Arthritis Demystified: Understanding and Managing Joint Health

What is arthritis?

There are many different conditions or diseases that may cause inflammation of the joints³. And these conditions are not limited to the elderly only – arthritis can affect people of any age, even children⁴. The good news is that with current available treatments, most people living with arthritis can still lead full, active lives³.

Most common types of arthritis

While there are many different types of arthritis, the two that occur most commonly in adults are osteoarthritis and rheumatoid arthritis⁴:

Osteoarthritis

Osteoarthritis, the most common form of arthritis⁵,results from degeneration (wear and tear) of the cartilage that cushions the ends of the bones that form the joint².

Cartilage is a strong layer of tissue that allows bones to glide over each other safely and smoothly. Wear and tear of cartilage mostly results from overuse, as seen when a particular task is performed repetitively (e.g., playing a favourite sport or practicing a hobby), but it may also arise from carrying excess body weight. It may also occur due to a previous sport or traumatic injury^2,5. The (repeated) impact on the joint lining causes thinning of the cartilage and, over time, the bones will rub together, causing a grating sensation. This will reduce the flexibility of the joint and bone spurs may develop. The joint will swell.  Pain that becomes worse with exercising or after immobility is usually the first symptom of osteoarthritis².

This type of arthritis most often develops in people in their mid-40’s or older and often affects the hands, spine, knees, or hips. It occurs more frequently in women or in people with a family history thereof. However, it can develop at any age because of a previous injury. Sometimes it is associated with other joint conditions, such as gout or rheumatoid arthritis⁴. However, unlike rheumatoid arthritis, it’s not a systemic disease and rarely causes crippling deformities¹.

Rheumatoid arthritis

With rheumatoid arthritis, the immune system mistakenly targets the body’s own healthy tissues with antibodies and/or enzymes that destroy the linings of joints.

This results in inflammation². The joint becomes swollen, painful, and difficult to move, and may also become deformed². Joint stiffness is especially problematic upon awakening¹. Any joint can be affected, but rheumatoid arthritis usually involves the joints in the fingers, wrists, elbows, shoulders, knees, feet, and ankles^1,2.

Rheumatoid arthritis is an autoimmune disease and because the above-mentioned antibodies and enzymes may also have detrimental effects on tissues other than those lining the joints,

it may also produce systemic symptoms, such as fatigue, fever, weight loss, eye inflammation, anaemia, lumps under the skin (known as subcutaneous nodules), or inflammation of the lining of the lungs (known as pleurisy)^1,2. It usually affects the same joints on both sides of the body¹.

It can present at any age, but most typically is diagnosed in someone’s thirties or forties¹. Juvenile rheumatoid arthritis, however, affects children¹.

This type of arthritis is characterised by a striking tendency towards spontaneous remission and exacerbation. Although the course varies greatly from individual to individual, continuing inflammation will damage or destroy the joint cartilage¹.

Other types of arthritis

In addition to osteoarthritis and rheumatoid arthritis, there are several other types of arthritis. Some examples include:

Gout

This type of arthritis results from the buildup of uric acid crystals in a joint. It usually involves the big toe, but any joint can be affected³. (please see the GOUT section on this website for more information)

Ankylosing spondylitis

This type of arthritis affects the spine and often causes redness, heat, swelling, and pain. It may also affect the joint at the bottom of the spine where it joins the pelvic bone³.

Juvenile arthritis

The term “juvenile arthritis” refers to arthritis in children^1,3.

Psoriatic arthritis

Psoriasis is also an autoimmune disease characterized by skin lesions in the form of scaly red and white patches. In some individuals, it may also affect the joints and areas where tissues attach to bone³.

Septic arthritis

When bacteria gain access to a joint space (often through a penetrating injury), it may cause an infection that damages the cartilage lining of the joint³.

Reactive arthritis

An infection in the body may sometimes cause pain or swelling in a joint that is remote from the location of the infection. This type of arthritis may be accompanied by red, swollen eyes, and inflammation in the urinary tract³.

Symptoms and signs of arthritis

Symptoms and signs of arthritis will vary depending on the type. It is therefore important to seek medical advice to obtain an accurate diagnosis in the presence of:

• Joint pain, tenderness, and stiffness
• Inflammation in and around a joint (or joints)
• Restricted movement of a joint
• Warm skin over an infected joint
• Weakness and muscle wasting (reduction in muscle size)^4,6.

The presence of fever, weight loss, breathing problems, or rash or itch will alert the clinician to the presence of underlying diseases^3,6.

Causes and risk factors

Research has identified certain genes that make people more prone to develop arthritis.

If someone has such a gene, a trigger in the environment – such as a virus or injury – may lead to the development of the condition^3,7.

Risk factors for arthritis are not universal, but specific to the type of arthritis. For osteoarthritis, possible risk factors include:

• Recurring injuries and/or repetitive use¹.
• Age – risk increases as one gets older⁵.
• Gender – women are more susceptible than men⁴.
• Obesity – carrying extra bodyweight puts extra strain on the joints⁵.

