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Welcome my compendium website on Arthritis Pain Treatment. As many as 1 in 3 adults in the United States currently suffers from chronic joint symptoms or arthritis. Could you be one of them?
Arthritis isn’t just 1 disease; it’s a complex disorder that comprises more than 100 distinct conditions and can affect people at any stage of life. Two of the most common forms are osteoarthritis and rheumatoid arthritis.

These 2 forms have very different causes, risk factors, and effects on the body, yet they often share a common symptom—persistent joint pain. The joint pain of arthritis can appear as hip pain, knee pain, hand pain, or wrist pain, as well as joint pain in other areas of the body. If you have joint pain, stiffness and/or swelling for more than 2 weeks, you may have arthritis. Make an appointment with your doctor.

Arthritis or chronic joint symptoms affect approximately 70 million adults, or roughly 1 in 3 Americans.


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You can find this site again  by typing in the  Google search engine  the unique word " 1sitirhtrA"  which is  OR " Arthritis1 " backwards.

26,122 Words on this very large Arthritis Website.

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Arthritis

Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. Arthritis is the leading cause of disability in people over the age of 65.

There are many forms of arthritis, each of which has a different cause. Rheumatoid arthritis and psoriatic arthritis are autoimmune diseases in which the body is attacking itself. Septic arthritis is caused by joint infection. Gouty arthritis is caused by deposition of uric acid crystals in the joint that results in subsequent inflammation. Additionally, there is a less common form of gout that is caused by the formation of needle shaped crystals of calcium pyrophosphate. This form of gout is known as pseudogout. The most common form of arthritis, osteoarthritis is also known as degenerative joint disease and occurs following trauma to the joint, following an infection of the joint or simply as a result of aging. There is emerging evidence that abnormal anatomy may contribute to early development of osteoarthritis.

 

[edit] History and physical examination

All arthritides feature pain. Patterns of pain differ among the arthridities and the location. Osteoarthritis is classically worse at night or following rest. Rheumatoid arthritis is generally worse in the morning and in the early stages, patients often do not have symptoms following their morning shower. In elderly people and children, pain may not be the main feature, and the patient simply moves less (elderly) or refuses to use the affected limb (children).

Elements of the history of the pain (onset, number of joints and which involved, duration, aggravating and relieving factors) all guide diagnosis. Physical examination typically confirms diagnosis. Radiographs are often used to follow progression or assess severity in a more quantitative manner.

Blood tests and X-rays of the affected joints often are performed to make the diagnosis.

Screening blood tests may be indicated if certain arthridities are suspected. This may include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen and specific antibodies.

 

[edit] Types of arthritis

Primary forms of arthritis:

Secondary to other diseases:

Diseases that can mimic arthritis include:

[edit] Treatment

Treatment options vary depending on the type of arthritis and include physical and occupational therapy, medications (symptomatic or targeted at the disease process causing the arthritis), and as a last resort, arthroplasty. Although prosthetic joint replacement is a treatment of last resort, it is generally very effective and more than 90% of patients are very satisfied.

[edit] History

While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC. Around 500 BC willow bark gained popularity when it was discovered to help relieve some of the aches and pains of arthritis. It wasn't until more than 2,000 years later, in the early 1820s, that European scientists began to scientifically study the chemical compound in willow bark that alleviated the arthritis symptoms. They discovered the compound was salicin. When they isolated salicin, however, they found it was very noxious to the stomach. Almost 80 years later, in 1897, an employee of Bayer Company -- then a dye production company -- named Felix Hoffman discovered how to isolate the compound and make it less irritating to the stomach. Hoffman was attempting to make the drug in order to help his father, who was suffering from arthritis. In 1899, Bayer Company trademarked Hoffman's discovery under the name "Aspirin." Today it is believed that over a trillion tablets of aspirin have been sold worldwide.[1]
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Arthritis and Your Joints
Arthritis is a medical term that literally means joint inflammation. It can refer to any 1 of more than 100 or so diseases that make your joints feel painful, stiff, and swollen. The most common forms are osteoarthritis (OA) and rheumatoid arthritis (RA). Of these, OA is by far the more common, affecting approximately 21 million Americans, whereas an estimated 2.1 million people—about 1% of all American adults—have RA. If you have joint pain, stiffness, and/or swelling for more than 2 weeks, you may have arthritis. Make an appointment to speak with your doctor.  
Osteoarthritis (OA)

Osteoarthritis (OA) is the most common form of arthritis in the United States, affecting an estimated 21 million adults. OA begins with the breakdown of joint cartilage, resulting in pain and stiffness.

OA commonly affects the joints of the fingers, knees, hips, and spine. Other joints affected less frequently include the wrists, elbows, shoulders, and ankles. When OA is found in a less-frequently affected joint, there is usually a history of injury or unusual stress to that joint.

Work-related repetitive injury and physical trauma may contribute to the development of OA. For example, if you have a strenuous job that requires repetitive bending, kneeling, or squatting, you may be at high risk for OA of the knee.
Arthritis Symptom Checklist

Do you have pain, inflammation, or stiffness in your joints? Ask yourself the following questions to see if arthritis could be causing your discomfort:

  1. Have you had pain or stiffness in your joints for 3 or more days a week for the last month?
     Yes No
     
  2. Have you had swelling in your joints for 3 or more days a week for the last month?
     Yes No
     
  3. Do you have stiffness in your joints, especially after not moving for an extended period of time (eg, moving in the morning)?
     Yes No
     
  4. Do you have pain or discomfort in a joint that has a history of injury?
     Yes No
Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) can affect many different joints and, in some people, other parts of the body as well, including the blood, the lungs, and the heart.

Inflammation of the joint lining, called the synovium, can cause pain, stiffness, swelling, warmth, and redness. The affected joint may also lose its shape, resulting in loss of normal movement. RA can last a long time and can be a disease of flares (active symptoms) and remissions (few to no symptoms).

RA affects 2.1 million Americans, or about 1% of the adult population in the United States. This disease is 2 to 3 times more common in women than in men, and generally affects people between the ages of 20 and 50. However, young children can develop a form of RA called juvenile rheumatoid arthritis.

What are the symptoms of rheumatoid arthritis?
Symptoms of RA differ from person to person but can generally include:

  • Joint tenderness, warmth, and swelling. Both sides of the body are usually affected at the same time. This is also called a "symmetrical pattern" of inflammation. For example, if one knee is affected, the other one is also. This is in contrast to osteoarthritis, where it is possible for only one knee to be affected.
  • Pain and stiffness lasting for more than 1 hour in the morning or after a long rest.
  • Joint inflammation in the wrist and finger joints closest to the hand (although joints of the neck, shoulders, elbows, hips, knees, ankles, and feet can be affected as well).
  • Fatigue, an occasional fever, and a general sense of not feeling well (called malaise).
  • Symptoms that last for an extended period of time.
  • Symptoms in other parts of the body, not just in the joints.

RA causes inflammation of the joint lining, which can lead to pain, swelling, stiffness, and loss of function. It also can cause inflammation of your tear glands, salivary glands, the lining of your heart and lungs, and the lungs themselves.

As RA progresses, about 25% of people with the disease develop small lumps of tissue under the skin, called rheumatoid nodules. These rheumatoid nodules usually aren't painful. The nodules may form under the skin of the elbow, hands, the back of the scalp, over the knee, or on the feet and heels. They can be as small as a pea to as large as a walnut.

Although RA is often a chronic disease, the severity and duration of the symptoms may unpredictably come and go. For people with a severe case of RA, the disease is generally active, lasts for many years, and leads to serious joint damage and disability. Periods of increased disease activity, or worsening of symptoms, are called flare-ups or flares. Periods of remission are when the symptoms fade or disappear.

If you are experiencing any of the symptoms described above, it is important to find out from a doctor if you have RA. Early diagnosis may reduce the pain, joint damage, and disability that occurs in some RA patients.

What causes rheumatoid arthritis?
RA is an autoimmune disease. This means the body's natural immune system does not operate as it should; it attacks healthy joint tissue, initiating a process of inflammation and joint damage.

The exact cause of RA is not yet known. Although scientists do know that many factors may contribute to the development of RA. Genetic, or hereditary, factors play a role. Scientists have shown certain genes that play a role in the immune system may be involved in determining whether or not you develop RA. However, some people with RA do not have these particular genes, and other people who do have the genes never develop the disease.

Environmental factors may also contribute to the cause of the disease. Researchers have found that RA can be triggered by an infection, possibly a virus or bacterium, in people who have an inherited tendency for the disease. However, RA is not contagious; you can't "catch it" from anyone.

How is rheumatoid arthritis diagnosed?
If you have persistent discomfort and swelling in multiple joints on both sides of your body, make an appointment to see your doctor. Early intervention can ensure that you receive the right diagnosis and help you to start feeling better, sooner. Early intervention can also help prevent irreversible joint damage.

To determine if your symptoms are due to RA, your doctor will most likely:

  • Review your medical history and conduct a physical examination.
  • Request a blood test that looks for an antibody called rheumatoid factor. About 70% to 90% of people with RA have this antibody. However, it is also possible to have the rheumatoid factor in your blood and not have RA.
  • Perform a blood test that measures your erythrocyte sedimentation rate (or sed rate), which will indicate the presence of an inflammatory process in your body. People with RA tend to have abnormally high sed rates.
  • Take X-rays of your joints to determine the extent of damage in your affected joints. A sequence of X-rays obtained over time can show the progression of RA.

If you have joint pain, stiffness, and/or swelling for more than 2 weeks, you may have arthritis.
Talk with your doctor about your symptoms
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Arthritis Myths: Find Out about the Misconceptions about Arthritis Treatments and the Causes of Arthritis

One in Three Americans Are Affected by Arthritis or Other Chronic Joint Problems

About Arthritis: Answers to the Most Frequently Asked Questions

Learning about the Most Common Types of Arthritis

Suspect Your Aches and Pains Are from Arthritis? Where to Turn First for Help

Learning the Signs and Symptoms of Arthritis

Reasearchers Work to Discover Genes Linked to Arthritis

What is Arthritis? Learn About the Disease that Afflicts One Out of Seven Americans

 
Anklyosing Spondylitis   Coping with Ankylosing Spondylitis, Learn practical tips that can help in treating ankylosing spondylitis
Learn about Ankylosing Spondylitis, a chronic inflammatory type of arthritis that affects the spine.
 
Cervical Arthritis   Learn about Cervical Arthritis, a type of arthritis affecting the upper spine causing neck and shoulder pain.
 
Fibromyalgia   Fibromyalgia Medicines
Learn about Fibromyalgia, an often misunderstood type of arthritis causing wide-spread pain
Coping with Fibromyalgia: The Psychological and Emotional Battles
 
Gout   Gout Medications
Learn about Gout, the painful form of arthritis caused by the overproduction of uric acid in the body
 
Infectious Arthritis   Infectious or Septic Arthritis
 
Juvenile Rheumatoid Arthritis   Learn about Juvenile Rheumatoid Arthritis: the arthritis that causes pain and inflammation in the joints of children
 
Lumbosacral Arthritis   Lumbosacral Arthritis: Symptoms, Causes and Treatments
 
Osteoarthritis   Osteoarthritis: Know the Risk Factors, Symptoms, Medications and Other Available Treatments
 
Osteonecrosis   What is Osteonecrosis?
 
Osteoporosis   Osteoporosis Medications
What is Osteoporosis?
 
Paget's Disease   What is Paget’s Disease?
 
Psoriatic Arthritis   Psoriatic Arthritis: Symptoms, Causes and Treatments
 
Reiter's Syndrome   Reiter's Syndrome
 
Rheumatic Diseases   Systemic Lupus Erythematosus: Symptoms, Causes and Treatments
Tendonitis and Bursitis: Learn about the Causes, Symptoms, and Treatments
Juvenile Psoriatic Arthritis
 
Rheumatoid Arthritis   Vasculitis: A Serious Complication of Rheumatoid Arthritis
What is Rheumatoid Arthritis?
DMARDs: Rheumatoid Arthritis Medications
 
Rheumatoid Foot and Ankle   Rheumatoid Arthritis: Symptoms, Causes, and Treatments of Rheumatoid Foot and Ankle
 
Other Conditions   Polyarteritis
Marfan Syndrome
Sjogren’s Syndrome: Symptoms, Causes, and Treatments
Reflex Sympathetic Dystrophy Syndrome
Ehlers-Danlos Syndrome
Inflammatory Bowel Disease
Polymyalgia Rheumatica and Giant Cell Arteritis
Wegener's Granulomatosis
Juvenile Dermatomyositis
Charcot’s Joints
Myositis
Scleroderma
Undifferentiated Spondyloarthropathy
Sarcoidosis
Lyme Disease: Symptoms, Causes and Treatments
Still's Disease
Raynaud’s Phenomenon: Learn about the Causes, Symptoms, and Strategies for Preventing Raynaud’s Attacks
Pseudogout: Learn the Causes, Symptoms and Treatments
Osteogenesis Imperfecta
Kawasaki Syndrome: Causes, Symptoms and Treatments
Behcet's Disease

Arthritis
 
 
Forty-six million Americans report that a doctor told them they have arthritis or other rheumatic conditions. Arthritis is the leading cause of disability in the United States, limiting the activities of more than 17 million adults. The CDC Arthritis Program is working to improve the quality of life for people affected by arthritis and other rheumatic conditions by working with states and other partners to increase awareness about appropriate arthritis self management activities and expanding the reach of programs proven to improve the quality of life for people with arthritis.

