Arthritis involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.
Joint inflammation may result from:
An autoimmune disease (the body's immune system mistakenly attacks healthy tissue)
General "wear and tear" on joints
Infection, usually by bacteria or virus
Usually the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type. See: Osteoarthritis
The health care provider will perform a physical exam and ask questions about your medical history.
The physical exam may show:
Fluid around a joint
Warm, red, tender joints
Difficulty moving a joint (called "limited range of motion")
Some types of arthritis may cause joint deformity. This may be a sign of severe, untreated rheumatoid arthritis.
Blood tests and joint x-rays are often done to check for infection and other causes of arthritis.
Your doctor may also remove a sample of joint fluid with a needle and send it to a lab for examination.
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause cannot usually be cured.
Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint inflammation. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you.
Exercise programs may include:
Low-impact aerobic activity (also called endurance exercise)
Range of motion exercises for flexibility
Strength training for muscle tone
Physical therapy may be recommended. This might include:
Heat or ice
Splints or orthotics to support joints and help improve their position; this is often needed for rheumatoid arthritis
Get plenty of sleep. Sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent flare ups.
Avoid staying in one position for too long.
Avoid positions or movements that place extra stress on your sore joints.
Change your home to make activities easier. For example, install grab bars in the shower, the tub, and near the toilet.
Try stress-reducing activities, such as meditation, yoga, or tai chi.
Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E.
Eat foods rich in omega-3 fatty acids, such as cold water fish (salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3-7 days.
Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.
Medications may be prescribed along with lifestyle changes. All medications have risks, some more than others. It is important that you are closely monitored by a doctor when taking arthritis medications.
Generally, over-the-counter medications are recommended first:
Acetaminophen (Tylenol) is usually tried first. Take up to 4 grams a day (two arthritis-strength Tylenol every 8 hours). Do not take more than the recommended dose or take the drug along with a lot of alcohol. Doing so may damage your your liver.
Aspirin, ibuprofen, or naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs) that can relieve arthritis pain. However, they have many potential risks, especially if used for a long time. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage.
Prescription medicines include:
Biologics are used for the treatment of autoimmune arthritis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), rituximab (Rituxan), golimumab (Simponi), certolizumab (Cimzia), and tocilizumab (Actemra). These drugs can improve the quality of life for many patients, but can have serious side effects.
Corticosteroids ("steroids") help reduce inflammation. They may be injected into painful joints or given by mouth.
Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, gold salts, penicillamine, sulfasalazine, and hydroxychloroquine.
Immunosuppressants such as azathioprine or cyclophosphamide are used to treat patients with rheumatoid arthritis when other medications have not worked.
It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, because of side effects), you should talk to your doctor. Also make sure your doctor knows about all the medicines you are taking, including vitamins and supplements bought without a prescription.
SURGERY AND OTHER TREATMENTS
In some cases, surgery may be done if other treatments have not worked. This may include:
Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Med Clin North Am. 2009;93:127-43, xi.
Huizinga TW, Pincus T. In the clinic. Rheumatoid arthritis. Ann Intern Med. 2010 Jul 6;153(1):ITC1-1-ITC1-15.
Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.