Arthritis is a very common health condition with more than 1.5 million cases per year in Nigeria. Also known as Joint Inflammation, Arthritis is more common in adults aged 65 years or more, but can affect people of all ages, including children.
According to the Centers for Disease Control and Prevention (CDC), 54.4 million adults in the United States are diagnosed with arthritis. Of these 54.4 million adults, 23.7 million have been limited in some way by their conditions.1
What is Arthritis?
Arthritis simply means an inflammation of the joints, but this term is used to describe around 200 conditions that affect the joints, tissues around the joints, and other connective tissues. This can affect one or more joints. It is the swelling and tenderness of one or more of your joints.
The main symptoms of arthritis are joint pain and stiffness, which usually gets worse with age. Symptoms of arthritis usually develop over time, but can also appear suddenly. Arthritis is more common in women than men and in overweight people.
What are the types of arthritis? There are more than 100 types of arthritis with various causes and treatments. The two most common types are Osteoarthritis (OA) and Rheumatoid arthritis (RA).
Osteoarthritis causes the break down of cartilage (the hard and slippery tissue that covers the ends of the bones where it forms joints).
Rheumatoid arthritis is a disease in which the immune system attacks the joints, starting with the joint lining. Rheumatic conditions usually cause pain, tenderness, stiffness, and swelling in and around one or more joints.
Some of the type of arthritis include:
- Ankylosing spondylitis
- Joint infections
- Juvenile idiopathic arthritis
- Psoriatic arthritis
- Reactive arthritis
- Rheumatoid arthritis
- Septic arthritis
- Thumb arthritis
What causes Arthritis? There is no single cause of all types of arthritis. The causes vary depending on the type of arthritis, osteoarthritis or rheumatoid arthritis. The possible causes of arthritis are:
- Injuries that lead to degenerative arthritis
- Abnormal metabolism that causes gout and pseudogout
- Inheritance, as is the case with osteoarthritis
- Infections, as in the case of arthritis of Lyme disease
- Immune system dysfunction, as in the case of RA and SLE.
The most common arthritis, osteoarthritis, is wear and tear on your joint cartilage – a strong, smooth layer at the end of the bone where the bone forms the joint. Cartilage cushions the ends of your bones and allows the joint to move smoothly. However, with enough damage, the bone can grind directly on bone, which causes pain and limited movement. This wear can occur for years or can be accelerated by joint injury or infection.
Osteoarthritis also affects the entire joint. This causes bone changes and damage to the connective tissue that attaches muscles to the bones and holds the joints together. It also causes inflammation of the lining of the joints.
In rheumatoid arthritis, the immune system of the body attacks the lining of the joint capsule, a tough membrane that covers all the joints. This joints lining (synovial membrane) is inflamed and swollen. The disease process can eventually destroy cartilage and bone in the joints.
What are the early signs of arthritis? The most common signs of arthritis involve joints. Symptoms of arthritis that occur and how they occur varies greatly on the type. They can develop gradually or suddenly. Because arthritis is mostly a chronic condition, the symptoms may come and go or last a long time.
The most common symptoms of arthritis are joint pain, stiffness and swelling. Your range of motion can also be reduced and you may see redness around the joint. Many people with arthritis notice that the symptoms are worse in the morning.
Depending on the type of arthritis you have, your symptoms may include:
- Pain: Arthritis pain can be constant or can come and go. This can only affect parts of the body or be felt in many parts of the body
- Swelling: With some types of arthritis, the skin over the affected joint becomes red and swollen and feels warm.
- Stiffness: For some types, this is most likely when they wake up in the morning after sitting at a table or sitting in a car for a long time. For other types, stiffness can occur after exercise or persistent.
- Difficulty in moving the Joint: If moving the joint or leaving the chair is difficult or painful, it might indicate arthritis or other joint problems.
During a physical examination, the doctor will check for swelling, redness, and warmth in your joints. He will also want to see how well you can move your joints.
Depending on the type of arthritis, your doctor may suggest the following tests.