What’s New
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Efforts to Estimate the Number of Children with Arthritis

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Pediatric Arthritis Surveillance

In an effort to estimate the prevalence and burden of pediatric arthritis, the CDC Arthritis Program initiated a surveillance project—SPARCS (Significant Pediatric Arthritis and Rheumatologic Conditions Surveillance). Childhood arthritis is an emotional issue for parents and potentially devastating for the child. Considerable disagreement exists among experts about what is a clinical case and the number of cases. In response to Congressional language in the Arthritis Prevention Control and Cure Act of 2004, which directed CDC to estimate the prevalence of childhood arthritis, the Arthritis Program, and the American College of Rheumatology (ACR) cohosted a 1-day summit of experts in surveillance, rheumatologists, and key stakeholders in December 2004 to consider the options available for conducting surveillance of pediatric arthritis and making a standardized pediatric case definition for surveillance purposes. During FY 2006, the Arthritis Program worked with the American Academy of Pediatrics (AAP), ACR, and other stakeholders to refine these approaches to surveillance and definitions.

After a year and a half process of gathering and considering input, testing possibilities, and consulting with key constituents and partners, in June 2006 the CDC Arthritis Program finalized a paradigm for ongoing surveillance of pediatric arthritis. Mirroring that of adult surveillance, the method uses selected ICD-9CM diagnostic codes (PDF–11K) in health care and other diagnostically-based data systems to estimate both the number of ambulatory health care encounters and the number of children with pediatric arthritis. The Arthritis Program plans to publish the methods and resulting estimates with coauthors from ACR and the American Academy of Pediatrics (AAP) and add them to our Web site at that time. Estimates of childhood arthritis will then be produced on an ongoing basis using existing national data sets. Synthetic state-specific estimates will also be produced.

Arthritis    Overview

The word arthritis actually means joint inflammation. The term arthritis is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

A brief overview of the most common forms of arthritis will be discussed in this section. For a more detailed discussion of each of these conditions, follow the links provided for you. The Resources and Links section of our Web site can guide you to further information on many topics related to rheumatic diseases.  
 Questions and Answers About Reactive Arthritis

This booklet contains general information about reactive arthritis. It describes what reactive arthritis is and how it develops. It also explains how reactive arthritis is diagnosed and treated. Medical terms not defined in the text are defined in the "Key Words" section. If you have further questions after reading this booklet, you may wish to discuss them with your doctor.

What Is Reactive Arthritis?

Reactive arthritis is a form of arthritis, or joint inflammation, that occurs as a "reaction" to an infection elsewhere in the body. Inflammation is a characteristic reaction of tissues to injury or disease and is marked by swelling, redness, heat, and pain. Besides this joint inflammation, reactive arthritis is associated with two other symptoms: redness and inflammation of the eyes (conjunctivitis) and inflammation of the urinary tract (urethritis). These symptoms may occur alone, together, or not at all.

Reactive arthritis is also known as Reiter's syndrome, and your doctor may refer to it by yet another term, as a seronegative spondyloarthropathy. The seronegative spondyloarthropathies are a group of disorders that can cause inflammation throughout the body, especially in the spine. (Examples of other disorders in this group include psoriatic arthritis, ankylosing spondylitis, and the kind of arthritis that sometimes accompanies inflammatory bowel disease.)

In many patients, reactive arthritis is triggered by a venereal infection in the bladder, the urethra, or, in women, the vagina (the urogenital tract) that is often transmitted through sexual contact. This form of the disorder is sometimes called genitourinary or urogenital reactive arthritis. Another form of reactive arthritis is caused by an infection in the intestinal tract from eating food or handling substances that are contaminated with bacteria. This form of arthritis is sometimes called enteric or gastrointestinal reactive arthritis.

The symptoms of reactive arthritis usually last 3 to 12 months, although symptoms can return or develop into a long-term disease in a small percentage of people.

What Causes Reactive Arthritis?

Reactive arthritis typically begins about 1 to 3 weeks after infection. The bacterium most often associated with reactive arthritis is Chlamydia trachomatis, commonly known as chlamydia (pronounced kla-MID-e-a). It is usually acquired through sexual contact. Some evidence also shows that respiratory infections with Chlamydia pneumoniae may trigger reactive arthritis.

Infections in the digestive tract that may trigger reactive arthritis include Salmonella, Shigella, Yersinia, and Campylobacter. People may become infected with these bacteria after eating or handling improperly prepared food, such as meats that are not stored at the proper temperature.

Doctors do not know exactly why some people exposed to these bacteria develop reactive arthritis and others do not, but they have identified a genetic factor, human leukocyte antigen (HLA) B27, that increases a person's chance of developing reactive arthritis. Approximately 80 percent of people with reactive arthritis test positive for HLA-B27. However, inheriting the HLA-B27 gene does not necessarily mean you will get reactive arthritis. Eight percent of healthy people have the HLA-B27 gene, and only about one-fifth of them will develop reactive arthritis if they contract the triggering infections.

Is Reactive Arthritis Contagious?

Reactive arthritis is not contagious; that is, a person with the disorder cannot pass the arthritis on to someone else. However, the bacteria that can trigger reactive arthritis can be passed from person to person.

Who Gets Reactive Arthritis?

Overall, men between the ages of 20 and 40 are most likely to develop reactive arthritis. However, evidence shows that although men are nine times more likely than women to develop reactive arthritis due to venereally acquired infections, women and men are equally likely to develop reactive arthritis as a result of food-borne infections. Women with reactive arthritis often have milder symptoms than men.

What Are the Symptoms of Reactive Arthritis?

Reactive arthritis most typically results in inflammation of the urogenital tract, the joints, and the eyes. Less common symptoms are mouth ulcers and skin rashes. Any of these symptoms may be so mild that patients do not notice them. They usually come and go over a period of several weeks to several months.

Urogenital Tract Symptoms

Reactive arthritis often affects the urogenital tract, including the prostate or urethra in men and the urethra, uterus, or vagina in women. Men may notice an increased need to urinate, a burning sensation when urinating, and a fluid discharge from the penis. Some men with reactive arthritis develop prostatitis (inflammation of the prostate gland). Symptoms of prostatitis can include fever and chills, as well as an increased need to urinate and a burning sensation when urinating.

Women with reactive arthritis may develop problems in the urogenital tract, such as cervicitis (inflammation of the cervix) or urethritis (inflammation of the urethra), which can cause a burning sensation during urination. In addition, some women also develop salpingitis (inflammation of the fallopian tubes) or vulvovaginitis (inflammation of the vulva and vagina). These conditions may or may not cause any arthritic symptoms.

Joint Symptoms

The arthritis associated with reactive arthritis typically involves pain and swelling in the knees, ankles, and feet. Wrists, fingers, and other joints are affected less often. People with reactive arthritis commonly develop inflammation of the tendons (tendinitis) or at places where tendons attach to the bone (ethesitis). In many people with reactive arthritis, this results in heel pain or irritation of the Achilles tendon at the back of the ankle. Some people with reactive arthritis also develop heel spurs, which are bony growths in the heel that may cause chronic (long-lasting) foot pain. Approximately half of people with reactive arthritis report low-back and buttock pain.

Reactive arthritis also can cause spondylitis (inflammation of the vertebrae in the spinal column) or sacroiliitis (inflammation of the joints in the lower back that connect the spine to the pelvis). People with reactive arthritis who have the HLA-B27 gene are even more likely to develop spondylitis and/or sacroiliitis.

Eye Involvement

Conjunctivitis, an inflammation of the mucous membrane that covers the eyeball and eyelid, develops in approximately half of people with reactive arthritis. Some people may develop uveitis, which is an inflammation of the inner eye. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision. Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go.

Other Symptoms

Between 20 and 40 percent of men with reactive arthritis develop small, shallow, painless sores (ulcers) on the end of the penis. A small percentage of men and women develop rashes or small, hard nodules on the soles of the feet and, less often, on the palms of their hands or elsewhere. In addition, some people with reactive arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed.

How Is Reactive Arthritis Diagnosed?

Doctors sometimes find it difficult to diagnose reactive arthritis because there is no specific laboratory test to confirm that a person has it. A doctor may order a blood test to detect the genetic factor HLA-B27, but even if the result is positive, the presence of HLA-B27 does not always mean that a person has the disorder.

At the beginning of an examination, the doctor will probably take a complete medical history and note current symptoms as well as any previous medical problems or infections. Before and after seeing the doctor, it is sometimes useful for the patient to keep a record of the symptoms that occur, when they occur, and how long they last. It is especially important to report any flu-like symptoms, such as fever, vomiting, or diarrhea, because they may be evidence of a bacterial infection.

The doctor may use various blood tests besides the HLA-B27 test to help rule out other conditions and confirm a suspected diagnosis of reactive arthritis. For example, the doctor may order rheumatoid factor or antinuclear antibody tests to rule out reactive arthritis. (See "Key Words," below.) Most people who have reactive arthritis will have negative results on these tests. If a patient's test results are positive, he or she may have some other form of arthritis, such as rheumatoid arthritis or lupus. Doctors also may order a blood test to determine the erythrocyte sedimentation rate (sed rate), which is the rate at which red blood cells settle to the bottom of a test tube of blood. A high sed rate often indicates inflammation somewhere in the body. Typically, people with rheumatic diseases, including reactive arthritis, have an elevated sed rate.

The doctor also is likely to perform tests for infections that might be associated with reactive arthritis. Patients generally are tested for a Chlamydia infection because recent studies have shown that early treatment of Chlamydia-induced reactive arthritis may reduce the progression of the disease. The doctor may look for bacterial infections by testing cell samples taken from the patient's throat as well as the urethra in men or cervix in women. Urine and stool samples also may be tested. A sample of synovial fluid (the fluid that lubricates the joints) may be removed from the arthritic joint. Studies of synovial fluid can help the doctor rule out infection in the joint.

Doctors sometimes use x rays to help diagnose reactive arthritis and to rule out other causes of arthritis. X rays can detect some of the symptoms of reactive arthritis, including spondylitis, sacroiliitis, swelling of soft tissues, damage to cartilage or bone margins of the joint, and calcium deposits where the tendon attaches to the bone.

What Type of Doctor Treats Reactive Arthritis?

A person with reactive arthritis probably will need to see several different types of doctors because reactive arthritis affects different parts of the body. However, it may be helpful to the doctors and the patient for one doctor, usually a rheumatologist (a doctor specializing in arthritis), to manage the complete treatment plan. This doctor can coordinate treatments and monitor the side effects from the various medicines the patient may take. The following specialists treat other features that affect different parts of the body.

  • Ophthalmologist--treats eye disease
  • Gynecologist--treats genital symptoms in women
  • Urologist--treats genital symptoms in men and women
  • Dermatologist--treats skin symptoms
  • Orthopaedist--performs surgery on severely damaged joints
  • Physiatrist--supervises exercise regimens

How Is Reactive Arthritis Treated?

Although there is no cure for reactive arthritis, some treatments relieve symptoms of the disorder. The doctor is likely to use one or more of the following treatments:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)--NSAIDs reduce joint inflammation and are commonly used to treat patients with reactive arthritis. Some traditional NSAIDs, such as aspirin and ibuprofen, are available without a prescription, but others that are more effective for reactive arthritis, such as indomethacin and tolmetin, must be prescribed by a doctor. Less is known about whether a new class of NSAIDs, called COX-2 inhibitors, is effective for reactive arthritis, but they may reduce the risk of gastrointestinal complications associated with traditional NSAIDs.
  • Corticosteroid injections--For people with severe joint inflammation, injections of corticosteroids directly into the affected joint may reduce inflammation. Doctors usually prescribe these injections only after trying unsuccessfully to control arthritis with NSAIDs.
  • Topical corticosteroids--These corticosteroids come in a cream or lotion and can be applied directly on the skin lesions, such as ulcers, associated with reactive arthritis. Topical corticosteroids reduce inflammation and promote healing.
  • Antibiotics--The doctor may prescribe antibiotics to eliminate the bacterial infection that triggered reactive arthritis. The specific antibiotic prescribed depends on the type of bacterial infection present. It is important to follow instructions about how much medicine to take and for how long; otherwise the infection may persist. Typically, an antibiotic is taken for 7 to 10 days or longer.
    Some doctors may recommend a person with reactive arthritis take antibiotics for a long period of time (up to 3 months). Current research shows that in most cases, this practice is necessary.
  • Immunosuppressive medicines--A small percentage of patients with reactive arthritis have severe symptoms that cannot be controlled with any of the above treatments. For these people, medicine that suppresses the immune system, such as sulfasalazine or methotrexate, may be effective.
  • TNF inhibitors--Several relatively new treatments that suppress tumor necrosis factor (TNF), a protein involved in the body's inflammatory response, may be effective for reactive arthritis and other spondyloarthropathies. They include etanercept and infliximab. These treatments were first used to treat rheumatoid arthritis.
  • Exercise--Exercise, when introduced gradually, may help improve joint function. In particular, strengthening and range-of-motion exercises will maintain or improve joint function. Strengthening exercises builds up the muscles around the joint to better support it. Muscle-tightening exercises that do not move any joints can be done even when a person has inflammation and pain. Range-of-motion exercises improve movement and flexibility and reduce stiffness in the affected joint. For patients with spine pain or inflammation, exercises to stretch and extend the back can be particularly helpful in preventing long-term disability. Aquatic exercise also may be helpful. Before beginning an exercise program, patients should talk to a health professional who can recommend appropriate exercises.

What Is the Prognosis for People Who Have Reactive Arthritis?

Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities 2 to 6 months after the first symptoms appear. In such cases, the symptoms of arthritis may last up to 12 months, although these are usually very mild and do not interfere with daily activities. Approximately 20 percent of people with reactive arthritis will have chronic (long-term) arthritis, which usually is mild. Studies show that between 15 and 50 percent of patients will develop symptoms again sometime after the initial flare has disappeared. It is possible that such relapses may be due to reinfection. Back pain and arthritis are the symptoms that most commonly reappear. A small percentage of patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint deformity.

What Are Researchers Learning About Reactive Arthritis?

Researchers continue to investigate the causes of reactive arthritis and study treatments for the condition. For example:

  • Researchers are trying to better understand the relationship between infection and reactive arthritis. In particular, they are trying to determine why an infection triggers arthritis and why some people who develop infections get reactive arthritis while others do not. Scientists also are studying why people with the genetic factor HLA-B27 are more at risk than others.
  • Researchers are developing methods to detect the location of the triggering bacteria in the body. Some scientists suspect that after the bacteria enter the body, they are transported to the joints, where they can remain in small amounts indefinitely.
  • Researchers are testing combination treatments for reactive arthritis. In particular, they are testing the use of antibiotics in combination with TNF inhibitors and with other immunosuppressant medicines, such as methotrexate and sulfasalazine.

Where Can People Get More Information About Reactive Arthritis?

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
E-mail: NIAMSInfo@mail.nih.gov
www.niams.nih.gov

NIAMS provides information about skin diseases, arthritis and rheumatic diseases, and bone, muscle, and joint diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can be found on the NIAMS Web site.

American College of Rheumatology/Association of Rheumatology Health Professionals
1800 Century Place, Suite 250
Atlanta, GA 30345-4300
Phone: 404-633-3777
Fax: 404-633-1870
www.rheumatology.org

This association provides referrals to rheumatologists and physical and occupational therapists who have experience working with people who have a rheumatic disease. The organization also provides educational materials and guidelines about many different rheumatic diseases.

Arthritis Foundation
1330 West Peachtree Street, Suite 100
Atlanta, GA 30309
Phone: 404-872-7100 or 800-568-4045 (free of charge) or call your local chapter (listed in the telephone directory)
www.arthritis.org

This is the main voluntary organization devoted to arthritis. The foundation publishes a monthly magazine for members that provides up-to-date information on arthritis. The foundation can also provide physician and clinical referrals.

Spondylitis Association of America
P.O. Box 5872
Sherman Oaks, CA 91413
Phone: 800-777-8189 (free of charge)
E-mail: info@spondylitis.org
www.spondylitis.org

This is the main voluntary organization devoted to all forms of spondylitis, including reactive arthritis. The association publishes patient and professional materials and a newsletter for members.

Key Words

Antibodies--Special proteins produced by the body's immune system that recognize and help fight infectious agents, such as bacteria, viruses, and other foreign substances that invade the body.

Antinuclear antibodies--Antibodies that are in the bloodstream of people who have connective tissue diseases or certain autoimmune disorders.

Arthritis--Literally means joint inflammation. It is a general term for more than 100 conditions known as rheumatic diseases. These diseases affect not only the joints but also other parts of the body, including important supporting structures such as muscles, tendons, and ligaments, as well as some internal organs.

Corticosteroids--Potent anti-inflammatory hormones that are made naturally in the body or synthetically (man-made) for use as drugs. They are also called glucocorticoids. The most commonly prescribed drug of this type is prednisone.

Erythrocyte sedimentation rate--Also referred to as the "sed" rate. A blood test that signals the presence of inflammatory disease by measuring the speed at which red blood cells settle to the bottom of a test tube.

HLA-B27--Human leukocyte antigen-B27. A genetic marker often--but not always--found in the blood of patients with certain forms of arthritis, such as reactive arthritis and ankylosing spondylitis.

Immune system--The system that protects the body from infections.

Range of motion--A measurement of the extent to which a joint can go through all of its normal movements.

Rheumatoid arthritis--A chronic inflammatory disease that causes pain, stiffness, swelling, and loss of function in the joints. The primary target of rheumatoid arthritis is the synovium, or joint lining. This tissue, which normally is smooth and shiny, becomes inflamed, painful, and swollen. The disease can also cause inflammation in the blood vessels and the outer lining of the heart and lungs.

Rheumatoid factor--A kind of antibody found in the blood of many individuals who have rheumatoid arthritis. Rheumatoid factor may be found in many diseases besides rheumatoid arthritis. However, some people without health problems will also test positive for rheumatoid factor.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of Frank Arnett, M.D., University of Texas Medical School, Houston; Daniel Clegg, M.D., University of Utah, Salt Lake City; Robert Inman, M.D., Toronto Western Hospital and University of Toronto, Ontario, Canada; John H. Klippel, M.D., Arthritis Foundation, Washington, DC; Barbara Mittleman, M.D., NIAMS, NIH; Ralph Schumacher, M.D., Department of Veterans Affairs Medical Center, Philadelphia, PA; and Bernadette Tyree, Ph.D., NIAMS, NIH, in the preparation of this and previous versions of this booklet.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at www.niams.nih.gov.
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What Are Osteoporosis and Arthritis and How Are They Different?
 

Osteoporosis and arthritis are easy to confuse. This fact sheet explains how they are alike and how they differ.

What Is Osteoporosis?

Osteoporosis is a disease that makes bones weak and more likely to break. People with osteoporosis most often break bones in the hip, spine, and wrist. Osteoporosis is called the “silent disease” because bone is lost with no symptoms. You may not know you have osteoporosis until a strain, bump, or fall causes a bone to break.

There is no cure for osteoporosis, but there are ways to prevent and treat the disease. They include:

  • A diet rich in calcium and vitamin D
  • Daily exercise
  • Medicines.

What Is Arthritis?

Arthritis affects the joints and nearby tissues. Joints are places in the body where bones meet, such as the elbows and knees. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

  • Osteoarthritis (OA) is a joint disease that causes pain in the hips, knees, neck, back, or hands. Being overweight, playing sports, and overusing joints in other ways can hurt them and lead to OA. With time, the cushions on the ends of the bones in the joint get thin or wear off, and the bones can rub against each other.
     
  • Rheumatoid arthritis (RA) is a disease that strikes joints in the hands and feet. In rheumatoid arthritis, the body attacks its own healthy tissues. This damages the lining of joints and causes pain, swelling, and stiffness.

How Are Osteoporosis and Arthritis Different?

Osteoporosis and osteoarthritis are sometimes confused because their names sound the same. But these illnesses have different:

  • Symptoms
  • Diagnosis
  • Treatment.

People with OA do not often have osteoporosis. Because some of the medicines used to treat RA cause bone loss, people with RA may get osteoporosis. Bone loss in RA may also occur as a direct result of the disease.

How Do People With Osteoporosis and Arthritis Cope?

If you have osteoporosis or arthritis, exercise can help. It can build strength, improve posture, and increase range of motion. Some examples are:

  • Low-impact aerobics
  • Swimming
  • Tai chi
  • Low-stress yoga.

People with osteoporosis should try not to bend forward, twist the spine, or lift heavy weights. People with arthritis need to learn ways to cope with joints that don’t move well and may be unstable. It is important to check with your doctor to learn what types of exercise are safe for you.

What About Pain?

Most people with arthritis have pain every day. But people with osteoporosis often only need pain relief if they break a bone. Ways to manage pain are similar for people with osteoporosis, OA, and RA and include pain medications, certain types of exercise, physical therapy, and sometimes surgery.

 

What Is Rheumatoid Arthritis?
 

What Is Rheumatoid Arthritis?
Who Gets Rheumatoid Arthritis?
What Causes Rheumatoid Arthritis?
How Is Rheumatoid Arthritis Diagnosed?
How Is Rheumatoid Arthritis Treated?
What Research Is Being Done on Rheumatoid Arthritis?

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is disease that affects the joints. It causes pain, swelling, and stiffness. If one knee or hand has rheumatoid arthritis, usually the other does too. This disease often occurs in more than one joint and can affect any joint in the body. People with this disease may feel sick and tired, and they sometimes get fevers.

Some people have this disease for only a few months, or a year or two. Then it goes away without causing damage. Other people have times when the symptoms get worse (flares), and times when they get better (remissions). Others have a severe form of the disease that can last for many years or a lifetime. This form of the disease can cause serious joint damage.

Who Gets Rheumatoid Arthritis?

Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is most common in older people. But children and young adults can also get it.

What Causes Rheumatoid Arthritis?

Doctors don't know the exact cause of rheumatoid arthritis. They know that with this arthritis, a person's immune system attacks his or her own body tissues. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are:

  • Genes (passed from parent to child)
  • Environment
  • Hormones.

How Is Rheumatoid Arthritis Diagnosed?

People can go to a family doctor or rheumatologist to be diagnosed. A rheumatologist is a doctor who helps people with problems in the joints, bones, and muscles. Rheumatoid arthritis can be hard to diagnose because:

  • There is no single test for the disease
  • The symptoms can be the same as other kinds of joint disease
  • The full symptoms can take time to develop.

To diagnose rheumatoid arthritis, doctors use medical history, physical exam, x rays, and lab tests.

How Is Rheumatoid Arthritis Treated?

Doctors have many ways to treat this disease. The goals of treatment are to:

  • Take away pain
  • Reduce swelling
  • Slow down or stop joint damage
  • Help people feel better
  • Help people stay active.

Treatment can include patient education, self-management programs, and support groups that help people learn about:

  • Treatments
  • How to exercise and relax
  • How to talk with their doctor
  • Problem solving.

These programs help people:

  • Learn about the disease
  • Reduce pain
  • Cope with physical issues and emotions
  • Feel more control over the disease
  • Build confidence
  • Lead full and active lives.

Treatment for rheumatoid arthritis may involve:

  • Lifestyle changes
  • Medicine
  • Surgery
  • Regular doctor visits
  • Alternative therapies.

Lifestyle Changes

Here are some ways to take care of yourself:

  • Keep a good balance between rest and exercise
  • Take care of your joints
  • Lower your stress
  • Eat a healthy diet.

Medicine

Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on:

  • The person's general health
  • How serious the rheumatoid arthritis is
  • How serious the rheumatoid arthritis may become
  • How long the person will take the drug
  • How well the drug works
  • Possible side effects.

Surgery

There are many kinds of surgery for people with severe joint damage. Surgery is used to:

  • Reduce pain
  • Help a joint work better
  • Help people be able to do daily activities.

Surgery is not for everyone. Talk about the option with your doctor.

Regular Doctor Visits

Regular medical care is important so doctors can:

  • See if the disease gets worse
  • See if drugs are helping
  • Look for drug side effects
  • Change treatment when needed.

Your care may include blood, urine, and other lab tests and x rays.

Alternative Therapies

Special diets, vitamins, and other alternative therapies are sometimes suggested to treat rheumatoid arthritis. Some therapies help people reduce stress. Many of these treatments are not harmful, but they may not be well tested or have any real benefits.

People should talk with their doctor before starting an alternative therapy. If the doctor feels the therapy might help and isn't harmful, it can become part of regular care.

What Research Is Being Done on Rheumatoid Arthritis?

Research is being done in many areas:

  • Immune systems
  • Genes
  • Families with rheumatoid arthritis
  • The way hormones and the nervous and immune systems interact
  • Infectious agents, like viruses and bacteria
  • Research registries (collection of medical and family-history data on people with rheumatoid arthritis)
  • Rheumatoid arthritis and pregnancy
  • New drugs or drug combinations
  • Quality of life for people with this disease.
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Questions and Answers About Arthritis and Rheumatic Diseases

This fact sheet answers basic questions about arthritis and rheumatic diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has other fact sheets and booklets that provide more information about specific forms of arthritis and rheumatic diseases. NIAMS also has information about exercise and arthritis, pain and arthritis, and diet and arthritis.

If you have further questions after reading this information, you may wish to discuss them with your doctor.

What Are Rheumatic Diseases and What Is Arthritis?

Rheumatic diseases are characterized by inflammation (signs are redness and/or heat, swelling, and pain) and loss of function of one or more connecting or supporting structures of the body. They especially affect joints, tendons, ligaments, bones, and muscles. Common symptoms are pain, swelling, and stiffness. Some rheumatic diseases can also involve internal organs. There are more than 100 rheumatic diseases.

Many people use the word "arthritis" to refer to all rheumatic diseases. However, the word literally means joint inflammation. The many different kinds of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic diseases are described as connective tissue diseases because they affect the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they occur when the immune system, which normally protects the body from infection and disease, harms the body's own healthy tissues. Throughout this fact sheet the terms "arthritis" and "rheumatic diseases" are sometimes used interchangeably.

