Arthritis

Arthritis is one of the most common diseases in this country. It affects millions of adults and half of all people age 65 and older.

Arthritis causes pain and loss of movement. It can affect joints in any part of the body. It often is a chronic disease, which means that it can affect you over a long period of time. The more serious forms can cause swelling, warmth, redness, and pain.

There are more than 100 different kinds of arthritis and many different symptoms and treatments. Scientists do not know what causes most forms of arthritis. They understand some better than others.

Common Forms of Arthritis

The three most common kinds of arthritis in older people are osteoarthritis, rheumatoid arthritis, and gout.

Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis in older people. It mostly affects cartilage—the tissue that cushions the ends of bones within the joint. OA often affects the hands and the large weight-bearing joints of the body, such as knees and hips.

OA occurs when cartilage begins to fray, wear, and decay. In some cases, all of the cartilage may wear away between the bones of the joint, leaving bones that rub against each other. Symptoms can range from stiffness and mild pain that comes and goes, to severe joint pain. OA can cause:

• Joint pain,
• Less joint motion,
• And sometimes, disability.

Scientists think there may be several causes for OA in different joints. OA in the hands or hips may run in families. OA in the knees is linked with being overweight. Injuries or overuse may cause OA in joints such as knees, hips, or hands.

Treatment. Rest, exercise, a healthy, well-balanced diet, and learning the right way to use your joints are key parts of any arthritis treatment program. Treatment is different for each kind of arthritis.

Right now there are no treatments that cure OA, except surgery to replace joints. But improving the way you use your joints through rest and exercise and keeping your weight down will help you control the pain.

There are some drugs that help people manage OA pain. They are called COX-2 inhibitors and NSAIDs (nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen). These drugs reduce swelling without use of stronger drugs like cortisone or other steroids. COX-2 inhibitors are a newer type of drug. They work like NSAIDs but may cause fewer side effects.

Another new treatment involves shots of hyaluronic acid (hyaluronic acid viscosupplementation) to the area around the knee joint. The treatment adds fluid to replace natural fluids that the body has lost. It can help people with arthritis keep movement in the knee without pain.

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. People with RA often have a wide range of other symptoms such as feeling tired, running a fever, or generally not feeling well.

RA may occur in a balanced pattern throughout the body. For example, if one knee or hand is involved, the other one is too. The disease often affects wrist and finger joints closest to the hand.

Treatment. RA treatments can help relieve your pain, reduce swelling, slow down or stop joint damage, increase your ability to function, and improve your sense of well being. Treatment may include antirheumatic drugs, called DMARDs (disease-modifying antirheumatic drugs), which can slow the disease. Doctors will sometimes have you take other drugs, called corticosteroids to relieve swelling while you wait for DMARDs to take effect. Other drugs called biologic response modifiers, sometimes work for people with mild-to-moderate RA who have not been helped by other treatment.

Gout

Gout is one of the most painful rheumatic diseases. It is caused by deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both. These deposits lead to inflammatory arthritis, which causes swelling, redness, heat, pain, and stiffness in the joints.

Gout affects the toes, ankles, elbows, wrists, and hands. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender. Medicines can stop gout attacks and prevent further attacks and joint damage.

Treatment. With the right treatment, most people with gout feel better. Treatment can help ease the pain that comes with acute attacks, prevent future attacks, and keep new uric acid deposits and kidney stones from forming.

The most common treatment for an acute attack of gout uses high doses of NSAIDs and shots of glucocorticoids drugs into the affected joint to lessen swelling. You may start to feel better within a few hours of treatment. The attack usually goes away fully within a few days.

Warning Signs

The warning signs of arthritis are:

• Swelling in one or more joints,
• Stiffness around the joints that lasts for at least 1 hour in the early morning,
• Constant or recurring pain or tenderness in a joint,
• Difficulty using or moving a joint normally,
• Warmth and redness in a joint.

If any one of these symptoms lasts longer than 2 weeks, see your regular doctor or a doctor who specializes in arthritis (a rheumatologist). The doctor will ask questions about the history of your symptoms and do a physical exam. The doctor may take x-rays or do lab tests before developing a treatment plan.

What Else Can You Do?

Along with taking the right medicines, exercise is key to managing arthritis symptoms. Daily exercise, such as walking or swimming, helps keep joints moving, reduces pain, and strengthens muscles around the joints. Rest also is important for joints affected by arthritis.

Three types of exercise are best for people with arthritis:

• Range-of-motion exercises (for example, dancing) help keep normal joint movement and relieve stiffness. This type of exercise also helps you stay flexible.
• Strengthening exercises (for example, weight training) help keep or increase muscle strength. Strong muscles can help support and protect joints affected by arthritis.
• Aerobic or endurance exercises (for example, bicycle riding) improve cardiovascular fitness, help control weight, and improve overall function. Some studies show that aerobic exercise also may reduce swelling in some joints.

The National Institute on Aging (NIA) has a 48-minute video showing you how to start and stick with a safe exercise program. The Institute also has an 80-page companion booklet. Call 1-800-222-2225 (TTY: 1-800-222-4225) for more information. Before beginning any exercise program, talk with your doctor or health care worker.

Along with exercise, some people find other ways to help ease the pain around joints. These include applying heat or cold, soaking in a warm bath, swimming in a heated pool, and controlling or losing weight. Weight control is key for people who have arthritis because extra weight puts extra pressure on many joints. Weight loss can lower stress on joints and help prevent more damage.

Your doctor may suggest surgery when damage to the joints becomes disabling or when other treatments fail to reduce pain. Surgeons can repair or replace damaged joints with artificial ones. In the most common operations, doctors replace hips and knees.

Unproven Remedies

Many people with arthritis try remedies that have not been tested. Some of these remedies, such as snake venom, are harmful. Others, such as copper bracelets, are harmless but also useless. The safety of many unproven remedies is unknown.

Some people try taking dietary supplements, such as Glucosamine and Chondroitin, to ease arthritis pain. Scientists are studying these and other alternative treatments to find out if they work and are safe. More information is needed before any recommendations can be made.

Here are some signs that a remedy may be unproven:

• The remedy claims that a treatment, like a lotion or cream works, for all types of arthritis and other diseases;
• Scientific support comes from only one research study; or
• The label has no directions for use or warnings about side effects.

For more information on arthritis contact:

National Institute of Arthritis and Musculoskeletal and Skin Diseases
NIAMS Information Clearinghouse
1 AMS Circle
Bethesda, Maryland 20892–3675
301-495-4484
877-22-NIAMS (226-4267)
TTY: 301-565–2966
Fax: 301-718-6366
Web: www.niams.nih.gov
Email: niamsinfo@mail.nih.gov

American College of Rheumatology/Association of Rheumatology Health Professionals
1800 Century Place
Suite 250
Atlanta, GA 30345-4300
404-633-3777
Fax: 404-633-1870
E-mail: acr@rheumatology.org
http://www.rheumatology.org

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357-0669
1-800-283-7800, or check the telephone directory for your local chapter
Fax: 404-872-0457
E-mail: help@arthritis.org
http://www.arthritis.org

For more information about health and aging, call or write:

National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
E-mail: niainfo@jbs1.com
http://www.nia.nih.gov

National Institute on Aging
U. S. Department of Health and Human Services
National Institutes of Health
January 2002

This publication sourced from the National Institute on Aging.