Arthritis

Pain Management for Arthritis

Arthritis2018-12-31T09:48:44-04:00

ArthritisThe term “arthritis” means inflammation of one or more joints, which is a painful condition experienced by many people in the world. There are more than 100 different types of arthritis and related conditions, ranging from wear and tear of cartilage to inflammation resulting from an overactive immune system.

People of all ages, sexes, and races suffer from arthritis, making it the leading cause of disability in America. It is more common among women than men, and it occurs more frequently in older people. By the age of 60, you have a 20% chance of having arthritis.

In This Article:

What Is Arthritis?

Most types of arthritis involve inflammation of one or more joints, such as a knee or wrist; however, arthritis can also cause problems with organs. When arthritis attacks a joint, there is inflammation and stiffness that’s frequently accompanied by pain. Some types of inflammatory arthritis (e.g., rheumatoid and psoriatic arthritis) can damage the eyes, internal organs, and other parts of the body.

Severe arthritis can result in chronic pain and make it difficult to perform normal daily activities like walking and climbing stairs. Arthritis can cause permanent joint change. Some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin as well as the joints. The Arthritis Foundation has a complete list of the many different types of arthritis.

Common Classifications of Arthritis

  • Degenerative Arthritis is one of the most common types of arthritis in which the cartilage wears away and bone rubs against bone (osteoarthritis). The resulting friction causes pain, swelling, and stiffness. If untreated, the joints can lose strength, and the pain may become chronic.
  • Inflammatory Arthritis. Many forms of inflammatory arthritis are autoimmune diseases, such as lupus (systemic lupus erythematosus). The immune system turns against the body, and mistakenly attacks the joints with harmful inflammation. This attack can potentially cause joint erosion, and damage internal organs, eyes, and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis.
  • Infectious Arthritis. Sometimes bacteria, a virus, or a fungus can infect a joint and trigger inflammation, causing infectious arthritis. Examples of organisms that can infect joints are salmonella and shigella (food poisoning or contamination) and hepatitis C (blood-to-blood infection). In many cases, timely treatment with antibiotics may clear the joint infection, but the arthritis can become chronic.
  • Metabolic Arthritis is gout (gouty arthritis). Gout results from high levels of uric acid which forms needle-like crystals in a joint causing pain and tenderness. Gout usually first appears in the big toe.

Common Types of Arthritis

Some of the more common types of arthritis include:

  • Osteoarthritis. The most common type of arthritis is from wear-and-tear of joint cartilage, which is the hard, slick coating on the ends of bones. If there is enough damage, the bones of the joint start grinding together, causing pain, and restricting movement. The wear and tear can occur because of many years of use, or it can be the result of a joint injury or infection. Staying active, maintaining a healthy weight, and avoiding injury and repetitive movements is one of the best ways to prevent osteoarthritis.
  • Rheumatoid arthritis is an autoimmune disease that causes inflammation of the tissue that lines the inside of joints (synovial membrane), causing it to thicken which causes pain. The disease most commonly affects the joints of the hands, wrists, elbows, knees, ankles, and feet. Rheumatoid arthritis can also affect the cardiovascular and respiratory systems.
  • Gout. Uric acid is produced when the body breaks down waste products, mainly purines found in many foods. When high levels of uric acid build up in the body, the substance can form needle-like crystals in the joints. These crystals result in a sudden bout of extreme joint pain (gout attack). Gout can come and go in episodes, or if the body cannot maintain proper uric acid levels, it can become chronic, causing ongoing pain and disability.
  • Lupus. The exact cause of this autoimmune form of arthritis, which affects the organs and joints, is unknown. Scientists believe environmental factors trigger the disease.
  • Psoriatic Arthritis. Scientists believe this form of arthritis is the result of genetics. Psoriatic arthritis causes inflammation as a result of an overactive immune system.

Note: Fibromyalgia is often confused with arthritis, because the early stages of arthritis produce symptoms similar to fibromyalgia. Though fibromyalgia is considered an arthritis-related condition, it neither cause tissue inflammation nor damages joints or muscles; therefore, is not a true form of arthritis.

What Causes Arthritis?

The cause of a patient’s arthritis depends on the form of arthritis. Causes can include:

  • Injury (leading to osteoarthritis).
  • Metabolic abnormalities (such as gout).
  • Hereditary factors.
  • The direct and indirect effect of infections (bacterial and viral).
  • Autoimmunity: misdirected responses of the immune system (such as in rheumatoid arthritis).
  • Some forms of arthritis have unknown causes.

Risk Factors

The risk factors for developing arthritis include:

  • Family history. Some types of arthritis run in families. A child is more likely to develop arthritis if parents or sibling have the disorder. Genes can make a person more susceptible to environmental factors which might trigger arthritis.
  • Age. The primary risk for many types of arthritis, including osteoarthritis, rheumatoid arthritis, and gout, increases with age.
  • Your sex. Women are more likely to develop rheumatoid arthritis, while men are likely to develop gout.
  • Obesity. Individuals who are overweight have an increased risk of developing arthritis. Excess weight places extra stress on joints, particularly the knees, hips, and spine.
  • Previous joint injury. People who suffer an injury to a joint have a higher probability of developing arthritis in that joint.