Examples of Rheumatic Diseases

  • Osteoarthritis--This is the most common type of arthritis, affecting an estimated 21 million adults in the United States. Osteoarthritis primarily affects cartilage, which is the tissue that cushions the ends of bones within the joint. In osteoarthritis, the cartilage begins to fray and may entirely wear away. Osteoarthritis can cause joint pain and stiffness. Disability results most often when the disease affects the spine and the weight-bearing joints (the knees and hips).
  • Rheumatoid arthritis--This inflammatory disease of the synovium, or lining of the joint, results in pain, stiffness, swelling, joint damage, and loss of function of the joints. Inflammation most often affects joints of the hands and feet and tends to be symmetrical (occurring equally on both sides of the body). This symmetry helps distinguish rheumatoid arthritis from other forms of the disease. About 1 percent of the U.S. population (about 2.1 million people) has rheumatoid arthritis.
  • Juvenile rheumatoid arthritis--This is the most common form of arthritis in childhood, causing pain, stiffness, swelling, and loss of function of the joints. The arthritis may be associated with rashes or fevers, and may affect various parts of the body.
  • Fibromyalgia--Fibromyalgia is a chronic disorder that causes pain throughout the tissues that support and move the bones and joints. Pain, stiffness, and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Patients may also experience fatigue and sleep disturbances.
  • Systemic lupus erythematosus--Systemic lupus erythematosus (also known as lupus or SLE) is an autoimmune disease in which the immune system harms the body's own healthy cells and tissues. This can result in inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain.
  • Scleroderma--Also known as systemic sclerosis, scleroderma means literally "hard skin." The disease affects the skin, blood vessels, and joints. It may also affect internal organs, such as the lungs and kidneys. In scleroderma, there is an abnormal and excessive production of collagen (a fiber-like protein) in the skin or internal organs.
  • Spondyloarthropathies--This group of rheumatic diseases principally affects the spine. One common form--ankylosing spondylitis--not only affects the spine, but may also affect the hips, shoulders, and knees as the tendons and ligaments around the bones and joints become inflamed, resulting in pain and stiffness. Ankylosing spondylitis tends to affect people in late adolescence or early adulthood. Reactive arthritis, sometimes called Reiter's syndrome, is another spondyloarthropathy. It develops after an infection involving the lower urinary tract, bowel, or other organ and is commonly associated with eye problems, skin rashes, and mouth sores.
  • Gout--This type of arthritis results from deposits of needle-like crystals of uric acid in the joints. The crystals cause inflammation, swelling, and pain in the affected joint, which is often the big toe.
  • Infectious arthritis--This is a general term used to describe forms of arthritis that are caused by infectious agents, such as bacteria or viruses. Parvovirus arthritis and gonococcal arthritis are examples of infectious arthritis. Arthritis symptoms may also occur in Lyme disease, which is caused by a bacterial infection following the bite of certain ticks. In those cases of arthritis caused by bacteria, early diagnosis and treatment with antibiotics are crucial to get rid of the infection and minimize damage to the joints.
  • Polymyalgia rheumatica--Because this disease involves tendons, muscles, ligaments, and tissues around the joint, symptoms often include pain, aching, and morning stiffness in the shoulders, hips, neck, and lower back. It is sometimes the first sign of giant cell arteritis, a disease of the arteries characterized by inflammation, weakness, weight loss, and fever.
  • Polymyositis--This is a rheumatic disease that causes inflammation and weakness in the muscles. The disease may affect the whole body and cause disability.
  • Psoriatic arthritis--This form of arthritis occurs in some patients with psoriasis, a scaling skin disorder. Psoriatic arthritis often affects the joints at the ends of the fingers and toes and is accompanied by changes in the fingernails and toenails. Back pain may occur if the spine is involved.
  • Bursitis--This condition involves inflammation of the bursae, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursae. Bursitis produces pain and tenderness and may limit the movement of nearby joints.
  • Tendinitis (Tendonitis)--This condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.

What Causes Rheumatic Disease?

Scientists are studying risk factors that increase the likelihood of developing a rheumatic disease. Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. In lupus, rheumatoid arthritis, and scleroderma, the combination of genetic factors that determine susceptibility and environmental triggers are believed to be important. Family history also plays a role in some diseases such as gout and ankylosing spondylitis.

Gender is another factor in some rheumatic diseases. Lupus, rheumatoid arthritis, scleroderma, and fibromyalgia are more common among women. (See next section for details.) This indicates that hormones or other male-female differences may play a role in the development of these conditions.

Who Is Affected by Arthritis and Rheumatic Conditions?

An estimated 43 million people in the United States have arthritis or other rheumatic conditions. By the year 2020, this number is expected to reach 60 million. Rheumatic diseases are the leading cause of disability among adults age 65 and older.

Rheumatic diseases affect people of all races and ages. Some rheumatic conditions are more common among certain populations. For example:

  • Rheumatoid arthritis occurs two to three times more often in women than in men.
  • Scleroderma is more common in women than in men.
  • Nine out of 10 people who have lupus are women.
  • Nine out of 10 people who have fibromyalgia are women.
  • Gout is more common in men than in women.
  • Lupus is three times more common in African American women than in Caucasian women.
  • Ankylosing spondylitis is more common in men than in women.

What Are the Symptoms of Arthritis?

Different types of arthritis have different symptoms. In general, people who have arthritis feel pain and stiffness in the joints. Some of the more common symptoms are listed in the box. Early diagnosis and treatment help decrease further joint damage and help control symptoms of arthritis and many other rheumatic diseases.

Common Symptoms of Arthritis

  • Swelling in one or more joints
  • Stiffness around the joints that lasts for at least 1 hour in the early morning
  • Constant or recurring pain or tenderness in a joint
  • Difficulty using or moving a joint normally
  • Warmth and redness in a joint

How Are Rheumatic Diseases Diagnosed?

Diagnosing rheumatic diseases can be difficult because some symptoms and signs are common to many different diseases. A general practitioner or family doctor may be able to evaluate a patient or refer him or her to a rheumatologist (a doctor who specializes in treating arthritis and other rheumatic diseases).

The doctor will review the patient's medical history, conduct a physical examination, and obtain laboratory tests and x rays or other imaging tests. The doctor may need to see the patient more than once to make an accurate diagnosis.

Medical History

It is vital for people with joint pain to give the doctor a complete medical history. Answers to the following questions will help the doctor make an accurate diagnosis:

  • Is the pain in one or more joints?
  • When does the pain occur?
  • How long does the pain last?
  • When did you first notice the pain?
  • What were you doing when you first noticed the pain?
  • Does activity make the pain better or worse?
  • Have you had any illnesses or accidents that may account for the pain?
  • Is there a family history of any arthritis or other rheumatic disease?
  • What medicine(s) are you taking?

Because rheumatic diseases are so diverse and sometimes involve several parts of the body, the doctor may ask many other questions.

It may be helpful for people to keep a daily journal that describes the pain. Patients should write down what the affected joint looks like, how it feels, how long the pain lasts, and what they were doing when the pain started.

Physical Examination and Laboratory Tests

The doctor will examine the patient's joints for redness, warmth, damage, ease of movement, and tenderness. Because some forms of arthritis, such as lupus, may affect other organs, a complete physical examination that includes the heart, lungs, abdomen, nervous system, eyes, ears, and throat may be necessary. The doctor may order some laboratory tests to help confirm a diagnosis. Samples of blood, urine, or synovial fluid (lubricating fluid found in the joint) may be needed for the tests.

Common laboratory tests and procedures include the following:

Antinuclear antibody (ANA)--This test checks blood levels of antibodies that are often present in people who have connective tissue diseases or other autoimmune disorders, such as lupus. Since the antibodies react with material in the cell's nucleus (control center), they are referred to as antinuclear antibodies. There are also tests for individual types of ANAs that may be more specific to people with certain autoimmune disorders. ANAs are also sometimes found in people who do not have an autoimmune disorder. Therefore, having ANAs in the blood does not necessarily mean that a person has a disease.

C-reactive protein test--This is a nonspecific test used to detect generalized inflammation. Levels of the protein are often increased in patients with active disease such as rheumatoid arthritis, and may decline when corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation.

Complement--This test measures the level of complement, a group of proteins in the blood. Complement helps destroy foreign substances, such as germs, that enter the body. A low blood level of complement is common in people who have active lupus.

Complete blood count (CBC)--This test determines the number of white blood cells, red blood cells, and platelets present in a sample of blood. Some rheumatic conditions or drugs used to treat arthritis are associated with a low white blood count (leukopenia), low red blood count (anemia), or low platelet count (thrombocytopenia). When doctors prescribe medications that affect the CBC, they periodically test the patient's blood.

Creatinine--This blood test is commonly ordered in patients who have a rheumatic disease, such as lupus, to monitor for underlying kidney disease. Creatinine is a breakdown product of creatine, which is an important component of muscle. It is excreted from the body entirely by the kidneys, and the level remains constant and normal when kidney function is normal.

Erythrocyte sedimentation rate (sed rate)--This blood test is used to detect inflammation in the body. Higher sed rates indicate the presence of inflammation and are typical of many forms of arthritis, such as rheumatoid arthritis and ankylosing spondylitis, and many of the connective tissue diseases.

Hematocrit (PCV, packed cell volume)--This test and the test for hemoglobin (a substance in the red blood cells that carries oxygen throughout the body) measure the number of red blood cells present in a sample of blood. A decrease in the number of red blood cells (anemia) is common in people who have inflammatory arthritis or another rheumatic disease.

Rheumatoid factor--This test detects the presence of rheumatoid factor, an antibody found in the blood of most (but not all) people who have rheumatoid arthritis. Rheumatoid factor may be found in many diseases besides rheumatoid arthritis, and sometimes in people without health problems.

Synovial fluid examination--Synovial fluid may be examined for white blood cells (found in patients with rheumatoid arthritis and infections), bacteria or viruses (found in patients with infectious arthritis), or crystals in the joint (found in patients with gout or other types of crystal-induced arthritis). To obtain a specimen, the doctor injects a local anesthetic, then inserts a needle into the joint to withdraw the synovial fluid into a syringe. The procedure is called arthrocentesis or joint aspiration.

Urinalysis--In this test, a urine sample is studied for protein, red blood cells, white blood cells, and bacteria. These abnormalities may indicate kidney disease, which may be seen in several rheumatic diseases, including lupus. Some medications used to treat arthritis can also cause abnormal findings on urinalysis.

White blood cell count (WBC)--This test determines the number of white blood cells present in a sample of blood. The number may increase as a result of infection or decrease in response to certain medications or in certain diseases, such as lupus. Low numbers of white blood cells increase a person's risk of infections.

X Rays and Other Imaging Procedures

To see what the joint looks like inside, the doctor may order x rays or other imaging procedures. X rays provide an image of the bones, but they do not show cartilage, muscles, and ligaments. Other noninvasive imaging methods such as computed tomography (CT or CAT scan), magnetic resonance imaging (MRI), and arthrography show the whole joint. The doctor may look for damage to a joint by using an arthroscope, a small, flexible tube which is inserted through a small incision at the joint and which transmits the image of the inside of a joint to a video screen.

What Are the Treatments?

Treatments for rheumatic diseases include rest and relaxation, exercise, proper diet, medication, and instruction about the proper use of joints and ways to conserve energy. Other treatments include the use of pain relief methods and assistive devices, such as splints or braces. In severe cases, surgery may be necessary. The doctor and the patient work together to develop a treatment plan that helps the patient maintain or improve his or her lifestyle. Treatment plans usually combine several types of treatment and vary depending on the rheumatic condition and the patient.

Rest, Exercise, and Diet

People who have a rheumatic disease should develop a comfortable balance between rest and activity. One sign of many rheumatic conditions is fatigue. Patients must pay attention to signals from their bodies. For example, when experiencing pain or fatigue, it is important to take a break and rest. Too much rest, however, may cause muscles and joints to become stiff.

People with a rheumatic disease such as arthritis can participate in a variety of sports and exercise programs. Physical exercise can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being. Before starting any exercise program, people with arthritis should talk with their doctor. Exercises that doctors often recommend include:

  • Range-of-motion exercises (e.g., stretching, dance) to help maintain normal joint movement, maintain or increase flexibility, and relieve stiffness.
  • Strengthening exercises (e.g., weight lifting) to maintain or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
  • Aerobic or endurance exercises (e.g., walking, bicycle riding) to improve cardiovascular fitness, help control weight, and improve overall well-being. Studies show that aerobic exercise can also reduce inflammation in some joints.

Another important part of a treatment program is a well-balanced diet. Along with exercise, a well-balanced diet helps people manage their body weight and stay healthy. Weight control is important to people who have arthritis because extra weight puts extra pressure on some joints and can aggravate many types of arthritis. Diet is especially important for people who have gout. People with gout should avoid alcohol and foods that are high in purines, such as organ meats (liver, kidney), sardines, anchovies, and gravy.

Medications

A variety of medications are used to treat rheumatic diseases. The type of medication depends on the rheumatic disease and on the individual patient. The medications used to treat most rheumatic diseases do not provide a cure, but rather limit the symptoms of the disease. Infectious arthritis and gout are exceptions if medications are used properly. Another example is Lyme disease, caused by the bite of certain ticks, where symptoms of arthritis may be prevented or may disappear if the infection is caught early and treated with antibiotics.

Medications commonly used to treat rheumatic diseases provide relief from pain and inflammation. In some cases, the medication may slow the course of the disease and prevent further damage to joints or other parts of the body.

The doctor may delay using medications until a definite diagnosis is made because medications can hide important symptoms (such as fever and swelling) and thereby interfere with diagnosis. Patients taking any medication, either prescription or over-the-counter, should always follow the doctor's instructions. The doctor should be notified immediately if the medicine is making the symptoms worse or causing other problems, such as an upset stomach, nausea, or headache. The doctor may be able to change the dosage or medicine to reduce these side effects.

Analgesics (pain relievers) such as acetaminophen (Tylenol)* and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are used to reduce the pain caused by many rheumatic conditions. NSAIDs have the added benefit of decreasing the inflammation associated with arthritis. A common side effect of NSAIDs is stomach irritation, which can often be reduced by changing the dosage or medication. New NSAIDs, including celecoxib (Celebrex), were introduced to reduce gastrointestinal side effects and offer additional options for treatment. However, even new medications are occasionally associated with reactions ranging from mild to severe, and their long-term effects are still being studied. The dosage will vary depending on the particular illness and the overall health of the patient. The doctor and patient must work together to determine which analgesic to use and the appropriate amount. If analgesics do not ease the pain, the doctor may use other medications.

