Arthritis: Causes, types, and treatments

Arthritis means joint inflammation, but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. It is a rheumatic condition.

The most common form of arthritis is osteoarthritis. Other common rheumatic conditions related to arthritis include gout, fibromyalgia, and rheumatoid arthritis (RA).

Rheumatic conditions tend to involve pain, aching, stiffness, and swelling in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Some forms of arthritis, such as rheumatoid arthritis and lupus (SLE), can affect multiple organs and cause widespread symptoms.

According to the Centers for Disease Control and Prevention (CDC), 54.4 million adults in the United States have received a diagnosis of some form of arthritis. Of these, 23.7 million people have their activity curtailed in some way by their condition.

Arthritis is more common among adults aged 65 years or older, but it can affect people of all ages, including children.

Fast facts on arthritis

Here are some key points about arthritis. More detail is in the main article.

Arthritis refers to around 200 rheumatic diseases and conditions that affect joints, including lupus and rheumatoid arthritis.

It can cause a range of symptoms and impair a person’s ability to perform everyday tasks.

Physical activity has a positive effect on arthritis and can improve pain, function, and mental health.

Factors in the development of arthritis include injury, abnormal metabolism, genetic makeup, infections, and immune system dysfunction.

Treatment aims to control pain, minimize joint damage, and improve or maintain quality of life. It involves medications, physical therapies, and patient education and support.

Treatment

woman receiving physical therapy on hand
The doctor will likely recommend a course of physical therapies to help you manage some of the symptoms of arthritis.

Treatment for arthritis aims to control pain, minimize joint damage, and improve or maintain function and quality of life.

A range of medications and lifestyle strategies can help achieve this and protect joints from further damage.

Treatment might involve:

medications

non-pharmacologic therapies

physical or occupational therapy

splints or joint assistive aids

patient education and support

weight loss

surgery, including joint replacement

Medication

Non-inflammatory types of arthritis, such as osteoarthritis, are often treated with pain-reducing medications, physical activity, weight loss if the person is overweight, and self-management education.

These treatments are also applied to inflammatory types of arthritis, such as RA, along with anti-inflammatory medications such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and a relatively new class of drugs known as biologics.

Medications will depend on the type of arthritis. Commonly used drugs include:

Analgesics: these reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab). Tylenol is available to purchase online.

Non-steroidal anti-inflammatory drugs (NSAIDs): these reduce both pain and inflammation. NSAIDs include available to purchase over-the-counter or online, includeing ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Some NSAIDs are available as creams, gels or patches which can be applied to specific joints.

Counterirritants: some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these on the skin over a painful joint can modulate pain signals from the joint and lessen pain. Various creams are available to purchase online.

Disease-modifying antirheumatic drugs (DMARDs): used to treat RA, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).

Biologics: used with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).

Corticosteroids: prednisone and cortisone reduce inflammation and suppress the immune system.

inflamed female joints
Inflammatory arthritis can affect several joints, damaging the surface of the joints and the underlying bone.

Inflammatory arthritis is characterized by damaging inflammation that does not occur as a normal reaction to injury or infection. This type of inflammation is unhelpful and instead causes damage in the affected joints, resulting in pain, stiffness and swelling.

Inflammatory arthritis can affect several joints, and the inflammation can damage the surface of the joints and also the underlying bone.

Examples of inflammatory arthritis include:

Rheumatoid arthritis (RA)

Reactive arthritis

Ankylosing spondylitis

Arthritis associated with colitis or psoriasis

The word “arthritis” means “joint inflammation,” but inflammation may also affect the tendons and ligaments surrounding the joint.

Degenerative or mechanical arthritis

Degenerative or mechanical arthritis refers to a group of conditions that mainly involve damage to the cartilage that covers the ends of the bones.

The main job of the smooth, slippery cartilage is to help the joints glide and move smoothly. This type of arthritis causes the cartilage to become thinner and rougher.

To compensate for the loss of cartilage and changes in joint function, the body begins to remodel the bone in an attempt to restore stability. This can cause undesirable bony growths to develop, called osteophytes. The joint can become misshapen. This condition is commonly called osteoarthritis.

