What is arthritis?
Arthritis is characterised by an inflammation of the joints (the area in which two bones in the body meet). This can cause difficulties with movement of affected body parts and result in varying degrees of discomfort.
Inflammation can affect one area (or joint) or multiple portions of the body, with symptoms developing over time. Symptoms as a result of inflammation may also develop rapidly. The most common symptoms associated with arthritis conditions are joint stiffness and pain (arthralgia), as well as swelling (inflammation). Such symptoms typically worsen with age which contributes to a decreased range of motion.
While arthritis refers to the common symptoms of stiffness, pain and inflammation affecting the joints, it is not classified as a single condition. There are many forms and variations of joint pain or joint disease.
When inflammation affects a single joint in the body, this is known as monoarthritis. When two or three joints are affected, the condition is known as oligoarthritis. Four or more affected joints in the body is known as polyarthritis.
Symptoms of arthritis can range from mild to moderate or severe. Many may describe their range of discomfort as ‘the same’ for long periods of time (sometimes years) before noticing a distinctive change. The nature of arthritic conditions is that symptoms do progress over time and can worsen to the point of severe. Severe arthritis can lead to chronic pain, greatly affecting the ability to perform normal daily activities. Chronic pain increases risk for permanent changes to the joints. Permanent physical changes can include knobby finger joints, and an array of internally affected areas of the body which can be seen through imaging tests, such as X-rays.
Damage through inflammation can also extend beyond the joints and affect surrounding tissues, including those of the eyes, lungs, kidneys, heart and skin.
Arthritis, as a condition is more commonly diagnosed in females than males, especially where excess weight is an issue. Adults over the age of 65 commonly develop arthritis conditions, but inflammation is also known to develop in younger adults, as well as children and teenagers.
As arthritis is a progressive condition, it’s important to seek medical intervention for appropriate treatment. Once the specific form or type is determined and diagnosed, appropriate treatment can be implemented as a way to reduce symptom effects on the body and improve a person’s overall quality of life.
Types of arthritis
Did you know? There are more than 100 different variations of arthritis and associated conditions.
What are the different types of arthritis?
‘Arthritis’ is characterised by similar symptoms, but is broken into various forms according to different causes and treatment methods. Many variations or arthritis or musculoskeletal conditions share similar characteristics.
As a result, arthritis conditions have been split into 7 main characteristic groupings:
- Degenerative (or mechanical) arthritis: This category refers to those conditions which are characterised by damage to the cartilage that covers the ends of the body’s bones. The normal smooth surface of cartilage becomes rougher and thinner with damage. Bone effectively rubs against bone and wears away the slick, cushioning surface. The body reacts to this by attempting to restore cartilage stability and begins to ‘remodel the bone’. Osteophytes (bony growths) or misshapen joints may develop as a result. In the process, bone loses strength resulting in pain and stiffness. The most common form of this category is osteoarthritis (thinning of the bones).
- Inflammatory arthritis: Inflammation in the body is part of a normal, healthy healing process and defence against bacteria and viruses. When inflammation occurs without the presence of infection or injury, it causes distress to the joints and surrounding tissues, especially ligaments and tendons (enthesitis). The result is swelling, stiffness and pain. Inflammation can affect several joints in the body, causing erosive damage to the surface of the joints as well as underlying bone structures. Types of inflammatory arthritis include rheumatoid arthritis, reactive arthritis, ankylosing spondylitis (this can lead to the fusing of vertebrae in the spine) and that which is associated with conditions such as colitis and psoriasis (psoriatic arthritis). These variations of arthritis are best diagnosed and treated early to prevent permanent damage to the joints.
- Soft tissue musculoskeletal pain: This category variation refers to pain that is experienced in the joints, bones and surrounding soft tissues. This can happen as a result of an injury or overuse of specific areas of the body. Tennis elbow is one such example. Pain and inflammation effectively begins in the soft tissues and muscles which support the joints. When pain such as this becomes more widespread, the condition may be diagnosed as fibromyalgia.
- Connective tissue disease (CTD): Tissues, such as ligaments, tendons or cartilage, which separate, bind together or support the joints can become inflamed and lead to joint pain in the body. This can result as a symptom of CTD which can further affect the body’s muscles, kidneys, lungs and skin tissues as well. CTD can be broken down into further condition variations, all experiencing symptoms of joint pain, such as Systemic lupus erythematosus (SLE), Scleroderma (systemic sclerosis) or dermatomyositis.
- Back pain: Pain and inflammation is usually associated with a specific cause and can originate in the body’s muscles, nerves, discs, ligaments, joints, bones, and even organs. All can result in sensations of referred pain. Osteoarthritis, arthritis in the facet joints of the vertebrae or a ‘slipped disc’ can result in back pain where inflammation and damage occurs in the spine.
- Metabolic arthritis: Elevated levels of uric acid can accumulate and form needle-like crystals on the joints in the body. This can result in sudden bursts of severe pain or even a gout attack. Uric acid is normally produced as a chemical when purines, found in the body’s cells and various foods, are broken down and dissolved in the blood. Most of the chemical will normally travel through the bloodstream to the kidneys, where it will be passed out of the body in urine. It can happen that some people naturally produce excess (more than the body needs or can get rid of during the breakdown process). When some of this remains, and accumulates, symptoms or arthritis can occur. Sharp episodes of pain can affect a single joint or multiple joints in the body. Common areas where pain is experienced are the hands or a big toe (usually extremities that are not close to the warmest areas of the body).
