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Arthritis
Joint inflammation Last reviewed: February 14, 2011. Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. There are over 100 different types of arthritis. See also: Joint pain

Causes, incidence, and risk factors

Arthritis involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness. Joint inflammation may result from:

An autoimmune disease (the body's immune system mistakenly attacks healthy tissue) Broken bone General "wear and tear" on joints Infection, usually by bacteria or virus

Usually the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type. See: Osteoarthritis Other, more common types of arthritis include:

Ankylosing spondylitis Gonococcal arthritis Gout Juvenile rheumatoid arthritis (in children)

Other bacterial infections (nongonococcal bacterial arthritis) Psoriatic arthritis Reactive arthritis (Reiter syndrome) Rheumatoid arthritis (in adults) Scleroderma Systemic lupus erythematosus (SLE)

Symptoms
Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include:

Joint pain Joint swelling Reduced ability to move the joint Redness of the skin around a joint Stiffness, especially in the morning Warmth around a joint

Signs and tests

The health care provider will perform a physical exam and ask questions about your medical history. The physical exam may show:

Fluid around a joint Warm, red, tender joints Difficulty moving a joint (called "limited range of motion")

Some types of arthritis may cause joint deformity. This may be a sign of severe, untreated rheumatoid arthritis. Blood tests and joint x-rays are often done to check for infection and other causes of arthritis. Your doctor may also remove a sample of joint fluid with a needle and send it to a lab for examination.

Treatment
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause cannot usually be cured. LIFESTYLE CHANGES Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint inflammation. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you. Exercise programs may include:

Low-impact aerobic activity (also called endurance exercise) Range of motion exercises for flexibility Strength training for muscle tone

Physical therapy may be recommended. This might include:

Heat or ice

Splints or orthotics to support joints and help improve their position; this is often needed for rheumatoid arthritis Water therapy Massage

Other recommendations:

Get plenty of sleep. Sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flareup more quickly and may even help prevent flare ups. Avoid staying in one position for too long. Avoid positions or movements that place extra stress on your sore joints. Change your home to make activities easier. For example, install grab bars in the shower, the tub, and near the toilet. Try stress-reducing activities, such as meditation, yoga, or tai chi. Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E. Eat foods rich in omega-3 fatty acides, such as cold water fish (salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts. Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3-7 days. Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.

MEDICATIONS Medications may be prescribed along with lifestyle changes. All medications have risks, some more than others. It is important that you are closely monitored by a doctor when taking arthritis medications. Generally, over-the-counter medications are recommended first:

Acetaminophen (Tylenol) is usually tried first. Take up to 4 grams a day (two arthritis-strength Tylenol every 8 hours). Do not take more than the recommended dose or take the drug along with a lot of alcohol. Doing so may damage your your liver. Aspirin, ibuprofen, or naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs) that can relieve arthritis pain. However, they have many potential risks, especially if used for a long time. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage.

Prescription medicines include:

Biologics are used for the treatment of autoimmune arthritis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), rituximab (Rituxan), golimumab (Simponi), certolizumab (Cimzia), and tocilizumab (Actemra). These drugs can improve the quality of life for many patients, but can have serious side effects. Corticosteroids ("steroids") help reduce inflammation. They may be injected into painful joints or given by mouth. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, gold salts, penicillamine, sulfasalazine, and hydroxychloroquine. Immunosuppressants such as azathioprine or cyclophosphamide are used to treat patients with rheumatoid arthritis when other medications have not worked.

It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, because of side effects), you should talk to your doctor. Also make sure your doctor knows about all the medicines you are taking, including vitamins and supplements bought without a prescription. SURGERY AND OTHER TREATMENTS In some cases, surgery may be done if other treatments have not worked. This may include:

Arthroplasty to rebuild the joint Joint replacement, such as a total knee joint replacement

Expectations (prognosis)
A few arthritis-related disorders can be completely cured with proper treatment. Most forms of arthritis however are long-term (chronic) conditions.

Complications
Complications of arthritis include:

Long-term (chronic) pain Disablity Difficulty performing daily activities

Calling your health care provider

Call your doctor if:

Your joint pain persists beyond 3 days. You have severe unexplained joint pain. The affected joint is significantly swollen. You have a hard time moving the joint. Your skin around the joint is red or hot to the touch. You have a fever or have lost weight unintentionally.

Prevention
Early diagnosis and treatment can help prevent joint damage. If you have a family history of arthritis, tell your doctor, even if you do not have joint pain. Avoiding excessive, repeated motions may help protect you against osteoarthritis.

References
1. D'Cruz DP, Khamashta MA, Hughes GR. Systemic lupus erythematosus. Lancet. 2007;369(9561):587-96. 2. Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Med Clin North Am. 2009;93:127-43, xi. 3. Huizinga TW, Pincus T. In the clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1-1-ITC1-15. Review Date: 2/14/2011. Reviewed by: Michael E. Makover, MD is a professor and attending in rheumatology at the New York University Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Copyright 2011, A.D.A.M., Inc.

What works?

Certolizumab pegol for adults with rheumatoid arthritis Certolizumab pegol for adults with rheumatoid arthritis This summary of a Cochrane review presents what we know from research about the effect of certolizumab pegol on adult people with rheumatoid arthritis:

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Drugs of interest

Methotrexate Methotrexate is used to treat severe psoriasis (a skin disease in which red, scaly patches form on some areas of the body) that cannot be controlled by other treatments. Methotrexate is also used along with rest, physical therapy and sometimes other medications to treat severe active rheumatoid arthritis (RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) that cannot be controlled by certain other medications. Methotrexate is also used to treat certain types of cancer including cancers that begin in the tissues that form around a fertilized egg in the uterus, breast cancer, lung cancer, certain cancers of the head and neck, certain types of lymphoma, and leukemia (cancer that begins in the white blood cells). Methotrexate is in a class of medications called antimetabolites. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.

