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Arthritis
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Arthritis



Related terms
Background
Treatment
Author information
Bibliography
Causes

Related Terms
  • Arthrocentesis, arthroscope, arthroscopic debridement, arthroscopic lavage, autoimmune, autoimmune disease, autoimmune disorder, autoimmunity, cartilage, corticosteroid, degenerative joint disease, disease-modifying antirheumatic drugs, DMARDs, frozen shoulder, joint disease, immune system, immunosuppressants, inflammation, joint, joint disease, joint inflammation, joint replacement, nodules, osteoarthritis, osteoarthrosis, periarthritis, rheumatoid, rheumatoid arthritis.

Background
  • The term arthritis literally means joint inflammation or swelling. More than 100 different diseases fall under the general category of arthritis. Arthritis conditions affect the joints, the tissues surrounding the affected joints, and other connective tissues.
  • Common forms of arthritis include rheumatoid arthritis, osteoarthritis, and periarthritis.
  • Osteoarthritis, also called degenerative joint disease or osteoarthrosis, occurs when the cartilage in the joints starts to break down. The cartilage serves as a cushion between bones, allowing the joint to move without pain. Therefore, patients with osteoarthritis experience pain and reduced mobility in their joints. Osteoarthritis may affect any joint in the body.
  • Osteoarthritis occurs most often in individuals older than 45 years, but it may develop at any age. Females are more likely to develop the disorder than males, suggesting that heredity may play a role in the development of the condition. Individuals who are obese, have weak muscles, have cartilage disorders, and/or have malformed joints have an increased risk of developing osteoarthritis.
  • Rheumatoid arthritis is an autoimmune disorder that occurs when the body's immune system, which normally fights against disease and infection, attacks itself. Unlike osteoarthritis, which only affects the bones and cartilage, rheumatoid arthritis may also cause swelling in other areas of the body.
  • Women are two to three times more likely to develop rheumatoid arthritis than men. Most cases of rheumatoid arthritis occur in individuals who are 20-50 years old. However, rheumatoid arthritis may also develop in young children and older adults. Although there is currently no cure for osteoarthritis or rheumatoid arthritis, treatment can help reduce pain and help individuals remain active.
  • Periarthritis is a chronic inflammatory disease of a joint and the tissues surrounding it. The condition primarily affects patients who are 50 years old or older. Periarthritis most commonly affects the shoulder. Periarthritis of the shoulder is also called adhesive capsulitis or frozen shoulder. Patients typically receive cortisol injections, anti-inflammatories, and physical therapy. Without aggressive treatment, periarthritis of the shoulder can be permanent.

