The Facts

Arthritis is a chronic disorder that affects 1 in 7 Canadians, half of whom are between the ages of 30 to 50 years old. The word arthritis is derived from the Greek words arthron for "joint" and itis for "inflammation." Today, the term is used for over 100 different varieties of joint problems that have specific symptoms, such as pain, swelling, and stiffness.

Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common types of arthritic conditions. Other types of arthritis include gout, ankylosing spondylitis, systemic lupus erythematosus (SLE or lupus), and psoriatic arthritis.

The effects of arthritis are often mild, but in some cases they can be crippling. RA affects 1 to 2 out of every 100 people, with more women than men being affected. Joints and other organs may be affected by this form of arthritis. The Arthritis Foundation estimates that almost every person over the age of 60 years probably has OA to some degree, but fewer than half have it severe enough to notice any symptoms. OA occurs equally in both sexes but in people under 45 years of age, it is more common in men.

Causes

Some types of arthritis are genetic or inherited (i.e., they tend to run in families). Others are related to a chemical imbalance or are due to an overactive immune system. All forms of arthritis affect the joints; however, some also involve the muscles and connective tissues of the body.

OA is the most common form of arthritis, primarily affecting people over the age of 60 years. It is degenerative in nature - cartilage in the joints gradually wears away, causing the ends of the bones to rub against each other. OA can develop spontaneously for no apparent reason or be due to a secondary cause, where the joint damage results from an injury or trauma.

Wear-and-tear is the principal cause of OA but it is now recognized that flare-ups may occur that have an inflammatory component. An athlete who has suffered joint injuries or someone who works in a job that puts daily stress on the joints is at higher risk of developing OA later in life.

RA is caused by inflammation and thickening of the joint's lining, called the synovium. Scientists believe inflammatory forms of arthritis such as RA may be triggered by bacterial or viral infections heightened by a flaw in the body's immune system. The result is an abnormal immune response that destroys the body's own tissues - in the case of RA, the joints are the target.

Some forms of arthritis are due to metabolic problems, called crystal-associated arthritis. These include gout and pseudogout, which are caused by crystal deposits within the joints. 80% of gout sufferers are men. Gout is often genetic, but it can also be precipitated by excessive alcohol consumption, obesity, and conditions that suddenly break down large amounts of tissue. Gout results from the accumulation of uric acid, a waste product from the breakdown of digested foods. Excess uric acid forms sodium urate crystals that collect in many tissues, including the joint linings - this causes inflammation.

Symptoms and Complications

Symptoms of OA include:

• stiffness on awakening or after prolonged rest
• pain in a joint during or after use
• discomfort in a joint before or during a change in weather
• swelling and a loss of flexibility in a joint
• bony lumps (nodules) that develop on the end or middle joint of the fingers

Symptoms of RA include:

• pain and swelling in the smaller joints of the hands and feet
• overall aching or stiffness, especially after sleeping or periods of motionlessness
• joints that are swollen, painful, and warm to the touch during the initial attack and ensuing flare-ups
• nodules, or lumps, that most commonly occur near the elbow (but can occur anywhere)

Symptoms of gout include:

• joint pain and swelling
• acute joint inflammation with heat and redness
• accumulation of uric acid or urate crystals in the joints

Pain associated with OA may also arise from other body parts around the joint, such as the bone, muscle, ligament, or tendon due to swelling or inflammation, usually following physical activity. People with OA often stop using the affected and painful joint, but inactivity can weaken the muscles and worsen the condition.

RA symptoms may linger, although there may also be periods of remission where there is little or no pain. Complications occur when fluid builds up in the joint space and causes swelling and intense pain. Surrounding tissues can also swell, making the whole joint and the area around it painful to touch and move. Muscles may also contract, spasm, and become stiff from inactivity.

A gout attack is extremely painful and can last 5 to 7 days and possibly up to 3 weeks. The first attack often starts in the big toe, but the ankles, knees, elbows, and fingers can also be affected.