- Infectious and septic arthritis: Infectious arthritis typically develops if a virus, fungus or bacterium, such as salmonella or Shigella (food contamination), gonorrhoea or chlamydia (sexually transmitted diseases), or hepatitis C (blood-to-blood infection) enters the body’s joints. Septic arthritis typically affects the joints of the hips and knees and develops quickly, thus requiring prompt medical diagnosis and treatment. The infected joint results in inflammation and pain, but is usually treatable with antibiotics or antimicrobial medications. Symptoms of arthritis can sometimes result in damage to the joints, causing chronic discomfort. Symptoms must be treated by a medical doctor as soon as possible to prevent extensive damage. If damage is extensive, having persisted over a long period of time without appropriate treatment, it can be irreversible. Some existing conditions or treatment processes can increase a person’s risk of developing septic arthritis. These include chronic conditions such as sickle cell disease or diabetes, the use of artificial joint implants, medications that suppress the immune system, intravenous (IV) medications, joint arthroscopy (recent), or a joint injury (recent).
Which are some of the most common forms of arthritis and associated conditions?
- Rheumatoid arthritis(RA): Inflammation which persists in the synovia (the clear, lubricating fluid which is secreted in the joint cavities, tendon sheaths and the bursae cavities that counter friction in the joints) can cause cartilage and bone degeneration. This results in swelling, joint pain and sometimes joint deformity. Without adequate treatment, RA (an autoimmune disease, whereby the immune system ‘attacks parts of the body’) can severely compromise a person’s quality of life.
- Osteoarthritis: This type of arthritis can develop gradually (over months or years) and is typically seen to worsen after the age of 40. Also a degenerative joint disease (leading to the breaking down of tissues), damage affects the entire joint, joint lining, ligaments and underlying bone. The most common areas affected are those that are most used (the ‘wear and tear effect’) – the knees, hands (especially the base of the thumb), hips, spine, and big toe joint. Without adequate treatment and careful management, osteoarthritis can become quite debilitating, especially for seniors during their later years. Essentially, the body’s natural ‘shock absorber’ is degenerated and worn down in the process.
- Psoriatic arthritis: This condition often occurs as a result of an existing skin disease known as psoriasis (the build-up of skin cells that forms dry, itchy raised red and white patches and scales). This form of arthritis develops as an abnormal immune response in the body, adding to the overproduction of skin cells, and resulting in inflammation and symptoms of pain. Not all cases of psoriasis will develop psoriatic arthritis (generally only 10% to 30%).
- Childhood arthritis: There are at least three variations of childhood arthritis classifications – JRA (juvenile rheumatoid arthritis), JCA (juvenile chronic arthritis) and JIA (juvenile idiopathic arthritis). All are typically diagnosed in children under the age of 16. The most commonly diagnosed is JRA.
- Fibromyalgia: Widespread pain which also affects the body’s joints can cause additional symptoms of sleep disturbance, fatigue, and psychological distress. Abnormal pain processing in the body can result in severe chronic pain in the body. Many with this condition experience strong painful reactions to various activities that most would not experience any discomfort with. Causes of the condition are largely unknown, but can sometimes appear to be associated with PTSD (post-traumatic stress disorder), a genetic predisposition, problems with obesity, or conditions such as SLE, chronic fatigue syndrome and RA or viral infections and repetitive injuries.
- Gout: Joint pain is typically acute (red, hot and swollen) occurring in flares for several days or weeks. Gout may go into remission for long periods of time and then flare up in chronic cycles of severe or agonising pain. If chronic, it can develop into gouty arthritis. Risk factors that can lead to the onset of this condition include hypertension (high blood pressure), obesity or excessive weight, alcohol abuse, use of diuretics, or poor kidney function.
What causes arthritis?
As arthritis is medically classified into so many different variations, causes typically relate to a specific type or category of this condition.
Most forms of arthritis are as a result of a combination of factors which contribute to related symptoms of inflammation, pain and stiffness. Some arthritic conditions appear to have no obvious cause, with symptoms that occur unpredictably.
The most common potential causes as they relate to the different classified categories are:
- Injuries – broken bones (can lead to degenerative arthritis symptoms)
- Genetic factors (arthritis which appears to run in families)
- Infections in the body (bacterial, viral or fungal)
- Immune system impairment or dysfunction
- Abnormal metabolism
- Physically demanding occupations – ‘wear and tear’ of joints (contributing to overuse and unnecessary joint pressure)
- Uric acid or calcium pyrophosphate dihydrate crystal formations in the body (joints)
Factors which can aggravate an underlying cause for arthritis include:
- Foods which increase inflammation in the body (such as refined sugars or animal-derived foodstuffs)
- Foods which provoke an immune system response (such as a diet high in purines – seafood, red wine and red meat)
How does arthritis affect the body?
Signs and symptoms of arthritis (general)
Symptoms as related to direct causes vary. The type of arthritis is directly related to the pattern and location of arthritic symptoms.
The general signs and symptoms associated with all variations of arthritis include:
- Joint pain, swelling and stiffness
- Joint tenderness and inflammation (without pain)
- Decreased range of motion (movements associated with large joints such as the knees)
- Redness (inflammation) of the skin surround affected joints (including warm sensations)
- Loss of hand grip or grip strength (usually when small joints such as those in the fingers are affected)
These symptoms may be at the worst first thing in the morning. Symptoms may develop suddenly or over a period of time (within months or even years). Symptoms can also occur in flares (come and go) and as damage worsens, may begin to persist for longer periods.
Pain in the joints can fluctuate in varying degrees or be constant. It may be isolated to one specific area of the body or in multiple parts, depending on the number of affected joints. Stiffness is more often a problem first thing in the morning once awake, but can also be problematic after sitting for long periods of time, and even after exercise.
As some types of arthritis are closely associated with other types of conditions, a range of related symptoms over and above those which affect the joints can be experienced as well. Types of symptoms in this regard include fatigue, fever, swollen lymph nodes, weight loss, general malaise, as well as a range of others showing problems with the heart, lungs and kidneys.
