Arthritis

What are the different types of arthritis?

Arthritis is not a single disease. The term refers to any of roughly 100 conditions affecting the joints—including osteoarthritis, rheumatoid arthritis, gout, pseudogout, ankylosing spondylitis, and psoriatic arthritis. Here are the most common types:

Osteoarthritis. The most common type of arthritis, osteoarthritis (OA), occurs when the cartilage that cushions the space between bones wears away. The bones then rub against each other—particularly in the hands, spine, knees, and hips—causing pain and difficulty moving the joint. The symptoms of OA usually develop over many years and can range from mild to severe. The first sign often is joint pain after strenuous activity or overusing a joint. Joints may be stiff in the morning but loosen up after a few minutes of movement. Or the joint may be mildly tender, and movement may cause a crackling or grating sensation. OA affects slightly more women than men.

Rheumatoid arthritis. Rheumatoid arthritis (RA) is an autoimmune disease. When the body's immune system does not operate as it should, white blood cells that usually attack bacteria or viruses attack healthy tissue instead—in this case, joint tissue. RA causes pain, stiffness, warmth, redness, and swelling in joints. Over time, the affected joints may become misshapen, misaligned, and permanently damaged. RA usually occurs in a symmetrical pattern, meaning that if one knee or hand is affected, the other usually is as well. Because RA can affect the entire body, people also may experience inflammation in other areas, including the heart, lungs, or eyes.

Gout. Gout is caused by too much uric acid in the blood and tissues. When uric acid levels are too high, tiny crystals form that lodge in joints, causing pain, swelling, redness, and heat. (Uric acid crystals can also lodge in the kidneys, causing kidney stones.) Gout usually occurs in only one joint at a time. It is often found in the big toe but can affect any joint including other toe joints, ankles, knees, and wrists.

Reactive arthritis. Reactive arthritis causes inflammation of the joints and, in many cases, other areas of the body, especially the urinary tract and eyes. It is triggered by an infection, usually by a sexually transmitted disease (particularly chlamydia) or certain gastrointestinal bacteria, such as salmonella, shigella, campylobacter, or Yersinia which are often found in contaminated food or water. While these infections are common, reactive arthritis is not. Scientists believe that people who develop reactive arthritis have a particular genetic makeup that increases their risk.

Psoriatic arthritis. Psoriatic arthritis is a chronic disease in which a person with psoriasis—a skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk, and scalp—develops the symptoms and signs of arthritis, including joint pain, stiffness, and swelling. There are five types of psoriatic arthritis. They are classified by severity, whether both sides of the body are equally affected, and which joints are involved.
 

• Asymmetric inflammatory arthritis. Often knees, ankles, wrists, or fingers are involved, with a total of one to four inflamed joints. Usually, this kind of arthritis does not affect both sides of the body equally.
• Symmetric arthritis. Multiple joints are inflamed, often more than four, and the same joints on both sides of the body are affected. Fingernails often are ridged and pitted. This condition can mimic rheumatoid arthritis.
• Psoriatic spondylitis. One or both sacroiliac joints (the joints linking the spine and pelvis at the lower back), and sometimes other spine joints, are inflamed, causing stiffness and limited motion in the involved joints, especially in the morning.
• Isolated finger involvement. This usually involves only the last finger joint near the nail. One or more of these joints may be inflamed.
• Arthritis mutilans. This is the most severe and rarest form of psoriatic arthritis. In this form, the fingers shorten because of the destruction of the joints and nearby bones.

What are symptoms of arthritis?

Most types of arthritis share similar symptoms, including joint inflammation, pain, stiffness, and diminished range of motion. The   location and severity of symptoms varies from one type of arthritis to another. . Symptoms range from mild to severe and may come and go. Some symptoms may stay about the same for years, but can also progress and get worse over time.
For osteoarthritis (OA), the most common type of arthritis, symptoms include:

• Joint pain and swelling after activity or in response to a change in weather
• Limited flexibility, especially after not moving for a while
• Bony lumps at the fingertips or on the middle joints of fingers
• A grinding sensation when the joint moves
• Numbness or tingling in an arm or leg, which can happen if arthritis has caused bone changes that are putting pressure on a nerve; for example, in the neck or lower back

People with OA feel a deep ache centered in the joint. Typically, the pain is aggravated by using the joint and relieved by rest. However, as the disease worsens, the pain becomes more constant. The pain can be significant during the night and interfere with sleep.