Making the Diagnosis

To diagnose arthritis, your doctor will take a thorough history and conduct a physical examination to determine which joints are affected.

The presence of pain and stiffness in either one or a few joints is key to diagnosing osteoarthritis (OA). A clue to OA may be the presence of bony lumps that appear in the end and middle joints of fingers. Arthritic joints will be painful if moved to extremes and may be thicker than normal.

If painful joints involve both sides of the body, a diagnosis of rheumatoid arthritis (RA) is more likely, and lab tests will be done to confirm the diagnosis. Special blood tests to detect a special antibody called rheumatoid factor (RF) may help confirm the presence of RA. Other blood tests may be used to detect the presence of other types of arthritis such as gout, lupus, or ankylosing arthritis.

X-rays may show bone spurs in joints with OA and may also be used to follow the progression of arthritis over time.

Treatment and Prevention

Unfortunately, there's no cure for most forms of arthritis. The goal of treatment is to reduce symptoms of pain and inflammation with the help of exercise programs, physiotherapy, and medications.

There are things everyone can do today to prevent the possibility of OA later in life. For example, it may help to limit stress on the joints by keeping your weight under control. Recent studies have shown that a weight gain of only 10 to 20 extra pounds in early adulthood increases wear and tear on the shock-absorbing cartilage in joints and can lead to serious joint damage in the long run. Avoiding repetitive movements over long periods of time can help, but if repetitive motions are part of a job or leisure activities, proper training is important. If someone has a traumatic injury to a joint, they need medical care and rehabilitation to avoid further damage. Talk to a doctor about the proper use of ice, rest, heating pads, hot water bottles, and hot baths for treating any injury.

Exercise programs to maintain muscle tone are useful for managing OA. These may include special exercises prescribed by your physician or physical therapist to strengthen muscles and improve range of motion. Walking is an excellent form of therapy for arthritis in the knees. In some cases, joint pain due to OA is often relieved with rest.

Medications for OA include a wide range of pain relievers and anti-inflammatory medications. Acetaminophen* is generally a good choice for long-term use. If acetaminophen is not effective or if inflammation is present, acetylsalicylic acid (ASA) or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or diclofenac may be recommended. Acetaminophen and some forms of ASA and NSAIDs are available without a prescription, but always check with a doctor or pharmacist before taking any of these medications. Prescription pain relievers such as morphine and oxycodone can help people who experience acute periods of pain. If other options have failed, local injections of corticosteroid medication into the affected joints are another treatment option. For severe cases, surgery such as a hip or knee replacement may be needed.

Therapy for RA and other inflammatory types of arthritis includes specially tailored exercises and medication, such as anti-inflammatory medications including ASA and other NSAIDs. The group of medications called disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine, gold injections, hydroxychloroquine, azathioprine, and methotrexate can be helpful for RA, but they require time (weeks to months) before they start working. DMARDs can help to prevent joint destruction. Another group of medications called biologics (e.g., abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab) can also help improve RA symptoms and slow down joint destruction. Corticosteroids (e.g., prednisone, methylprednisolone) may also be used to control inflammation. Many of these medications are combined with other medications to treat RA (e.g., a biologic is often combined with a DMARD).

Relieving stress on joints is important to avoid further damage. Canes, walkers, or crutches are helpful to reduce the amount of body weight placed on certain joints. Splints may be used to keep joints from becoming permanently bent and stiff.

NSAIDs are also used to treat the acute symptoms of gout, but ASA should be avoided as it affects the manner in which the kidneys handle uric acid and may lead to kidney stones. Colchicine or corticosteroids may also be used to treat acute gout. In some cases, people are prescribed medications (e.g., allopurinol, probenecid, or sulfinpyrazone) to help prevent acute gout attacks.

Living and coping with arthritis, as with any chronic disease, can be difficult. It may affect daily activities slightly, or it can be more severe and extremely debilitating. Some people may benefit from counselling or support groups to deal with the challenges of living with arthritis. There are many resources available - it's important to take advantage of them.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.