Signs and symptoms associated with the more common types of arthritis
- Rheumatoid arthritis (RA): The most common affected joints are the fingers, wrists, knees, ankles and feet (on both sides of the body). Common symptoms include morning stiffness (which persists for about an hour or longer), joint pain (the same joints every day on both sides), decreased range of motion, joint deformation, pleurisy (inflammation of the lining of the lungs and chest cavity that causes chest pain when inhaling or taking a breath), dry eyes and mouth, burning or itching eyes (with discharge), the formation of nodules under the skin’s surface, numbness in the hands and feet (including tingling or burning sensations), difficulties with sleep, fatigue, loss of appetite, and anaemia. Symptoms either begin suddenly or come on gradually, and are typically more severe than osteoarthritis. Main areas of discomfort are the hands, wrists, knees, ankles, feet, shoulders, elbows, neck and jaw. Joint swelling is also typically constant which affects the ability to comfortably perform an array of daily tasks, such as walking or driving. If ill managed symptoms can affect organs such as the heart, lungs and eyes, causing further complications.
- Osteoarthritis: A key differentiator between Osteoarthritis and Rheumatoid arthritis is that symptoms generally occur in joints on both sides with RA. Common signs and symptoms include joint pain (deep and aching) and stiffness (especially first thing in the morning or after a period of rest), worsening pain in the joints following exercise, while walking or when pressure is placed on a specific joint, problems with sleep (due to pain) and a rubbing, crackling or grating sound when moving. Symptoms usually result in trouble performing daily tasks such as dressing, holding or gripping objects, brushing or combing hair, climbing stairs or bending. Affected joints may also be warm to the touch, swollen and more difficult to move comfortably.
- Psoriatic arthritis: Symptoms are often mild and affect a few joints, more typically the fingers and toes. Severe cases can lead to spinal damage (in the lower spine and sacrum) and result in burning sensations, as well as pain and stiffness. Fingernails may also become discoloured and pitted. Symptoms of psoriasis are also common and include skin and nail changes which worsen if the arthritis is not sufficiently managed.
- Childhood arthritis: Symptoms include red and swollen joints (which are warm and tender to the touch), difficulties with movement (limited range of motion) or problems with using a limb (often resulting in limping), a sudden high fever, joint stiffness and pain, a skin rash (usually on the trunk or extremities and accompanied by fever), swollen lymph glands, general malaise and a sickly appearance (pale complexion), eye pain (along with photophobia) and redness, and vision changes or disturbances.
- Fibromyalgia: Symptoms include widespread pain and specific tender points (these are known as trigger points and include the back of the neck, front of the neck, upper back, lower back, shoulders, chest, hips, elbows and knees), fatigue, problems with sleep (due to pain), morning stiffness, numbness in the hands and feet (including tingling sensations), headaches or migraines, IBS (irritable bowel syndrome), ‘fibro fog’ (memory and concentration problems), painful menstrual periods and psychological distress.
- Gout: Symptoms include sudden pain (throbbing or crushing) most often in the big toes, ankle and knee joints, warm sensation and tenderness in the affected area, redness and swelling, fever (occasionally) and tophi (lumps just beneath the surface of the skin around the joints, fingertips or ears).
When to seek medical assistance
It is important to take symptoms of arthritis seriously, no matter the type, as some forms require earlier intervention than others. In all cases, the risk for permanent damage or further complications to other bodily tissues (especially organs) increases over time. Arthritis should be diagnosed following a thorough medical evaluation by a doctor or specialist (rheumatologist).
If any of the general arthritis symptoms are being experienced, especially when discomfort persists for at least 3 days (or longer) or several episodes occur within a period of a month, it is best to see your doctor for an evaluation.
‘Arthritis’ in general terms is not considered a diagnosis, however, and it is best to keep this in mind. With there being so many different underlying causes of arthritic symptoms and various types and medical classifications of the condition (more than 100 related conditions or diseases), an evaluation done early enough can determine the exact variation for a diagnosis. A diagnosis is necessary in order to implement the correct, most beneficial treatment plan.
Infectious or septic arthritis, for instance, does require prompt action so as to avoid permanent damage and health further complications. In all instances where arthritis occurs rapidly, a quick diagnosis and implementation of treatment can help to better preserve joint function as well.
Who should you see?
A good place to start is your general practitioner (GP) or primary healthcare provider. Arthritis can be a little tricky to diagnose initially, but if your GP suspects this enough, he or she may refer to a rheumatologist who specialises in joint, muscle and bone function (and associated medical conditions).
A rheumatologist will test and evaluate as appropriate, make a diagnosis (not matter how complex) and implement the most beneficial treatment plan possible, including home management on a daily basis.
In some instances, an orthopaedic specialist or joint surgeon may also be able to assist with evaluation, looking at the physical or mechanical causes of joint symptoms, in order to make a diagnosis. For the most comprehensive evaluation, a rheumatologist is usually best.
Diagnosing and treating arthritis
How will arthritis be diagnosed?
A consultation will likely begin with a medical review which will cover the following areas:
- Your symptoms: How long ago did you notice symptoms? How would you describe the level of pain or discomfort? Are there specific times you have noticed symptoms of stiffness? How long does stiffness typically last? Are your symptoms constant or do they come and go? Have you tried anything that has either alleviated your symptoms or worsened them?
- Health check – current, recent or past: This is to assess any previous, current or recently experienced health conditions, such as high blood pressure or diabetes, you may have been evaluated for or diagnosed with. Your doctor may ask whether you have been unwell recently, travelled abroad or experienced any joint injuries. He or she may also ask whether you have or have been evaluated for an autoimmune condition. Other questions which may come up include:
- Are you in the habit of playing contact sports?
- Does the nature of your job require long hours of sitting, standing, or other repetitive motion, such as kneeling or climbing stairs?
- Do you use any medications (prescription or over-the-counter) to treat any existing conditions?
- Do you use or take any supplements (including herbal products)?
A doctor will also assess some of your habits, which may include smoking (if applicable), exercise routines (what you do and how often you participate in activity), sleeping patterns and nutrition (or lack of a healthy diet). He or she may also ask questions relating to any possible mental health problems such as anxiety or depression, or whether you are currently stressed.
