Health Conditions : Arthritis

Number of people affected:
More than 40 million people in the United States. Osteoarthritis is the most common form, affecting more than 20 million people.

Who gets it:
Half of all people age 65 and older. Older people most often have 3 forms: osteoarthritis, rheumatoid arthritis or gout.

Symptoms:
Pain and stiffness in joints

Treatments:
Acetaminophen and pain relievers, COX-2 inhibitors, Corticosteroids, hyaluronic acid, disease-modifying anti-rheumatic drugs (DMARDs) and topical creams

Doctors to see:
Rheumatologist

Arthritis may be caused by inflammation, of the tissue lining the joints. Joints are places where two bones meet, such as the elbow or knee. Over time, in some types of arthritis but not in all, the joints involved can become severely damaged.

There are several types of arthritis. The three most common ones are osteoarthritis, rheumatoid arthritis and gout.

Osteoarthritis is the most common form of arthritis. This condition usually comes with age and most often affects the fingers, knees, and hips.

Rheumatoid arthritis happens when the body’s own defense system doesn’t work properly. It affects joints and bones (often of the hands and feet), and may also affect internal organs and systems.

Gout is caused by crystals that build up in the joints. It usually affects the big toe, but many other joints may be affected.

Pain and stiffness in the joints is the most common symptom of arthritis, but depending on the type of arthritis your loved one has, symptoms may vary. Here are common symptoms for each type:

Osteoarthritis: Joint pain, swelling, tenderness, stiffness after getting out of bed, and a crunching feeling or sound of bone rubbing on bone.

Rheumatoid Arthritis: Inflammation of the joint lining. This inflammation causes warmth, redness, swelling, and pain around the joints. A person also feels sick, tired, and sometimes feverish. Rheumatoid arthritis generally occurs in a symmetrical pattern. If one knee or hand is affected, the other one is also likely to be affected.

Gout: Hyperuricemia, meaning high levels of uric acid in the body, contributes to arthritis that develops in one day, producing a swollen, red, and painful joint. Gout attacks usually begin at night.

Doctors will use a combination of methods and tests including a medical history, a physical examination, X-rays, and laboratory tests. Specific tests are conducted for the various types of arthritis in seniors:

Rheumatoid Arthritis: Rheumatoid factor test, erythrocyte sedimentation rate, which indicates the presence of inflammation in the body, a test for white blood cell count; and a blood test for anemia.

Gout: To confirm a diagnosis of gout, the doctor inserts a needle into the inflamed joint and draws a sample of synovial fluid, the substance that lubricates a joint. A laboratory technician places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If crystals are found in the joint fluid, the person usually has gout.

Osteoarthritis: X-rays are limited in their capacity to reveal how much joint damage may have occurred in osteoarthritis. X-rays usually don't show osteoarthritis damage until there has been a significant loss of cartilage.

Treatments

Osteoarthritis: For pain relief, doctors usually start with acetaminophen because the side effects are minimal. Next, try non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, or COX-2 inhibitors such as celecoxib and valdecoxib may be used.

Gout: The most common treatments for gout are high doses of non-steroidal anti-inflammatory drugs, or NSAIDs, which are taken by mouth, or corticosteroids, which are taken by mouth or injected into the affected joint. When NSAIDs or corticosteroids fail to control pain and swelling, the doctor may use another drug, colchicine.

Rheumatoid Arthritis: Disease-modifying anti-rheumatic drugs or DMARDs, can often slow the course of the disease. DMARDs include methotrexate, leflunomide, sulfasalazine, and cyclosporine. Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation. Cortisone, hydrocortisone, and prednisone are commonly used.

In some cases, a doctor will recommend surgery to restore function or relieve pain in a damaged joint. Surgery may also improve a person's ability to perform daily activities. Joint replacement and tendon reconstruction are two types of surgery available to patients with severe joint damage.

Scientists have some understanding of the factors that cause osteoarthritis, rheumatoid arthritis, and gout:

• Osteoarthritis: Researchers suspect that osteoarthritis is caused by a combination of factors in the body and the environment. The chance of developing osteoarthritis increases with age. By age 65, half of the population has x-ray evidence of osteoarthritis in at least one joint, most often in the hips, knees, or fingers.
• Rheumatoid Arthritis: Rheumatoid arthritis results from the interaction of many factors such as genes, hormones, and the environment. Research suggests that a person's genetic makeup is an important part of the picture, but not the whole story. Some evidence shows that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. However, a specific agent or agents are not yet known.
• Gout: Researchers have discovered some of the risk factors for gout. Up to 8 percent of people with gout have a family history of the disease. In addition to inherited traits, diet, weight, and alcohol play a role in the development of gout. The disease is more common in men. Most people with gout have too much uric acid in their blood, a condition called hyperuricemia. The extra uric acid moves from the blood to the joints, which may trigger the inflammation seen in gout.

Although there is no cure for most forms of arthritis, various therapies can help patients manage symptoms and improve their overall quality of life. The choice of treatment depends on the type of arthritis, the severity of symptoms, the patient's general health, and other factors. In addition to medications prescribed, these treatments might help ease your loved one's pain.

• Heat and cold. For temporary relief of pain from arthritis, use warm towels, hot packs, or a warm bath or shower. In some cases, cold packs can relieve pain or numb the sore area.
• Exercise. Exercise is one of the best treatments for arthritis. It can improve mood and outlook, decrease pain and increase flexibility. The amount and form of exercise will depend on which joints are involved, how stable the joints are, whether or not the joint is swollen, and whether a joint replacement has already been done. Ask your doctor or physical therapist what exercises are best for your loved one.
• Supplements. For some people, glucosamine and chondroitin sulfate may help relieve symptoms. Scientific studies have shown that these supplements may have some benefit for people with arthritis.