Arthritis is the swelling and tenderness of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.
Osteoarthritis causes cartilage — the hard, slippery tissue that covers the ends of bones where they form a joint — to break down. Rheumatoid arthritis is a disease in which the immune system attacks the joints, beginning with the lining of joints.
Uric acid crystals, which form when there’s too much uric acid in your blood, can cause gout. Infections or underlying disease, such as psoriasis or lupus, can cause other types of arthritis.
Treatments vary depending on the type of arthritis. The main goals of arthritis treatments are to reduce symptoms and improve quality of life.
The most common signs and symptoms of arthritis involve the joints. Depending on the type of arthritis you have, your signs and symptoms may include:
- Decreased range of motion
The two main types of arthritis — osteoarthritis and rheumatoid arthritis — damage joints in different ways.
“The most common type of arthritis, osteoarthritis involves wear-and-tear damage to your joint’s cartilage — the hard, slick coating on the ends of bones where they form a joint. Cartilage cushions the ends of the bones and allows nearly frictionless joint motion, but enough damage can result in bone grinding directly on bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can be hastened by a joint injury or infection.
Osteoarthritis also affects the entire joint. It causes changes in the bones and deterioration of the connective tissues that attach muscle to bone and hold the joint together. It also causes inflammation of the joint lining.”
“In rheumatoid arthritis, the body’s immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining (synovial membrane) becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint.”
Risk factors for arthritis include:
Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger arthritis.
The risk of many types of arthritis — including osteoarthritis, rheumatoid arthritis and gout increases with age.
Women are more likely than men to develop rheumatoid arthritis, while most of the people who have gout, another type of arthritis, are men.
Previous joint injury.
People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. People with obesity have a higher risk of developing arthritis.
GO FOR MEDICAL CARE
If joint pain, swelling, stiffness, redness, loss of motion or deformity occurs, medical evaluation by a health care professional is warranted.
Even minor joint symptoms that persist unexplained for over one week should be evaluated.
For many forms of arthritis, it is essential that patients have an early evaluation as it is clear that this can both prevent damage and disability as well as make optimal treatment easier.
Primary care physicians such as internists, family practice doctors, and general practitioners frequently diagnose and treat common musculoskeletal conditions and straightforward cases of arthritis.
Rheumatologists are specialists in the more than 100 different types of arthritis and have great expertise in the diagnosis and treatment of arthritis, from straightforward to complex cases.
Orthopedists (also known as orthopedic surgeons) commonly treat arthritis, especially when surgical management is necessary.
Other medical specialists who may be involved in the treatment of arthritis include physical therapists and occupational therapists.
DIAGONOSIS OF ARTHRITIS
- The first step in the diagnosis of arthritis is a meeting between the doctor and the patient. The doctor will review the history of symptoms, examine the joints for inflammation and deformity, as well as ask questions about or examine other parts of the body for inflammation or signs of diseases that can affect other body areas.
- Furthermore, certain blood, urine, joint fluid, and/or x-ray tests might be ordered. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and any blood test and x-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis.
- Earlier and accurate diagnosis can help to prevent irreversible damage and disability.
- Properly guided programs of exercise and rest, medications, physical therapy, and surgery options can idealize long-term outcomes for arthritis patients.
- An opinion regarding the cause or the type of the arthritis can usually be adequately obtained by consulting a general family doctor. It is often unnecessary to see an arthritis specialist (rheumatologist) for this purpose. However, if the diagnosis or treatment plan is unclear, a rheumatologist might be consulted.
- A rheumatologist is a medical doctor who specializes in the nonsurgical treatment of rheumatic illnesses, especially arthritis. Rheumatologists have special interests in unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia. They often serve as consultants, acting like medical detectives at the request of other doctors.
- Rheumatologists have particular skills in the evaluation of the over 100 forms of arthritis and have special interest in rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still’s disease, dermatomyositis, Sjögren’s syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch-Schönlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud’s disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others.
- When specific organs are affected by disease aside from the joints associated with the arthritis, other medical specialists might be consulted.
- The treatment of arthritis depends on which particular form of arthritis is present, its location, severity, persistence, and any underlying background medical conditions of the patient.
- Each treatment program must be customized for the individual patient.
- Treatment programs can incorporate home remedies, nonprescription and prescription medications, joint injections, and surgical operations.
- Some treatment programs involve weight reduction and avoiding activities that exert excessive stress on the joint.
The goal of treatment of arthritis is to reduce joint pain and inflammation while preventing damage and improving and maintaining joint function
- Treatment may not be necessary for arthritis with minimal or no symptoms. When symptoms are troubling and persist, however, home remedies might include pain and antiinflammatory medications as below. Furthermore, heat/cold applications and topical pain creams can be helpful.
- As a first step, rest, heat/cold applications, and topical pain creams can be helpful. For osteoarthritis, the over-the-counter food supplements glucosamine and chondroitin have been helpful for some, though their benefits are still controversial according to national research studies. These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a three-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements “rebuild” cartilage. This claim has not been adequately verified by scientific studies to date.
- For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammation properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis. Obesity has long been known to be a risk factor for osteoarthritis of the knee. Weight reduction is recommended for patients who are overweight and have early signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees. Of note, even modest weight reduction can be helpful.
- Pain medications that are available over the counter, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis and are often recommended as the first medication treatment. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis.
