•  Arthritis Center •  Arthritis Prevention

We ask a lot of our joints. We bend and twist all day and think nothing of it -- until arthritis sets in. In 2006, more than 46 million Americans were diagnosed with arthritis – and with a rapidly aging population, that number is expected to jump to nearly 70 million by 2030. "Arthritis" literally means joint inflammation, and can refer to any condition that causes pain and stiffness in the joints. A case of arthritis may be mild or severe, short-lived or permanent. But no matter what form of the disease a person has, today's treatments can make life better.

Anything that can damage a joint can cause arthritis. The list of common culprits includes injuries, infections, overactive immune systems, and simple wear and tear. According to the National Institutes of Health, researchers have identified more than 100 different forms of arthritis. Distinguishing one variety from another can sometimes be tricky, but it's a crucial step toward getting the right treatment.

The most familiar form of the disease is osteoarthritis. This condition occurs when the cartilage that cushions the joints starts to wear out, a process that usually occurs over a long period of time. Osteoarthritis comes on gradually, and usually affects either a single joint or just a few joints. Most people with the condition experience pain and stiffness in a hip, knee, or hand.

Rheumatoid arthritis is another common type, and it arises when the immune system attacks joint tissue. Unlike osteoarthritis, it can strike people of any age, from infants to seniors. (In children 16 and under, the condition is called juvenile idiopathic arthritis or juvenile arthritis.) And unlike osteoarthritis, it often affects many joints at once.

•Gout. Doctors report that many of their patients with gout are amazed to learn it's a form of arthritis. Gout can cause excruciating pain if untreated, and is caused by a buildup of needle-like uric acid crystals in joints. Gout most often affects the big toe.

•Systemic lupus erythematosus (more commonly called lupus). Like rheumatoid arthritis, lupus is caused by an overly aggressive immune system. A chronic inflammatory disease, lupus affects different parts of the body, especially the joints, skin, blood, and kidneys. Symptoms range from joint pain and a butterfly-shaped facial rash to anemia, hair loss, kidney problems, and mouth or nose ulcers. The disease tends to come and go, or, as a doctor would say, it follows a pattern of flare-ups and remission. Lupus is nine times more common in women than in men.

•Ankylosing spondylitis. This form of arthritis usually affects the joints in the spine. It can cause intense pain and make the back, hips, and shoulders very stiff. In severe cases, the spine fuses and the sufferer takes on a stooped posture. Ankylosing spondylitis is known as a "reactive" form of arthritis. According to the latest theories, the disease is a reaction to an infection. Ninety percent of people with ankylosing spondylitis carry a certain gene that makes them vulnerable to the condition.

•Bursitis. Major joints are protected by small saclike cushions, or bursae. When bursae are strained or overused, they can become sore and swollen, a condition called bursitis. Shoulders and hips are commonly affected by bursitis.

•Tendinitis. Like bursitis, tendinitis results from overusing a joint. In this case, the tendons that connect muscle to bone become irritated and inflamed. People who work on computers are often afflicted with tendinitis; keying in data for many hours a day over a long period of time, for example, can cause tendinitis in the arms.

•Fibromyalgia. An estimated 5 million Americans suffer from this common rheumatic syndrome, which causes pain in the body's fibrous ligaments and muscles. Although it doesn't inflame or damage the joints, people with this condition typically experience pain, stiffness, and achiness over their entire body. Close to 90 percent of people who visit a doctor with symptoms of fibromyalgia are women.

•Septic arthritis. This condition occurs when a bacterial infection spreads to a joint, resulting in pain and swelling.

The symptoms of arthritis vary, but some will be familiar to just about every arthritis sufferer. First of all, inflamed joints tend to hurt, especially when they're in motion. Also, arthritic joints are usually stiff. The stiffness is most noticeable in the morning or after any long period of rest. Simple tasks like opening a jar or walking up the stairs may be very difficult. Depending on the type of arthritis, the affected joints may also be swollen, red, and warm to the touch.

Not surprisingly, different forms of arthritis call for different treatments. Easing the pain is almost always the first priority. For patients with osteoarthritis, large doses of over-the-counter pain relievers such as naproxen and ibuprofen are often first-line therapies. Collectively, these drugs are known as nonsteroidal anti-inflammatory drugs, or NSAIDs.

NSAIDs are not without risk, however. In April 2005, the US Food and Drug Administration issued a health advisory for both prescription and over-the-counter NSAIDs. The FDA has asked manufacturers of over-the-counter NSAIDs to revise their labels to include more specific information about the potential for cardiovascular problems and gastrointestinal bleeding, as well as possible serious skin reactions. The agency also wants manufacturers to emphasize the importance of sticking to the recommended dosage and duration of use.

Another first-line option for osteoarthritis is the pain reliever acetaminophen (Tylenol), which is not a NSAID.

