Arthritis

What is arthritis?

Arthritis and other rheumatic diseases are characterized by pain, swelling, and limited movement in joints and connective tissues in the body. According to the CDC, nearly 50 million people in the U.S. have some form of arthritis or chronic joint symptoms.

Arthritis, which literally means inflammation of a joint (where two or more bones meet), actually refers to more than 100 different diseases. Rheumatic diseases include any diseases that cause pain, stiffness, and swelling in joints or other supportive body structures, such as muscles, tendons, ligaments, and bones.

Arthritis and other rheumatic diseases are often mistakenly associated with old age because osteoarthritis (the most common form of arthritis) occurs more often among elderly persons. However, arthritis and other rheumatic diseases affect people of all ages and are more common in women than men.  

Arthritis is usually chronic, which means that it rarely changes, or it progresses slowly. Specific causes for most forms of arthritis are not yet known.

What are the parts of a joint?

Joints are the areas where two bones meet. Most joints are mobile, allowing the bones to move. Joints consist of:

• Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.

• Synovial membrane. A tissue called the synovial membrane lines the joint. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.

• Ligaments. Strong ligaments (tough, elastic bands of connective tissue) surround the joint to give support and limit the joint's movement.

• Tendons. Tendons (another type of tough connective tissue) on each side of a joint attach to muscles that control movement of the joint.

• Bursas. Fluid-filled sacs, called bursas, between bones, ligaments, or other adjacent structures help cushion the friction in a joint.

What are the most common types of arthritis?

The three most prevalent forms of arthritis include:

• Osteoarthritis. The most common type of arthritis. It is a chronic disease involving the joints, particularly the weight-bearing joints such as the knee, hip, and spine. Osteoarthritis is characterized primarily by the destruction of cartilage and narrowing of the joint space. It can also include bone overgrowth, spur formation, and impaired function.

  It occurs in most people as they age, but also may occur in young people as a result of injury or overuse.

• Fibromyalgia. A chronic, widespread pain in muscles and soft tissues surrounding the joints throughout the body.

• Rheumatoid arthritis. An inflammatory disease that involves the lining of the joint (synovium). The inflammation may affect all of the joints.

• Other forms of arthritis, or related disorders, include the following:

  • Gout. A result of a defect in body chemistry (such as uric acid in the joint fluid), this painful condition most often attacks small joints, especially the big toe. It can usually be controlled with medication and changes in diet.

  • Systemic lupus erythematosus (lupus). A very serious, chronic, autoimmune disorder characterized by periodic episodes of inflammation of and damage to the joints, tendons, other connective tissues, and organs, including the heart, lungs, blood vessels, brain, kidneys, and skin.

  • Scleroderma. A very serious disease of the body's connective tissue that causes thickening and hardening of the skin.

  • Ankylosing spondylitis. A disease that affects the spine, causing the bones of the spine to grow together.

  • Juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA). A form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow JRA. However, the disease can affect bone development in the growing child.

What are the symptoms of arthritis?

The following are the most common symptoms of arthritis. However, each individual may experience symptoms differently. Symptoms may include:

• Pain and stiffness in the joints

• Swelling in one or more joints

• Continuing or recurring pain or tenderness in a joint

• Difficulty using or moving a joint in a normal manner

• Warmth and redness in a joint

The symptoms of arthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is arthritis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for arthritis may include:

• X-rays or other imaging procedures (to show the extent of damage to the joint)

• Blood tests and other laboratory tests, including:

  • Antinuclear antibody (ANA) test (to check levels of antibodies in the blood)

  • Arthrocentesis or joint aspiration (to remove a sample of the synovial fluid to determine if crystals, bacteria, or viruses are present)

  • Complete blood count (to determine if white blood cell, red blood cell, and platelet levels are normal)

  • Creatinine (to monitor for underlying kidney disease)

  • Sedimentation rate (to detect inflammation)

  • Hematocrit (to measure the number of red blood cells)

  • Rheumatoid factor test (to determine if rheumatoid factor is present in the blood)

  • Urinalysis (to determine levels of protein, red blood cells, white blood cells, and casts)

  • White blood cell count (to determine level of white blood cells in the blood)

  • Uric acid (to diagnosis gout)

  • HLA tissue typing (to look for genetic markers in ankylosing spondylitis)

• Skin biopsy (to diagnose a type of arthritis that involves the skin, such as lupus or psoriatic arthritis)

• Muscle biopsy (to diagnose arthritis or rheumatic diseases, such as polymyositis or vasculitis)   

Rehabilitation for arthritis

An arthritis rehabilitation program is designed to meet the needs of the individual patient, depending on the type and severity of the arthritis. Active involvement of the patient and family is vital to the success of the program.

The goal of arthritis rehabilitation is to help the patient return to the highest level of function and independence possible while improving the overall quality of life--physically, emotionally, and socially. The focus of rehabilitation is on relieving pain and increasing motion in the affected joint(s).

In order to help reach these goals, arthritis rehabilitation programs may include the following:

• Exercises and to control joint pain and swelling

• Exercises to improve mobility (movement) and physical fitness

• Heat and cold therapy

• Massage

• Transcutaneous electrical nerve stimulation to help relieve pain

• Acupuncture

• Stress management and emotional support

• Joint immobilization and methods to protect the joints from further damage, degeneration, and deformities

• Nutritional counseling to improve weight control

• Use of assistive devices

• Patient and family education

Rehabilitation after joint replacement

The goal of hip and knee replacement surgery is to improve the function of the joint. Full recovery after joint replacement usually takes about three to six months, depending on the type of surgery, overall health of the patient, and the success of rehabilitation.

Rehabilitation programs after joint replacement may include the following:

• Exercises to improve mobility (movement) and physical fitness

• Gait (walking) retraining

• Pain management

• Nutritional counseling to improve weight control

• Use of assistive devices

• Patient and family education

The arthritis rehabilitation team

Arthritis rehabilitation programs can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the arthritis rehabilitation team, including any or all of the following:

• Orthopedist/orthopedic surgeon

• Rheumatologist

• Physiatrist

• Primary care doctor (for example, family medicine or internal medicine) 

• Rehabilitation nurse

• Dietitian

• Physical therapist

• Occupational therapist

• Social worker

• Psychologist/psychiatrist

• Recreational therapist

• Vocational therapist