Useful patient information

The following offers a summary of information about arthritis.

What is arthritis?

Arthritis is the number one cause of chronic disability in the United States. Affecting nearly 40 million Americans, it refers to more than 100 diseases that cause pain, stiffness and swelling from the inflammation of a joint or the area around joints.

What is Osteoarthritis?

Osteoarthritis is the most common type of arthritis affecting about 16 million Americans, usually middle-aged and older people. This is a non inflammatory degenerative joint disease characterized by the breakdown of the joint's cartilage. The exact cause of osteoarthritis is unknown.

What is Fibromyalgia?

Fibromyalgia is the second most common type of arthritis affecting 3.7 million Americans, mostly women; 70 to 90 percent of people who develop this disease are women aged 20 to 50. Fibromyalgia is a disease involving pain in muscles or joints with no clinical signs of infection. It is often misdiagnosed as chronic fatigue syndrome, and usually does not require surgery.

What is Rheumatoid Arthritis?

In some types of arthritis, such as rheumatoid arthritis, the synovium becomes inflamed. This inflammation causes chemicals to be released that thicken the synovium and damage the cartilage and bone of the affected joint. This leads to inflammation of the synovium causing pain and swelling.

What causes arthritis?

The causes of the 100 types of arthritis are unknown. Because there are so many different forms of arthritis, the causes are likely to vary. Scientists are currently examining how the roles of major factors including genetics and lifestyles affect the development of arthritis.

What changes occur in the cartilage of an arthritic hip?

In a healthy hip, cartilage cushions the area surrounding the hip ball and socket to allow easy movement without pain. In an unhealthy hip, the cartilage is damaged or worn away causing pain from bones rubbing and grinding together.

What changes occur in the cartilage of an arthritic knee?

In a healthy knee, cartilage protects and cushions bone surfaces that come together at the joint allowing bones to move without friction. In an unhealthy knee, cartilage is damaged or worn away causing pain from bones rubbing together.

What are some of the symptoms of arthritis?

Pain from arthritis can be continuous or intermittent. Pain may occur after activity or exercise but it may also happen even if you've been resting and still for a period of time. Pain may be concentrated in one spot or you may feel it all over your body. Joints may feel stiff and difficult to move. Daily chores such as climbing stairs and opening cans may become a challenge. You may notice that pain is more severe during certain times of the day or after performing certain tasks.

Some kinds of arthritis cause swelling or inflammation. The skin over the joint may appear swollen and red, and feel hot when touched. Arthritis may also cause fatigue.

How can I know if I have arthritis?

Early diagnosis and treatment tailored to an individual's needs are crucial in slowing or preventing damage to joints. Only a physician can determine if you have arthritis and what type it is. Arthritis is diagnosed based on the overall pattern of symptoms, medical history, physical exam, x-rays and lab tests.

What are the treatment options for arthritis?

Because there are so many types of arthritis, each type of arthritis has different symptoms and treatments. The good news is that many things work to help control arthritis. Care for arthritis often involves more than one type of treatment. Treatment may vary over time and may be different depending on the kind of arthritis. Consult your doctor to discuss the best treatment options for you. Medication: Many drugs, both prescriptions and over-the-counter medications, are used to treat arthritis. Common medications are aspirin-free pain relievers, anti-inflammatory drugs, corticosteroids, disease modifiers, and sleep medications.

Exercise: Regular exercise is important to keep the body moving and flexible. It helps to lessen pain, increase movement, reduce fatigue, and helps you look and feel better.

Heat or Cold: Use of heat or cold over joints may provide short- term relief from pain and stiffness.

Pacing Activities: Pacing helps protect your joints by alternating periods of activity with periods of rest so that your joints don't tire from the stress of repeated tasks.

Joint Protection: Joints can be protected by learning to use them in ways that avoid excess stress. One way of doing this is to avoid using sore and weak joints. Unless larger joints are sore, for example, it is best to use them when carrying heavy items. The second method is walking with assistive devices like a cane. Lastly, weight control helps ease pain by reducing stress on your joints.

Self-Help Skills: You can learn ways to better manage how arthritis affects you emotionally by talking about your feelings with family members and friends, doing mental exercises, and by joining your local arthritis support group. Surgery: Most people will not need surgery, but in severe cases surgery may be effective in eliminating pain when other treatment methods have failed.

The Arthritis Foundation (www.arthritis.org) and American Academy of Orthopaedic Surgeons (www.aaos.org) web sites contain many articles and patient education information that you may find helpful as well.

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Osteoarthritis affects an estimated 21 million people in the United States and is characterized by mild to debilitating pain in the hands and joints such as knees, hips, feet and back. According to the Arthritis Foundation, the disease is most prevalent among individuals 45 years of age and older. Women are more prone to the disease.