- Assess family history: Also part of the discussion is a quick assessment for any signs of autoimmune conditions or rheumatic disease in your family line. Your doctor may ask relevant questions regarding your parents, siblings, aunts and uncles or even grandparents.
Once notes have been made during the medical review, a doctor will wish to conduct a physical examination. This part of the evaluation is ‘hands-on’ and is necessary in order to assess, in detail, any visible signs of joint tenderness, redness (inflammation), swelling or stiffness.
A doctor can physically assess which fingers, for instance, are affected. He or she will want to determine if there is a particular pattern of symptoms by assessing all joints. Is there a symptomatic pattern which is symmetrical (i.e. the same joint is affected on both sides, such as the ankles)? He or she may also note a count of affected joints in the body.
The doctor will also need to assess signs of warmth, swelling, tenderness and fluid build-up (near the affected joint areas). A doctor may also gently prod specific areas to assess the level of tenderness and how far away from affected joints this symptom is being experienced. Joints may also be moved to assess your range of motion during the evaluation.
The doctor will also assess and note a temperature reading, check for swollen lymph nodes (glands), assess the eyes, blood pressure, and throat, as well as conduct a reflex check.
Are there any tests involved?
To determine the best course of action, a doctor will need to have a clearer idea as to which variation of arthritis you have. It is also possible to have more than one variation of arthritis at the same time. For treatment to prove beneficial, the type/s of arthritis in the body (or associated conditions) will need to be determined through a series of tests.
The medical review discussion and physical exam will likely give your doctor distinctive clues to work with, ensuring that appropriate tests are done to either rule out or conclusively determine the root cause of symptoms. In this way, a conclusive diagnosis will likely be made.
Tests that are commonly used to make a diagnosis are:
- Laboratory analysis tests: Your doctor may request a few different body fluid samples for testing in the laboratory. These tests can help to pinpoint a specific form of the condition and through analysis, determine the cause of inflammation and pain. Fluid samples will include those of blood (taken through a vein in the arm), joint fluid (taken using a sterilised needle in an affected joint – known as aspiration) and urine (provided in a small, sealed cup for urinalysis). Blood samples will be analysed for signs of inflammation, Rheumatoid factors (proteins that attack healthy tissues in the body), the presence of antibodies (anti-CCP antibody and antinuclear antibody or ANA), HLA antigens for HLA B27 analysis (check for the presence of human leukocyte antigen B27 or HLA-B27 protein in white blood cells), as well as check that general systems (such as liver and kidney function – C-reactive protein, and a complete blood count) are in working order. A doctor may also assess your erythrocyte sedimentation rate (ESR) – the rate at which red blood cells sediment during an hour-long period of time, a synovial fluid analysis, blood culture, and uric acid measurement in the blood or urine. Joint aspiration will be used to assess your cell count, perform a gram stain and culture and examine the formation of crystals under a microscope.
- Imaging tests: These give your doctor a view of the inside of the body and can help to detect problem areas, such as the joints. A doctor will wish to assess any possible structural changes in the joints, as well as check for signs of joint erosion, soft tissue tears, inflammation, cartilage loss, and the presence of any loose fragments of tissue. A doctor will also be looking for location of fluid build-up and how much is present in the affected areas. Tests which are useful for making a diagnosis are X-rays (low levels of radiation can help to create clear images of bone, and show any cartilage loss, damage or bone spurs, as well as monitor progression of the condition), a computerised tomography (CT) scan (cross-sectional views of bone and cartilage structures, as well as surrounding soft tissues), a magnetic resonance imaging (MRI) scan (a highly detailed cross-sectional visual of structures, such as ligaments, tendons, and cartilage) and an ultrasound scan (high-frequency sound waves which create visuals of fluid-containing structures, soft tissues and cartilage, as well as guide joint aspiration tests or the accurate administering of injections).
Other tests (where applicable) may include:
- Electrocardiogram (ECG)
- Thyroid function test
- Synovial biopsy
- Schirmer’s test (assess tear production)
- Tear test
- Slit lamp eye examination
- A salivary gland biopsy
Diagnosing arthritis may be a comprehensive process, which can sometimes be fairly straightforward. If the process shows up other associated conditions or problems, a diagnosis may be a little more complex.
A diagnosis will largely be based on the apparent pattern of symptoms, test findings and the distribution or number of affected joints in the body.
Of the many forms of arthritis, osteoarthritis and rheumatoid arthritis are typically the most common of the lot. A doctor will look for key features, such as a distinctive inflammatory cause, which will point him or her in the right direction for testing and diagnosis. Even if it isn’t clear, after a thorough evaluation, a doctor will carefully assess what is known and advise appropriate means of reducing inflammation to try and avoid as much potential further damage (which can sometimes be irreversible) as possible. The earlier a diagnosis is made and treatment implemented, the better.
Treatments and medications
Many doctors and specialists strongly recommend early treatment that prescribes an aggressive regimen. ‘Early treatment’ refers to a ‘window of opportunity’ during the initial two years following symptom onset.
In the case of RA, in particular, aggressive treatment during this period could prevent disease progression which is evident in the erosion of the joints that takes place. Not all doctors pay much attention to this ‘window of opportunity’ and rather take the stance that anyone diagnosed with a form of arthritis must be appropriately treated as soon as possible, no matter how far advanced a condition is. The earlier, the better applies to all.
Early treatment is especially important for those at higher risk of developing another, more serious medical condition. If this is of particular concern, treatment may be aggressive and constant monitoring will likely be required.
The primary aim of treatment is to gain control over symptoms of pain and discomfort, both medically and with lifestyle adjustments, in order to prevent potentially irreversible joint damage, or possible risk of developing a more destructive medical condition.
Treatment will also focus on improving joint function and mobility. Often, combination treatment methods work best to accomplish substantial improvements.