Diagnosis

The earlier one is diagnosed and start treatment for arthritis, the better⁵. Therefore, in the presence of unexplained swelling or stiffness in a joint that does not go away, it is important to make an appointment with a medical practitioner as soon as possible⁸.

If the doctor suspects arthritis, it is important to distinguish between inflammatory and non-inflammatory forms of arthritis, while also recognising potentially disabling and life-threatening problems⁶.

In order to reach the correct diagnosis, it is important that one provides a detailed medical history and have a physical examination⁶. The medical history will provide important clues as to the type of arthritis. For example, if weight bearing and movement make the pain worse, it indicates non-inflammatory types of arthritis such as osteoarthritis. This type of arthritis also generally causes less than one hour of morning stiffness and usually involve weight-bearing joints in the legs in an asymmetrical pattern. Symmetrical involvement (on both the right and left side of the body) is more indicative of an underlying inflammatory arthritis, such as rheumatoid arthritis⁶.

Special investigations to assist with the final diagnosis may include:

• X-rays^3,6
• Ultrasound⁶
• MRI (magnetic resonance imaging)⁶
• Blood tests^5,6.

Treating arthritis

While conditions such as osteoarthritis or rheumatoid and psoriatic arthritis have no cure, treatment may help to relieve symptoms and slow progression^3,4. These include lifestyle interventions, medication, applying hot or cold, and physiotherapy⁴. In the case of osteoarthritis, surgery may also be an option⁴. Low-impact exercise can keep joints mobile and increase strength².

Physiotherapy

Physiotherapy will aim to increase the range of motion of the affected joints, strengthen the muscles around the joints to take pressure off them, and to teach one improved ways of moving to best protect one’s joints.

Exercise

Appropriate exercises can strengthen the muscles that support the joints, improve movement, reduce stiffness, and help with weight loss^2,3. Low-impact activities, such as walking, swimming, and cycling are best as they are kinder to the joints².

Weight loss

Losing weight takes pressure off the joints – especially weight-bearing joints, such as the hips and knees⁵.

Heat and Cold

Applying heat or cold can provide relief from pain and swelling³.

Medication

Your treating doctor will select the type of medication based on the underlying type of arthritis. All medicines have potential side effects and the efficacy of some may diminish over time¹. It is therefore important to attend regular check-ups so that your treating doctor can monitor the safety and effectiveness of the treatment you are receiving.

Treatment options include:

• Painkillers – Also called analgesics, these medicines may help to reduce pain but will not address the underlying inflammation. Examples include acetaminophen (paracetamol), tramadol, and oxycodone.
• Non-steroidal anti-inflammatory drugs (NSAIDs) – These medicines will help to reduce pain and inflammation¹.
• Corticosteroids – These medicines are able to treat inflammation very effectively, but long-term use is often restricted by adverse effects.
• Disease-modifying anti-rheumatic drugs (DMARDs) – These medicines are effective treatment options for arthritis resulting from autoimmune diseases such as rheumatoid and psoriatic arthritis. They suppress the (overactive) immune system and thus slow progression of the disease by inhibiting further joint damage^1,8.

Surgery

In the case of severe osteoarthritis, joint replacement surgery, for example, knee- or hip-replacement surgery, may be considered if conversative treatment with medicines, physiotherapy, and lifestyle changes do not provide adequate pain and symptom relief¹.

Surgery may also be indicated to correct established deformities caused by rheumatoid arthritis¹.

General measures

• Keep your weight at a healthy level to avoid straining your joints unnecessarily. Fat tissue may produce enzymes that promote inflammation which may damage cartilage⁵.
• Stay active to control your weight, lower blood sugar, strengthen supportive muscles and improve joint mobility³.
• Protect your joints by practising good, healthy movement patterns to limit strain on your joints².
• Maintain a generally healthy lifestyle, inclusive of a healthy diet, regular exercise, getting enough sleep, managing stress, not smoking, and limiting alcohol.

Helpful tools

A number of clever gadgets exist specifically to help people living with arthritis to perform everyday tasks. These include⁹:

• Reacher: Helps to reach things without getting up or stretching.
• Walker or cane: Helps negotiate uneven terrain.
• Grab rails and bath bench: Prevent bathroom falls.
• Jar openers: Make it easier to open jars on your own.
• Grooming and dressing aids: Allow one to get ready on your own.

Medical professionals in your corner

• GP: Speak to your GP about your symptoms first³.
• Rheumatologist: Specialises in arthritis and other diseases that involve the bones, joints and muscles – your GP may refer you to a rheumatologist if necessary³.
• Physiotherapist: Can teach you to move better and help you strengthen the muscles around your joints – both of which will help take pressure off your joints⁴.
• Occupational therapist: Advises you on how to adapt your home and workplace and recommends adaptive devices that will make day-to-day living easier¹⁰.

What to eat if you have arthritis

Limit the intake of¹⁰:

• Gluten – found in wheat, barley and rye
• Salt
• Foods with a high glycaemic index
• Refined sugar
• Alcohol
• Milk products
• Saturated fats – found in animal products

Eat more¹⁰:

• Fibre-rich foods
• Foods with a low glycemic index
• Antioxidant-rich foods
• Omega-3 fatty acids
• Vitamin D
• Probiotics