018 at http://www.arthritis.org/about-arthritis/types/osteoarthritis/
- Derry S., Moore RA., Rabbie R. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2012;9:CD007400. doi: 10.1002/14651858.CD007400.pub2
- Up to Date. Patient Information: Osteoarthritis treatment (Beyond the Basics). Updated April 16, 2014. Accessed Nov. 24, 2018 at uptodate.com/homeindexcontents/osteoarthritis-treatment-beyond-the-basics
- National Library of Medicine. MedlinePlus. Osteoarthritis. Accessed Nov. 26, 2018 at http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
- Wang TJ, Belza B, Thompson E, et al. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. J Adv Nurs. 2007;57:141-52.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.