In the mix of options are:
- Medications: When it comes to pain and inflammation management, a doctor may prescribe or recommend the following types of medications – analgesics, such as Tramadol (Ultram) (these will alleviate pain, not inflammation), nonsteroidal anti-inflammatory medications or NSAIDS, such as ibuprofen taken orally or rubbed on affected areas as a cream or gel, or applied as a patch (these alleviate pain and inflammation), or menthol / capsaicin creams (these counterirritants can help to alleviate the transmission of pain signals to the joints). Other medication options include DMARD (disease-modifying antirheumatic) medications (used to treat RA by suppressing the immune system so as to prevent it from attacking the joints), biologic response modifiers (often used in combination with DMARDs, these target protein molecules which play a role in immune response) and corticosteroids (these alleviate inflammation and suppresses the immune system). All medications will need to be used according to the recommended dosage so as to avoid potentially harmful side-effects. It is a good idea to discuss all over-the-counter medications with your doctor before use to ensure that possible interactions will not cause harmful effects to the treatment of your condition.
- Physical (or occupational) therapy: An important (ongoing) part of treatment, physical therapy involves a series of recommended exercises which are aimed at strengthening muscles surrounding affected joints to improve mobility and body strength. Where necessary, physical therapy may also involve splints, joint adhesive aids or braces. For the most part, physical therapy will involve warm water therapy sessions (exercises performed in a warm water pool), a tailored daily exercise programme and occupational therapy (how to manage fatigue, prevent joint damage during daily activity and practical advice for home care and overall lifestyle).
- Surgery: Knee and hip replacements are an option if damage is extensive. Joint fusions are also a possibility, especially if damage is severe in the wrists, ankles and fingertips (smaller joints). This procedure focuses on locking bones together until they ‘fuse’ or grow together to form one, as opposed to replacing them with an artificial joint (as is done in a replacement procedure). Joint repair is another option, whereby the joint surfaces can be realigned or smoothed in an effort to alleviate pain and promote better mobility.
Some relief may be achieved through some alternative treatment means. Not all are medically approved, but those that may provide some relief without causing any major harm include:
- Glucosamine (this is an amino sugar supplement but the use of this should still be discussed with your doctor)
- Yoga and tai chi
Coping with arthritis
What to do and what not to do
The amount of available information for managing arthritis may be a little on the overwhelming side at first. There are plenty of references offering up the best ways to manage this condition. It may be difficult at first to feel settled in your normal lifestyle with so much to take into consideration or even try out for effective symptom relief. Everything you do or don’t do will have some influence on your condition. It is often a good idea to make changes slowly, one at a time, keeping a journal of how these influence your condition.
So, how do you know what will best work for you? Your doctor is the best person to guide you, as can a team of physical therapists and a nutritionist (if you’d like to have one). When it comes to medication usage – whether in pill, patch, injection or cream form, it is advisable to use these as per your doctor’s recommended instructions. Overall, however, finding a comfortable balance in managing a chronic condition such as arthritis may take a little time, but it is doable.
Here are a few tips and things to consider:
1. The basics of everyday lifestyle:
- Do keep the lines of communication open with your doctor to better understand your overall condition and monitor treatment. Sometimes another physical concern that arises may not be entirely unrelated to the effects of arthritis. When in doubt, talk to your doctor and allow him or her the opportunity to best assist with adapting treatment for the best possible results.
- Do engage in gentle movements throughout the day, including evenings to alleviate morning stiffness. Movement can alleviate pain. Simple ways to do this include pacing your movements and taking adequate breaks to ensure that you do not overuse a particular joint, adjusting your positions frequently (standing, sitting, walking, laying down), tilting your neck periodically (side to side), stretching your legs, standing or walking every half-hour or so and changing the position of your hands. Regular or routine check-ups are also important to stick to, so as to monitor the progression of arthritis and keep it under better control.
2. Exercise activity:
- Do get into the habit of exercising, as well as being mindful of gentle movement, as this helps to improve your motion range abilities, strengthen muscles in the body and also increase your levels of endurance. Exercise can boost endorphins (chemicals in the brain) and have the double bonus of not only enhancing your mood, but also blocking pain signals in the brain.
- Do work with your physical or occupational therapist to incorporate exercise activities that will best suit you and help decrease painful flares. Along with exercise, stretching and gradual strength training is also important. The added benefit is that exercise activity will also help to maintain your weight and improve your overall mood.
- Don’t engage in high impact repetitive motion activities such as tennis (especially a tennis serve), high-impact aerobics or running.
- Do balance out activity with adequate rest. Allowing the body time to recuperate is just as important as maintaining enough movement. Allowing fatigue to set in can aggravate pain symptoms which will cause you to backtrack and not make sufficient progress in achieving your treatment goals.
3. Medication use:
- Do double check with your doctor when adding over-the-counter medications to your treatment programme that may not have originally been recommended. This will ensure that you avoid experiencing unnecessary side-effects or adverse interactions when taking other medications for pain and inflammation management. No medication (prescription or over-the-counter) is entirely free of side-effects.
- Don’t over use medications or under treat your symptoms by allowing prolonged periods of arthritis pain. Rather use medications as directed for optimum treatment.
4. Emotional / mental wellbeing:
- Do pay attention to your mental or emotional wellbeing. Persistent pain can take a toll and leave a person feeling discouraged from time to time. Discouragement can worsen, however. Depression and anxiety are not uncommon in chronic arthritis sufferers and can be effectively managed alongside the physical effects of the condition. Some antidepressants have been known to help treat symptoms of depression as well as physical pain. A doctor may recommend specific therapy types to help better manage the emotional effects of living with arthritis. Therapy options include cognitive behavioural therapy, relaxation therapy, and deep breathing exercises . Whatever helps you to reduce levels of stress, ensure that you take measures that work for you. It can be as simple as listening to soothing music or heading out to a favourite location that provides a mental escape. Stress can aggravate or intensify physical pain. Whatever healthy activity or treatment works for you to alleviate stress, will be the best option.
