Diseases & Conditions

Arthritis


Overview, Causes, & Risk Factors

Arthritis refers to inflammation of a joint. The inflammation may cause pain, swelling, and stiffness.

What is going on in the body?

The joint inflammation of arthritis can occur for many reasons. Often the lining of the joint, the synovium, becomes inflamed. It reacts by making extra synovial fluid. This causes the joint to become swollen. The smooth white surface of the joint, the hyaline cartilage, can become thin, worn, and rough. Any joint in the body can be affected by some form of arthritis.

What are the causes and risks of the condition?

There are many types of arthritis, with a host of different causes, such as:

  • ankylosing spondylitis, which affects the spine and other joints
  • arthritis caused by mechanical problems, such as a bone fracture or dislocation
  • gout, which is caused by an accumulation of uric acid crystals in the joint
  • infectious arthritis, which is caused by an infection such as Borrelia burgdorferi.\ It is passed to humans through tick bites. ',CAPTION,'Lyme Disease');" onmouseout="return nd();">Lyme disease or a Neisseria gonorrhoeae\ bacteria. These infections are usually acquired through sexual contact. A gonococcal infection may also be passed from mother to baby during childbirth. ',CAPTION,'Gonococcal Infections');" onmouseout="return nd();">gonococcal infection
  • osteoarthritis, a degenerative process that is also called wear-and-tear arthritis
  • pseudogout, which is caused by an accumulation of calcium pyrophosphate crystals in the joint
  • psoriatic arthritis, which develops in some people who have a chronic skin condition known as psoriasis
  • reactive arthritis, which may develop after an infection of the urinary tract, bowel, or other organs
  • rheumatoid arthritis, an autoimmune disorder in which the body makes antibodies to its own tissues
  • Some of the risk factors for arthritis are as follows:

  • aging changes in the bones and joints
  • bodywide infections that affect the joints
  • diabetes
  • genetic or hereditary tendency to arthritis
  • immunodeficiency disorders, such as HIV
  • injury to the joints
  • menopause, which increases a woman's risk for osteoarthritis
  • overweight or obesity
  • smoking, which doubles a woman's risk for rheumatoid arthritis

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms vary according to the type of arthritis and how severe it is. However, common symptoms include the following:

  • difficulty with weight-bearing activities, such as walking, bending, and moving
  • joint deformity
  • joint pain and swelling
  • joint stiffness, especially in the early morning
  • limping or making other adjustments to protect the affected joint
  • warmth or redness in a joint
  • weakness of the joint

  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of arthritis starts with a medical history and physical examination. Joint X-rays may be normal at first, perhaps showing some swelling. Later the X-rays may show narrowing of the joint space, roughness of the joint surface, or poor alignment of the joint. Bone spurs, which are calcium deposits at the edge of the joint, may also be seen.

    Blood tests, including a complete blood count, or CBC, can help detect some types of arthritis. Joint aspiration, which means removing joint fluid with a needle under local anesthesia, can sometimes provide useful information. Rarely, a magnetic resonance imaging, or MRI, is needed to determine the cause or extent of the arthritis.


    Prevention & Expectations

    What can be done to prevent the condition?

    Following sports safety guidelines for children, adolescents, and adults may help prevent some joint damage. Injuries and infections should be treated promptly. For example, a severe ankle sprain that is not properly splinted may lead to osteoarthritis. Untreated Neisseria gonorrhoeae\ bacteria. These infections are usually acquired through sexual contact. A gonococcal infection may also be passed from mother to baby during childbirth. ',CAPTION,'Gonococcal Infections');" onmouseout="return nd();">gonococcal infections may lead to infectious arthritis.

    What are the long-term effects of the condition?

    If the arthritis progresses, joint function may keep declining. The person will have more joint pain, stiffness, and swelling. The amount and rate of decline depend on the type of arthritis and how well the available treatments work.

    What are the risks to others?

    Arthritis is not contagious. It poses no risk to others. If the arthritis is caused by an infection, such as gonorrhea, the infection may be contagious.


    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment varies quite a bit, depending on the type of arthritis and its severity. The age, health, and activity level of the person also are factors to consider. Education about the disease can help bring about improved daily self-management and coping skills.

    Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and aspirin, are often used to treat early symptoms of arthritis. COX-2 specific inhibitors, such as rofecoxib or celecoxib, can also help to relieve symptoms. For some forms of arthritis, corticosteroids such as prednisone can work very well. Corticosteroids can be taken by mouth or injected into the joint. Depression and sleep disorders may be treated with low doses of antidepressant medicines, such as amitriptyline.

    A wide variety of medicines are used to treat rheumatoid arthritis:

  • antibiotics, such as doxycycline and minocycline
  • anti-inflammatory medicines
  • corticosteroids, such as prednisone
  • COX-2 specific inhibitor NSAIDs
  • disease-modifying medicines, such as D-penicillamine, which slow down the progression of the disease
  • immunosuppressant medicines, such as methotrexate, which change the body's immune response
  • infliximab and etanercept, which block the effects of an important protein
  • If there is a bacterial infection of the joint, antibiotics are critical. The joint may be drained by repeated aspiration or by open surgical drainage.

    A change in diet may help some forms of arthritis. People who have arthritis might experience loss of appetite or anemia, which is a low red blood cell count. Frequent small feedings or protein supplements may be prescribed. Some medicines, such as oral corticosteroids, can stimulate the appetite and lead to weight gain. Losing excess weight can help, especially when the leg joints are affected. Foods high in protein, iron, and vitamins contribute to tissue building and repair.

    Physical activity is important in the treatment of arthritis. Thirty minutes of moderate exercise a day can help to prevent complications of arthritis, as well as heart disease, stroke, and diabetes. Low impact aerobics and water aerobics are two exercises that minimize joint stress.

    A recent study focused on adults with osteoarthritis who used tai chi, a form of Chinese exercise that uses slow, fluid movements. Study participants reported better management of their symptoms, along with improved physical and mental health.

    Surgery may be indicated when pain cannot be controlled or function is lost. Several types of surgery may be done:

  • arthroplasty, which is the partial or total replacement of a joint, such as knee joint replacement or a hip joint replacement
  • arthroscopy, a procedure that uses a small scope and instruments to get inside the joint without opening it
  • arthrotomy, which involves opening the joint through a larger incision
  • osteotomy, or realignment of the bone next to the joint
  • synovectomy, or removal of the lining of the joint
  • There has been a great deal of interest lately in the use of glucosamine and chondroitin. These dietary supplements may decrease joint pain associated with arthritis. A large scale study is currently being conducted to determine their effectiveness.

    What are the side effects of the treatments?

    Medicines used to treat arthritis may cause stomach upset, allergic reaction, and decreased resistance to infection. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

    What happens after treatment for the condition?

    Most types of arthritis require lifelong treatment. Exercises to maintain range of motion and muscle strength are very important.

    How is the condition monitored?

    A healthcare provider will monitor the person's level of comfort and function of the joint. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:John A.K. Davies, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:08/31/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:08/01/01