Early treatment is best defense against arthritis

Dear Dr. Crutchfield, what is arthritis?

Arthritis is a condition where the joints become tender, swollen and painful. The pain is a result of significant inflammation in the joints.

When arthritis affects the joints of the hips and knees, it can make it difficult to walk. When the arthritis affects the joints of the hands, it can make it nearly impossible to complete the normal everyday tasks of living.

Untreated, the joints of arthritis can become misshapen and gnarled. There are several types of arthritis. The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis. This article will focus on these two types of arthritis.

Osteoarthritis

Osteoarthritis results from the destruction of the smooth and slippery covering on the ends of the bones, the cartilage. This smooth protective covering of cartilage erodes and wears away over years with everyday use. The cartilage breaks down. The joint space becomes narrow and crowded. Bone spurs can also occur and cause pain.

With advanced stages of osteoarthritis, the covering is gone and the bone can grind, bone-on-bone, in the joint. This can produce pain, joint deformity, and limitation in movement. Sometimes injury or infection can cause or make osteoarthritis worse.

Rheumatoid arthritis

In rheumatoid arthritis, the body’s immune system becomes confused and attacks the joint and its components. This includes an inflammatory attack on the thick membrane covering of the joint called the synovium. In addition to a swollen and inflamed synovial membrane around the joint, the associated cartilage can wear down, the nearby bone can erode, and the joints can fuse and become stiff, leading to a condition called ankylosis.

The immune system attack causes pain, inflammation, and eventually the permanent destruction of the joint. There is a similar condition called psoriatic arthritis that affects patients with psoriasis. It is similar to rheumatoid arthritis.

Osteoarthritis results from wearing away of the smooth protective covering on the ends of bones in your joints. In rheumatoid arthritis, the capsule that that covers, protects and lubricates joints becomes attacked and inflamed. Both can cause the loss of use of the affected joints.

Risk factors for arthritis

• Family history. Some types of arthritis run in families.
• Age. The risk of developing arthritis increases with age.
• Sex. Women more commonly develop arthritis.
• Previous joint injury or infection. Playing traumatic sports can also lead to arthritis.
• Obesity. Excessive weight, force and trauma on the joints from obesity can lead to arthritis.

Symptoms of arthritis

• Pain
• Stiffness
•  Swelling
• Tenderness
• Redness
• Decreased flexibility
• Joint destruction

Diagnosis and laboratory tests

On physical examination, your doctor will check your joints for tenderness, pain, warmth, swelling and range of motion. The fluid of the affected joint can be examined under the microscope to aid in the diagnosis of arthritis.

Imaging tests can also help determine the diagnosis. These include:

• X-rays.
• Magnetic resonance imaging (MRI)
• Computerized tomography (CT
• Ultrasound

Arthroscopy (looking into the joint): In some cases a small, flexible tube with a camera-like tip can be inserted into the joint via a small incision and the inflamed joint can be visualized on a TV-like monitor. This can also help determine the diagnosis and treatment options for arthritis.

Arthritis treatments

Lifestyle modifications may improve arthritis. These include:

• Weight loss
• Exercise, especially low-impact like water aerobics

• Heat and cold. Hot or cold compresses may reduce joint pain.
• Movements/Stretching. The key is to increase range-of-motion.
• Massage

Often there are many treatments for arthritis. Some treatments will work better in some patients than in others. Some treatments will work better for certain types of arthritis. Sometimes multiple treatments may have to be tried and used for best results.

Additional arthritis treatments include:

• Pain relievers
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Depleters of Substance P, the chemical that transmits pain. Creams that contain capsaicin, the ingredient that makes peppers hot, is the common medication here. Rubbing these preparations on the skin can cause a blockage of the pain signal in arthritic joints.
• Disease-modifying medications. These are medicines that turn down the inflammatory attack on the joints. Methotrexate is one of these medicines.
• Biologics agents. These are designer proteins that directly interfere with and block the immune system’s inflammatory attack on joints.
• Glucocorticosteroids. Cortisone and prednisone are common medicines here. They reduce inflammation and pain in arthritic joints.
• Physical therapy. Physical therapy can be very beneficial in treating certain types of arthritis. It can improve range-of-motion and strengthen the joints.
• Surgery. Joint replacement is for joints at an advanced stage where repair or effective treatment is not possible. Joint replacement therapy has become common and can be life-changing for those who need it. It can greatly improve the quality of life.

If you have arthritis, be sure to check with your doctor. Many forms can be progressive and degenerative. Early treatment and intervention are important to preserve joints and quality of life. Fortunately, there are many excellent treatments for arthritis.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.