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Arthritis

Learn all about the symptoms of arthritis, including how to prevent and treat it. 

The term arthritis generally refers to wear and damage of joints. There are many types of arthritis, and many conditions that can cause arthritis. Arthritis pain can result from normal mechanical wear over time, trauma, joint damage caused by an infection, and inflammatory diseases that cause destructive changes in and around joints.  

How does arthritis develop?

Arthritis usually starts as mild wear and damage to the cartilage surfaces lining the joint. The cartilage then starts to wear through and the joint develops areas of bone on bone contact. The bone itself starts to change and deform. The joint surfaces may flatten out and the joint may become broader. The edges of a joint may develop a rim or other protrusions, called bone spurs or osteophytes. Eventually, as  the joint becomes larger, it may develop nodules, and it may not bend or straighten fully.  

Symptoms of arthritis  

Arthritis symptoms can include stiffness, pain, swelling, and sometimes catching or locking. The joints may become enlarged or deformed, and with the more inflammatory types of arthritis, they can become warm and red. 

A person with arthritis often experiences morning stiffness in their joints. They may feel pain during or after strenuous activities and feel achy and stiff the next day. Many people with arthritis are uncomfortable staying in one position too long, especially those with back arthritis and hip arthritis.  

The pain of arthritis is often the result of inflammation in and around the joint, from direct bone on bone contact, and from irritation of adjacent structures such as muscles, tendons, and sometimes nerves. People with arthritis often walk with a limp or they walk more stiffly because they no longer have full range of motion at their ankles, knees, hips, and low back. For some, the pain and limitations are bad enough that they require a total knee replacement or hip replacement.   

While arthritis can be quite severe and disabling for some patients, some individuals have what looks like significant arthritis on an X-ray but they have no pain, or they just notice a little stiffness. So, while arthritis is often referred to as degenerative joint disease or DJD, it’s often more of a natural consequence of aging, like wrinkles and grey hair, than a disease. 

Types of arthritis

Osteoarthritis (OA) is the most common type of arthritis.  Osteoarthritis is the result of mechanical wear on our joints over time. It is part of the natural process of aging, but there can be a genetic predisposition to developing osteoarthritis and some patients develop it long before they’re elderly.   Osteoarthritis can affect one or two joints or multiple joints, and the symptoms can be mild or severe.

Post-traumatic arthritis is a type of osteoarthritis that develops in a joint that has been injured. It can develop because the cartilage was damaged at the time of trauma, or because the trauma resulted in a joint that is less stable or is stiff and doesn’t have normal motion.

Inflammatory arthritis is a broad category of arthritis that includes a variety of diseases like rheumatoid arthritis, gout, lyme disease, and psoriatic arthritis. In inflammatory arthritis, the joints are damaged by an inflammatory process triggered by a person’s own immune system. Inflammatory arthritis can occur in people of all ages, including children.  With inflammatory arthritis, there can be greater joint destruction and the joints are often more painful, swollen, and sometimes become more deformed than with osteoarthritis.  

Inflammatory arthritis is often diagnosed with blood tests, joint fluid analysis and other studies. While conditions like gout are often managed by a primary care physician, treatment of some other types of inflammatory arthritis is often managed by a rheumatologist. 

Prevention of arthritis

While heredity can’t be modified, there are some modifiable lifestyle-associated risk factors that can provide arthritis pain relief and impact the development and progression of arthritis, especially osteoarthritis. 

Obesity  

Obesity is a major risk factor for arthritis. Being overweight places a lot more pressure on the weight-bearing joints, especially the knees, ankles, and hips. It causes alterations in gait, stance, and alignment that result in abnormal forces being applied to the joints. Obesity can also result in accelerated wear of the spine. Weight loss is an important treatment intervention to prevent further joint damage in patients with arthritis.  

Inactivity

A sedentary lifestyle is also a risk factor for developing osteoarthritis. Unfortunately, the pain from arthritis can impact a person’s activity tolerance to the point where they may become sedentary. Exercise keeps joints moving, builds the strength of the muscles and tendons around joints, and helps maintain better range of motion, which is vital to joint function, and it helps joints stay lubricated. A good rule of thumb is: “motion is lotion!”

Treatment of arthritis

Arthritis relief treatment includes a variety of medications and other modalities to help control pain, and to improve and maintain joint function. These may include:

Medications

  • Analgesic medications, such as acetaminophen
  • NSAIDs (non-steroidal anti-inflammatory medications), which have analgesic and anti-inflammatory effects, but have some risks associated with them and may not be safe for some individuals  
  • Occasionally opiate drugs such as codeine or hydrocodone
  • Corticosteroid drugs, taken by mouth, or sometimes injected directly into joints, tendon nodules, or other structures
  • Visco supplements injected into the knee to help “lubricate” the joint   
  • Topical pain-relieving creams, rubs and sprays
  • Several types of drugs for specific types of inflammatory arthritis 
  • Physical therapy, massage, and other hands-on treatment to improve joint function
  • Heat treatment (warm baths, heating pads and wraps, etc.)
  • Cold therapy (cold packs, ice massage, etc.)
  • Massage (with a therapist familiar with arthritis-stressed joints) 
  • Acupuncture may be used in some settings
  • Joint rest (bracing or splinting) 
  • TENS (transcutaneous electrical nerve stimulation), using mild electric pulses on the skin over affected areas
  • Oral nutritional supplements, such as glucosamine and chondroitin sulfate, vitamins, fish oil, Omega-3 are thought to have a possible impact on joint health
  • Vitamin D: many people in northern climates are Vitamin D deficient, which can cause substantial musculoskeletal pain and back pain, even in the absence of arthritis 

Exercise program

  • Strengthening exercises to build the muscles that support the joints affected by arthritis
  • Range of motion exercises, such as stretching your arms, legs, and back, to help keep your joints flexible
  • Endurance exercises, such as walking or swimming, to help keep your heart, lungs, and muscles strong
  • Patient education 
  • Lifestyle modifications, weight loss, appropriate exercise

Joint protection strategies

  • Proper lifting techniques
  • Carry less at one time
  • Use of ergonomic kitchen and garden tools
  • Posture and comfort aids
  • Balancing activity with rest; arthritis sufferers need to pace themselves and take frequent breaks, especially with activities such as gardening, which can be hard on the back, knees and hands   

Orthopedic surgery 

Surgery may be recommended in some cases to improve joint function, or in some cases to replace a joint altogether.  

Choosing an appropriate exercise program

Arthritis sufferers often walk a fine line between too much and too little activity. While exercise generally improves overall health and cardiovascular fitness, the wrong type of exercise can accelerate joint wear and make arthritis worse.  It’s important to choose activities that are appropriate to a person’s age, fitness level and tailored to whatever conditions they have. 

Running can load our lower limbs with four to nine times our body weight, so it may not be the best choice for someone who has significant arthritis in their hips and lower extremities. An elliptical trainer works the same muscles without loading the joints as much.    

Vigorous bench presses and pushups can load the AC joints at the shoulders and stress the wrists and elbows too much.  There are lower impact weight-training exercises that can maintain strength and fitness without loading the joints excessively.  

Aquatic exercises, swimming and water aerobics are often a better choice for people with arthritis and back pain, and for patients who are quite overweight and just getting started with an exercise program. As always, check with your physician to make sure exercise is safe and appropriate for you, especially if you have heart disease or other significant medical problems, or if you are over 50.