Severe arthritis, particularly when it affects the hands or arms, can make it difficult to do daily tasks. Arthritis of weight-bearing joints can make walking difficult, while also making it hard to sit up straight. In some cases, joints may become twisted and deformed. The outlook for patients with arthritis depends on the severity of the condition, complications, and whether the disease affects internal organs.

What are the Symptoms of Arthritis?

Arthritis symptoms vary by individual, and by the type of arthritis. The most common symptoms include:

  • Pain in one or more joints that doesn’t go away, or comes back.
  • Tenderness of the inflamed joint with, or without, pain.
  • Warmth and redness in an area of one or more joints.
  • Swelling in one or more joints that may be painful.
  • Stiffness that develops gradually and is progressive in one or more joints.
  • Trouble moving one or more joints in a normal way, or a decrease in normal range of motion.

In the case of large joints (like the knee), there can be a loss of cartilage with a limitation in the range of motion due to the joint damage. If arthritis affects small joints (like the fingers), there can be loss of grip strength of the hand.

Symptoms may come and go. They can be mild, moderate, or severe. They may stay about the same for years but may progress or get worse over time.

Arthritis can also be the result of rheumatic diseases in which the symptoms can affect various organs that do not directly involve a joint. Therefore, some patients may experience fever, gland swelling (swollen lymph nodes), weight loss, and fatigue.

Symptoms of infectious arthritis may include:

  • Fever.
  • Chills.
  • Joint inflammation.
  • Tenderness.
  • Sharp pain.

In children, the signs of the onset of some types of juvenile rheumatoid arthritis can include:

  • Intermittent fever.
  • Loss of appetite.
  • Weight loss.
  • Anemia.
  • Blotchy rash on the arms and legs.
  • Joint stiffness.
  • Limping.
  • Joint swelling.

How is Arthritis Diagnosed?

Diagnosing arthritis often begins with a physical exam by a physician. The doctor may also do blood tests and imaging scans to help determine the type of arthritis. The doctor will also review the history of symptoms, and examine joints for inflammation and deformity. In some cases, laboratory tests of different body fluids can help pinpoint the type of arthritis. Fluids commonly analyzed include blood, urine, and joint fluid.

Imaging

Imaging can help detect problems within the joints that may be causing the symptoms. Examples of the imaging tests include:

  • X-rays. Low levels of radiation allow the doctor to see cartilage loss, bone damage, and bone spurs. X-rays may not reveal early arthritic damage, but a series of x-rays, over time, can track the progression of the disease.
  • Computerized Tomography (CT). The CT scan combines X-rays from many different angles, to create cross-sectional views of internal body structures. CTs show both bone and surrounding soft tissues.
  • Magnetic Resonance Imaging (MRI). A combination of radio waves and a strong magnetic field can produce very detailed cross-sectional images of soft tissues such as cartilage, tendons, and ligaments.
  • Ultrasound. Using high-frequency sound waves, the ultrasound produces images of soft tissues, cartilage, and fluid-containing structures (such as bursae).

Other tests include:

  • Joint aspiration (arthrocentesis). A test on a small sample of the synovial fluid (liquid that lubricates a joint) to look for crystals, bacteria, or viruses that may be present in the fluid.
  • Urine test. This test checks for the presence of protein and various kinds of blood cells.
  • HLA tissue typing. This test looks for genetic markers of ankylosing spondylitis (a form of spinal arthritis).
  • Skin biopsy. A check of a small piece of tissue to help diagnose a particular type of arthritis that involves the skin (lupus and psoriatic arthritis).
  • Muscle biopsy. A check of a small piece of tissue to help diagnose certain types of arthritis that affect muscles (polymyositis or vasculitis).

How is Arthritis Treated?

Unfortunately, there is no cure for arthritis. However, it is possible to reduce or even relieve symptoms, limit pain and inflammation, and help ensure joint function. The type of treatment varies depending on the type of arthritis, in addition to the patient’s age and general health. An early diagnosis of arthritis increases the chances for successful treatment and helps prevent irreversible damage and disability. The focus of arthritis treatment is on improving quality of life.