- Some patients get significant relief of pain symptoms by dipping their hands in hot wax (paraffin) dips in the morning. Hot wax can often be obtained at local pharmacies or medical supply stores. It can be prepared in a special warming device for use at home and be reused after it hardens as a warm covering over the hands by peeling it off and replacing it into the melted wax. Warm water soaks and wearing nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms. Gentle range of motion exercises performed regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.
- Pain-relieving creams that are applied to the skin over the joints can provide relief of daytime minor arthritis pain. Examples include capsaicin (ArthriCare, Zostrix, Capsagel), diclofenac cream (Voltaren gel), salicin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall). For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.
- There are a few forms of arthritis, such as gout, that can be impacted by dietary changes.
- Finally, when arthritis symptoms persist, it is best to seek the advice of a doctor who can properly guide the optimal management for each individual patient.
How much: Health authorities like The American Heart Association and the Academy of Nutrition and Dietetics recommend three to four ounces of fish, twice a week. Arthritis experts claim more is better.
Why: Some types of fish are good sources of inflammation-fighting omega-3 fatty acids. A study of 727 postmenopausal women, published in the Journal of Nutrition in 2004, found those who had the highest consumption of omega-3s had lower levels of two inflammatory proteins: C-reactive protein (CRP) and interleukin-6.
More recently, researchers have shown that taking fish oil supplements helps reduce joint swelling and pain, duration of morning stiffness and disease activity among people who have rheumatoid arthritis (RA).
Best sources: Salmon, tuna, sardines, herring, anchovies, scallops and other cold-water fish. Hate fish? Take a supplement. Studies show that taking 600 to 1,000 mg of fish oil daily eases joint stiffness, tenderness, pain and swelling.
Nuts & Seeds
How much: Eat 1.5 ounces of nuts daily (one ounce is about one handful).
“Multiple studies confirm the role of nuts in an anti-inflammatory diet,” explains José M. Ordovás, PhD, director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.
A study published in The American Journal of Clinical Nutrition in 2011 found that over a 15-year period, men and women who consumed the most nuts had a 51 percent lower risk of dying from an inflammatory disease (like RA) compared with those who ate the fewest nuts. Another study, published in the journal Circulation in 2001 found that subjects with lower levels of vitamin B6 – found in most nuts – had higher levels of inflammatory markers.
More good news:
Nuts are jam-packed with inflammation-fighting monounsaturated fat. And though they’re relatively high in fat and calories, studies show noshing on nuts promotes weight loss because their protein, fiber and monounsaturated fats are satiating. “Just keep in mind that more is not always better,” says Ordovás.
Walnuts, pine nuts, pistachios and almonds.
Fruits & Veggies
How much: Aim for nine or more servings daily (one serving = 1 cup of most veggies or fruit or 2 cups raw leafy greens).
Fruits and vegetables are loaded with antioxidants. These potent chemicals act as the body’s natural defense system, helping to neutralize unstable molecules called free radicals that can damage cells.
Research has shown that anthocyanins found in cherries and other red and purple fruits like strawberries, raspberries, blueberries and blackberries have an anti-inflammatory effect.
Citrus fruits – like oranges, grapefruits and limes – are rich in vitamin C. Research shows getting the right amount of that vitamin aids in preventing inflammatory arthritis and maintaining healthy joints.
Other research suggests eating vitamin K-rich veggies like broccoli, spinach, lettuce, kale and cabbage dramatically reduces inflammatory markers in the blood.
Colorful fruits and veggies – the darker or more brilliant the color, the more antioxidants it has. Good ones include blueberries, cherries, spinach, kale and broccoli.
Two to three tablespoons daily
Olive oil is loaded with heart-healthy fats, as well as oleocanthal, which has properties similar to nonsteroidal, anti-inflammatory drugs. “This compound inhibits activity of COX enzymes, with a pharmacological action similar to ibuprofen,” says Ordovás. Inhibiting these enzymes dampens the body’s inflammatory processes and reduces pain sensitivity.
Extra virgin olive oil goes through less refining and processing, so it retains more nutrients than standard varieties. And it’s not the only oil with health benefits. Avocado and safflower oils have shown cholesterol-lowering properties while walnut oil has 10 times the omega-3s that olive oil has.
About one cup, twice a week (or more)
Beans are loaded with fiber and phytonutrients, which help lower CRP, an indicator of inflammation found in the blood. At high levels, CRP could indicate anything from an infection to RA. In a study published in The Journal of Food Composition and Analysis in 2012, scientists analyzed the nutrient content of 10 common bean varieties and identified a host of antioxidant and anti-inflammatory compounds.
Beans are also an excellent and inexpensive source of protein, with about 15 grams per cup, which is important for muscle health.
Small red beans, red kidney beans and pinto beans rank among the U.S. Department of Agriculture’s top four antioxidant-containing foods (wild blueberries being in the number 2 spot).
Eat a total of 6 ounces of grains per day; at least 3 of which should come from whole grains. One ounce of whole grain would be equal to ½ cup cooked brown rice or 1 slice of whole-wheat bread.
Whole grains contain plenty of filling fiber – which can help you maintain a healthy weight. Some studies have also shown that fiber and fiber-rich foods can lower blood levels of the the inflammatory marker C-reactive protein.
Eat foods made with the entire grain kernel, like whole-wheat flour, oatmeal, bulgur, brown rice, quinoa. Some people may need to be careful about which whole grains they eat. Gluten – a protein found in wheat and other grains – has been linked to inflammation for some people.