Health Check; Arthritis

The term "arthritis" is used to describe numerous rheumatic diseases and conditions that affect joints. Some forms of arthritis, such as rheumatoid arthritis and lupus, can affect multiple organs and cause widespread symptoms. Arthritis is more common among adults aged 65 years or older, but people of all ages (including children) can be affected.

Typically, pain, aching, stiffness and swelling in and around one or more joints characterize rheumatic conditions. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Types of Arthritis
There are around 200 types of arthritis (or musculoskeletal conditions) which are split into seven main groups:

• Inflammatory arthritis
• Degenerative or mechanical arthritis
• Soft tissue musculoskeletal pain
• Back pain
• Connective tissue disease
• Infectious arthritis
• Metabolic arthritis

Inflammatory Arthritis
Inflammation is a normal part of the body's healing process. The inflammation tends to occur as a defense against viruses and bacteria or as a response to injuries such as burns. However, with inflammatory arthritis, inflammation occurs in people for no apparent reason. Inflammatory arthritis can affect several joints, damaging the surface of the joints and the underlying bone. The inflammation in inflammatory arthritis does not help to repair the body. Instead, it causes the tissues in and around the affected joints to become damaged, causing pain, stiffness and swelling.

The word "arthritis" means "joint inflammation", but inflammation may also affect the tendons and ligaments surrounding the joint - known as enthesitis. Inflammatory arthritis can affect several joints, and the inflammation can damage the surface of the joints and also the underlying bone.

Examples of inflammatory arthritis include:

• Reactive arthritis 
• Rheumatoid arthritis
• Ankylosing spondylitis
• Arthritis associated with colitis or psoriasis.

Degenerative or mechanical arthritis
Degenerative or mechanical arthritis refers to a group of conditions where damage to the cartilage that covers the ends of the bones is the primary issue. The main job of the smooth, slippery cartilage is to help the joint glide and move smoothly. This type of arthritis causes the cartilage to become thinner and rougher.

The bone underneath the cartilage attempts to repair the damage caused, but, as a result, sometimes overgrows, altering the shape of the joint. This condition is commonly called osteoarthritis.

Osteoarthritis can also result from previous damage to the joint such as a fracture or previous inflammation in the joint.

Soft tissue musculoskeletal pain
Soft tissue musculoskeletal pain is felt in tissues other than the joints and bones. The pain often affects a part of the body following injury or overuse, such as tennis elbow, and originates from the muscles or soft tissues supporting the joints. Sometimes if the pain is more widespread and associated with other symptoms, it could be diagnosed as fibromyalgia.

Back pain
Back pain can arise from the muscles, discs, ligaments, bones or joints. Back pain may even be caused by problems with organs inside the body - known as "referred pain". There can be a specific causes for back pain including conditions such as osteoarthritis, which is often called spondylosis when it occurs in the spine. A "slipped" disc is another cause of back pain, as is osteoporosis (thinning of the bones. In most cases it is not possible for a doctor to identify the exact cause of pain - this is often described as "non-specific" pain.

Metabolic Arthritis
Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in human cells and several foods. Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine. Some people have elevated levels of uric acid because they either naturally produce more than is needed or their body cannot clear the uric acid quickly enough.

Uric acid builds up and accumulates in some people and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout attack. Gout can either come and go in episodes or become chronic if uric acid levels are not reduced.

Rheumatoid Arthritis (RA)
There are an estimated 1.5 million adults in the U.S with RA. The prevalence of RA is believed to range from 0.5-1.0% in the general population. 
RA causes premature mortality, disability and compromises quality of life. The onset of RA can occur at any age and is associated with fatigue and prolonged stiffness after rest. Individuals with RA have a more severe functional status than those with osteoarthritis.

RA is an autoimmune condition whereby the inflammatory process primarily affects the lining of the joints (synovial membrane/synovium), but it can also affect other organs. The inflamed synovium leads to cartilage and bone erosion and at times, joint deformity. Pain, swelling and redness are common joint manifestations in people with RA.

The cause of RA is not fully understood. However, RA is suggested to be the consequence of a faulty immune response that results from an interaction between genetic factors and environmental exposures.

Childhood Arthritis
There are an estimated 294,000 children (or 1 in 250 children) under the age of 18 in the US that have been diagnosed with AORC. "Childhood arthritis" is an umbrella term that covers a number of types of arthritis. There are at least three clinical classification schemes of childhood arthritis including:

• Juvenile rheumatoid arthritis (JRA)
• Juvenile chronic arthritis (JCA)
• Juvenile idiopathic arthritis (JIA).

