What is Arthritis?

The term arthritis refers to the inflammation of one or more joints, characterized by swelling, warmth, redness of the overlying skin, pain and restriction of motion. Surprisingly, there are over 200 diseases that may cause arthritis! In general terms, arthritis can be divided into two main categories: (1) non-inflammatory arthritis and (2) inflammatory arthritis. This article will focus on the main cause of arthritis in each category: Osteoarthritis (OA) as a cause of non-inflammatory arthritis and Rheumatoid Arthritis (RA) as a cause of inflammatory arthritis.

Osteoarthritis (OA)

Who Is Affected?

Osteoarthritis is the most common form of arthritis and the second mostcommon cause of long-term disability among adults in the United States.The frequency of OA is about equal in males and females between theages of 45-55, but after age 55, women are more commonly affected. Overone-half of all people over the age of 65 have X-ray changes suggestive of OA, and virtually everyone has these changes in at least one joint after the age of 65.

Knee osteoarthritis is more common in African-American women than Whites. Other factors that correlate to OA: obesity, trauma, and genetics.

What Is Osteoarthritis?

OA causes damage to cartilage, the dense connective tissue that serves as a “shock absorber” between our bones. Overtime, the cartilage erodes and then eventually is lost. This results in bone on bone contact in the joint, leading to deterioration in movement and function. Weight bearing joints including the lower back, hips, knees and feet are most commonly affected.

Symptoms
Painis gradual or insidious in onset, worsens by using the joint,andimproves or is relieved by rest.Morning stiffness is usually lessthan 30 min.Thepainand stiffness are affected by changes in weather-usually worseningindamp, cool, rainy weather. Specific joints may be affecteddifferently:

1. Knees- instability or buckling, especially with going down stairs
2. Hips- problems with gait, and groin pain
3. Hands- problems with dexterity
4. Spine- neck or low back pain

Diagnosis
Your doctor, based on history and physical exam, can almost always make the diagnosis. Routine blood tests are usually normal. An X-ray of the involved joint usually confirms the diagnosis.

Treatment
The principles of treatment include:

• relieving symptoms
• maintaining or improving function
• limiting physical disability

Your doctor may advise weight loss, as obesity is strongly associated with the development of OA. Physical therapy and exercise improves outcome in OA by improving flexibility and strengthening the muscles supporting the affected joint. Exercises that protect the joint, such as swimming, bicycling, or walking are recommended.

Your doctor may also prescribe medication to help relieve the pain. Acetaminophen (Tylenol) is often the drug of choice. If this medicine fails, non-steroidal anti-inflammatory medications (NSAIDS) such as Ibuprofen and a new class of drugs called COX-2 inhibitors can be used. Other options for therapy include: joint injections with steroids, topical creams, or even orthopedic surgery. Discuss the options with your doctor because your current medical condition plays an important role in determining which option is best for you.

Rheumatoid Arthritis (RA)

Who Is Affected?
Anyone can get rheumatoid arthritis. It is 3x more common in women then men, and affects all ethnic groups. The risk of having RA increases with age, and peaks between the ages of 50-70.

What Is Rheumatoid Arthritis?
RA is a form of arthritis that causes inflammation of the joints. The joint lining (synovium) becomes thickened and may cause warmth, swelling and pain in the joint. Usually joints are affected symmetrically (on both sides of the body), unlike OA. The joints affected include: wrists, finger joints, elbows, shoulders, neck, jaw, hips, knees, ankles and feet.

The cause of RA is unknown. It is an autoimmune disorder in which the immune system attacks your body’s own joints and other organs. This leads to joint inflammation and accumulation of fluid in the joint. If the inflammation persists, destruction of the cartilage, bone, tendon, and ligaments can occur. This can lead to joint deformity and disability.

Symptoms
Joint inflammation may fluctuate, but generally is persistent. Joints are warm, swollen, tender, painful, and difficult to move. RA is characterized by morning stiffness that often lasts longer than 2 hours. RA can affect your entire body, unlike OA. You may lose your appetite, lose weight, have a low-grade fever, and have little energy. You may develop nodules under the skin, usually over bony areas exposed to pressure (i.e. elbow). Occasionally, people may develop inflammation of the lining of the heart and lungs.

Diagnosis
If you suspect that you have arthritis, you should see your doctor or health care provider for an evaluation. The diagnosis of RA, like OA, is based on your history and physical exam. The pattern of affected joints helps distinguish RA from OA.

Your physician may recommend certain blood tests and X-rays. The presence of Rheumatoid Factor in your blood may indicate RA, but its absence does not rule out the diagnosis. Another lab test abnormality is an elevated ESR (Erythrocyte Sedimentation Rate), which indicates inflammation. While blood tests are helpful in making a diagnosis, there is no single test that can establish or exclude RA. X-ray findings of RA usually only become evident after the disease has been present for several months or more than a year. Your doctor may send you to a Rheumatologist, a physician specializing in arthritis, for help in making the diagnosis.

Treatment
Medications used to treat RA can be divided into two groups: those which help to relieve symptoms (NSAIDS/steroids) and those with the potential to modify the disease (methotrexate). There are several new drugs that have come on the market recently that may significantly improve the treatment for RA. Your physician may recommend using two or more medications at a time, each serving a distinct purpose. Monitoring for potential side effects from the medications is important. If any of the medications is causing side effects, you should contact your physician promptly.

Alternative Treatments For Arthritis
If you are interested in alternative treatments for arthritis, I suggest that you got to the Arthritis Foundation web site at www.arthritis.org. You will find information that has been extensively researched and reviewed by many experts in the field of rheumatology and arthritis.

LaShonda Spencer, M.D.
Internal Medicine and Pediatrics