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21 Arthritis Facts: It's A Game Changer

Medically reviewed on Feb 10, 2018 by L. Anderson, PharmD.

Do You Really Know What Arthritis Is?

Arthritis is so common almost everyone thinks they know what it is, but "arthritis" is really many different conditions.

The most common forms of arthritis are osteoarthritis, which is a breakdown of the cartilage in the joints due to wear-and-tear over time, and rheumatoid arthritis, which is an autoimmune disease leading to inflammation of the tissue lining the joints, and inflammation of other body tissues in the most severe cases.

Rheumatoid arthritis and osteoarthritis may be confused because they are both often just referred to as "arthritis." But in fact, they are very different types of arthritis, with different causes, symptoms and treatments.

Arthritis Facts: It's A Game-Changer

Arthritis is common - in fact, as reported by the CDC in 2017, an estimated 54.4 million US adults (1 in 4 adults) have arthritis: including osteoarthritis, rheumatoid arthritis, gout, lupus or fibromyalgia - all forms of arthritis.

Arthritis punches a hefty price tag, too: it costs at least $81 billion in direct medical costs annually. And the number of people dealing with arthritis is growing - by 2040, an estimated 78 million (26%) of US adults are projected to have doctor-diagnosed arthritis, and the disability and costs that go along with it.

Arthritis Awareness: Get Up to Speed

National Arthritis Awareness Month is held each spring and encompasses a series of walks held throughout the country by the Arthritis Foundation to increase knowledge of the nation's leading cause of disability. The "Walk to Cure Arthritis" fundraiser is held each spring and summer and raises millions for arthritis research.

Warm weather is the best time to get outside and walk - because walking is one of the best exercises for people with arthritis. Walk With Ease (WWE) is a program designed to help people manage their arthritis pain. Follow along to learn more about this disease that impacts quality of life, and learn how you can get out and walk!

Rheumatoid Arthritis: Explained

Rheumatoid arthritis (RA) occurs when the body's immune system starts attacking itself in areas like the joints, bones, and internal organs. RA leads to inflammation of the joints in areas like the hands, feet or wrist. The joints become painful, stiff, and tender and may feel warm or look red.

Normally, inflammation is a normal process used for repair of injury or illness. However, in an autoimmune disease like RA, healthy tissues are attacked. Maybe you've seen the way joints can become twisted and deformed in RA due to this destruction.

RA cannot be cured but there are treatments that help control the pain, inflammation and joint destruction. RA differs from osteoarthritis, which is due to the wear-and tear on the joints and cartilage over time.

Osteoarthritis: Explained

Osteoarthritis (OA) is what many people are thinking of when they talk about of arthritis. The aching pain in your knees, hips and back - often noticed with a change in weather - is usually due to osteoarthritis.

OA becomes more common with age and is due in part to the gradual wear and tear of cartilage (bone cushion) in the joints. Injuries, obesity, a family history and weak muscles can play a part in OA development, and symptoms can occur at a younger age, too.

OA most commonly occurs in the hands, knees, hips and spine with symptoms of pain, joint stiffness, and possibly swelling due to fluid accumulation.

Arthritis is Widespread: Other Types of Arthritis

The most common forms of arthritis are osteoarthritis and rheumatoid arthritis, but there are many other conditions (some autoimmune) that may have an arthritis component, including:

Got These Symptoms? See Your Doc

If you are suffering from arthritis you may have these common symptoms:

  • Joint pain
  • Swelling
  • Early morning stiffness
  • A warm, hot and/or red joint
  • Reduced ability to move the joint
  • Many joints affected
  • Fatigue

For some forms of arthritis, like rheumatoid arthritis, early treatment is best to help prevent joint damage, so make an appointment to get checked out. See your doctor if any joint pain persists beyond 3 days, too.

How Is Arthritis Diagnosed?

A family history is important to know, so your doctor may ask about close relatives with arthritis.

Your doctor will also ask you about your symptoms.

  • Do you have pain and swelling?
  • How about morning stiffness?
  • Do your joints feel hot to the touch?
  • Are your joints red?

A physical exam will determine your range-of-motion - just how easily can you rotate your joints around? Blood tests and x-rays of your joints may be needed.

If you have fluid around your joints, your doctor may remove some with a needle to look for infection or other causes of arthritis, such as crystals, which cause gout.