Analyzing various types of body fluids can help in determining the type of arthritis you might have. Fluids that are usually analyzed include blood, urine, and synovial fluid. To take a sample of your synovial fluid, your doctor will clean and numb the area before inserting the needle into the joint space to collect fluid.
This type of test can identify problems in your joints that can cause your symptoms. The examples are:
- X-rays: X-rays use a low level of radiation exposure to visualize bones, to show cartilage loss, bone damage, and bone spurs. X-rays may not show early arthritic damage but are often used to monitor the progress of the disease.
- CT scan: Computerized tomography scanners take X-rays from various angles and combine the information to create a cross-section view of internal structures. CT can show the bone and surrounding soft tissues.
- Magnetic resonance imaging: By combining radio waves with strong magnetic fields, Magnetic resonance imaging can produce more detailed cross-sectional images of soft tissue such as cartilage, tendons, and ligaments.
- Ultrasound: This technology uses high-frequency sound waves to visualize soft tissue, cartilage, and fluid-containing structures near the joint. Ultrasound is also used to control needle placement for aspiration and joint injection.
What are the risk factors for arthritis? Certain risk factors have been associated with arthritis. Some of these risk factors for arthritis include:
- Gender: Women are more likely to get rheumatoid arthritis than men, while most people with gout, another type of arthritis, are men.
- Genetic Factors: Some types of arthritis occur in families, so you are more likely to develop arthritis if your parents or siblings suffer from the condition. Your genes can make you more vulnerable to the environmental influences that can cause arthritis.
- Previous joint injury: People who have suffered a joint injury in the past, for example when exercising, are more likely to experience arthritis in these joints.
- Age: The risk of various types of arthritis – including osteoarthritis, rheumatoid arthritis and gout – increases with age.
- Obesity: Being overweight puts pressure on your joints, especially your knees, hips, and spine. Obese people are at higher risk of developing arthritis.
- Infection: Many pathogenic microbes can infect the joints and cause the development of various forms of arthritis.
- Occupation: Certain professions where the knee repeatedly bends and squats is associated with osteoarthritis of the knee.
How is arthritis treated? The main aim of arthritis treatment is to relieve pain and prevent further joint damage. You will learn what works best for you in controlling pain. Some people find heating pads and ice packs to reduce their pain. Others use mobility aids such as walking sticks or walkers to reduce pressure on the diseased joint.
Improving your joint function is also important. Your doctor may prescribe a combination of treatments so you get the best results.
Treatment can help reduce the pain, but this condition can’t be cured. Medication, physiotherapy or surgery may help reduce the symptoms and improve your quality of life.
Possible treatments for arthritis include:
Do medications treat arthritis? Medications to treat arthritis vary depending on your type of arthritis. Medications commonly used for arthritis treatment are:
- Analgesics: These medicines relieve pain, but do not affect inflammation. Commercially available options include acetaminophen (Tylenol). For severe pain, opioids which work on the central nervous system to relieve pain such as Tramadol, Oxycodon or Hydrocodon can be prescribed. With long-term use, opioids can become habitual and cause mental or physical dependence.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs relieve pain and inflammation. Over-the-counter options include Ibuprofen and Naproxen. Some types can only be obtained by prescription from a doctor. Oral NSAIDs can cause stomach irritation and increase the risk of heart attack or stroke. Some are also available as creams or gels that you can rub on the joints.
- Counter-irritant: Some creams and ointments contain menthol or capsaicin, ingredients that make hot peppers spicy. Rubbing this preparation on the skin over your aching joint can prevent the transmission of pain signals from the joint.
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs are often used to treat rheumatoid arthritis and slow down or prevent your immune system from attacking your joints. Examples include methotrexate and hydroxychloroquine.
- Biologic response modifiers: Commonly used in conjunction with DMARDs, biologic response modifiers are genetic drugs that target different protein molecules involved in the immune response. There are many types of biologic response modifiers. Tumour necrosis factor (TNF) inhibitors are usually prescribed. Examples include Etanercept and Infliximab. Other drugs target other substances that play a role in inflammation, such as interleukin-1 l, interleukin-6, Janus kinase enzymes, and certain types of white blood cells called B-cells and T cells.