* Brand names included in this fact sheet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Depending on the type of arthritis, a person may be asked to take a disease-modifying antirheumatic drug (DMARD). This category includes several unrelated medications that are intended to slow or prevent damage to the joint and thereby prevent disability and discomfort. DMARDs include methotrexate, sulfasalazine, and leflunomide (Arava).

Biological response modifiers are new drugs used for the treatment of rheumatoid arthritis. They can help reduce inflammation and structural damage of the joints by blocking the reaction of a substance called tumor necrosis factor, a protein involved in immune system response. These drugs include etanercept (Enbrel), infliximab (Remicade), and anakinra (Kineret).

Corticosteroids, such as prednisone, cortisone, solumedrol, and hydrocortisone, are used to treat many rheumatic conditions because they decrease inflammation and suppress the immune system. The dosage of these medications will vary depending on the diagnosis and the patient. Again, the patient and doctor must work together to determine the right amount of medication.

Corticosteroids can be given by mouth, in creams applied to the skin, or by injection. Short-term side effects of corticosteroids include swelling, increased appetite, weight gain, and emotional ups and downs. These side effects generally stop when the drug is stopped. It can be dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together when changing the corticosteroid dose. Side effects that may occur after long-term use of corticosteroids include stretch marks, excessive hair growth, osteoporosis, high blood pressure, damage to the arteries, high blood sugar, infections, and cataracts.

Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint. They are usually injected directly into the joint to help provide temporary relief of pain and flexible joint movement.

Devices Used in Treatment

Transcutaneous electrical nerve stimulation (TENS) has been found effective in modifying pain perception. TENS blocks pain messages to the brain with a small device that directs mild electric pulses to nerve endings that lie beneath the painful area of the skin.

A blood-filtering device called the Prosorba Column is used in some health care facilities for filtering out harmful antibodies in people with severe rheumatoid arthritis.

Heat and Cold Therapies

Heat and cold can both be used to reduce the pain and inflammation of arthritis. The patient and doctor can determine which one works best.

Heat therapy increases blood flow, tolerance for pain, and flexibility. Heat therapy can involve treatment with paraffin wax, microwaves, ultrasound, or moist heat. Physical therapists are needed for some of these therapies, such as microwave or ultrasound therapy, but patients can apply moist heat themselves. Some ways to apply moist heat include placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower.

Cold therapy numbs the nerves around the joint (which reduces pain) and may relieve inflammation and muscle spasms. Cold therapy can involve cold packs, ice massage, soaking in cold water, or over-the-counter sprays and ointments that cool the skin and joints.

Capsaicin cream is a preparation put on the skin to relieve joint or muscle pain when only one or two joints are involved.

Hydrotherapy, Mobilization Therapy, and Relaxation Therapy

Hydrotherapy involves exercising or relaxing in warm water. The water takes some weight off painful joints, making it easier to exercise. It helps relax tense muscles and relieve pain.

Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation. (Someone other than the patient moves stiff joints through their normal range of motion.) When done by a trained professional, these methods can help control pain, increase joint motion, and improve muscle and tendon flexibility.

Relaxation therapy helps reduce pain by teaching people various ways to release muscle tension throughout the body. In one method of relaxation therapy, known as progressive relaxation, the patient tightens a muscle group and then slowly releases the tension. Doctors and physical therapists can teach patients a variety of relaxation techniques.

Assistive Devices

The most common assistive devices for treating arthritis pain are splints and braces, which are used to support weakened joints or allow them to rest. Some of these devices prevent the joint from moving; others allow some movement. A splint or brace should be used only when recommended by a doctor or therapist, who will show the patient the correct way to put the device on, ensure that it fits properly, and explain when and for how long it should be worn. The incorrect use of a splint or brace can cause joint damage, stiffness, and pain.

A person with arthritis can use other kinds of devices to ease the pain. For example, the use of a cane when walking can reduce some of the weight placed on a knee or hip affected by arthritis. A shoe insert (orthotic) can ease the pain of walking caused by arthritis of the foot or knee. Other devices can help with activities such as opening jars, closing zippers, and holding pencils.

Surgery

Surgery may be required to repair damage to a joint after injury or to restore function or relieve pain in a joint damaged by arthritis. The doctor may recommend arthroscopic surgery, bone fusion (surgery in which bones in the joint are fused or joined together), or arthroplasty (also known as total joint replacement, in which the damaged joint is removed and replaced with an artificial one).

Nutritional Supplements

Nutritional supplements are often reported as helpful in treating rheumatic diseases. These include products such as S-adenosylmethionine (SAM-e) for osteoarthritis and fibromyalgia, dehydroepiandrosterone (DHEA) for lupus, and glucosamine and chondroitin sulfate for osteoarthritis. Reports on the safety and effectiveness of these products should be viewed with caution since very few claims have been carefully evaluated.

Myths About Treating Arthritis

At this time, the only type of arthritis that can be cured is that caused by infections. Although symptoms of other types of arthritis can be effectively managed with rest, exercise, and medication, there are no cures. Some people claim to have been cured by treatment with herbs, oils, chemicals, special diets, radiation, or other products. However, there is no scientific evidence that such treatments cure arthritis. Moreover, some may lead to serious side effects. Patients should talk to their doctor before using any therapy that has not been prescribed or recommended by the health care team caring for the patient.

Work With Your Doctor To Limit Your Pain

The role you play in planning your treatment is very important. It is vital for you to have a good relationship with your doctor in order to work together. You should not be afraid to ask questions about your condition or treatment. You must understand the treatment plan and tell the doctor whether or not it is helping you. Research has shown that patients who are well informed and participate actively in their own care experience less pain and make fewer visits to the doctor.

What Can Be Done To Help?

Studies show that an estimated 18 percent of Americans who have arthritis or other rheumatic conditions believe that their condition limits their activities. People with arthritis may find that they can no longer participate in some of their favorite activities, which can affect their overall well-being. Even when arthritis impairs only one joint, a person may have to change many daily activities to protect that joint from further damage and reduce pain. When arthritis affects the entire body, as it does in people with rheumatoid arthritis or fibromyalgia, many daily activities have to be changed to deal with pain, fatigue, and other symptoms.

Changes in the home may help a person with chronic arthritis continue to live safely, productively, and with less pain. People with arthritis may become weak, lose their balance, or fall. In the bathroom, installing grab bars in the tub or shower and by the toilet, placing a secure seat in the tub, and raising the height of the toilet seat can help. Special kitchen utensils can accommodate hands affected by arthritis to make meal preparation easier. An occupational therapist can help people who have rheumatic conditions identify and make adjustments in their homes to create a safer, more comfortable, and more efficient environment.

Friends and family members can help a patient with a rheumatic condition by learning about that condition and understanding how it affects the patient's life. Friends and family can provide emotional and physical assistance. Their support, as well as support from other people who have the same disease, can make it easier to cope. The Arthritis Foundation has a wealth of information to help people with arthritis. (See the list of resources.)

What Research Is Being Done on Arthritis?

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and rheumatic diseases. The NIAMS sponsors research and research training on the NIH campus in Bethesda, Maryland, and at universities and medical centers throughout the United States. Research activities include both basic (laboratory) and clinical (involving patients) research studies to better understand what causes these conditions and how best to treat and prevent them.

The NIAMS currently supports three types of research centers that study arthritis, rheumatic diseases, and other musculoskeletal conditions: Multidisciplinary Clinical Research Centers (MCRCs), Specialized Centers of Research (SCORs), and Core Centers. A list of these centers and their locations can be obtained from the Institute (listed at the end of this fact sheet).

The MCRCs are programs that focus on clinical research designed to assess and improve outcomes for patients affected by arthritis and other rheumatic diseases, musculoskeletal disorders (including bone and muscle diseases), and skin diseases. Each center studies one or more of the diseases within the NIAMS mission and provides resources for developing clinical projects using more than one approach.

Each SCOR focuses on a single disease. Currently, rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, osteoporosis, and scleroderma are being studied. Combining laboratory and clinical studies under one roof speeds up research on the causes of these diseases and hastens transfer of advances from the laboratory to the bedside to improve patient care.

Core Centers promote interdisciplinary collaborative efforts among scientists doing high-quality research related to a common theme. By providing funding for facilities, pilot and feasibility studies, and program enrichment activities at the Core Center, the Institute reinforces investigations already underway in NIAMS program areas. Current centers include Rheumatic Diseases Research Core Centers, Skin Disease Research Core Centers, and Core Centers for Musculoskeletal Disorders.

Research registries provide a means for collecting clinical, demographic, and laboratory information from patients and, sometimes, their relatives. These registries facilitate studies that could ultimately lead to improved diagnosis, treatment, and prevention. NIAMS currently supports research registries for rheumatoid arthritis, antiphospholipid syndrome (an autoimmune disorder), ankylosing spondylitis, lupus and neonatal lupus, scleroderma, juvenile rheumatoid arthritis, and juvenile dermatomyositis.

Some current NIAMS research efforts in rheumatic diseases are outlined below.

Biomarkers

Recent scientific breakthroughs in basic research have provided new information about what happens to the body's cells and other structures as rheumatic diseases progress. Biomarkers (laboratory and imaging signposts that detect disease) help researchers determine the likelihood that a person will develop a specific disease and its possible severity and outcome. Biomarkers have the potential to lead to novel and more effective ways to predict and monitor disease activity and responses to treatment. The NIAMS supports research on biomarkers for rheumatic and skin diseases, including a new initiative on osteoarthritis. Additional studies on specific rheumatic diseases follow.

Rheumatoid Arthritis

Researchers are trying to identify the cause of rheumatoid arthritis in order to develop better and more specific treatments. They are examining the role that the endocrine (hormonal), nervous, and immune systems play, and the ways in which these systems interact with environmental and genetic factors in the development of rheumatoid arthritis. Some scientists are trying to determine whether an infectious agent triggers rheumatoid arthritis. Others are studying the role of certain enzymes (specialized proteins in the body that spark biochemical reactions) in breaking down cartilage. Researchers are also trying to identify the genetic factors that place some people at higher risk than others for developing rheumatoid arthritis.

Moreover, scientists are looking at new ways to treat rheumatoid arthritis. They are experimenting with new drugs and "biologic agents" that selectively block certain immune system activities associated with inflammation. Newly developed drugs include etanercept (Enbrel) and infliximab (Remicade). Followup studies show promise for their effectiveness in slowing disease progression. Studies for additional new drugs continue. Other investigators have shown that minocycline and doxycycline, two antibiotic medications in the tetracycline family, have a modest benefit for people with rheumatoid arthritis. Research continues in this area.

Novel studies using imaging technologies are underway as well. These techniques help identify targets for new drugs by allowing researchers to see changes in cells during the disease process.

Osteoarthritis

The NIAMS has embarked on several innovative approaches to understand the causes and identify effective treatment and prevention methods for osteoarthritis. Through a public/ private partnership, researchers are identifying biomarkers for osteoarthritis to help develop and test new drugs. Imaging studies designed to better identify joint disorders and assess their progression are taking place as well.

The National Center for Complementary and Alternative Medicine and the NIAMS at the National Institutes of Health are currently funding a study on the usefulness of the dietary supplements glucosamine and chondroitin sulfate for osteoarthritis. Previous studies suggest these substances may be effective for reducing pain in knee osteoarthritis. Researchers are also investigating whether they prevent the loss of cartilage.

Some genetic and behavioral studies are focusing on factors that may lead to osteoarthritis. Researchers recently found that daughters of women who have knee osteoarthritis have a significant increase in cartilage breakdown, thus making them more susceptible to disease. This finding has important implications for identifying people who are susceptible to osteoarthritis. Other studies of risk factors for osteoarthritis have identified excessive weight and lack of exercise as contributing factors to knee and hip disability.

Researchers are working to understand what role certain enzymes play in the breakdown of joint cartilage in osteoarthritis and are testing drugs that block the action of these enzymes.

Studies of injuries in young adults show that those who have had a previous joint injury are more likely to develop osteoarthritis. These studies underscore the need for increased education about joint injury prevention and use of proper sports equipment.

Systemic Lupus Erythematosus

Researchers are looking at how genetic, environmental, and hormonal factors influence the development of systemic lupus erythematosus. They are trying to find out why lupus is more common in certain populations, and they have made progress in identifying the genes that may be responsible for lupus. Researchers also continue to study the cellular and molecular basis of autoimmune disorders such as lupus. Promising areas of research on treatment include biologic agents; newer, more selective drugs that suppress the immune system; and bone transplants to correct immune abnormalities. Contrary to the widely held belief that estrogens can make the disease worse, clinical studies are revealing that it may be safe to use estrogens for hormone replacement therapy and birth control in women with lupus.

Scleroderma

Current studies on scleroderma are focusing on overproduction of collagen, blood vessel injury, and abnormal immune system activity. Researchers hope to discover how these three elements interact to cause and promote scleroderma. In one study, researchers found evidence of fetal cells within the blood and skin lesions of women who had been pregnant years before developing scleroderma. The study suggests that fetal cells may play a role in scleroderma by fostering the maturation of immune cells that promote the overproduction of collagen. Scientists are continuing to study the implications of this finding.

Treatment studies are underway as well. One study in particular is looking at the effectiveness of oral collagen in treating scleroderma.