It may be necessary to try several different treatments, or combinations of treatments, before finding the best possible course of treatment. It is important to find a treatment plan that best meets each patient’s unique needs. The various treatments include:

Medications

The medications for treating arthritis vary depending on the type of arthritis. Common medications include:

  • Analgesics. Medications that help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others) and tramadol (Ultram, Ultracet, others).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Some types of NSAIDs are available only by prescription.
  • Counterirritants. Various creams and ointments that contain menthol or capsaicin, the spicy component in hot peppers. Rubbing these preparations on the skin over an aching joint may interfere with the transmission of pain signals from the joint itself.
  • Disease-modifying antirheumatic drugs (DMARDs). Primarily for treating rheumatoid arthritis, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
  • Transcutaneous electrical nerve stimulation (TENS). Pain reduction may be possible with the use of a TENS device. The device sends mild, electrical pulses to nerve endings in the painful area, blocking pain signals to the brain and changing the perception of pain.
  • Biologic response modifiers. Typically for use in conjunction with DMARDs, biologic response modifiers are special drugs that target protein molecules responsible for the body’s immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).
  • Corticosteroids. This class of drug (prednisone and cortisone) reduces inflammation and suppresses the immune system.
  • Hyaluronic acid therapy. The fluid surrounding the joints appears to break down in people with osteoarthritis. The injection of this fluid into a joint, such as a knee, may help relieve symptoms.

Therapy

Physical therapy can be helpful for some types of arthritis.

  • Exercises. Specific exercises help improve the range of motion and strengthen muscles of the surrounding joints. In some cases, splints or braces are beneficial.
  • Joint immobilization. The use of a splint or brace can help a joint rest while protecting it from further injury.

Surgery

If conservative measures don’t help, surgery may be an option. Full recovery after surgery takes up to 6 months. Following surgery, a rehabilitation program is an important part of the treatment. Some types of surgery are:

  • Joint repair. In some instances, smoothing or realigning joint surfaces can help reduce pain and improve function.
  • Joint replacement. This procedure replaces an arthritic joint with an artificial one. It is most common for replacing hip and knee joints.
  • Joint fusion. This procedure is often used with smaller joints, such as those in the wrist, ankle, and fingers. Joint fusion removes the ends of the two bones of the joint, then locks the ends together until they heal into one rigid unit.

Alternative Medicine

Although there is little reliable evidence to support the use of these practices, many people use alternative remedies for arthritis. The most promising of these alternative treatments for arthritis include:

  • Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce many types of pain, including that caused by some types of arthritis.
  • Glucosamine. Although study results are mixed, it appears that glucosamine reduces pain and improves function in some patients. Another study found an improvement in joint pain, stiffness, and function in some patients with moderate-to-severe arthritis when combining glucosamine and chondroitin.
  • Yoga or tai chi. The slow, stretching movements associated with yoga and tai chi may help improve joint flexibility and range of motion in people with some types of arthritis.
  • Massage. Light stroking and kneading of muscles help increase blood flow, while also warming arthritic joints, temporarily relieving pain.

Lifestyle and Home Remedies

In many cases, there are things a patient can do at home to help reduce arthritis symptoms:

  • Weight loss. Losing weight, if obese, will reduce the stress on weight-bearing joints. The loss of weight can increase mobility and possibly limit future joint injury.
  • Exercise. Regular exercise helps keep joints flexible. Swimming and water aerobics may be good choices because the buoyancy of the water reduces stress on weight-bearing joints.
  • Heat and cold. The use of moist heat (warm bath or shower) or dry heat (heating pad) on the joint can ease pain. Ice (ice pack) wrapped in a towel can help ease pain and swelling in the joint.
  • Assistive devices. Using canes, walkers, and other assistive devices can help protect joints and improve the ability to perform daily tasks.

Is it Possible to Prevent Arthritis?

Genetics are a factor with many forms of arthritis, so some arthritic conditions may be unavoidable. However, there are things we can do to help lower the risk of developing arthritis. Younger people, particularly those in their 20s and 30s, can take steps to protect their joints throughout their entire life. For most people, for example, maintaining a proper body weight significantly reduces the risk of having some forms of arthritis.

Sports injuries are a primary cause of arthritis. Therefore, it’s important to use techniques and equipment that prevent injury. Furthermore, if you suffer a sports injury, it is important to see a doctor.

It is also important for everyone to have a regular stretching program throughout every stage of life. Maintaining flexibility as we age is helpful to lower the risk of joint injury, thereby reducing the risk of arthritis.

Novus Spine & Pain Center

Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating arthritis pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.

To schedule an appointment, please contact us online, request a call back, or call our office at 863-583-4445.

Arthritis Resources

What is Arthritis? (Arthritis Foundation)
Types of Arthritis (Arthritis Foundation)
Arthritis Facts (MedicineNet.com)
Arthritis at Any Age (WebMD)
Understanding Arthritis Symptoms (WebMD)
Top 3 Types of Arthritis (WebMD)
Arthritis (Mayo Clinic)
Arthritis: Causes, types, and treatments (Medical News Today)
Arthritis (JohnsHopkins.org)
Arthritis (MedlinePlus.gov)
Arthritis (Wikipedia)
Types of Arthritis (Arthritis-Health.com)
Arthritis Types (Centers for Disease Control)
Hyaluronic Acid Injections for Osteoarthritis (Arthritis.org)