Infliximab Injection Infliximab injection is used to relieve the symptoms of certain autoimmune disorders (conditions in which the immune system attacks healthy parts of the body and causes pain, swelling, and damage) including: rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) that is also being treated with methotrexate (Rheumatrex, Trexall). Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever) that has not improved when treated with other medications. ulcerative colitis (condition that causes swelling and sores in the lining of the large intestine) that has not improved when treated with other medications. ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas causing pain and joint damage). psoriasis (a skin disease in which red, scaly patches form on some areas of the body). psoriatic arthritis (joint pain and swelling and scales on the skin). Infliximab injection is in a class of medications called tumor necrosis factor-alpha (TNF-alpha) inhibitors. It works by blocking the action of TNF-alpha, a substance in the body that causes inflammation.

Etanercept Injection Etanercept is used to relieve the symptoms of certain autoimmune disorders (conditions in which the immune system attacks healthy parts of the body and causes pain, swelling, and damage) including: rheumatoid arthritis (condition in which the body attacks its own joints, causing pain, swelling, and loss of function) alone or in combination with methotrexate (Rheumatrex, Trexall) psoriatic arthritis (condition that causes joint pain and swelling and scales on the skin) juvenile idiopathic arthritis (JIA; swelling of the lining of the joints that begins in children younger than 16 years of age) ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas causing pain and joint damage), chronic plaque psoriasis (a skin disease in which red, scaly patches form on some areas of the body) Etanercept is in a class of medications called tumor-necrosis factor (TNF) inhibitors. It works by blocking the activity of TNF, a substance in the body that causes inflammation

Adalimumab Injection

Adalimumab injection is used alone or with other medications to relieve the symptoms of certain autoimmune disorders (conditions in which the immune system attacks healthy parts of the body and causes pain, swelling, and damage) including the following: rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever) that has not improved when treated with other medications, ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas causing pain and joint damage), psoriatic arthritis (a condition that causes joint pain and swelling and scales on the skin). Adalimumab injection is in a class of medications called tumor necrosis factor (TNF) inhibitors. It works by blocking the action of TNF, a substance in the body that causes inflammation.

Rituximab Injection Rituximab is used alone or with other medications to treat certain types of non-Hodgkin's lymphoma (NHL; a type of cancer that begins in a type of white blood cells that normally fights infection). Rituximab is also used with another medication to treat the symptoms of rheumatoid arthritis (RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) in people who have already been treated with a certain type of medication called a tumor necrosis factor (TNF) inhibitor. Rituximab is in a class of medications called biologic antineoplastic agents. It treats NHL by causing the death of blood cells that have multiplied abnormally. It treats rheumatoid arthritis by causing the death of certain blood cells that may cause the immune system to attack the joints.

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Joint pain Rheumatoid arthritis Juvenile rheumatoid arthritis Systemic lupus erythematosus Scleroderma Psoriatic arthritis Ankylosing spondylitis Reactive arthritis Adult Still's disease Viral arthritis Gonococcal arthritis Septic arthritis Tuberculous arthritis Blastomycosis Unicompartmental knee arthroplasty

Arthritis

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Osteoarthritis
Osteoarthritis is a chronic disease of the joint cartilage and bone, often thought to result from "wear and tear" on a joint, although there are other causes such as congenital defects, trauma and metabolic disorders. Joints appear larger, are stiff and painful and usually feel worse the more they are used throughout the day.

Osteoarthritis
Osteoarthritis is associated with the aging process and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing bone to rub against bone. Bony spurs develop on the unprotected bones causing pain and inflammation.

Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints affected is usually symmetrical, involves the hands and other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body organs, whereas osteoarthritis is limited to the joints. Over time, both forms of arthritis can be crippling.

Rheumatoid arthritis
Rheumatoid arthritis is a systemic autoimmune disease which initially attacks the synovium, a connective tissue membrane that lines the cavity between joints and secretes a lubricating fluid.

Rheumatoid arthritis
The affect of rheumatoid arthritis can progress to the degree that it is crippling. Deformities distinctive to late-stage rheumatoid arthritis such as ulnar deviation of the bones of the hands, or swan-neck deviation of the fingers occur because muscles and tendons on one side of the joint may overpower those on the other side, pulling the bones out of alignment.

Osteoarthritis vs. rheumatoid arthritis

Osteoarthritis is a deterioration of cartilage and overgrowth of bone often due to "wear and tear". Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage.

Arthritis in hip
Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when walking. Arthritis involves the breakdown of cartilage. Without the usual amount of cartilage, the bones of the joint rub together, causing pain, swelling and stiffness.

Synovial fluid
The synovial membrane is the inner membrane of tissue that lines a joint. The synovial membrane secretes synovial fluid which serves to lubricate the joint.

Rheumatoid arthritis
Rheumatoid arthritis is another form of arthritis. The bodys own immune system attacks a joints synovial membrane, which secretes fluid and lines the joint. The synovium becomes inflamed, produces excess fluid, and the cartilage becomes rough and pitted.

Review Date: 2/14/2011. Reviewed by: Michael E. Makover, MD is a professor and attending in rheumatology at the New York University Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Disclaimer Copyright 2011, A.D.A.M., Inc. PubMed Health. A service of the National Library of Medicine, National Institutes of Health.