All classifications define childhood arthritis as occurring in people younger than 16 years. The most common form of childhood arthritis is JRA. JRA involves at least 6 weeks of incessant arthritis in children younger than 16 years with no other type of noticeable childhood arthritis.

Fibromyalgia
Fibromyalgia is a disorder of unknown cause characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often, psychological distress. Individuals are usually diagnosed with fibromyalgia during middle age and prevalence increases with age. 
People that suffer from fibromyalgia have abnormal pain perception processing and react strongly to things that other people would not find painful.

Fibromyalgia affects an estimated 5.0 million adults in the US. The prevalence of fibromyalgia is around 2%, with prevalence significantly higher among women (3.4%) than men (0.5%). Children can also have the disorder. Fibromyalgia often co-occurs up to 25-65% with other rheumatic conditions such as RA, SLE and ankylosing spondylitis.

Causes and risk factors of fibromyalgia are unknown. However there are some factors that have been loosely associated with disease onset such as:

• Stressful or traumatic events, including car accidents and post-traumatic stress disorder (PTSD).
• Repetitive injuries.
• Illness - viral infections.
• Certain diseases - SLE, RA, chronic fatigue syndrome.
• Genetic predisposition.
• Obesity.

Psoriatic Arthritis
Estimates of the prevalence of psoriatic arthritis in the US population vary between 0.3-1%, with a reported prevalence of 7-42% in patients with psoriasis. Psoriatic arthritis is a joint problem that often occurs with a skin condition called psoriasis. While most people with psoriatic arthritis develop psoriasis first and are later diagnosed with psoriatic arthritis, joint problems can occasionally occur previous to the emergence of psoriasis skin lesions.

Psoriatic arthritis occurs when the immune system attacks healthy cells and tissue. The abnormal immune response causes inflammation in the joints and an overproduction of skin cells. Several factors can increase the risk of psoriatic arthritis, including:

• Psoriasis: having psoriasis is the greatest risk factor for developing psoriatic arthritis.
• Family history: many people with psoriatic arthritis have a parent or a sibling with the disease. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.
• Age: although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30-50.

The severity of psoriatic arthritis is reflected not only in the accrual of joint damage but also in increased mortality. Patients with psoriatic arthritis are at an increased risk for death with a standardized mortality ratio of 1.62. The causes of death are similar to those in the general population, with cardiovascular causes being the most common.

Gout
Gout is a rheumatic disease that occurs due to deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process occurs because of an overproduction or underexcretion of uric acid from the body.

Acute gout will typically manifest itself as a severely red, hot and swollen joint with agonizing pain. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic. Recurrent attacks of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis. Gout causes agonizing pain in the joint, with the area becoming red, hot and swollen. Contributory risk factors for gout include:

• Being overweight or obese
• Hypertension
• Alcohol
• Diuretic use
• A diet rich in meat and seafood
• Common medicines
• Poor kidney function
• Weight loss lowers the risk for gout

Systemic Lupus Erythematosus (SLE)
SLE is an autoimmune disease whereby the immune system produces antibodies to cells within the body leading to widespread inflammation and tissue damage. The disease is characterized by periods of illness and remissions. Although the peak occurrence of SLE is between the ages of 15-40 and more common in women, SLE can occur from infancy to old age in both females and males.

SLE can affect the joints, skin, brain, lungs, kidneys and blood vessels. People with SLE may experience fatigue, pain or swelling in joints, skin rashes and fevers. The causes of SLE are not confirmed, but they could be linked with factors such as genetics, environment and hormones.

Signs and Symptoms of Arthritis
As with the cause of arthritis, the pattern and location of symptoms of arthritis can also vary depending on the type. Warning signs of arthritis include pain, swelling, stiffness and difficulty moving a joint. Arthritis symptoms can develop gradually or suddenly, and as arthritis is most often a chronic disease, symptoms may come and go, or persist over time.

There are four key warning signs of arthritis that should prompt a discussion with a health care provider:

• Pain. Pain from arthritis can be constant, or it may come and go. Pain might be isolated to one place or felt in many parts of the body.
• Swelling. Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch.
• Stiffness. Stiffness is a typical arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time.
• Difficulty moving a joint. Moving a joint or getting up from a chair should not be hard or painful.