What is osteoarthritis?

A degenerative joint disease, osteoarthritis is one of the oldest and most common forms of arthritis. The disease causes cartilage breakdown found in joints. This breakdown removes the buffer between bones and the resulting bone against bone friction causes pain and eventual loss of movement. Symptoms include joint pain or aching (often after exercise or extended periods of pressure on weight-bearing joints) and limited or eventual loss of range of motion.

How do you get osteoarthritis?

There are a wide array of factors that cause the development and progression of the disease.

Risk factors include:

• Aging
• Obesity
• Joint injuries (sports, work or accidents)
• Genetics

How do patients find out if they have osteoarthritis?

An individual must seek the diagnosis of a physician. After a physical examination and full detailing of symptoms have been discussed, the physician may also recommend X-rays to confirm presence of the disease.

What are treatment options?

The treatment options for osteoarthritis, include:

• Joint and muscle exercises to improve strength and flexibility
• Weight management to relieve stress on weight-bearing joints
• Anti-inflammatory drugs for degenerative joint disorders
• Heat/Cold therapies
• Synovectomy (surgical removal of inflamed synovial tissue)
• Osteotomy (restructuring of the bones to shift stresses from diseased to more healthy tissue)
• Partial knee replacements (unicompartmental knee - replaces only diseased portion of the joint)
• Total knee replacement (used when severe osteoarthritis is present)

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Can exercise really affect my lifestyle?

Americans could significantly improve their health and quality of life by practicing some form of physical activity on a regular basis. According to the Surgeon General's Report on Physical Activity and Health, regular, moderate physical activity is beneficial in decreasing fatigue, strengthening muscles and bones, increasing flexibility and stamina, and improving an overall sense of well-being.

Is there a specific benefit of exercise for an arthritis sufferer?

Exercise helps to:

• Keep joints moving
• Strengthen muscles around the joints
• Strengthen and maintain bone and cartilage tissue
• Improve overall ability to do everyday activities
• Improve health and fitness by:
  • increasing energy level
  • improving sleep
  • assisting weight control
  • improving overall cardiovascular condition
  • decreasing depression
  • improving self-esteem and emotional health

What happens if I don't exercise?

Lack of exercise contributes to:

• Smaller and weaker muscles
• Brittle bones
• Pain
• Disfigured joints that stay in one position for so long that the ability to straighten them may be lost
• Loss of mobility in joints that may become locked in a position if they are not routinely worked

What type of exercise programs should an arthritis sufferer use?

A balanced exercise program is best. It should include a combination of the three main types of exercise:

• Range-of-Motion Exercises: These are basic stretching exercises to keep joints supple and mobile by moving them in their "range-of-motion" the normal distance joints can move in certain directions.
• Strengthening Exercises: These are beneficial because they help maintain or increase muscle strength. Common ones include isometric exercises (tightening muscles without moving joints) and isotonic exercises (moving joints without strengthening muscles).
• Endurance Exercises: These are beneficial because they strengthen the heart, while making the lungs more efficient and improving stamina. They also help improve sleep, weight loss and your mood. Examples are walking, cycling and swimming.

Before you begin an exercise program, you should consult a physician or a physical therapist, especially if you have not exercised in a while, have had any surgical procedures, or are over age 40.

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What can I do to ensure I'm eating a balanced diet?

Physicians recommend seven basic steps for a balanced, healthy diet based on The Food Guide Pyramid developed by the U.S. Department of Agriculture and Health and Human Services:

1. Eat a variety of foods
2. Maintain an appropriate weight
3. Consume fat and cholesterol in moderation
4. Consume sugar in moderation
5. Eat plenty of fresh fruits and veges
6. Use salt and sodium in moderation
7. Drink alcohol in moderation

Why is calcium important?

A diet low in calcium and Vitamin D increases the risk of developing osteoporosis-- a condition where bones become thin and brittle. As calcium is one of the principal factors that helps the body build and maintain strong bones, not getting enough calcium may hinder bone development. Obtaining enough Vitamin D is also important because it aids in absorbing calcium from food. Vitamin D is found in foods such as fortified dairy products and in sunlight.

Arthritis in my hands makes it difficult to cook. What do you suggest?

Several things can be done to make meal preparation easier when joints are sore or swollen. Some include:

1. Take rests while preparing meals to give joints a break
2. Use convenience foods once in a while to lower the strain of cooking food
3. Keep common cooking utensils in an easy-to-reach place
4. Buy presliced and prechopped veges from the grocery store to eliminate work involved in slicing and dicing
5. Use kitchen appliances such as electric can openers and microwave ovens to ease the burden of cooking

How will losing weight help my arthritis?