Fibromyalgia

Scientists are looking at the basic causes of chronic pain and the health status of young women affected by fibromyalgia. The effectiveness of behavior therapy, acupuncture, and some alternative medical approaches for dealing with pain and loss of sleep are being tested. Researchers are also studying whether certain genes contribute to this disease.

Spondyloarthropathies

Researchers are working to understand the genetic and environmental causes of spondyloarthropathies, which include ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, and reactive arthritis (Reiter's syndrome), as well as related conditions of the eye. They are also looking at new imaging methods that will help with early and accurate diagnosis, guide treatment, and detect responses to treatment. Research on new treatments is also underway.

Questions and Answers about Arthritis and Exercise

Information Box

This booklet answers general questions about arthritis and exercise. The amount and form of exercise recommended for each individual will vary depending on which joints are involved, the amount of inflammation, how stable the joints are, and whether a joint replacement procedure has been done. A skilled physician who is knowledgeable about the medical and rehabilitation needs of people with arthritis, working with a physical therapist also familiar with the needs of people with arthritis, can design an exercise plan for each patient.

What Is Arthritis?

There are over 100 forms of arthritis and other rheumatic diseases. These diseases may cause pain, stiffness, and swelling in joints and other supporting structures of the body such as muscles, tendons, ligaments, and bones. Some forms can also affect other parts of the body, including various internal organs.

Many people use the word “arthritis” to refer to all rheumatic diseases. However, the word literally means joint inflammation; that is, swelling, redness, heat, and pain caused by tissue injury or disease in the joint. The many different kinds of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic diseases are described as connective tissue diseases because they affect the body’s connective tissue—the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they are caused by a problem in which the immune system harms the body’s own healthy tissues. Examples of some rheumatic diseases are:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Fibromyalgia
  • Systemic lupus erythematosus
  • Scleroderma
  • Juvenile rheumatoid arthritis
  • Ankylosing spondylitis
  • Gout

In this booklet, the term arthritis will be used as a general term to refer to arthritis and other rheumatic diseases.

Should People With Arthritis Exercise?

Yes. Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength, cardiac fitness, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being.

How Does Exercise Fit Into a Treatment Plan for People With Arthritis?

Exercise is one part of a comprehensive arthritis treatment plan. Treatment plans also may include rest and relaxation, proper diet, medication, and instruction about proper use of joints and ways to conserve energy (that is, not waste motion) as well as the use of pain relief methods.

What Types of Exercise Are Most Suitable for Someone With Arthritis?

Three types of exercise are best for people with arthritis:

  • Range-of-motion exercises (e.g., dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.
  • Strengthening exercises (e.g., weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
  • Aerobic or endurance exercises (e.g., bicycle riding) improve cardiovascular fitness, help control weight, and improve overall function. Weight control can be important to people who have arthritis because extra weight puts extra pressure on many joints. Some studies show that aerobic exercise can reduce inflammation in some joints.

Most health clubs and community centers offer exercise programs for people with physical limitations.

How Does a Person With Arthritis Start an Exercise Program?

People with arthritis should discuss exercise options with their doctors and other health care providers. Most doctors recommend exercise for their patients. Many people with arthritis begin with easy, range-of-motion exercises and lowimpact aerobics. People with arthritis can participate in a variety of, but not all, sports and exercise programs. The doctor will know which, if any, sports are off-limits.

The doctor may have suggestions about how to get started or may refer the patient to a physical therapist. It is best to find a physical therapist who has experience working with people who have arthritis. The therapist will design an appropriate home exercise program and teach clients about pain-relief methods, proper body mechanics (placement of the body for a given task, such as lifting a heavy box), joint protection, and conserving energy.

Step Up to Exercise: How To Get Started

  • Discuss exercise plans with your doctor.
  • Start with supervision from a physical therapist or qualified athletic trainer.
  • Apply heat to sore joints (optional; many people with arthritis start their exercise program this way).
  • Stretch and warm up with range-of-motion exercises.
  • Start strengthening exercises slowly with small weights (a 1- or 2-pound weight can make a big difference).
  • Progress slowly.
  • Use cold packs after exercising (optional; many people with arthritis complete their exercise routine this way).
  • Add aerobic exercise.
  • Consider appropriate recreational exercise (after doing range-of-motion, strengthening, and aerobic exercise). Fewer injuries to joints affected by arthritis occur during recreational exercise if it is preceded by range-of-motion, strengthening, and aerobic exercise that gets your body in the best condition possible.
  • Ease off if joints become painful, inflamed, or red, and work with your doctor to find the cause and eliminate it.
  • Choose the exercise program you enjoy most and make it a habit.

What Are Some Pain Relief Methods for People With Arthritis?

There are known methods to help stop pain for short periods of time. This temporary relief can make it easier for people who have arthritis to exercise. The doctor or physical therapist can suggest a method that is best for each patient. The following methods have worked for many people:

  • Moist heat supplied by warm towels, hot packs, a bath, or a shower can be used at home for 15 to 20 minutes three times a day to relieve symptoms. A health professional can use short waves, microwaves, and ultrasound to deliver deep heat to noninflamed joint areas. Deep heat is not recommended for patients with acutely inflamed joints. Deep heat is often used around the shoulder to relax tight tendons prior to stretching exercises.
  • Cold supplied by a bag of ice or frozen vegetables wrapped in a towel helps to stop pain and reduce swelling when used for 10 to 15 minutes at a time. It is often used for acutely inflamed joints. People who have Raynaud’s phenomenon should not use this method.
  • Hydrotherapy (water therapy) can decrease pain and stiffness. Exercising in a large pool may be easier because water takes some weight off painful joints. Community centers, YMCAs, and YWCAs have water exercise classes developed for people with arthritis. Some patients also find relief from the heat and movement provided by a whirlpool.
  • Mobilization therapies include traction (gentle, steady pulling), massage, and manipulation (using the hands to restore normal movement to stiff joints). When done by a trained professional, these methods can help control pain and increase joint motion and muscle and tendon flexibility.
  • TENS (transcutaneous electrical nerve stimulation) and biofeedback are two additional methods that may provide some pain relief, but many patients find that they cost too much money and take too much time. In TENS, an electrical shock is transmitted through electrodes placed on the skin’s surface. TENS machines cost between $80 and $800. The inexpensive units are fine. Patients can wear them during the day and turn them off and on as needed for pain control.
  • Relaxation therapy also helps reduce pain. Patients can learn to release the tension in their muscles to relieve pain. Physical therapists may be able to teach relaxation techniques. The Arthritis Foundation has a self-help course that includes relaxation therapy. Health spas and vacation resorts sometimes have special relaxation courses.
  • Acupuncture is a traditional Chinese method of pain relief. A medically qualified acupuncturist places needles in certain sites. Researchers believe that the needles stimulate deep sensory nerves that tell the brain to release natural painkillers (endorphins). Acupressure is similar to acupuncture, but pressure is applied to the acupuncture sites instead of using needles.

How Often Should People With Arthritis Exercise?

  • Range-of-motion exercises can be done daily and should be done at least every other day.
  • Strengthening exercises should be done every other day unless you have severe pain or swelling in your joints.
  • Endurance exercises should be done for 20 to 30 minutes three times a week unless you have severe pain or swelling in your joints. According to the American College of Rheumatology, 20- to 30-minute exercise routines can be performed in increments of 10 minutes over the course of a day.

What Type of Strengthening Program Is Best?

This varies depending on personal preference, the type of arthritis involved, and how active the inflammation is. Strengthening one’s muscles can help take the burden off painful joints. Strength training can be done with small free weights, exercise machines, isometrics, elastic bands, and resistive water exercises. Correct positioning is critical, because if done incorrectly, strengthening exercises can cause muscle tears, more pain, and more joint swelling.

Are There Different Exercises for People With Different Types of Arthritis?

There are many types of arthritis. Experienced doctors, physical therapists, and occupational therapists can recommend exercises that are particularly helpful for a specific type of arthritis. Doctors and therapists also know specific exercises for particularly painful joints. There may be exercises that are off-limits for people with a particular type of arthritis or when joints are swollen and inflamed. People with arthritis should discuss their exercise plans with a doctor. Doctors who treat people with arthritis include rheumatologists, orthopaedic surgeons, general practitioners, family doctors, internists, and rehabilitation specialists (physiatrists).

How Much Exercise Is Too Much?

Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too strenuous. People with arthritis should work with their physical therapist or doctor to adjust their exercise program when they notice any of the following signs of strenuous exercise:

  • Unusual or persistent fatigue
  • Increased weakness
  • Decreased range of motion
  • Increased joint swelling
  • Continuing pain (pain that lasts more than 1 hour after exercising)

Should Someone With Rheumatoid Arthritis Continue To Exercise During a General Flare? How About During a Local Joint Flare?

It is appropriate to put joints gently through their full range of motion once a day, with periods of rest, during acute systemic flares or local joint flares. Patients can talk to their doctor about how much rest is best during general or joint flares.

Are Researchers Studying Arthritis and Exercise?

Researchers are looking at the effects of exercise and sports on the development of musculoskeletal disabilities, including arthritis. They have found that people who do moderate, regular running have low, if any, risk of developing osteoarthritis. However, studies show that people who participate in sports with high-intensity, direct joint impact are at risk for the disease. Examples are football and soccer. Sports involving repeated joint impact and twisting (such as baseball and soccer) also increase osteoarthritis risk. Early diagnosis and effective treatment of sports injuries and complete rehabilitation should decrease the risk of osteoarthritis from these injuries.

Researchers also are looking at the effects of muscle strength on the development of osteoarthritis. Studies show, for example, that strengthening the quadriceps muscles can reduce knee pain and disability associated with osteoarthritis. One study shows that a relatively small increase in strength (20–25 percent) can lead to a 20–30 percent decrease in the chance of developing knee osteoarthritis. Other researchers continue to look for and find benefits from exercise to patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, and fibromyalgia. They are also studying the benefits of short- and long-term exercise in older populations.

Handout on Health: Rheumatoid Arthritis

Illustration

Information Boxes

This booklet is for people who have rheumatoid arthritis, as well as for their family members, friends, and others who want to find out more about this disease. The booklet describes how rheumatoid arthritis develops, how it is diagnosed, and how it is treated, including what people can do to help manage their disease. It also highlights current research efforts supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the Department of Health and Human Services' National Institutes of Health (NIH). If you have further questions after reading this booklet, you may wish to discuss them with your doctor.

Features of Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that make it different from other kinds of arthritis. (See "Features of Rheumatoid Arthritis.") For example, rheumatoid arthritis generally occurs in a symmetrical pattern, meaning that if one knee or hand is involved, the other one also is. The disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides the joints. (See "Other Parts of the Body.") In addition, people with rheumatoid arthritis may have fatigue, occasional fevers, and a general sense of not feeling well.

Rheumatoid arthritis affects people differently. For some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

Features of Rheumatoid Arthritis

  • Tender, warm, swollen joints
  • Symmetrical pattern of affected joints
  • Joint inflammation often affecting the wrist and finger joints closest to the hand
  • Joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles, and feet
  • Fatigue, occasional fevers, a general sense of not feeling well
  • Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest
  • Symptoms that last for many years
  • Variability of symptoms among people with the disease

Although rheumatoid arthritis can have serious effects on a person's life and well-being, current treatment strategies--including pain-relieving drugs and medications that slow joint damage, a balance between rest and exercise, and patient education and support programs--allow most people with the disease to lead active and productive lives. In recent years, research has led to a new understanding of rheumatoid arthritis and has increased the likelihood that, in time, researchers will find even better ways to treat the disease.

How Rheumatoid Arthritis Develops and Progresses

The Joints

A joint is a place where two bones meet. The ends of the bones are covered by cartilage, which allows for easy movement of the two bones. The joint is surrounded by a capsule that protects and supports it. (See illustration.) The joint capsule is lined with a type of tissue called synovium, which produces synovial fluid, a clear substance that lubricates and nourishes the cartilage and bones inside the joint capsule.

Like many other rheumatic diseases, rheumatoid arthritis is an autoimmune disease (auto means self), so-called because a person's immune system, which normally helps protect the body from infection and disease, attacks joint tissues for unknown reasons. White blood cells, the agents of the immune system, travel to the synovium and cause inflammation (synovitis), characterized by warmth, redness, swelling, and pain--typical symptoms of rheumatoid arthritis. During the inflammation process, the normally thin synovium becomes thick and makes the joint swollen and puffy to the touch.

Normal Joint and Joint affected by Rheumatoid Arthritis

A joint (the place where two bones meet) is surrounded by a capsule that protects and supports it. The joint capsule is lined with a type of tissue called synovium, which produces synovial fluid that lubricates and nourishes joint tissues. In rheumatoid arthritis, the synovium becomes inflamed, causing warmth, redness, swelling, and pain. As the disease progresses, the inflamed synovium invades and damages the cartilage and bone of the joint. Surrounding muscles, ligaments, and tendons become weakened. Rheumatoid arthritis also can cause more generalized bone loss that may lead to osteoporosis (fragile bones that are prone to fracture).

As rheumatoid arthritis progresses, the inflamed synovium invades and destroys the cartilage and bone within the joint. The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak and unable to work normally. These effects lead to the pain and joint damage often seen in rheumatoid arthritis. Researchers studying rheumatoid arthritis now believe that it begins to damage bones during the first year or two that a person has the disease, one reason why early diagnosis and treatment are so important.