Osteoarthritis can also result from previous damage to the joint such as a fracture or previous inflammation in the joint.

Soft tissue musculoskeletal pain

Soft tissue musculoskeletal pain is felt in tissues other than the joints and bones. The pain often affects a part of the body following injury or overuse, such as tennis elbow, and originates from the muscles or soft tissues supporting the joints.

Pain that is more widespread and associated with other symptoms may indicate fibromyalgia.

Back pain

Back pain can arise from the muscles, discs, nerves, ligaments, bones, or joints. Back pain may stem from problems with organs inside the body. It can also be a result of referred pain, for example, when a problem elsewhere in the body leads to pain in the back.

There may be a specific cause, such as osteoarthritis. This is often called spondylosis when it occurs in the spine. Imaging tests or a physical examination may detect this.

A “slipped” disc is another cause of back pain, as is osteoporosis, or thinning of the bones.

If a doctor cannot identify the exact cause of back pain, it is often described as “non-specific” pain.

Connective tissue disease (CTD)

Connective tissues support, bind together, or separate other body tissues and organs. They include tendons, ligaments, and cartilage.

CTD involves joint pain and inflammation. The inflammation may also occur in other tissues, including the skin, muscles, lungs, and kidneys. This can result in various symptoms besides painful joints, and it may require consultation with a number of different specialists.

Examples of CTD include:

SLE, or lupus

scleroderma, or systemic sclerosis

dermatomyositis.


Infectious arthritis

A bacterium, virus, or fungus that enters a joint can sometimes cause inflammation.

Organisms that can infect joints include:

Salmonella and Shigella, spread through food poisoning or contamination

chlamydia and gonorrhea, which are sexually transmitted diseases (STDs)

hepatitis C, a blood-to-blood infection that may be spread through shared needles or transfusions

A joint infection can often be cleared with antibiotics or other antimicrobial medication. However, the arthritis can sometimes become chronic, and joint damage may be irreversible if the infection has persisted for some time.

Metabolic arthritis

Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in human cells and several foods.

Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine. Some people have high levels of uric, acid because they either naturally produce more than they need or their body cannot clear the uric acid quickly enough.

Uric acid builds up and accumulates in some people and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout attack.

Gout can either come and go in episodes or become chronic if uric acid levels are not reduced.

It commonly affects a single joint or a small number of joints, such as the big toe and hands. It usually affects the extremities. One theory is that uric acid crystals form in cooler joints, away from the main warmth of the body.

Some of the more common types of arthritis are discussed below.

Rheumatoid arthritis

comparison of osteoarthritis and rheumatoid arthritis
Rheumatoid arthritis and osteoarthritis share some characteristics, but they are different conditions.

Rheumatoid arthritis (RA) occurs when the body’s immune system attacks the tissues of the body, specifically connective tissue, leading to joint inflammation, pain, and degeneration of the joint tissue.

Cartilage is a flexible, connective tissue in joints that absorb the pressure and shock created by movement like running and walking. It also protects the joints and allows for smooth movement.

Persistent inflammation in the synovia leads to the degeneration of cartilage and bone. This can then lead to joint deformity, pain, swelling, and redness.

RA can appear at any age and is associated with fatigue and prolonged stiffness after rest.

RA causes premature mortality and disability and it can compromise quality of life. Conditions it is linked to include cardiovascular diseases, such as ischemic heart disease and stroke.

Diagnosing RA early gives a better chance of learning how to manage symptoms successfully. This can reduce the impact of the disease on quality of life.

Osteoarthritis

comparison of healthy joint and joint with osteoarthritis
Osteoarthritis is caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life.

Osteoarthritis is a common degenerative joint disease that affects the cartilage, joint lining and ligaments, and underlying bone of a joint.

The breakdown of these tissues eventually leads to pain and joint stiffness.

The joints most often affected by osteoarthritis are those that get heavy use, such as hips, knees, hands, the spine, the base of the thumb, and the big toe joint.

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