In recent years, many patients found relief with the help of prescription drugs celecoxib (Celebrex), rofecoxib (Vioxx), and valdecoxib (Bextra), called COX-2 inhibitors. However, though doctors had high hopes for these drugs, they have proven to have serious side effects for some people. In September 2004, the manufacturer of Vioxx, a popular COX-2 inhibitor, voluntarily removed the drug from the market after reports that it caused increased risk of stroke and heart attack in some people. In April 2005, the FDA asked the manufacturer of Bextra (valdecoxib) to withdraw the drug from the market. After reviewing available data, the agency concluded that the risk of taking these drugs outweighed their benefits.

A month after the Bextra recall, the FDA asked the manufacturers of COX-2 inhibitors to add a boxed warning label advising users of an increased risk of cardiovascular problems and gastrointestinal bleeding associated with the drugs. The Celebrex label must also include information about a study that found an increased risk of heart problems in some participants. In the study, the manufacturer of Celebrex halted studies of the drug's effectiveness against cancer when participants in one of the studies experienced in increased risk of heart problems. Participants in the cancer studies were given 400 to 800 milligrams of Celebrex, while arthritis patients are usually prescribed anywhere from 100 to 400 milligrams.

Over-the-counter or prescription pain medicines are also helpful for rheumatoid arthritis, but treatment usually doesn't end there. Doctors often combine pain relievers with powerful disease-modifying anti-rheumatic drugs (DMARDs). DMARDs can be "biologic" or "nonbiologic" -- the differences between them have to do with how pharmaceutical companies manufacture them and how doctors administer them.

The most commonly used, nonbiologic DMARD is methotrexate (Rheumatrex), a drug that slows down the immune system. (Methotrexate may irritate the stomach, inflame the mucous membranes, and affect the liver; taking 1 milligram of folic acid daily helps protect against these possible side effects, according to a July 2001 study in Arthritis and Rheumatism.) Other common nonbiologic DMARDs include leflunomide (Arava) and hydroxychloroquine (Plaquenil).

Biologic DMARDs include drugs like etanercept (Enbrel) and infliximab (Remicade). According to the American College of Rheumatology, the rate of biologic DMARD use is rising rapidly. Doctors are now prescribing these drugs early and often with the hopes of slowing the progress of the disease and preventing long-term damage.

Doctors frequently treat other types of arthritis by going after the source. Gout, for instance, often improves with the help of medications and lifestyle changes that reduce the amount of uric acid in the blood. Likewise, septic arthritis is treated with antibiotics.

For more information on arthritis medications, please click here.

If a joint is badly deformed by arthritis, joint replacement surgery sometimes provides a new lease on life. Artificial hips, knees, and wrists are now commonplace. Surgery may also help fix bone deformities or remove debris that irritates joint tissues. For more information on arthritis surgery, click here.

You and your doctor will have to work together to manage your arthritis. In addition to taking medications as directed, you must take proper care of your joints. First and foremost, you need to find the right balance of rest and exercise. You don't want to put undue strain on your sore joints, but you should use them as much as possible. Your doctor can recommend range-of-motion and endurance exercises and other activities that will help keep your joints strong and flexible: Hydrotherapy, stretching, weight training, and t'ai chi have all been shown to relieve pain. Even simple steps like using ice and heat -- including taking a warm bath or shower -- can help ease pain and stiffness by relaxing muscles.

If you're overweight, your doctor may also suggest slimming down to take the extra strain off your joints. This can be especially helpful to overweight people with osteoarthritis in the knee or hip, according to the American College of Rheumatology. One study of 40 overweight patients who had osteoarthritis in the knee found that losing excess body fat through exercise relieved pain and other symptoms.

You may also want to enroll in a patient education program, like the six-week self-help program sponsored by the Arthritis Foundation. Participants in such programs have reported a 15 to 20 percent decline in pain, as well as lower health-care expenses, according to a Johns Hopkins report. The course is taught by nonprofessionals who have arthritis and have undergone special training. Contact your local chapter of the Arthritis Foundation for details.

Finally, many special devices can help you manage daily tasks. Canes and walkers may be useful if you're having difficulty walking. Labor-saving tools, including lever handles, foam-handled utensils, tongs, rubber bottle and jar openers, and wheeled carts, can also make life a lot easier.

No matter what form of arthritis you may have, take it seriously. There's no reason to put up with the pain, and there's no reason to tackle it alone.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education.

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First published September 26, 2002
Last updated June 10, 2008
Copyright © 2002 Consumer Health Interactive

• If you’re seeing your doctor soon, print out our Questions for You and Your Doctor to make sure you cover all the bases during the appointment. • Check out our nine quick tips on managing your pain. • Staying active is a crucial weapon in the fight against arthritis. Our articles on exercise, tai chi, weightlifting, and aquatic therapy are all written specifically for people with arthritis. • Try to maintain a normal weight. If your body mass index rises above 25, your risk of a cartilage tear is much higher.

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