- Corticosteroids: This class of drugs, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken by mouth or injected directly into joints.
Can surgery cure arthritis? If conservative measures do not help, your doctor may recommend surgery, such as:
- Joint repair: In some cases, the joint surface can be smoothed or trimmed to relieve pain and improve function. Such interventions can often be done arthroscopically – by making small cuts to the joints.
- Joint replacement: This will remove your affected joint and replace it with an artificial one. The most commonly replaced joints are the hips and knees.
- Joint fusion: This is more often used for smaller joints such as wrists, ankles and fingers. This removes the ends of the two bones in the joint and then locks them until they heal into one unit.
Can physical therapy help with arthritis? Physiotherapy help with certain types of arthritis. Doctors often recommend physical therapy to help patients with arthritis overcome several challenges and reduce mobility restrictions. Exercise can increase the range of movement and strengthen muscles around the joints. In some cases, splints or braces can be warranted.
Recommended forms of physiotherapy include:
- Hydrotherapy: Exercises in a warm water pool. The water supports your weight and puts less pressure on your muscles and joints.
- Stretching: Stretching exercises can increase mobility and physical function.
- Physiotherapy: Special exercises tailored to individual conditions and needs, sometimes combined with analgesic treatments such as ice or hot packs and massages help in the treatment of arthritis.
- Occupational therapy: Practical tips for coping with daily tasks, choosing specialized aids and special devices, protecting joints from further damage, and overcoming fatigue also help in treating the condition.
- Acupuncture: Use of needles in certain areas of the body to relieve pain and treat other conditions. It is a form of traditional Chinese medicine.
Self-care of certain symptoms of arthritis is also important.
Basic strategies include maintaining physical activity, achieving and maintaining a healthy weight, going for regular checkups with your doctor and protecting your joints from unnecessary stress.
Some habits that can help arthritis patients manage their conditions include:
- Eating a balanced diet: A healthy diet with exercise can help you achieve and maintain a healthy weight. Add anti-inflammatory foods that are high in antioxidants to control inflammation.
- Being organized: Take responsibility for your treatment plan by monitoring symptoms, pain levels, medications, and possible side effects so that you and your doctor can determine what works best for you.
- Managing pain: Medical regimens can be combined with non-medical pain therapy. Learning how to deal with pain is the key to living comfortably with arthritis. Talk to your doctor about the best pain relief.
- Addressing the emotional side: Handling new diagnoses and the pain and limitations that can arise can be emotional. Try to learn about emotional effects so you can manage them better.
- Dealing with Fatigue: Fatigue can be caused by your illness or the stresses of daily life with chronic illness. There is an easy way to overcome fatigue.
- Improving sleep: Pain and sleep disorders can go hand in hand. The pain makes it difficult to fall asleep. Poor sleep can worsen pain. Take steps to improve sleep hygiene so that you can fall asleep and sleep more easily. Avoid caffeine and strenuous exercise at night and limit screen time before bed.
- Being active: This may be the last thing you want to do if you are in pain, but exercise helps. It strengthens the muscles that support diseased joints, makes your joints move, helps you sleep well, improves your mood, and helps you lose extra weight, which creates tension in your joints.
- Balancing activity with rest: Rest is important when your illness is active and your joints feel sore, swollen, or stiff. Make your schedule and tasks easier and ask for help when you need it.
- Arthritis: Overview. Mayo Clinic Staff. mayoclinic.org/diseases-conditions/arthritis/home/ovc-20168903
- Rheumatoid arthritis causes. Arthritis Foundation.
- What is osteoarthritis? Arthritis Foundation.
- What is rheumatoid arthritis? Arthritis Foundation.
- Arthritis [Fact sheet]. Centers for Disease Control and Prevention. cdc.gov/chronicdisease/resources/publications/aag/arthritis.htm