Other Parts of the Body

Some people with rheumatoid arthritis also have symptoms in places other than their joints. Many people with rheumatoid arthritis develop anemia, or a decrease in the production of red blood cells. Other effects that occur less often include neck pain and dry eyes and mouth. Very rarely, people may have inflammation of the blood vessels, the lining of the lungs, or the sac enclosing the heart.

Occurrence and Impact of Rheumatoid Arthritis

Scientists estimate that about 2.1 million people, or between 0.5 and 1 percent of the U.S. adult population, have rheumatoid arthritis. Interestingly, some recent studies have suggested that the overall number of new cases of rheumatoid arthritis actually may be going down. Scientists are investigating why this may be happening.

Rheumatoid arthritis occurs in all races and ethnic groups. Although the disease often begins in middle age and occurs with increased frequency in older people, children and young adults also develop it. Like some other forms of arthritis, rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease.

By all measures, the financial and social impact of all types of arthritis, including rheumatoid arthritis, is substantial, both for the Nation and for individuals. From an economic standpoint, the medical and surgical treatment for rheumatoid arthritis and the wages lost because of disability caused by the disease add up to billions of dollars annually. Daily joint pain is an inevitable consequence of the disease, and most patients also experience some degree of depression, anxiety, and feelings of helplessness. For some people, rheumatoid arthritis can interfere with normal daily activities, limit job opportunities, or disrupt the joys and responsibilities of family life. However, there are arthritis self-management programs that help people cope with the pain and other effects of the disease and help them lead independent and productive lives. (See "Diagnosing and Treating Rheumatoid Arthritis.")

Searching for the Causes of Rheumatoid Arthritis

Scientists still do not know exactly what causes the immune system to turn against itself in rheumatoid arthritis, but research over the last few years has begun to piece together the factors involved.

Genetic (inherited) factors: Scientists have discovered that certain genes known to play a role in the immune system are associated with a tendency to develop rheumatoid arthritis. Some people with rheumatoid arthritis do not have these particular genes; still others have these genes but never develop the disease. These somewhat contradictory data suggest that a person's genetic makeup plays an important role in determining if he or she will develop rheumatoid arthritis, but it is not the only factor. What is clear, however, is that more than one gene is involved in determining whether a person develops rheumatoid arthritis and how severe the disease will become.

Environmental factors: Many scientists think that something must occur to trigger the disease process in people whose genetic makeup makes them susceptible to rheumatoid arthritis. A viral or bacterial infection appears likely, but the exact agent is not yet known. This does not mean that rheumatoid arthritis is contagious: a person cannot catch it from someone else.

Other factors: Some scientists also think that a variety of hormonal factors may be involved. Women are more likely to develop rheumatoid arthritis than men, pregnancy may improve the disease, and the disease may flare after a pregnancy. Breastfeeding may also aggravate the disease. Contraceptive use may alter a person's likelihood of developing rheumatoid arthritis. Scientists think that levels of the immune system molecules interleukin 12 (IL-12) and tumor necrosis factor-alpha (TNF-α) may change along with the changing hormone levels seen in pregnant women. This change may contribute to the swelling and tissue destruction seen in rheumatoid arthritis. These hormones, or possibly deficiencies or changes in certain hormones, may promote the development of rheumatoid arthritis in a genetically susceptible person who has been exposed to a triggering agent from the environment.

Even though all the answers are not known, one thing is certain: rheumatoid arthritis develops as a result of an interaction of many factors. Researchers are trying to understand these factors and how they work together. (See "Current Research.")

Diagnosing and Treating Rheumatoid Arthritis

Diagnosing and treating rheumatoid arthritis requires a team effort involving the patient and several types of health care professionals. A person can go to his or her family doctor or internist or to a rheumatologist. A rheumatologist is a doctor who specializes in arthritis and other diseases of the joints, bones, and muscles. As treatment progresses, other professionals often help. These may include nurses, physical or occupational therapists, orthopaedic surgeons, psychologists, and social workers.

Studies have shown that patients who are well informed and participate actively in their own care have less pain and make fewer visits to the doctor than do other patients with rheumatoid arthritis.

Patient education and arthritis self-management programs, as well as support groups, help people to become better informed and to participate in their own care. An example of a self-management program is the Arthritis Self-Help Course offered by the Arthritis Foundation and developed at a NIAMS-supported Multipurpose Arthritis and Musculoskeletal Diseases Center. (See the Arthritis Foundation listing in "For More Information.") Self-management programs teach about rheumatoid arthritis and its treatments, exercise and relaxation approaches, communication between patients and health care providers, and problem solving. Research on these programs has shown that they help people:

  • understand the disease
  • reduce their pain while remaining active
  • cope physically, emotionally, and mentally
  • feel greater control over the disease and build a sense of confidence in the ability to function and lead full, active, and independent lives.

Diagnosis

Rheumatoid arthritis can be difficult to diagnose in its early stages for several reasons. First, there is no single test for the disease. In addition, symptoms differ from person to person and can be more severe in some people than in others. Also, symptoms can be similar to those of other types of arthritis and joint conditions, and it may take some time for other conditions to be ruled out. Finally, the full range of symptoms develops over time, and only a few symptoms may be present in the early stages. As a result, doctors use a variety of the following tools to diagnose the disease and to rule out other conditions:

Medical history: This is the patient's description of symptoms and when and how they began. Good communication between patient and doctor is especially important here. For example, the patient's description of pain, stiffness, and joint function and how these change over time is critical to the doctor's initial assessment of the disease and how it changes over time.

Physical examination: This includes the doctor's examination of the joints, skin, reflexes, and muscle strength.

Laboratory tests: One common test is for rheumatoid factor, an antibody that is present eventually in the blood of most people with rheumatoid arthritis. (An antibody is a special protein made by the immune system that normally helps fight foreign substances in the body.) Not all people with rheumatoid arthritis test positive for rheumatoid factor, however, especially early in the disease. Also, some people test positive for rheumatoid factor, yet never develop the disease. Other common laboratory tests include a white blood cell count, a blood test for anemia, and a test of the erythrocyte sedimentation rate (often called the sed rate), which measures inflammation in the body. C-reactive protein is another common test that measures disease activity.

X rays: X rays are used to determine the degree of joint destruction. They are not useful in the early stages of rheumatoid arthritis before bone damage is evident, but they can be used later to monitor the progression of the disease.

Treatment

Doctors use a variety of approaches to treat rheumatoid arthritis. These are used in different combinations and at different times during the course of the disease and are chosen according to the patient's individual situation. No matter what treatment the doctor and patient choose, however, the goals are the same: to relieve pain, reduce inflammation, slow down or stop joint damage, and improve the person's sense of well-being and ability to function.

Good communication between the patient and doctor is necessary for effective treatment. Talking to the doctor can help ensure that exercise and pain management programs are provided as needed, and that drugs are prescribed appropriately. Talking to the doctor can also help people who are making decisions about surgery.

 

Goals of Treatment
  • Relieve pain
  • Reduce inflammation
  • Slow down or stop joint damage
  • Improve a person's sense of well-being and ability to function
Current Treatment Approaches
  • Lifestyle
  • Medications
  • Surgery
  • Routine monitoring and ongoing care

Health behavior changes: Certain activities can help improve a person's ability to function independently and maintain a positive outlook.

Rest and exercise: People with rheumatoid arthritis need a good balance between rest and exercise, with more rest when the disease is active and more exercise when it is not. Rest helps to reduce active joint inflammation and pain and to fight fatigue. The length of time for rest will vary from person to person, but in general, shorter rest breaks every now and then are more helpful than long times spent in bed.

Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Exercise can also help people sleep well, reduce pain, maintain a positive attitude, and lose weight. Exercise programs should take into account the person's physical abilities, limitations, and changing needs.

Joint care: Some people find using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Splints are used mostly on wrists and hands, but also on ankles and feet. A doctor or a physical or occupational therapist can help a person choose a splint and make sure it fits properly. Other ways to reduce stress on joints include self-help devices (for example, zipper pullers, long-handled shoe horns); devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a person carries out daily activities.

Stress reduction: People with rheumatoid arthritis face emotional challenges as well as physical ones. The emotions they feel because of the disease-fear, anger, and frustration-combined with any pain and physical limitations can increase their stress level. Although there is no evidence that stress plays a role in causing rheumatoid arthritis, it can make living with the disease difficult at times. Stress also may affect the amount of pain a person feels. There are a number of successful techniques for coping with stress. Regular rest periods can help, as can relaxation, distraction, or visualization exercises. Exercise programs, participation in support groups, and good communication with the health care team are other ways to reduce stress.

Healthful diet: With the exception of several specific types of oils (see "Current Research"), there is no scientific evidence that any specific food or nutrient helps or harms people with rheumatoid arthritis. However, an overall nutritious diet with enough-but not an excess of-calories, protein, and calcium is important. Some people may need to be careful about drinking alcoholic beverages because of the medications they take for rheumatoid arthritis. Those taking methotrexate may need to avoid alcohol altogether because one of the most serious long-term side effects of methotrexate is liver damage.

Climate: Some people notice that their arthritis gets worse when there is a sudden change in the weather. However, there is no evidence that a specific climate can prevent or reduce the effects of rheumatoid arthritis. Moving to a new place with a different climate usually does not make a long-term difference in a person's rheumatoid arthritis.

Medications: Most people who have rheumatoid arthritis take medications. Some medications are used only for pain relief; others are used to reduce inflammation. Still others, often called disease-modifying antirheumatic drugs (DMARDs), are used to try to slow the course of the disease. The person's general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug's effectiveness and potential side effects are important considerations in prescribing drugs for rheumatoid arthritis. The table below shows currently used rheumatoid arthritis medications, along with their uses and effects, side effects, and monitoring requirements.

Biologic response modifiers are new drugs used for the treatment of rheumatoid arthritis. They can help reduce inflammation and structural damage to the joints by blocking the action of cytokines, proteins of the body's immune system that trigger inflammation during normal immune responses. Three of these drugs, etanercept (Enbrel*), infliximab (Remicade), and adalimumab (Humira), reduce inflammation by blocking the reaction of TNF-α molecules. Another drug, called anakinra (Kineret), works by blocking a protein called interleukin 1 (IL-1) that is seen in excess in patients with rheumatoid arthritis.

For many years, doctors initially prescribed aspirin or other pain-relieving drugs for rheumatoid arthritis, as well as rest and physical therapy. They usually prescribed more powerful drugs later only if the disease worsened.

Today, however, many doctors have changed their approach, especially for patients with severe, rapidly progressing rheumatoid arthritis. Studies show that early treatment with more powerful drugs, and the use of drug combinations instead of one medication alone, may be more effective in reducing or preventing joint damage. Once the disease improves or is in remission, the doctor may gradually reduce the dosage or prescribe a milder medication.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Surgery: Several types of surgery are available to patients with severe joint damage. The primary purpose of these procedures is to reduce pain, improve the affected joint's function, and improve the patient's ability to perform daily activities. Surgery is not for everyone, however, and the decision should be made only after careful consideration by patient and doctor. Together they should discuss the patient's overall health, the condition of the joint or tendon that will be operated on, and the reason for, as well as the risks and benefits of, the surgical procedure. Cost may be another factor. Commonly performed surgical procedures include joint replacement, tendon reconstruction, and synovectomy.

Joint replacement: This is the most frequently performed surgery for rheumatoid arthritis, and it is done primarily to relieve pain and improve or preserve joint function. Artificial joints are not always permanent and may eventually have to be replaced. This may be an important consideration for young people.

Tendon reconstruction: Rheumatoid arthritis can damage and even rupture tendons, the tissues that attach muscle to bone. This surgery, which is used most frequently on the hands, reconstructs the damaged tendon by attaching an intact tendon to it. This procedure can help to restore hand function, especially if the tendon is completely ruptured.

Synovectomy: In this surgery, the doctor actually removes the inflamed synovial tissue. Synovectomy by itself is seldom performed now because not all of the tissue can be removed, and it eventually grows back. Synovectomy is done as part of reconstructive surgery, especially tendon reconstruction.

Routine Monitoring and Ongoing Care: Regular medical care is important to monitor the course of the disease, determine the effectiveness and any negative effects of medications, and change therapies as needed. Monitoring typically includes regular visits to the doctor. It also may include blood, urine, and other laboratory tests and x rays.

People with rheumatoid arthritis may want to discuss preventing osteoporosis with their doctors as part of their long-term, ongoing care. Osteoporosis is a condition in which bones become weakened and fragile. Having rheumatoid arthritis increases the risk of developing osteoporosis for both men and women, particularly if a person takes corticosteroids. Such patients may want to discuss with their doctors the potential benefits of calcium and vitamin D supplements, hormone therapy, or other treatments for osteoporosis.

Alternative and Complementary Therapies: Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although many of these approaches may not be harmful in and of themselves, controlled scientific studies either have not been conducted on them or have found no definite benefit to these therapies. Some alternative or complementary approaches may help the patient cope or reduce some of the stress associated with living with a chronic illness. As with any therapy, patients should discuss the benefits and drawbacks with their doctors before beginning an alternative or new type of therapy. If the doctor feels the approach has value and will not be harmful, it can be incorporated into a patient's treatment plan. However, it is important not to neglect regular health care. The Arthritis Foundation publishes material on alternative therapies as well as established therapies, and patients may want to contact this organization for information. (See the "For More Information" section.)

What Is Osteoarthritis?
Who Gets Osteoarthritis?
What Causes Osteoarthritis?
How Is Osteoarthritis Diagnosed?
How Is Osteoarthritis Treated?
How Can Self-Care and a “Good-Health Attitude” Help?
What Research Is Being Done on Osteoarthritis?