Symptoms of rheumatoid arthritis (RA) include:

• Pain, swelling, limited motion, warmth, and tightness around affected joints, which most commonly include the hands and wrists, feet and ankles, elbows, shoulders, neck, knees, and hips, usually in a symmetrical pattern. Over time, joints may develop deformities.
• Fatigue, soreness, stiffness, and aching, particularly in the morning and afternoon (described as morning stiffness and afternoon fatigue)
• Lumps or rheumatoid nodules below the skin
• Weight loss
• Low-grade fever and sweats
• Trouble sleeping
• Weakness and loss of mobility
• Depression

Generally, RA pain is described as a dull ache similar to a headache or toothache. The pain is typically worse in the morning, and it is not rare to have 30 minutes to an hour or more of morning stiffness. When the disease is more active, people may experience fatigue, loss of appetite, low-grade fever, sweats, and difficulty sleeping.

Which joints are most commonly affected by arthritis?

Arthritis can affect one joint or several, depending on the type. For instance, osteoarthritis (OA), the most common type, can be limited to one joint or begin in one joint, usually the knee, hip, hand, finger, foot, shoulder, or spine. It also can involve several joints. If the hand is affected by OA, many joints of the fingers become arthritic.

Rheumatoid arthritis (RA), the most disabling form of arthritis, generally strikes more than one joint at a time. Commonly affected joints include those in the hands, wrists, feet, ankles, elbows, shoulders, hips, knees, and neck. RA can result in loose, deformed joints, loss of mobility, and diminished strength. It also can cause painless lumps the size of a pea or acorn, called rheumatoid nodules. These develop under the skin, especially around the elbow or beneath the toes.

Gout, another type of arthritis, usually involves only one joint during the initial attack. The most common site is the big toe, but it can also occur in a knee, ankle, wrist, foot, or finger. However, later episodes are more likely to strike multiple joints. Some people with gout also develop tophi — large, visible nodules made of uric acid crystals that appear around the joints, mostly on the feet, knees, wrists, fingers, and ears.

What are some self-care strategies for arthritis?

Following are some do-it-yourself strategies and therapies that can make coping with arthritis a little easier.

• Heat and cold therapy. Applying heat or cold or alternating between the two can temporarily relieve pain. Your doctor also can advise you on how to use heating pads, hot baths, and ice packs to ease discomfort.
• Massage. Gently rubbing the joints can increase blood flow to the affected area and ease sore spots. Because arthritic joints can be sensitive, consult a massage therapist specializing in treating arthritis.
• Exercise. Exercise can reduce pain, improve flexibility, strengthen the muscles that support the joints, and help you lose any extra weight straining your joints. Swimming and riding a stationary bicycle are good exercises as they don’t put undue stress on painful joints. Weight-bearing exercises such as walking and lifting weights can strengthen weakened muscles without risking additional joint damage. Your doctor or physical therapist can design an exercise program to address your arthritis pain.
• Diet. People with gout can lower blood uric acid levels by reducing or eliminating their intake of meat and shellfish and cutting back on alcohol and soft drinks.
• Physical therapy. An occupational therapist or physical therapist can offer suggestions and guidance as you manage ordinary tasks around your home and at work. In addition, a therapist can provide special devices to help you conserve energy and protect your joints during your daily activities. Wearing a splint, brace, sling, or Ace bandage when joints are tender can relieve pressure and protect them from injury. A podiatrist can provide shoe inserts (orthotics), which also may help. 

How is arthritis treated?

There is no cure for arthritis. The goal of treatment is to reduce and manage pain and inflammation and lower the frequency of episodes. Many approaches have been shown to be effective and can significantly improve a person’s quality of life.
 
Medication. Over-the-counter pain medication like acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs—ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and aspirin—can reduce inflammation and ease pain and stiffness associated with many types of arthritis. Topical pain-relieving creams and rubs applied to joints also may help with pain relief. Different classes of prescription drugs can also  help reduce pain and inflammation.

For rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs) appear to slow or halt disease progression by altering the function of the body’s immune system. Janus kinase (JAK) inhibitors block an enzyme involved in inflammation and are often used to treat rheumatoid and psoriatic arthritis.
Gout sufferers often need xanthine oxidase inhibitors to lower uric acid levels.

Injections. Corticosteroid injections into affected joints can temporarily relieve pain in people with inflammatory forms of arthritis, such as rheumatoid arthritis, or in people with osteoarthritis. Hyaluronic acid injections treat knee osteoarthritis by replacing the fluid that naturally lubricates the joints. Biologics, a particular type of DMARDs given by injection or through an IV at a doctor’s office, help people with rheumatoid arthritis.

Surgery. In severe cases where deterioration is significant, your doctor may recommend surgery to remove inflamed tissue, correct deformity in a joint, or reconstruct or replace a joint, most commonly a hip or knee joint. People with rheumatoid arthritis may require surgical tendon repair to fix tendon damage caused by the condition, especially in the hand and wrist.