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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.