Treatment
  • General: Osteoarthritis, rheumatoid arthritis, and periarthritis are managed with medications that reduce pain and inflammation. Patients with rheumatoid arthritis may also require treatment with medications that weaken the immune system, such as corticosteroids or immunosuppressants. In severe cases, surgery may be necessary to repair damage.
  • In order to properly manage pain and prevent joint damage, patients should take their medications exactly as prescribed by their healthcare providers. Patients should also tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter) because they may interfere with treatment.
  • Abatacept (Orencia®): Abatacept (Orencia®) is a type of drug called a costimulation modulator. Abatacept reduces inflammation and joint damaged caused by rheumatoid arthritis. The drug prevents white blood cells, called T-cells, from attacking the joints. Patients receive a monthly injection through a vein in the arms.
  • Side effects may include headache, nausea, and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, may develop.
  • Antidepressants: Some patients with arthritis may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include amitriptyline (Elavil®), nortriptyline (Aventyl®, Pamelor®), and trazodone (Desyrel®).
  • Arthroscopic lavage and/or debridement: In some cases, patients with osteoarthritis may suffer from severe joint damage. In such cases, surgical procedures called arthroscopic lavage and/or arthroscopic debridement may be recommended. During the surgery, a small incision is made near the joint. A small tubular instrument called an arthroscope is then inserted. The arthroscope has a small light and camera attached to it, allowing the surgeon to see inside the joint. During arthroscopic lavage, the surgeon squirts saline into the joint to remove any blood, fluid, or loose debris inside the joint. During arthroscopic debridement, loose fragments of bone or cartilage are removed from the joint. In some cases, built up scar tissue may also be removed.
  • Both of these procedures may provide temporary pain relief and improved joint function. However, recent studies suggest that they may not be effective in some patients with osteoarthritis. Therefore, patients should discuss the potential risks and health benefits of the procedure with their healthcare providers.
  • Corticosteroids: Corticosteroids, such as prednisone (e.g. Deltasone®) and methylprednisolone (Medrol®), have been used to reduce inflammation and pain and slow joint damage caused by rheumatoid arthritis. These drugs are generally very effective when used short-term. However, if these drugs are used for many months to years, they may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes.
  • Occasionally, corticosteroids are used to treat patients with severe osteoarthritis. The medication is injected into the affected joints to reduce pain and inflammation.
  • Patients with periarthritis typically receive corticosteroid injections into affected joints to reduce pain and inflammation.
  • Corticosteroids are usually prescribed for a certain amount of time and then the patient is gradually tapered off the medication. Patients should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.
  • Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain.
  • Disease-modifying antirheumatic drugs (DMARDs): During the early stages of rheumatoid arthritis, patients typically receive disease-modifying antirheumatic drugs (DMARDs) to limit the amount of permanent joint damage. These drugs may take weeks to months before they begin to take effect. Therefore, they are often used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. Commonly prescribed DMARDs include the gold compound auranofin (Ridaura®), hydroxychloroquine (Plaquenil®), minocycline (Dynacin® or Minocin®), sulfasalazine (Azulfidine®), and methotrexate (Rheumatrex®).
  • Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, patients may take a hot shower or bath before exercise to help reduce pain.
  • Immunosuppressants: Patients with rheumatoid arthritis may take prescription drugs called immunosuppressants. These medications weaken the body's immune system, which limits the amount of joint damage. Commonly prescribed immunosuppressants include leflunomide (Arava®), azathioprine (Imuran®), cyclosporine (Neoral®, Sandimmune®), and cyclophosphamide (Cytoxan®).
  • These medications may have serious side effects, including increased risk of infections, kidney problems, high blood pressure, and decreased levels of red blood cells. Other side effects may include increased hair growth, loss of appetite, vomiting, and upset stomach.
  • Fusing bones: If there is serious joint damage, the bones of a joint, such as the ankle, may be surgically fused to together in a procedure called arthrodesis. This surgery helps increase stability and reduces pain. However, the joint no longer has any flexibility and cannot bend or move.
  • Joint replacement surgery: In some cases, patients with osteoarthritis or rheumatoid arthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed and it is replaced with a plastic or metal device called a prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints, can be replaced.
  • Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. According to the American College of Rheumatology, most hip and knee replacements last for 20 years or longer. After a successful surgery and several months of rehabilitation, patients are able to use their new joints without pain.
  • As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers.
  • Lifestyle: Many lifestyle changes, including regular exercise, weight management, and healthy diet may help reduce symptoms of osteoarthritis. A healthcare provider may recommend a physical therapist or nutritionist to help a patient determine the best treatment plan for him/her.
  • Individuals with osteoarthritis or rheumatoid arthritis should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking.
  • Patients with osteoarthritis or rheumatoid arthritis may require canes, walkers, or other devices to help them get around. If the hands are severely affected, braces may be beneficial. Patients should talk to their healthcare providers about assistive devices that are available.
  • Individuals with osteoarthritis or rheumatoid arthritis should maintain good posture. This allows the body's weight to be evenly distributed among joints.
  • Non-selective Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by osteoarthritis, rheumatoid arthritis, and periarthritis. Commonly used over-the-counter NSAIDs include ibuprofen (Advil® or Motrin®) and naproxen sodium (Aleve®). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam® or Voltaren®), nabumetone (Relafen®), and ketoprofen (Orudis®). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms.
  • The frequency and severity of side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.
  • Pain relievers: Prescription pain relievers, including tramadol (Ultram®), have been used to reduce pain caused by osteoarthritis or rheumatoid arthritis. Although this drug, which is available by prescription, does not reduce swelling, it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups.
  • Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine®), hydrocodone/acetaminophen (Lorcet®, Lortab®, or Vicodi®), or oxycodone (OxyContin® or Roxicodone®), may be prescribed to treat severe arthritis pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because patients may become addicted to them.
  • Rituximab (Rituxan®): A medication called rituximab (Rituxan®) has been used to treat patients with rheumatoid arthritis. This medication, which is injected into the patient's vein, reduces the number of B-cells in the body. This medication helps reduce swelling because the B-cells are involved in inflammation.
  • Side effects may include flu-like symptoms, such as fever, chills, and nausea. Some people experience extreme reactions to the infusion, such as difficulty breathing and heart problems.
  • Selective COX-2 inhibitors: Celecoxib (Celebrex®) has been taken by mouth to reduce pain and inflammation caused by osteoarthritis, rheumatoid arthritis, or periarthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long term to manage symptoms.
  • COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea.
  • Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin. Many over-the-counter pain relievers may temporarily help reduce the pain caused by osteoarthritis. Products such as Aspercreme®, Sportscreme®, Icy Hot®, and Ben-Gay® may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Arthritis Society. .
  2. Arthritis Foundation Homepage. .
  3. Bijlsma JW, Knahr K. Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Pract Res Clin Rheumatol. 2007 Feb;21(1):59-76. .
  4. Centers for Disease Control and Prevention. .
  5. Combe B. Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol. 2007 Feb;21(1):27-42. .
  6. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). .
  7. Natural Standard: The Authority on Integrative Medicine. .
  8. Penninx BW, Messier SP, Rejeski WJ, et al. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med. 2001 Oct 22;161(19):2309-16. .
  9. Rousseau JC, Delmas PD. Biological markers in osteoarthritis. Nat Clin Pract Rheumatol. 2007 Jun;3(6):346-56. .
  10. Sohen S. [Adverse effects of corticosteroids in treatment of rheumatoid arthritis.] [Article in Japanese.] Nippon Rinsho. 2005 Jan;63 Suppl 1:556-9. .