Treatments for Arthritis: The Options

Ultimately, you and your doctor will select the most appropriate medication for your specific form of arthritis. Your treatment may be as simple as occasional use of:

  • Over-the-counter (OTC) medicines like NSAIDs or acetaminophen (Tylenol).
  • Prescription NSAIDs
  • Anti-inflammatory corticosteroids
  • Disease Modifying Anti-Rheumatic Drugs (DMARDs) for rheumatoid arthritis.
  • Rarely, very short-term use of narcotic painkillers may be used to ease a flare-up; although many clinicians strongly discourage use of opioids due to side effects and concern for misuse.

Topical capsaicin or topical diclofenac (Voltaren Gel) may help relieve the symptoms of OA, and injectable joint lubricators such as hyaluronan (Orthovisc, Synvisc) may relieve OA pain for up to six months.

OTC Arthritis Pain Options

Mild pain relievers, such as over-the-counter acetaminophen (Tylenol) or NSAIDs (like Advil or Motrin) are effective for mild or intermittent forms of arthritis and may be most affordable.

Acetaminophen reduces mild pain but does not help with inflammation or swelling like Advil or Motrin. However, acetaminophen may show success in patients with milder forms of osteoarthritis. These agents may also be used with other medications for more severe forms of arthritis, like rheumatoid arthritis.

An excessive dose of acetaminophen, and mixing with alcohol, can lead to liver toxicity. High doses and long-term use of NSAIDs can cause side effects like stomach ulcers and bleeding, so be sure to check with your doctor for the appropriate dose.

Prescription NSAIDs

There are many NSAIDs on the market that require a prescription if OTC products don't do the trick, but they can be associated with serious bleeding side effects, too. For example, piroxicam (Feldene), fenoprofen (Nalfon), or indomethacin (Indocin) may be options. Celebrex (celecoxib), somewhat safer for the stomach, is now available in generic form.

However, just like the OTC NSAIDs, these agents can still be linked with stomach ulceration and bleeding. Also, the FDA asked manufacturers of all NSAIDs to include a warning label on their products that alerts users to an increased risk of cardiovascular events (heart attacks and strokes) and stomach bleeding.

Glucosamine and Chondroitin: Worthy of Your Dollars?

The use of glucosamine and chondroitin for the treatment of osteoarthritis (OA) is controversial even though they are widely marketed and used in the U.S.

Research has yielded conflicting results on the benefits of glucosamine and chondroitin. In general, research on chondroitin has not shown it to be helpful for pain from knee or hip osteoarthritis. In an NIH study, patients with mild knee osteoarthritis were given either glucosamine hydrochloride, chondroitin, both supplements together, celecoxib, or a placebo (an inactive substance).

Those who received celecoxib had better short-term pain relief (at 6 months) than those who received a placebo. But those who received the supplements had no significant improvement in knee pain or function, although the investigators saw evidence of improvement in a small subgroup of patients with moderate-to-severe pain who took glucosamine and chondroitin together.

These agents have few toxic side effects so your doctor may agree to a trial of use. There may be a risk of an interaction with the anticoagulant drug warfarin (Coumadin). Patients who are allergic to shellfish should not use glucosamine. Treatment should be stopped after 6 months if there is no positive effect on OA symptoms.

The Pros and Cons of Corticosteroids

Short-term oral therapy with corticosteroids may be used to lessen the pain and inflammation in arthritis. An advantage to corticosteroid use, like prednisone, is that other RA medications can be combined with treatment. Steroid injections (methylprednisolone, triamcinolone) into the joint can also reduce pain and inflammation, but they may not be effective for every patient. A 2017 study in hip arthritis shows that steroid injections caused bone death 3 to 9 months later, although researchers suggest more data is needed.

The combination of oral corticosteroids and NSAIDs should be avoided due to a risk of stomach ulcers and bleeding. Long-term use of corticosteroids can be problematic, too: bruising, psychosis, cataracts, weight gain, infections, diabetes, high blood pressure and osteoporosis (bone loss) can occur.

Rheumatoid Arthritis Therapy: Limit Joint Damage Early

Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to pain, swelling and destruction of joint tissues. RA usually occurs in people between the ages of 20 and 50 years old, but it can affect children and seniors, too. At least three-quarters of people afflicted with RA are women.

Minimizing pain, inflammation and joint damage are the top goals of RA treatment. Plus, the treatment of RA has significantly improved in the last 50 years -- treatments have allowed patients to control pain, remain active, and limit progressive joint destruction.

DMARDs: The Backbone of RA Therapy

Non-biologic disease-modifying anti-rheumatic drugs (DMARDs) are the anchor drugs used for treatment of rheumatoid arthritis (RA), but their full effect may take one to three months. DMARDs decrease inflammation, lessen joint damage, and help to maintain joint function.