Rheumatoid arthritis
RA usually affects the joints on both sides of the body equally. The joints of the wrists, fingers, knees, feet and ankles are the most commonly affected. Joint symptoms may include:

• Morning stiffness, lasting more than 1 hour, is common.
• Joint pain is often felt on the same joints on both sides of the body.
• Over time, joints may lose their range of motion and may become deformed.
• Chest pain when taking a breath (pleurisy).
• Dry eyes and mouth (Sjögren's syndrome).
• Eye burning, itching and discharge.
• Nodules under the skin (usually a sign of more severe disease).
• Numbness, tingling or burning in the hands and feet.
• Sleep difficulties.

Osteoarthritis
People with osteoarthritis may experience the following symptoms:

• Pain and stiffness in the joints.
• Pain that becomes worse after exercise or pressure on the joint.
• Rubbing, grating or crackling sound when a joint is moved.
• Morning stiffness.
• Pain that causes sleep disturbances.

Even though X-rays show the changes of osteoarthritis, some people may not experience symptoms.

Childhood arthritis
Symptoms of childhood arthritis include:

• Swollen, red, or warm joint.
• Limping or problems using a limb.
• Sudden high fever.
• Rash (on trunk and extremities) that comes and goes with fever.
• Stiffness, pain and limited movement in a joint.
• Body-wide symptoms such as pale skin, swollen lymph gland and a "sick" appearance.

JRA can also cause eye problems called uveitis, iridocyclitis, or iritis. There may be no symptoms, but when eye symptoms do occur they can include:

• Red eyes
• Eye pain made worse by looking at light (photophobia)
• Vision changes

Septic arthritis
Symptoms of septic arthritis occur rapidly. There is often fever, joint swelling in one joint and intense joint pain that becomes more severe with movement. 

Symptoms in newborns or infants include:

• Cries when infected joint is moved.
• Fever.
• Inability to move the limb with the infected joint (pseudoparalysis).
• Irritability.

Symptoms in children and adults include:

• Pseudoparalysis.
• Intense joint pain.
• Joint swelling.
• Joint redness.
• Fever.
• Chills sometimes occur but are an uncommon symptom.

Fibromyalgia
People with fibromyalgia may experience the following symptoms:

• Widespread pain.
• Sleep disturbance.
• Fatigue.
• Psychological stress.
• Morning stiffness.
• Tingling or numbness in hands and feet.
• Headaches, including migraines.
• Irritable bowel syndrome.
• Cognitive problems with thinking and memory - sometimes called "fibro fog".
• Painful menstrual periods and other pain syndromes.

Psoriatic arthritis
Symptoms of psoriatic arthritis may be mild and involve only a few joints such as the end of fingers or toes. In people with severe psoriatic arthritis, the disease may affect multiple joints, including the spine. Spinal symptoms are usually felt in the lower spine and sacrum and consist of stiffness, burning and pain. People with psoriatic arthritis often have the skin and nail changes of psoriasis, and the skin gets worse at the same time as the arthritis.

Gout
Symptoms of gout include:

• Big toe, knee or ankle joints most often affected.
• Sudden pain, often during the night, described as throbbing, crushing or excruciating.
• Joint appearing warm and red, tender and swollen.
• Occasional fever.

Tophi are lumps below the skin around joints or apparent on fingertips and ears. Tophi can develop after a person has had gout for many years. These lumps may drain chalky material.

Sjögren's syndrome
Symptoms of Sjögren's syndrome include:

• Dry eyes.
• Itching eyes.
• Feeling that something is in the eye.
• Dry mouth.
• Difficulty swallowing or eating.
• Loss of sense of taste.
• Problems speaking.
• Thick or stringy saliva.
• Mouth sores or pain.
• Hoarseness.
• Fatigue.
• Fever.
• Change in color of hands or feet
• Joint pain or joint swelling.
• Swollen glands.

Scleroderma
Symptoms of scleroderma may include:

• Fingers or toes that turn blue or white in response to cold temperatures (Raynaud's phenomenon).
• Hair loss.
• Skin that becomes darker or lighter than normal.
• Stiffness and tightness of skin of fingers, hands, forearm and face.
• Small white lumps beneath the skin that sometimes ooze a white substance that looks like toothpaste.
• Sores (ulcers) on the fingertips or toes.
• Tight and mask-like skin on the face.
• Joint pain.
• Numbness and pain in the feet.
• Pain, stiffness and swelling of fingers and joints.
• Wrist pain.
• Dry cough.
• Shortness of breath.
• Wheezing.
• Bloating after meals.
• Constipation.
• Diarrhea.
• Difficulty swallowing.
• Esophageal reflux or heartburn.
• Problems controlling stools.