Osteoarthritis is a joint disease that mostly affects cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.

People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. Rheumatoid arthritis – the second most common form of arthritis – affects other parts of the body besides the joints. Osteoarthritis is the most common type of arthritis.

Who Gets Osteoarthritis?

Osteoarthritis occurs most often in older people. Younger people sometimes get osteoarthritis primarily from joint injuries.

What Causes Osteoarthritis?

The cause of osteoarthritis is unknown. Factors that might cause it include:

  • Being overweight
  • Getting older
  • Joint injury
  • Joints that are not properly formed
  • A genetic defect in joint cartilage
  • Stresses on the joints from certain jobs and playing sports.

How Is Osteoarthritis Diagnosed?

Osteoarthritis can occur in any joint. It occurs most often in the hands, knees, hips, and spine.

Warning signs of osteoarthritis are:

  • Stiffness in a joint after getting out of bed or sitting for a long time
  • Swelling or tenderness in one or more joints
  • A crunching feeling or the sound of bone rubbing on bone.

No single test can diagnose osteoarthritis. Most doctors use several methods to diagnose the disease and rule out other problems:

  • Medical history
  • Physical exam
  • X rays
  • Other tests such as blood tests or exams of the fluid in the joints.

How Is Osteoarthritis Treated?

Doctors often combine treatments to fit a patient’s needs, lifestyle, and health. Osteoarthritis treatment has four main goals:

  • Improve joint function
  • Keep a healthy body weight
  • Control pain
  • Achieve a healthy lifestyle.

Osteoarthritis treatment plans can involve:

  • Exercise
  • Weight control
  • Rest and joint care
  • Nondrug pain relief techniques to control pain
  • Medicines
  • Complementary and alternative therapies
  • Surgery.

How Can Self-Care and a “Good-Health Attitude” Help?

Three kinds of programs help people learn about osteoarthritis and self-care and improve their good-health attitude:

  • Patient education programs
  • Arthritis self-management programs
  • Arthritis support groups.

These programs teach people about osteoarthritis and its treatments. They also have clear and long-lasting benefits. People in these programs learn to:

  • Exercise and relax
  • Talk with their doctor or other health care providers
  • Solve problems.

People with osteoarthritis find that self-management programs help them:

  • Understand the disease
  • Reduce pain while staying active
  • Cope with their body, mind, and emotions
  • Have more control over the disease
  • Live an active, independent life.

People with a good-health attitude:

  • Focus on what they can do, not what they can’t do
  • Focus on their strengths, not their weaknesses
  • Break down activities into small tasks that are easy to manage
  • Build fitness and healthy eating into their daily routines
  • Develop ways to lower and manage stress
  • Balance rest with activity
  • Develop a support system of family, friends, and health care providers.

What Research Is Being Done on Osteoarthritis?

Osteoarthritis is not simply a disease of “wear and tear” that happens in joints as people get older. There is more to the disease than aging alone. Researchers are studying:

  • Tools to detect osteoarthritis earlier
  • Genes
  • Tissue engineering
  • A wide range of treatment strategies
  • Osteoarthritis in animals
  • Medicines to prevent joint damage
  • Complementary and alternative therapies
  • Vitamins and other supplements
  • Injection of hyaluronic acid (a natural part of cartilage and joint fluid)
  • Estrogen
  • Biological and structural markers (biomarkers) for osteoarthritis.
 
Having Shorter Leg Ups Arthritis Risk

 

Study Shows Even Small Difference in Leg Length Increases Disease Risk and Severity

Nov. 14, 2006 (Washington, D.C.) -- Having one leg shorter than the other may increase a person's risk of developing arthritis in a knee or hip, according to a study presented today at the American College of Rheumatology's 2006 annual meeting in Washington, D.C.

People with a leg length difference of as little as 2 centimeters -- four-fifths of an inch -- were more likely to have osteoarthritisosteoarthritis in their right hip or their left or right knee. They were also more likely to have more severe arthritis, the study showed.

Often referred to as the "wear-and-tear" form of the disease, osteoarthritis (OA) affects nearly 21 million people in the U.S.

It is characterized by the breakdown of the joints' cartilage, the lining that cushions the ends of bones and allows for easy joint movement.

Breakdown of this cartilage leaves the bones to rub against each other, resulting in pain, stiffness, and loss of movement in the affected joint, according to the Atlanta-based Arthritis Foundation.

"The findings from this study may help us predict who may develop osteoarthritis and who may have symptoms that worsen, or have a potential risk of increased disability," study researcher Joanne M. Jordan, MD, MPH, says in a news release.

"Studies to test whether correction of leg length inequality with orthotics or shoe lifts can prevent the onset of osteoarthritis, or its progression, would be a logical next step," adds Jordan, who is an associate professor of medicine and orthopaedics at the University of North Carolina Thurston Arthritis Research Center in Chapel Hill.
Arthritis Rising: Are You at Risk?

Extra Pounds, Idle Lifestyles May Make Arthritis More Likely

Oct. 12, 2006 -- Arthritis is on the rise in the U.S., with no signs of a slowdown. But you might be able to buck that trend, says the CDC.First, the numbers. Picture a graph with a line headed upward, and you've got the basic idea.

More than 46 million U.S. adults -- over 21% -- say they've been told by a doctor that they have arthritis, goutgout, lupuslupus, or fibromyalgiafibromyalgia.

About 8% of U.S. adults -- more than 17 million people -- say arthritis or joint symptoms hamper their activities.That's according to CDC statistics from national health surveys done from 2003 to 2005. Those figures were lower in 2002.

Back then, nearly 43 million adults said they had doctor-diagnosed arthritis, gout, lupus, or fibromyalgia; slightly less than 8% said arthritis or joint problems limited their activities.By 2030, arthritis will affect 67 million U.S. adults, the CDC predicts.Those statistics appear in the CDC's Morbidity and Mortality Weekly Report.

Who's Affected

Arthritis is most common in the following groups:

  • Women
  • Older adults
  • Whites (compared with blacks and Hispanics)
  • People who are overweight or obese
  • People with sedentary lifestyles

After adjusting for age, people with low education levels and people who are obese or physically inactive were the most likely to say arthritis and joint problems limited their activities.

Remember, the CDC's findings are based on self-reports of doctor-diagnosed arthritis.

The researchers didn't check participants' medical records. They also don't know how many people have undiagnosed arthritis.

What You Can Do

Shedding extra pounds and becoming more active may give you an edge against arthritis.

For instance, 31% of obese adults and 21% of overweight (but not obese) adults said they'd been diagnosed with arthritis, compared with 16% of leaner adults.

A quarter of those who were physically inactive said they had doctor-diagnosed arthritis, compared with nearly 20% of physically active adults.

The surveys didn't directly test weight lossweight loss or physical activity as ways to prevent arthritis. But other studies have. Extra weight puts more stress on joints. And joints that get little use may feel more stiff and painful than if they get used.

Of course, you shouldn't pound your joints with overblown exercise, and you shouldn't sacrifice nutritionnutrition to lose weight. So check with your doctor before starting a new diet or exercise program.If you already have arthritis, ask your doctor what you can do to manage your condition.

Arthritis is inflammation of one or more joints, which results in pain, swelling, and limited movement.

See also joint pain.

Causes, incidence, and risk factors    Return to top

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

You may have joint inflammation for a variety of reasons, including:

  • Broken bone
  • Infection (usually caused by bacteria or viruses)
  • An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign)
  • General "wear and tear" on joints

Often, the inflammation goes away after the injury has healed, the disease is treated, or the infection has been cleared.

With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:

  • Being overweight
  • Previously injuring the affected joint
  • Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers, and construction workers are all at risk)

Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthritis include:

Symptoms   

If you have arthritis, you may experience:

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

Signs and tests   

First, your doctor will take a detailed medical history to see if arthritis or another musculoskeletal problem is the likely cause of your symptoms.

Next, a thorough physical examination may show that fluid is collecting around the joint. (This is called an "effusion.") The joint may be tender when it is gently pressed, and may be warm and red (especially in infectious arthritis and autoimmune arthritis). It may be painful or difficult to rotate the joints in some directions. This is known as "limited range-of-motion."

In some autoimmune forms of arthritis, the joints may become deformed if the disease is not treated. Such joint deformities are the hallmarks of severe, untreated rheumatoid arthritis.

Tests vary depending on the suspected cause. They often include blood tests and joint x-rays. To check for infection and other causes of arthritis (like gout caused by crystals), joint fluid is removed from the joint with a needle and examined under a microscope. See the specific types of arthritis for further information.

Treatment

Treatment of arthritis depends on the particular cause, which joints are affected, severity, and how the condition affects your daily activities. Your age and occupation will also be taken into consideration when your doctor works with you to create a treatment plan.

If possible, treatment will focus on eliminating the underlying cause of the arthritis. However, the cause is NOT necessarily curable, as with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at reducing your pain and discomfort and preventing further disability.

It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications. In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to lifestyle changes.

Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should be tailored to you as an individual. Work with a physical therapist to design an individualized program, which should include:

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

A physical therapist can apply heat and cold treatments as needed and fit you for splints or orthotic (straightening) devices to support and align joints. This may be particularly necessary for rheumatoid arthritis. Your physical therapist may also consider water therapy, ice massage, or transcutaneous nerve stimulation (TENS).

Rest is just as important as exercise. Sleeping 8 to 10 hours per night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent exacerbations. You should also:

  • Avoid positions or movements that place extra stress on your affected joints.
  • Avoid holding one position for too long.
  • Reduce stress, which can aggravate your symptoms. Try meditation or guided imagery. And talk to your physical therapist about yoga or tai chi.
  • Modify your home to make activities easier. For example, have grab bars in the shower, the tub, and near the toilet.

Other measures to try include:

  • Taking glucosamine and chondroitin -- these form the building blocks of cartilage, the substance that lines joints. These supplements are available at health food stores or supermarkets. Early studies indicate that these compounds are safe and may improve your arthritis symptoms. More research is underway.
  • Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruits and vegetables. Get selenium from Brewer's yeast, wheat germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
  • Apply capsaicin cream (derived from hot chili peppers) to the skin over your painful joints. You may feel improvement after applying the cream for 3-7 days.

MEDICATIONS

Your doctor will choose from a variety of medications as needed. Generally, the first drugs to try are available without a prescription. These include:

  • Acetaminophen (Tylenol) -- recommended by the American College of Rheumatology and the American Geriatrics Society as first-line treatment for osteoarthritis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can provide significant relief of arthritis pain without many of the side effects of prescription drugs. DO NOT exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol. These actions may damage your liver.
  • Aspirin, ibuprofen, or naproxen -- these nonsteroidal anti-inflammatory (NSAID) drugs are often effective in combating arthritis pain. However, they have many potential risks, especially if used for a long time. They should not be taken in any amount without consulting your doctor. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage. In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on their product that alerts users of an increased risk for heart attack, stroke, and gastrointestinal bleeding. If you have kidney or liver disease, or a history of gastrointestinal bleeding, you should not take these medicines unless your doctor specifically recommends them.

Prescription medicines include:

  • Cyclo-oxygenase-2 (COX-2) inhibitors -- These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. market following reports of heart attacks in patients taking the drugs. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Talk to your doctor about whether COX-2s are right for you.
  • Corticosteroids ("steroids") -- these are medications that suppress the immune system and symptoms of inflammation. They are commonly used in severe cases of osteoarthritis, and they can be given orally or by injection. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, high blood pressure, thinning of bones, cataracts, and increased infections. The risks are most pronounced when steroids are taken for long periods of time or at high doses. Close supervision by a physician is essential.
  • Disease-modifying anti-rheumatic drugs -- these have been used traditionally to treat rheumatoid arthritis and other autoimmune causes of arthritis. These drugs include gold salts, penicillamine, sulfasalazine, and hydroxychloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve your quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on the medication.
  • Anti-biologics -- these are the most recent breakthrough for the treatment of rheumatoid arthritis. Such medications, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are administered by injection and can dramatically improve your quality of life.
  • Immunosuppressants -- these drugs, like azathioprine or cyclophosphamide, are used for serious cases of rheumatoid arthritis when other medications have failed.

It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, due to intolerable side effects), you should talk to your doctor.

SURGERY AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthroplasty) or to replace the joint (such as a total knee joint replacement) may help maintain a more normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective.

Normal joints contain a lubricant called "synovial fluid." In joints with arthritis, this fluid is not produced in adequate amounts. One other treatment approach is to inject arthritic joints with a manmade version of joint fluid such as hylan G-F 20 (Synvisc) or other hyaluronic acid preparations. This synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for arthritis patients. Many studies are evaluating the effectiveness of this type of therapy.

Expectations (prognosis)  

A few arthritis-related disorders can be completely cured with treatment. Most are chronic (long-term) conditions, however, and the goal of treatment is to control the pain and minimize joint damage. Chronic arthritis frequently goes in and out of remission.

Complications   

  • Chronic pain
  • Lifestyle restrictions or disability

Calling your health care provider    Return to top

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  

If arthritis is diagnosed and treated early, you can prevent joint damage. Find out if you have a family history of arthritis and share this information with your doctor, even if you have no joint symptoms.

Osteoarthritis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to overwork a damaged or sore joint. Similarly, avoid excessive repetitive motions.

Excess weight also increases the risk for developing osteoarthritis in the knees, and possibly in the hips and hands. See the article on body mass index to learn whether your weight is healthy.

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