by on July 22, 2014
For those struggling with arthritis, many small chores can be prohibitively painful. It’s not an uncommon problem: about 23% of adults in the U.S. have arthritis, and almost half of them are limited by it. Arthritis is most prevalent in white, black and Native Americans, while Asians, Pacific Islanders and Hispanics are about half as likely to develop arthritis.
Arthritis, which comes in many forms, is characterized by the inflammation of one or more of the body’s joints. Although it is generally thought of as problem in old age, the majority of people who have arthritis are actually under age 65. Each year, arthritis and related conditions cost Americans billions of dollars.
Types of arthritis
The two most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are many more. In fact, while “arthritis” literally means joint inflammation, it is commonly used to refer to a class of conditions called rheumatic diseases. There are more than 100 defined rheumatic diseases, but a few are much more prevalent. Here are the main types of arthritis and rheumatic diseases, as well as their causes and symptoms.
The most common type of arthritis, osteoarthritis, OA, also known as degenerative joint disease, affects 13.9% of adults in the U.S. over age 25. It’s characterized by the loss of cartilage, ligaments and bone in joints that leads to pain. Osteoarthritis is caused by wear and tear, and is much more common in seniors, overweight people and those who have had joint injuries. A diagnosis of OA is usually made based on a combination of symptoms and evidence from an X-ray or other imaging scans. There is no cure for OA, but many medications are used to treat it.
This is an autoimmune disease, where the body’s immune system attacks normal joint tissue called synovium. Rheumatoid arthritis, RA, is unpredictable, can start at any age and in any joint, and symptoms tend to come and go. While RA most commonly affects the wrists and hands, painful inflammation can manifest itself in any of the body’s joints, and it usually does so in a symmetrical pattern, meaning that pain develops evenly on both sides of the body. A diagnosis of RA is made after looking at a number of criteria, including specific inflamed joints and specialized blood tests.
Vaguely called childhood or juvenile arthritis, there are actually many different rheumatic diseases that can affect children. The most common form is juvenile rheumatoid arthritis, which is similar to the adult form, but is often more severe. There have been no studies on the incidence of childhood arthritis, but it is estimated to affect nearly 300,000 children nationwide. Girls are more likely to be diagnosed with juvenile arthritis than are boys.
This rheumatic disease isn’t yet fully understood — to the point that some are skeptical of the diagnosis because symptoms are vague or attributed to other diseases. For this reason, fibromyalgia is difficult to diagnose and doesn’t even have a specified diagnostic code in the U.S. Even so, drugs have been approved to treat fibromyalgia, which affects an estimated 5 million adults in the nation. The condition is characterized by widespread pain, stiffness, fatigue and cognitive problems.
Gout starts when the body overproduces uric acid or doesn’t excrete it efficiently and uric acid crystals build up in tissues and fluids throughout the body. Some medications, alcohol and certain foods are known to contribute to the development of gout. It usually appears suddenly in one localized area that becomes painful, swollen and red. Gout can be treated and may go away, but it will often return to the same area, usually the toes and feet. This is the one inflammatory rheumatic disease that’s more common in men than women. To diagnose gout, a joint tissue sample is taken and examined under a microscope for uric acid crystals.
Like rheumatoid arthritis, systemic lupus erythematosus, SLE, also is an autoimmune disease, but lupus makes the body’s immune system attack any tissue, rather than only the joints. SLE is generally a young woman’s disease, and occurs most frequently in women of color between the ages of 15 and 40. Lupus is characterized by periods of illness and remission, and can affect skin, joints, brain, lungs, kidneys and blood vessels. Diagnosis of SLE is difficult, so it’s hard to know how many people are affected, but a common estimate is that 1.5 million Americans have SLE.
Another autoimmune disorder, psoriatic arthritis occurs in people who already have psoriasis, and in this case, joint pain sometimes occurs before a psoriasis diagnosis. The joint pain, stiffness and swelling of psoriatic arthritis can turn up anywhere in the body. Blood tests and imaging along with pre-existing psoriasis help diagnose psoriatic arthritis.
Treatment for arthritis
The major problem from most arthritis is pain, so treatment for arthritis often starts with pain medication, or analgesics. Arthritis pain medications may be over the counter or prescription strength, and include everything from common Tylenol to the heavy narcotic tramadol. For mild pain, topical analgesics such as Icy Hot, Bengay or Arthricare can be purchased at any drug store. When a stronger pain reliever is needed, doctors often prescribe narcotic analgesics like Vicodin, Percocet and Oxycontin.
Nonsteroidal anti-inflammatory drugs, or NSAIDs, like aspirin, ibuprofen and naproxen are sometimes used to reduce inflammation from arthritis, which in turn reduces pain. Some stronger NSAIDs such as Relafen, Indocin and Lodine are prescription only. NSAIDs can have serious side effects from heart attacks and strokes to internal bleeding when taken too long, so use of the drugs should be limited and with other medications. A newer NSAID, called a Cox-2 drug, is similar to others, but isn’t as damaging to the stomach. Currently, the only Cox-2 drug approved in the U.S. is Celebrex.
For autoimmune diseases, there is an additional class of drugs known as disease modifiers, which target the immune response and are intended for daily, long-term use. For rheumatic conditions, these are known as disease-modifying antirheumatic drugs, or DMARDs, and they can be biological or non-biological. Non-biological DMARDs are used less often, but work very well for a small population of people with rheumatoid arthritis. The options include plaquenil, methotrexate, and penicillamine, a molecule similar to penicillin.
Biological DMARDs, the new wave in rheumatoid arthritis drugs, include Enbrel, Humira, Rituxan and Orencia. All of these biological drugs target the immune system, and must be administered with a needle, either by injection or intravenously. While this class of drugs can be a challenge for people who are afraid of needles, DMARDs are attractive to some because they are administered once a week or less.
People with arthritis also sometimes take corticosteroids, which can quickly reduce pain and inflammation. These are not everyday drugs, and are usually used when the pain becomes too much to bear, especially if the pain is localized. Corticosteroids are often used for gout, osteoarthritis and rheumatoid arthritis, and can be administered as shots at the inflamed area or taken as a pill for a few days.
Some people with rheumatic diseases look to homeopathic or natural remedies to treat pain. Since many kinds of arthritis are related to being overweight and or obese, doctors often recommend heavier patients lose weight to relieve pain. Or, if you are at a healthy weight but don’t move around much, adding or increasing physical activity may also help manage pain. Activities such as swimming or water aerobics help ease the pressure on joints during workouts.
Another common remedy for pain is cold therapy, which is best used when inflammation, redness or swelling is present. A cold compress or ice pack can numb local pain and reduce inflammation. Similarly, hot therapy is good for stiffness, especially in the morning when joints tend to be less flexible. If you’re interested in dietary modifications, some evidence suggests omega-3 fatty acids and turmeric can help with joint pain. Some people also turn to yoga or acupuncture to help manage arthritic pain.
If you think you have arthritis, or have been diagnosed and are looking for help, talk with your doctor about pain management techniques. The right doctor can find a management plan that works for your condition and your budget.