Systemic lupus erythematosus
The most common signs of SLE are:

• Red rash or color change on the face, often in the shape of a butterfly across the nose and cheeks.
• Painful or swollen joints.
• Unexplained fever.
• Chest pain with deep breathing.
• Swollen glands.
• Extreme fatigue.
• Unusual hair loss.
• Pale or purple fingers or toes from cold or stress.
• Sensitivity to the sun.
• Low blood count.
• Depression, trouble thinking or memory problems.

Other signs are mouth sores, unexplained seizures (convulsions), "seeing things" (hallucinations), repeated miscarriages, and unexplained kidney problems.

Treatments for Arthritis
Whether you have a non-inflammatory or inflammatory type of arthritis or even a painful case of gout, there are numerous medications and recommendations to relieve pain and ensure that your joints do not become damaged further.

The doctor will likely recommend a course of physical therapies to help overcome some of the symptoms of arthritis. The focus of treatment for arthritis is to control pain, minimize joint damage and improve or maintain function and quality of life. According to the American College of Rheumatology, the treatment of arthritis might involve the following:

• Medications
• Non-pharmacologic therapies
• Physical or occupational therapy
• Splints or joint assistive aids
• Patient education and support
• Weight loss
• Surgery - joint replacement and joint surgery

Self-management
In combination with medical treatment, self-management of arthritis symptoms is also important. Key self-management activities include:

• Learn arthritis management strategies
• Be active
• Watch weight
• See the doctor
• Protect joints

There are seven important self-management habits that can help you successfully manage your disease:

• Be organized: keep track of symptoms, pain levels, medications, and possible side effects for consultations with your doctor.
• Manage pain and fatigue: a medication regimen can be combined with non-medical pain management. Learning to manage fatigue is key to living comfortably with arthritis.
• Stay active: exercise is beneficial for managing arthritis and overall health.
• Balance activity with rest: in addition to remaining active, rest is equally important when your disease is active.
• Eat a healthy balanced diet: a healthy diet can help you achieve a healthy weight and control inflammation by eating foods with anti-inflammatory properties and high in antioxidants.
• Improve sleep: poor sleep can aggravate arthritis pain and fatigue, there are measures that can be put in place to make sure you fall asleep and stay asleep such as avoiding caffeine or strenuous exercise in the evenings.
• Joint care: tips for protecting joints include using your stronger, larger joints as levers when opening doors, using several joints to spread the weight of an object such as using a backpack and gripping as loosely as possible by using padded handles. Do not sit in the same position for long periods; take regular breaks to keep mobile.

Physical therapies
The doctor will often recommend a course of physical therapies to help overcome some of the symptoms of arthritis. These may include any or all of the following:

• Warm water therapy - exercises in a warm-water pool. The water supports weight and puts less pressure on the muscles and joints.
• Physical therapy - specific exercises tailored to the condition and individual needs, sometimes combined with pain-relieving treatments such as ice or hot packs and massage.
• Occupational therapy - practical advice on managing everyday tasks, choosing specialized aids and equipment, protecting the joints from further damage and managing fatigue.

Physical activity
Research suggests that although individuals with arthritis may experience short-term increases in pain when exercise is first initiated, through continued physical activity, there is a long-term reduction of symptoms. People with arthritis can participate in joint-friendly physical activity on their own or with friends. Some of the joint-friendly physical activities that are appropriate for adults with heart disease and arthritis are the following:

• Walking
• Swimming
• Riding a bike

Living with arthritis is not easy and carrying out simple, everyday tasks can often be painful and difficult. However, there are many things you can do, and discuss with your doctor, to make sure you live a healthy lifestyle and have a better quality of life.

What causes Arthritis?
There is no one cause for arthritis; the cause depends on the type or form of arthritis. Potential causes for arthritis may include:

• Injury - leading to degenerative arthritis
• Abnormal metabolism - leading to gout and pseudogout
• Inheritance - such as in osteoarthritis
• Infections - such as in the arthritis of Lyme disease
• Overactive immune system - such as RA and SLE

For many arthritis conditions, there is a strong element of chance involved as to what is the main cause. However, for most types of arthritis, the cause is a combination of many factors working together. A person may naturally be more susceptible to certain conditions due to genetic makeup. If more susceptible, external factors such as previous injury, infection, smoking and physically demanding occupations could play a part. Some types of arthritis are caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life, such as osteoarthritis.

Culled and edited. Images: Medical News Today.