Other self-care management tips for managing pain and discomfort:
- Restrict alcohol consumption or cut out altogether: Alcohol will affect your ability to sleep comfortably which can in turn worsen physical symptoms of pain.
- Avoid smoking: Smoking can worsen symptoms of chronic pain, adding to your woes by worsening problems with circulation as well. It can also increase your risk of developing other medical conditions such as heart disease or cancer.
- Pain level tracking: It may be useful to keep a journal or logbook of pain on a daily basis. This may be most helpful in the early days following diagnosis. Keeping a daily pain score may help to distinguish patterns for both yourself and your doctor. You may find that certain activity habits aggravate your condition, or improve it. Having a logbook can help to see these patterns easily and find ways to improve your physical functioning abilities.
How to stay active when you have arthritis
There’s no good reason to feel incapable of living independently just because of the potential debilitating effects of a progressive physical condition. There are plenty of things you can actively do during each and every day to benefit your body and manage your condition. While it can sometimes feel like the symptoms of arthritis are ‘encouraging you to be immobile’, participating in moderate exercise actually works to alleviate pain and stiffness (not aggravate it). A lack of exercise actually weakens the muscles and tissues surrounding affected joints, resulting in added pressure and physical strain where it is least needed.
Continued physical activity has been shown to work best when it comes to managing arthritis symptoms in the long-term. Initially, pain may increase in the short-term when first getting into an exercise routine. This is normal, but it’s important to soldier on appropriately to gain any benefit at all.
It’s also important to listen to your body and know your limits. You don’t need to overdo it. Moderate exercise is usually best. You will soon work out what level of activity gives you the most effective results once you get going.
Benefits of exercise include:
- Maintaining bone strength
- Strengthening the muscles and tissues around the joints
- Providing an energy boost through the day
- Promoting better rest and a good night’s sleep
- Maintaining a healthy weight (or lose excess weight)
- Improving your balance
- Enhancing your mood and overall quality of life
Exercise activity types which are more joint-friendly include:
- Range of motion: Moderate exercise movements (through a full range of motion) can help to alleviate stiffness and improve your ability to move affected joints. Exercises which may prove beneficial include slowly raising your arms above your head and rolling your shoulders (forwards and backwards).
- Exercises for strength: To build strong muscles to better support and protect your joints, exercises for strength will be recommended. Exercises with weights can be performed regularly with rest days in between workouts, especially if joints are swollen or painful during flare-ups. You will likely be advised to take care not to exercise the same muscle groups over two or more consecutive days to avoid overworking sensitive areas. A workout programme of 2 to 3 days a week should be sufficient for adequate strength training.
- Aerobic exercise: This is important for building up endurance in the body and improving overall fitness levels, stamina (energy levels) and cardiovascular health. Aerobic exercise also aids in maintaining a healthier weight. Walking, biking (or cycling), swimming and water aerobics (the most ideal pool temperature for water activity is 28.3 degrees Celsius or 83 degrees Fahrenheit), or using an elliptical machine are great, joint-friendly means of exercise to participate in. You may be encouraged to work your way up to approximately 150 minutes of moderate aerobic exercise a week, which can be split any which way is most comfortable for you to achieve.
- Other: If walking bores you, there’s no reason why you can’t get creative and participate in different activities that boost your mood as well as benefit your body. Play video games (Nintendo or Wii sports games can help you achieve moderate exercise activity in just the same way a brisk walk can), rope in some company on walks (family, the dog or a group of friends can make a walk more pleasurable and feel a little less like treatment for your condition), hand wash your car (for a little moderate activity working multiple muscle groups and encouraging range of motion), carry your groceries (the weight of your shopping will add some intensity to your walk and help strengthen your upper body), do some housework (it can be a good workout that increases your heart rate and encourages you to alternate motion, using different areas, muscles and joints in your body. But be mindful of overdoing things and overextending your reach), dancing or tending a garden (you can have fun while working up a little bit of a sweat as well as improve your flexibility and strengthen muscle groups), suggest active social meetups (sometimes meeting up with friends or family in settings that promote physical activity, such as a hike or a walk in the park, or volunteering at a local animal shelter can help to keep you moving and socialising too), or use the stairs or strategically park your car in a spot further away (where you have an opportunity to encourage additional activity, make the most of it).
*It is best to involve your doctor when deciding on activity types. Some exercise activities are better for certain forms of arthritis than others, and will also depend on the nature and severity of your condition.
What are the best ways to protect your joints while participating in activity?
If you are new to regular exercise, the best way to start is gradually. Ease your joints into exercise activity and be mindful about over-exerting yourself. If you over-work your muscles, you will place additional pressure and strain on your joints and worsen your symptoms.
Some tips to keep in mind are:
- Opt for low impact activity: Stationary or recumbent bicycles, water activity / exercises and elliptical machines are great ways to ease into activity while keeping strain on the joints low.
- Heat treatments: Warm (not hot) towels, a shower or hot pack and compresses can help to relax the muscles and joints, as well as alleviate pain and stiffness, when applied for about 20 minutes before exercise activity.
- Warm up gently: A good warm-up of movement for between 5 and 10 minutes before any strength or aerobic work-outs will place less strain on muscles and joints.
- Slow and steady wins the race: Your exercise regime is not a competition. Slow and easy movements as you exercise are best. If you notice any unusual sensations or feel any sharp pain, take a break. If you note any swelling or redness near your joints, slow down a little. Pace yourself and increase your efforts as your intensity tolerance levels improve. A little movement at regular intervals can go a long way in promoting long-term improvement, but over-exertion will compromise your efforts.
- Ice and cold compresses: Following activity, you can apply cloth-wrapped ice to your joints for up to 20 minutes to help alleviate swelling. It is normal to experience some pain after activity if your fitness levels are particularly low. If you experience pain for more than 2 hours post-workout, you may have over-worked your muscles and joints. When in doubt about what level of pain is normal or not, talk to your doctor for advice and guidance.
