University at Buffalo

Behavioral Medicine Clinic

 
 

What is Arthritis?

arthritis

There are two major types of arthritis: osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis among older people. Osteoarthritis occurs when cartilage, the tissue that cushions the ends of the bones within the joints, breaks down and wears away. In some cases, all of the cartilage may wear away, leaving bones to rub up against each other.

Symptoms range from stiffness and mild, intermittent pain to severe joint pain. Osteoarthritis can affect the hands, neck, and weight-bearing joints such as knees, hips, and feet.

Causes and Risk Factors

Researchers suspect that osteoarthritis is caused by a combination of factors in the body and the environment. The chance of developing osteoarthritis increases with age. By age 65, half of the population has x-ray evidence of osteoarthritis in at least one joint, most often in the hips, knees, or fingers.

Osteoarthritis often results from years of wear and tear on joints. This wear and tear mostly affects the cartilage, the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when the cartilage begins to fray, wear away, and decay.

Putting too much stress on a joint that has been previously injured, improper alignment of joints, muscle weakness, and excess weight all may contribute to the development of osteoarthritis.

Symptoms and Diagnosis

Different types of arthritis have different symptoms. In general, people with most forms of arthritis have pain and stiffness in their joints.

Osteoarthritis usually develops slowly and can occur in any joint, but often occurs in weight–bearing joints. Early in the disease, joints may ache after physical work or exercise. Most often, osteoarthritis occurs in the hands, hips, knees, and neck.

Common signs of osteoarthritis include joint pain, swelling, and tenderness; stiffness after getting out of bed; and a crunching feeling or sound of bone rubbing on bone. Not everyone with osteoarthritis feels pain, however. In fact, only a third of people with x-ray evidence of osteoarthritis report pain or other symptoms.

To make a diagnosis of osteoarthritis, most doctors use a combination of methods and tests including a medical history, a physical examination, x-rays, and laboratory tests. However, x-rays are limited in their capacity to reveal how much joint damage may have occurred in osteoarthritis. X-rays usually don't show osteoarthritis damage until there has been a significant loss of cartilage.

The doctor will use a combination of tests to try to find out if osteoarthritis is causing the symptoms. A patient’s attitudes, daily activities, and levels of anxiety or depression have a lot to do with how severe the symptoms of osteoarthritis may be.

Treatment

Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans can include exercise, rest and joint care, pain relief, weight control, medicines, surgery, and non-traditional treatment approaches.

Current treatments for osteoarthritis can relieve symptoms such as pain and disability, but right now there are no treatments that can cure osteoarthritis. Exercise is one of the best treatments for osteoarthritis. It can improve mood and outlook, decrease pain, increase flexibility, and help you maintain a healthy weight.

For pain relief, doctors usually start with medications such as acetaminophen because the side effects are minimal. If acetaminophen does not relieve pain, then non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be used. Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription.

Corticosteroids, hyaluronic acid, glucosamine and topical creams are also used. Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. For example, people over the age of 65 and those with any history of ulcers or stomach bleeding should use NSAIDs with caution.

Your doctor may recommend surgery. The decision to have an operation depends on several factors. Both the surgeon and the patient should consider the patient's level of disability, intensity of pain, lifestyle, age, and occupation. Today, more than 80 percent of surgeries for osteoarthritis involve replacing the hip or knee joint.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It can cause mild to severe symptoms. Rheumatoid arthritis not only affects the joints, it may also attack tissue in the skin, lungs, eyes, and blood vessels.

Rheumatoid arthritis is classified as an autoimmune disease. An autoimmune disease occurs when the immune system turns against parts of the body it is designed to protect.

Causes and Risk Factors

Scientists believe that rheumatoid arthritis may result from the interaction of many factors such as genetics, hormones, and the environment. Although rheumatoid arthritis sometimes runs in families, the actual cause of rheumatoid arthritis is still unknown.

It is important to note that rheumatoid arthritis is not contagious. A person cannot catch it from someone else.

Symptoms and Diagnosis

Different types of arthritis have different symptoms. In general, people with most forms of arthritis have pain and stiffness in their joints. Rheumatoid arthritis is characterized by inflammation of the joint lining. This inflammation causes warmth, redness, swelling, and pain around the joints. A person may also feel sick, tired, and sometimes feverish.

Treatment

Treatments for rheumatoid arthritis can help relieve your pain, reduce swelling, slow down or help prevent joint damage, increase your ability to function, and improve your sense of well–being.

Exercise, medication, and, in some cases, surgery are common treatments for rheumatoid arthritis.

Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation. Still others, called disease-modifying anti-rheumatic drugs (DMARDs), can often slow the course of the disease. DMARDs include methotrexate, leflunomide, sulfasalazine, and cyclosporine. Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids. Another class of medications is called biologic response modifiers. Commonly used biologics are antibodies that blocks a substance called TNF. TNF stands for "Tumor Necrosis Factor", a substance the body produces that promotes inflammation. By blinding to and blocking TNF, anti–TNF agents stimulate or restore the ability of the immune system to fight arthritis.

Managing Your Arthritis Pain

Oftentimes, medications are not enough to combat the pain, physical limitations, suffering and joint deformities that plague a person living with arthritis. When severe, arthritis can lead to such problems as depression, anxiety, and feelings of helplessness, all of which can exacerbate pain and disability. Researchers have found that OA or RA patients can learn ways to carry out daily activities more comfortably by using body mechanics, learning pain management skills, and developing realistic expectations of what they can do. Researchers at Duke University have found that these skills help improve pain control, coping skills, and mental and physical well–being in patients who do not fully respond to standard medical treatments. A prestigious panel of experts convened by the National Institutes of Health concluded that a behavioral pain management strategy is highly effective in controlling pain in arthritis.

If you or someone you know is suffering from arthritis pain that medications or other therapies are not effectively controlling, the Behavioral Medicine Clinic may be able to help. Contact us online or call us at 716–898–5671 to get the help you need.

Source:

Anonymous. (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. Journal of American Medical Association, 276(4), 313–318.

Dixon, K. E., Keefe, F. J., Scipio, C. D., et al. (2007). Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychology, 26, 241–250.

Did you know ... ?
Arthritis is not just an old person’s disease. It can affect anyone at any age.

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