Causes
  • Osteoarthritis: The exact cause of osteoarthritis remains unknown. Most researchers believe that several factors, including obesity, age, joint injury or stress, genetics, and muscle weakness, may contribute to the development of osteoarthritis.
  • Some researchers believe that cartilage damage may occur when cartilage releases too many enzymes that allow for the natural breakdown and regeneration of cartilage. If the body releases too many of these enzymes, the cartilage will be destroyed faster than it can be regenerated. However, it is unknown exactly what causes an imbalance of the cartilage enzyme.
  • When individuals have osteoarthritis, their bodies try to repair the cartilage damage. However, the body cannot regenerate enough cartilage. Instead, new bone grows alongside the existing bone, causing small lumps to form. Although these lumps cause minimal if any pain, they may be disfiguring and limit the joint's mobility.
  • Rheumatoid arthritis: The exact cause of rheumatoid arthritis remains unknown. Rheumatoid arthritis is considered an autoimmune disorder because the immune system does not function properly. Normally, the immune system helps the body fight against harmful foreign invaders, such as bacteria, that may cause disease and infection. However, in rheumatoid arthritis patients, the immune system attacks body cells because they are mistaken for harmful invaders.
  • Patients with rheumatoid arthritis have high levels of white blood cells in the synovial membrane, which line the body's joints. As a result, the joints became painful and swollen. The inflammation causes proteins to be released over months or years, which then results in the thickening of the synovial membranes. This may also lead to damaged bones, cartilage, tendons, and ligaments.
  • Some researchers believe that this autoimmune process is triggered by an infection with a virus or bacterium. Heredity may also play a role in the development of rheumatoid arthritis.
  • Periarthritis: Periarthritis typically occurs after the joint becomes injured, which causes scarring, thickening, and shrinkage of the joint. It may also occur after exposure to cold temperatures. Periarthritis typically affects the shoulder.
  • Individuals who have other types of long-term arthritis that affect the shoulders have an increased risk of developing periarthritis of the shoulder, also called adhesive capsulitis or frozen shoulder.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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