Many who suffer from arthritis experience discomfort in the hand joints. There are a few simple exercises you can do to alleviate pain and stiffness in the hands and fingers:
- Hold your hand in a relaxed and neutral position with straightened fingers. Then slowly bend your thumb inwards, across the palm of your hand until you can touch the base of your small finger with the tip. If this is somewhat difficult, move your thumb as far across your palm as you can and repeat the exercise multiple times on each hand.
- Hold your hand in a straight position with fingers closed together and thumb relaxed. Now bend the middle and end joints of your fingers towards your open palm, while keeping the knuckles straight. With slow and smooth movements, extend your fingers to a straight position and repeat multiples times on each hand.
- Hold your hand in a straight position with fingers closed together and thumb relaxed. Now close your fingers into a fist and wrap your thumb around the outside of your fingers and knuckles. This is a gentle exercise, so you should be mindful not to squeeze the fingers in this position. Slowly release the fingers from the fist and return to the starting position. Repeat the exercise multiple times on both hands.
- Hold your hand in a straight position with fingers closed together and thumb relaxed. Now, gently curve your fingers into a C shape. Slowly return the fingers to their straight position, and repeat the exercise multiple times on each hand.
- Hold your hand in a straight position with fingers closed together and thumb relaxed. With each fingertip (individually), form an O shape by touching your thumb, one finger at a time. Start with your index finger, then the middle, ring and small fingers before returning to the start position. Repeat multiple times on each hand.
- Place your hand on a flat surface, palm facing downwards and fingers stretched out. Relax your thumb away from your index finger / hand. Now move your index finger towards your thumb, followed by your middle, ring and small fingers independently (one at a time). Repeat the exercise multiple times on each hand.
What to eat
Food can be a trigger for inflammatory flare-ups, but there is not dedicated diet for arthritis sufferers. Knowing what to eat and what to avoid, however, is an important part of managing your condition. What you put into your body is going to have some influence on your overall condition, including symptoms of arthritis.
There are some foods which can provide an adequate amount of nutrients to improve overall joint health and alleviate inflammation. Some swear by a Mediterranean diet which includes a fair amount of fish, seeds, nuts, fruits, vegetables, olive oil, whole grains, and beans. Others focus on incorporating more fibre, or vegetarian diets only.
For the most part, diet can play a role when it comes to precipitating or aggravating symptoms but not to any great extent. In general, for most forms of the disease, foods with anti-inflammatory properties have shown some positive effect.
Key foods which can help promote joint health include:
- Fish: A minimum of 85 – 113 grams (3 to 4 ounces) twice a week may provide a good source of imega-3 fatty acids which can help to fend off inflammation in the body. Higher levels of omega-3 fatty acids in the body can help to lower C-reactive proteins and interleukin-6 (inflammatory proteins) which can be problematic for inflammatory variations of arthritis. Fish oil supplements (about 600 to 1 000 mg a day) can help to alleviate joint swelling, pain and lingering stiffness, especially those who have RA. Good sources of fish to include in your diet are tuna, salmon, sardines, anchovies, herring, scallops and other col-water fish.
- Seeds and nuts: A daily helping of about 42 grams (or 1.5 ounces) of nuts is a good addition to your diet for anti-inflammatory benefits. Studies have shown that over the long-term this can help to reduce inflammation in the body by up to 51%. Vitamin B-6 content in many nuts have high levels of inflammatory markers and monounsaturated fats which fend off inflammation in the body. The fat and calorie content may be higher, but the protein, fibre and monounsaturated fats in many nut variations can be quite satiating (meaning that you’re unlikely to reach for unhealthier snack options). One helping a day is sufficient – more will not always be better for you. Good sources to stock up on are almonds, walnuts, pistachios and pine nuts, as well as flaxseed.
- Olive oil: Adding a little olive oil (2 to 3 tablespoons) to your diet may also be beneficial for lowering inflammation. The oleocanthal content in olive oil has been found to have similar properties to anti-inflammatory, nonsteroidal medications which inhibit COX enzyme activity (Cyclooxygenase, also known as prostaglandin-endoperoxide synthase / PTGS which contribute to inflammatory responses in the body). The effect is a considerable reduction to pain sensitivity. The best option is extra virgin olive oil as this typically is not as processed and contains more nutrients than many other more refined products. Other good oil options are avocado, safflower or walnut varieties.
- Fruits and vegetables: Daily servings of about nine or more can help fuel the body with plenty of antioxidants that will fend off symptoms of arthritis. One serving equates to 1 cup of fruit and most veggies or 2 cups of raw leafy greens. Antioxidants are potent chemicals that help to stimulate the body’s natural defence system, neutralising cell-damaging free radicals. Red and purple fruits contain anthocyanins which have an anti-inflammatory effect on the body. Vitamin C-rich fruits and vegetables high in vitamin-K can also aid in alleviating inflammation. Good sources include raspberries, cherries, strawberries, blueberries, blackberries, grapefruit, oranges, limes, broccoli, spinach, kale, lettuce, and cabbage. Generally, the more colourful (darker and more brilliant) the fruits and veggies, the more antioxidant content they have.
- Beans: At least twice a week, one cup of beans add a healthy helping of fibre and phytonutrients which can help to lower C-reactive protein levels. Many bean varieties are high in antioxidants, a good source of protein and contain a host of anti-inflammatory compounds. Good sources include red kidney beans, small red beans or pinto beans. The protein content also promotes good muscle health too.
- Whole grains: About 85 to 170 grams (or 3 to 6 ounces) of grains per day contain plenty of fibre which reduces inflammatory C-reactive proteins in the body. The best sources are foods with the entire grain kernel, such as whole wheat flour, bulgur, oatmeal, brown rice and quinoa. Consuming too much gluten in these whole grains, however, can counteract anti-inflammatory benefits for some people.
What foods should you be more mindful of?
