Arthritis is a disease that causes pain and loss of movement of the joints. The word arthritis literally means joint inflammation (arth=joint, ritis=inflammation), and refers to more than 100 different diseases.
How Arthritis Affects You
Arthritis affects the movements you rely on for everyday activities. Arthritis is usually chronic. This means that it can last on and off for a lifetime.
There are over 100 kinds of arthritis that can affect many different areas of the body. In addition to the joints, some forms of arthritis are associated with diseases of other tissues and organs in the body. People of all ages, including children and young adults, can develop arthritis.
Inflammation is a reaction of the body that causes swelling, redness, pain, and loss of motion in an affected area. It is the major physical problem in the most serious forms of arthritis.
Normally, inflammation is the way the body responds to an injury or to the presence of disease agents, such as viruses or bacteria. During this reaction, many cells of the body's defense system (called the immune system) rush to the injured area to wipe out the cause of the problem, clean up damaged cells and repair tissues that have been hurt. Once the "battle" is won, the inflammation normally goes away and the area becomes healthy again.
In many forms of arthritis, the inflammation does not go away as it should. Instead, it becomes part of the problem, damaging healthy tissues of the body. This may result in more inflammation and more damage - a continuing cycle.
The damage that occurs can change the bones and other tissues of the joints, sometimes affecting their shape and making movement hard and painful. Diseases in which the immune system malfunctions and attacks healthy parts of the body are called autoimmune diseases.
Types of Arthritis
Arthritis pain and inflammation of joints has many forms. Rheumatoid arthritis can be one of the most disabling types of arthritis. Its course varies, from a few symptoms to severe and painful deformities.
Three times as many women as men are affected, usually at a fairly young age (between 25 and 50). The disease may come on slowly or appear suddenly.
Rheumatoid arthritis typically affects the small finger joints, wrists, knees and toes. All joints of the body, however, are potential targets.
Along with swelling and pain of joints, some of the early symptoms of the disease may include fatigue, loss of appetite, weight loss and fever. Stiffness in the joints and surrounding muscles that lasts for several hours after getting up in the morning is a regular symptom. Sometimes the disease involves other organs, causing damage to the heart, lungs, eyes, skin and nerves.
Many individuals with rheumatoid arthritis feel their arthritis is influenced by the weather, stress, temperature and exercise. A few have periods of remission when the disease seems to have gone away. Unfortunately, in most cases, the symptoms eventually return.
The cause of rheumatoid arthritis is unknown. Some scientists feel that it may result from an infection, but there is no evidence that it is contagious. For whatever reason, the joint lining becomes very inflamed and thickened, slowly destroying cartilage and bone. The goal of treatment is to halt the inflammation and prevent the destruction of joints.
Medical supervision is a must, because this form of arthritis can be crippling, other organs may be affected and all treatments may, on occasion, cause side effects.
Doctors now have many ways of treating rheumatoid arthritis. Large doses of aspirin or aspirin-like drugs can be effective in reducing pain and inflammation. If the arthritis is aggressive, drugs called DMARDs or SAARDs (disease-modifying antirheumatic drugs, or slow-acting antirheumatic drugs) such as the anti-malarials may be used. Certain immunosuppressants biologic response modifiers, corticosteroids, or gold therapy may be used. All these drugs require close supervision, since they may have hazardous side effects.
Rest, heat and physical therapy are important adjuncts to drug therapy. A healthy diet and exercise also helps patients retain mobility and strength, maintain or lose weight, sleep better, and even help maintain a positive attitude. Although there is no scientific evidence that eating or not eating certain foods reduces or aggravates symptoms of rheumatoid arthritis, some recent studies indicate that omega-3 fatty acids (found in certain fish and plant seed oils) may reduce the inflammation of rheumatoid arthritis.
Joint deformity or pain is sometimes so severe that surgery is the best alternative. A patient can have added years of mobility due to the hip, elbow, shoulder and knee replacements that can be performed today. Surgeries include joint replacement (replacing the joint with an artificial joint), tendon reconstruction (reconstructing damaged tendons) and synovectomy (removal of the inflamed tissue).
The use of a splint or brace can also help straighten some joints. Although surgery cannot cure all deformities, advances in the field have given rheumatoid patients, who previously would have been wheelchair-bound, the ability to continue in relatively normal lives.
One form of chronic arthritis (less widely known) is one that attacks children, juvenile rheumatoid arthritis. It may start with symptoms as general as fever and rash, and it may take a long time for a definite diagnosis to be reached. Some children complain of swelling and stiffness in a few scattered joints. When the disease threatens the function of the joints, skilled professional treatment is called for to prevent permanent deformity.
The disease in its juvenile form often stops progressing within 10 years, but the damage may be permanent and cause further deterioration of the joints. The major concern for the child, parent and doctor is to provide treatment that will spare the child a deformity that might persist long after the disease itself has disappeared.
Osteoarthritis is a disease that causes the breakdown of joint tissue, leading to joint pain and stiffness. It can affect any joint, but commonly occurs in the hips, knees, feet and spine. It also may affect some finger joints, the joint at the base of the thumb and the joint at the base of the big toe. It rarely affects the wrists, elbows, shoulders, ankles or jaw, except as a result of injury or unusual stress.
Osteoarthritis is one of the oldest and most common diseases in humans. It probably affects almost every person over age 60 to some degree, but only some have it badly enough to notice any symptoms. Osteoarthritis is also known by many other names, such as degenerative joint disease, arthrosis, osteoarthrosis, or hypertrophic arthritis.
Although there is no cure for osteoarthritis, proper treatment can help relieve the symptoms and prevent or correct serious joint problems. (See Health Profile: Osteoarthritis.)
A cornerstone of therapy of any form of arthritis is physical therapy and occupational therapy to maintain joint mobility and range of motion. The proper kind and amount of this therapy will vary depending upon the underlying cause and upon individual factors that your physician will discuss with you.
Many drugs are now used to treat the inflammation and pain associated with arthritis. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, and others), naproxen (Naprosyn, and others) and dicolfenac (Voltaren), have immediate analgesic and anti-inflammatory effects and are relatively safe.
Second-line drugs used for treatment of rheumatoid arthritis include hydroxychloroquine, gold, penicillamine, azathioprine, sulfasalazine and methotrexate. These agents (which have no immediate analgesic effect) can control symptoms and may possibly delay progression of the disease, but many of them can also cause severe adverse effects and diminish in effectiveness over time. NSAIDs are usually taken concurrently with the slower acting second-line drugs, which may take months to produce a therapeutic response.
Aspirin in high doses is as effective as any other NSAID and much less expensive, but some patients cannot tolerate the gastrointestinal toxicity. Aspirin interferes with platelet function and can rarely cause serious bleeding; this effect can persist for four to seven days after the drug has been discontinued.
Tinnitus (ringing in the ears) and rarely, hepatitis (liver inflammation) or renal (kidney) damage can also occur with high-dosage aspirin therapy. Enteric-coated aspirin is safer but may not be fully absorbed. Nonacetylated salicylates, such as sodium salicylate, salsalate (Disalcid, and others), and choline magnesium salicylate (Trilisate, and others), do not interfere with platelet function and may be safer than acetylated salicylates for aspirin-sensitive patients, but some clinicians have questioned their effectiveness.