Arthritis

Arthritis is an inflammation of the joints characterized by pain, stiffness, and difficulty of movement. It also affects surrounding structures such as connecting tissue, tendons, and ligaments. About one out of five American adults have doctor-diagnosed arthritis. It is also the primary cause of disability in people over 65, although it can occur at any age.

Types

There are more than 100 types of arthritis, each one caused by different factors. The most common form, osteoarthritis, may be caused by bone trauma, infection, or aging. It usually involves just one or two joints, most often the hands, knees, hips, and spine. It is also called degenerative joint disease.

Rheumatoid arthritis occurs when the immune system mistakenly attacks the joints. It is one of the most disabling forms of the disease, but affects only 1% of Americans. A similar form, psoriatic arthritis, is characterized by swelling of the toes and fingers. Most cases occur about 10 years after the onset of psoriasis, a chronic skin problem.

Gouty arthritis, or simply gout, is caused by the buildup of uric acid crystals in the joints. This results in inflammation and restricted movement, and is most likely to occur in middle age. It is one of the few types that are more common in men than in women.

Septic arthritis is an infection of the joints by foreign agents such as bacteria, viruses, and fungi. The bacteria may penetrate through skin lesions or be carried by the bloodstream. It is usually accompanied by fever and soft swelling.

Risk factors

Arthritis is usually associated with aging, although this is only one of many natural risk factors. The bones naturally get weaker with age, so the risk can start increasing as early as age 10. Gender is believed to be a factor; about 60% of all patients are women. Certain genes have also been linked to higher incidences of rheumatoid arthritis and systemic lupus erythematous (SLE).

There are also controllable risk factors, such as diet and lifestyle. Gout can be avoided by cutting down on animal organs (liver, kidneys, sweetbreads), fatty seafood, and game meats, while weight control in general can help prevent osteoarthritis and other degenerative forms. Joint injuries, infections, and frequent bending can make the joints wear out faster, thus contributing to the risk as well.

Treatment

Treatment of arthritis depends on the type and extent of the condition. Medications may be directed at the symptoms or the cause of the condition. Typical treatments involve pain relievers, anti-inflammatory medicine, and physical therapy to restore movement in the affected joint. Arthroplasty or joint replacement therapy may be performed in severe cases, or when the joint as eroded beyond repair.

Treating the most common forms of arthritis

Arthritis treatment depends on the type and cause of the disease. Some forms of arthritis are irreversible; that is, the symptoms can be relieved but the disease itself cannot be cured. Most arthritis treatments are accompanied by palliatives such as painkillers (analgesics), anti-inflammatory agents, and antipyretics. Below are some typical treatments for the most common forms of arthritis. 

Osteoarthritis 

Osteoarthritis is caused by degeneration of the joint tissues, which naturally wear out with age. Arthritis treatment can restore some function in the affected joints, but none can repair the damaged tissues. To reduce pain and inflammation, most doctors prescribe non-steroidal anti-inflammatory drugs (NSAIDs). 

Dietary and lifestyle changes can slow the progress of the disease. Antioxidants, rhizome extracts, and vitamins D3 and B9 can provide pain relief and lower the risk in those who are predisposed to the disease. 

Rheumatoid arthritis 

Until recently, there were no known treatments for rheumatoid arthritis besides pain relief. Today, rheumatoid arthritis treatment usually involves disease modifying anti-rheumatic drugs (DMARDs), a class of immune suppressants that prevent the immune system from attacking the joints. NSAIDs such as aspirin and ibuprofen are recommended for pain relief. 

The FDA has also recently approved biological drugs for rheumatoid arthritis treatment. Biological response modifiers can block a natural protein called Tumor Necrosis Factor (TNF), which is believed to be responsible for joint damage. The FDA-approved treatment combines the biological  drugs Remicade (infliximab) and methotrexate, although not all patients respond to the drugs. Other biological drugs include Enbrel (etanercept) and Arava (leflunomide). However, most of these drugs are highly potent and may have toxic side effects. They should be taken only on prescription and under close supervision by a doctor. 

Gout 

Gout, also called gouty or metabolic arthritis, is the buildup of uric acid crystals in the joints. Initial treatment also involves NSAIDs and other forms of pain relief. Depending on the extent of infection, these can simply be over-the-counter drugs or joint injections, such as glucocorticoids. If the joints are severely deformed, surgery may be needed to correct them and remove large, hardened deposits. 

Uric acid deposits can be dissolved by cleansing diets and medications. Arthritis treatment focuses on preventing recurrences, usually by a method called known as antihyperuricemic therapy. This involves avoiding purine-rich foods such as offal meats and seafood and increasing fluid intake. Low-purine foods such as cheese, cherries and strawberries are also recommended.

How to Relieve Arthritis Pain 

Of the more than 100 forms of arthritis, one thing is common: the first symptom is always pain. Arthritis pain generally results from inflammation of the joints, although the exact cause varies from one form to the other. Some patients experience mild pain for only a few months, while for others, the pain is acute and debilitating. Fortunately, there are several treatments available for relieving arthritis pain. Here are some of your options. 

Non-prescription medications 

Acetaminophen. One of the cheapest of pain relief, this drug is ideal for mild to moderate pain. However, it does not relieve inflammation and may increase the risk of liver problems, especially in heavy alcohol drinkers. Popular brands include Tylenol, Datril, and Anacin-3. 

Non-steriodal anti-inflammatory drugs (NSAIDs). NSAIDs have analgesic, anti-inflammatory, and sometimes antipyretic effects. They are used for moderate to severe arthritis pain, as well as inflammation and fever. Side effects include nausea, diarrhea, and dyspepsia. Some NSAIDs may interfere with other medications or aggravate existing conditions, so consult your doctor before taking any. 

COX-2 Inhibitors. These are a new class of NSAIDs that cause fewer side effects. They are usually more expensive, but are generally considered safer than other NSAIDs. Celebrex is the most common trade name. 

Prescription Medications 

Opioids. This includes strong analgesics such as morphine, codeine, oxycodone, and meperidine. They work well of severe, acute arthritis pain, but are seldom prescribed because they can be addictive. 

Narcotic analgesics. These are are either strong analgesics or a combination of weak and strong ones, such as acetaminophen and codeine. They are used to relieve severe pain, particularly when over-the-counter analgesics do not work. They are best used for short-term treatment, as they can cause serious side effects when taken regularly. 

Topical analgesics. This refers to external applications like creams, oils and ointments. Because they are applied only on the affected area, there is lower risk of side effects. However, the relief is usually short-lived. They work for specific types of arthritis pain, such as gout and rheumatoid arthritis attacks. 

Corticosteroids. Corticosteroids do not relieve arthritis pain, but reduce the symptoms that aggravate it, such as heat and inflammation. They are commonly used for treating severe osteoarthritis and rheumatoid arthritis pain. Glucocorticoids or cortisol are usually administered via joint injections. They are usually not recommended for diabetics, because they can affect glucose tolerance and insulin resistance.