There are certain vegetables you may want to avoid or limit to avoid painful arthritic flare-ups. Nightshade vegetables, such as tomatoes, goji berries, okra, red bell peppers, eggplant (aubergine) and white potatoes (not sweet potatoes) contain the chemical compound solanine, which can aggravate pain in an arthritic body.
Not everyone with arthritis will notice symptom aggravation when consuming these vegetables. Scientifically speaking, nightshade vegetables have not been conclusively proven as arthritis triggers, but many have found that limiting or avoiding them provides a little more symptom relief.
For the most part, doctors will agree that if you find that nightshade vegetables aggravate your symptoms, limiting consumption or avoiding these altogether is not necessarily a bad thing. If these vegetables don’t appear to aggravate symptoms, they’re not likely doing you any more harm.
Other foods which have been found to aggravate symptoms of arthritis, particularly inflammation, include:
- Alcohol (especially beer)
- Fructose, sucrose and other refined or processed sugar foodstuffs (soft drinks and corn syrup)
- Aspartame (artificial sweetener)
- Refined carbohydrates (white flour products, white rice and cereals which have a high-glycaemic index)
- Gluten and casein-containing foodstuffs (barley, rye and wheat or whey protein products)
- Saturated fats (such as cheese, red meat, organ meat, full-fat dairy, pasta and grains)
- Trans fats (found in most fast foods, fried foodstuffs, processed and frozen foods)
- Omega-6 fatty acids (mayonnaise, salad dressings and oils such as corn, grapeseed, soy, vegetable and peanut)
- MSG / mono-sodium glutamate additives (often found in pre-packaged foods to enhance flavour)
- Excess salt
Risk factors and common complications
Risk factors for arthritis
The nature of risk when it comes to conditions such as arthritis can effectively fall into two categories – those factors which you can’t control and those you can.
Factors which may place you at a higher risk for arthritis, which cannot be prevented are:
- Genetics and family history: It is not entirely known why, but genetics do appear to play a role. It’s not uncommon for arthritic conditions to run in families. Risk is higher if you have genes which may make you more susceptible to environmental influences which can trigger arthritis. Parents, siblings or even grandparents with an arthritis type can place you at higher risk for developing a similar condition too.
- The aging process: Arthritis symptoms do typically worsen with age, especially those of osteoarthritis, RA and gout.
- Your sex: A higher number of women tend to develop inflammatory arthritis conditions than men. Gout for instance, is more likely to develop in men than women.
Risk factors which may be prevented include:
- Obesity and excess weight: Those with excess weight problems are at higher risk of developing arthritis following prolonged periods of unnecessary stress on the body’s joints. Areas most vulnerable include the spine, hips and knees.
- Joint injuries (past): Previous injuries, even if they have healed, are at increased risk of eventually developing arthritic symptoms.
When it comes to lifestyle patterns and habits, you can influence your level of risk by making appropriate changes to your activity levels (especially repetitive motion), diet and even the environments which you frequent.
Complications which can arise from arthritis include:
- Chronic or long-term pain and stiffness
- Increased difficulties with performing basic daily activities
- Joint twisting or deformity
What is the outlook for someone with arthritis?
To date, there is no known medical cure for any of the various forms of arthritis. A tailored treatment plan, coupled with overall lifestyle adjustments usually produces the best results. The general outlook for arthritic symptoms is that this condition will require a lifelong commitment to taking the best care possible in managing its physical effects and preventing further damage.
Factors that come into play include regular exercise that allows for more joint flexibility without added pressure, plenty of rest which helps to promote healing and allows the body restorative benefits, loss of excess weight or maintaining a healthy weight, a healthy diet rich in antioxidants, and the use of mobility assistance devices (walkers or canes) and heating or cooling packs and compresses.
For the most part, the outlook for this condition is dependent on individual factors. How severe is the condition? Are there any known current or potential complications to manage? Are there any signs of non-joint manifestations of the condition, such as those affecting organs (lungs, eyes, kidneys etc.)?
Your doctor will look at your individual condition and make tailored recommendations to ensure optimum well-being and disease management. Combination treatments will likely provide the most comfortable results.
Can arthritis be prevented?
With some risk factors being beyond human control, there is no real way to prevent the onset of arthritic conditions. Prevention may be achievable, to some degree, if you can avoid joint injuries, piling on excess body weight or contracting certain infections during your lifetime. There is, however, no guarantee that if you are more susceptible to arthritis that it won’t develop at all.
What you can do is reduce your risk and potentially delay the onset of symptoms or influence their potential severity. The best means of ‘prevention’ is to take the best care of the body you have now, in its current state. If healthier changes are necessary (for instance, your diet or exercise habits), implement them.
I’ve heard that cracking your knuckles can cause arthritis – is this true?
It is estimated that between 24% and 54% of people develop knuckle-cracking habits. For this reason, studies have been conducted to determine a direct causal link to the development of arthritis. To date, no definitive links have been made.
That doesn’t mean you can happily continue cracking your knuckles, however. A conclusively proven causal link may not have been determined as yet, but a very high percentage of study participants who regularly crack their knuckles did develop arthritis symptoms in their hands. A slightly lower percentage who didn’t regularly crack their knuckles also developed arthritis in the hand joints. Causal links may have more to do with unmodifiable risk factors, such as genetics, age and sex than the action of cracking knuckles.
While knuckle cracking may not be directly responsible for the development of arthritis, what it does do is increase your risk for injury. When a joint locks due to cracking, inflammation in the hands increases and weakens functionality (such as the ability to grip). This can lead to similar symptoms of arthritis such as swelling, pain, the development of noises when moving, and decreased motion ability.
The cracking sound effectively comes from the formation of a cavity in the joint. The more obsessive the habit, the higher the risk for injury. The best way to break the habit if it is causing great discomfort or affecting your grip capabilities is to try and keep the hands busy (distract yourself or snap a rubber band around the wrist).