Being overweight puts stress on joints, particularly the weight-bearing joints such as the knees and hips. It has a negative impact on mobility. Losing weight can be made fun by engaging in physical activity that is enjoyable. Changes in diet will probably also be necessary, but the payoff is that being at an optimal weight makes people feel happier and stronger.

How will limiting my sodium intake help my arthritis?

Sodium, common in processed, fast foods, causes water retention, as do some arthritis drugs such as corticosteroids. Your doctor may recommend a low-sodium diet for arthritis patients because water retention may cause joints to swell, sometimes restricting movement.

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For people with arthritis, pain management is more complex than just taking aspirin. Arthritis is a chronic disease that can cause significant pain and discomfort. It requires a careful approach to pain management, including a combined effort involving you and your doctor.

The following provides a general overview of medications and other approaches to pain management. It will help you gain additional insight into pain management, but remember, it is very important that you discuss this subject with your doctor to determine what specific pain management course is right for you.

Here are a few basic considerations about the use of pain medications:

1. Not every drug is right for every patient.
2. Most drugs have some type of side effect.
3. A combination of drugs may be appropriate either by themselves or in conjuction with other drugs for some conditions if recommended by your doctor.
4. There's a great deal of information - and misinformation -available about medications. One helpful source is your pharmacist. The package insert and other labelling provided by the drug manufacturer is another. No matter where you start, it's important to talk with your doctor about using, changing, or discontinuing medications.

What are the analgesics prescribed for?

The primary purpose of an analgesic is to relieve pain. Some patients use aspirin, an analgesic that also reduces joint inflammation. The most commonly used analgesic, acetaminophen, is relatively effective and has few side effects. Acetaminophen does not contain aspirin, however, so it doesn't relieve joint inflammation. For this reason, acetaminophen is less likely to be used with rheumatoid arthritis and other types of arthritis that cause inflammation, and more likely to be used to treat osteoarthritis and fibromyalgia.

The main side effect of analgesics is a slight risk of dependency that can occur if the drugs are used for long periods of time.

What can you tell me about NSAIDs?

Non steroidal anti-inflammatory drugs (NSAIDS) are the most frequently used medications for arthritis. They are often used to treat osteoarthritis, rheumatoid arthritis, gout, juvenile arthritis, and bursitis. Some are available by prescription only, while others (such as aspirin, ibuprofen, and naproxen) can be purchased over the counter.

NSAIDs help reduce redness and swelling and relieve pain. The type of NSAID that your doctor recommends for you will depend on several factors:

1. The type of arthritis you have
2. The degree of pain and inflammation
3. How your body reacts to the NSAID
4. Other medications you are taking

As with all medications, there are side effects that can occur with NSAIDs. The most common side effects include constipation and stomach irritation (ranging from indigestion and heartburn to development of stomach ulcers if symptoms are left untreated). For this reason, your doctor will monitor you carefully, and you should report any symptoms immediately.

When would a doctor prescribe corticosteroids?

Corticosteroids are similar to the hormone, cortisol, which occurs naturally in the body. Corticosteroids reduce painful inflammation in joints, but because of potentially serious side effects, they are rarely used as a first choice for long-term treatment.

Corticosteroids are almost never used to treat osteoarthritis, and when they are prescribed for rheumatoid arthritis, it is generally to relieve severe symptoms while waiting for another drug, such as an NSAID, to reach an effective level. If they are used for a longer period of time, they are generally used in lower doses.

Are there any medications that can help people with fibromyalgia?

Fibromyalgia is often mistaken for chronic fatigue syndrome because the patients never feel fully rested. Fibromyalgia, affecting deep muscle tissues and their attachments to bone, is extremely painful. A number of drugs that are not generally used to treat other types of arthritis may be prescribed for fibromyalgia, including antidepressants and antianxiety drugs.

Taken in smaller doses than for depression, these drugs can give patients the type of deep sleep they need, which contributes to pain relief and increased energy. Muscle relaxants can also promote sleep and ease painful muscles. Possible side effects vary depending on which type of medication is taken. You should discuss with your doctor the side effects of the drug prescribed for you.

Do I have to take drugs to relieve arthritis pain?

Arthritis patients have found that they may benefit from a number of other pain management techniques that do not involve medication. The most popular are:

1. Sleep
2. Exercise
3. Stress Management
4. Massage Therapy
5. Relaxation Therapy
6. Biofeedback
7. Hot/Cold Treatment

Is it true that sleep can be a factor in arthritis pain?

Not getting a good night's sleep is a problem for many people with arthritis. If your pain continually awakens you, you may never reach Stage 3 sleep - the deep sleep that's needed for true rest. And your fatigue can worsen your pain. There are many sources of information about getting a better night's sleep - magazine articles, books, web sites, etc., and you should consult with your doctor, nurse, or therapist.

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