Methotrexate (MTX) is a first-line DMARD that is often used in conjunction with an NSAID or glucocorticoid anti-inflammatory while MTX takes affect. MTX is usually taken once per week as a pill or injection.

Other oral non-biologic DMARDs include:

  • hydroxychloroquine
  • leflunomide
  • sulfasalazine

Biologic DMARDs: An Advance in Treatment

What if your rheumatoid arthritis (RA) does not respond to the nonbiologic DMARDs? Another nonbiologic DMARD might be added, or a biologic can be tried alone or added to the nonbiologic DMARD.

The biologics are additional treatments for patients with a low initial response or who have severe RA disease. Most biologics are given by injection and can be added to non-biologic DMARDs, NSAIDs or corticosteriods.

Biologic DMARD examples include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), abatacept (Orencia), certolizumab (Cimzia), golimumab (Simponi), rituximab (Rituxan), and tocilizumab (Actemra).

Several biologics are now approved as biosimilars, too:

  • Amjevita (adalimumab-atto) and Cyltezo (adalimumab-adbm), both biosimilars to Humira
  • Renflexis (infliximab-abda), Inflectra (infliximab-dyyb), and Ixifi (infliximab-qbtx), all biosimilars to Remicade
  • Erelzi (etanercept-szzs), a biosimilar to Enbrel

How Do Biologics Affect Rheumatoid Arthritis?

Inflammation, pain, and joint destruction are the main culprits in rheumatoid arthritis. Biologics act to target proteins in the immune system that lead to this destructive path.

Learn More: Biologic Drug Treatment for Rheumatoid Arthritis: What Are Your Options?

The use of TNF blockers like Enbrel, Remicade, Humira, Simponi, and Cimzia, or the biosimilars, with or without methotrexate, is recommended for patients with early RA whose symptoms are more severe or do not have a good effect with non-biologic DMARDs.

Orencia, Rituxan, Kineret, Actemra and the newer oral Xeljanz are non-TNF biologics and target other immune system molecules; they may be used if a TNF blocker plus methotrexate is not adequate.

What Should I Know Before Starting a TNF Blocker?

TNF blockers can lower the infection-fighting ability of your immune system. It is important you report any signs of infection, such as a fever, to your healthcare provider. Also report any night sweats or weight loss that occurs during treatment.

Review your vaccination history with your doctor as you may need to update your vaccinations before biologic treatment begins.

Tell your doctor if you have a history of congestive heart failure (CHF), cancer or hepatitis. You will also be tested for tuberculosis (TB) before starting a biologic agent.

Non-Drug Therapies for Arthritis

Medication is only one component for the treatment of arthritis. The phrase "use it or lose it" really applies here.

Joint pain, inflammation, and stiffness often keep patients from using their affected joints. However, a regular pattern of exercise or physical therapy, range of motion exercises, and resting of inflamed joints are important added components to drug therapy. Non-weight bearing exercises like cycling or swimming can be helpful for those who experienve pain while walking.

Occupational therapy, general education programs, and strategies for preserving joint function can be helpful to control pain, depressed mood, and limits in the activities of daily living.

Can Your Arthritis Symptoms Predict the Weather?

Fact or myth? People with arthritis may be able to tell you when the weather will turn cold or rainy better than your local meteorologist.

Patients with arthritis will swear by this statement, although it is frequently challenged by scientists. However, some studies show that weather changes, like falling barometric pressure and temperature drops can increase pain. Tufts New England Medical Center conducted research and found that for every 10 degree drop in temperature an incremental increase in arthritis pain occurred.

Researchers suspect the reason these changes may happen is because atmospheric changes like a falling barometric pressure can increase swelling in the joint capsule. It simply could be chance too.

Is There Any Way to Prevent Arthritis?

Older age, family history, and being female are all unchangeable risk factors for arthritis. However, there are a few things you can do to help keep arthritis at bay.

Know that excess weight may increase the risk for osteoarthritis in the knees, hips and hands. Also, osteoarthritis may be more likely to develop if you overwork a damaged or sore joint and engage in excessive, repetitive motions.

Next, get a correct diagnosis. Early treatment for rheumatoid arthritis (RA) can help to prevent disabling joint damage. Regular exercise, controlling your weight, and healthy food choices can also help keep your joints strong, even after you are diagnosed with arthritis.

Finally, consider joining the Support Group for either Osteoarthritis or Rheumatoid Arthritis to ask questions and educate yourself on the latest research, news, and treatment recommendations.

Finished: 21 Arthritis Facts: It's A Game Changer

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