gout.
This overview will focus on osteoarthritis and rheumatoid arthritis and will present some of the treatment options available. Please consult your health care practitioners for complete, individualized information.
Osteoarthritis
Osteoarthritis (OA), or degenerative joint disease, is the most common form
of arthritis, affecting more than 20 million adults in the United
States. It most often occurs in people of middle-age or older.
Cartilage is the primary tissue damaged by OA.
This tissue cushions the ends of bones and allows them to slide
smoothly by each other. In extreme cases, the cartilage may
wear away entirely, leaving a bone-on-bone joint, causing great
pain and restriction of movement. OA can occur in joints that
have been previously injured by trauma, infection or inflammatory
processes, or prolonged heavy use. Some forms of OA may
be hereditary. The quality of life of people with OA is reduced
due to pain and loss of joint function.
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic inflammatory disease of the synovial membrane, or joint lining. It most frequently affects the joints of the hands and feet, occurs symmetrically (e.g. both hands), and can cause inflammation in body organs. The cause of RA is unknown; however, research shows that immunologic, hormonal, genetic, and environmental factors are important. RA affects more than two million people in the United States. It commonly begins between the ages of 20 and 45 and is more common in females.
Pain
Arthritis is the most common disease in people over age 45, with more than 40 million Americans suffering from some form. OA is by far the most common, while RA is the most crippling. Chronic pain is one of the most devastating effects of arthritis, often limiting daily activities.
Arthritis pain comes from different sources, including inflammation of the synovial membrane, tendons, or ligaments; damage within the joint, such as cartilage degeneration; muscle strain; and fatigue. Other factors affecting pain are activity level and emotions, such as depression and anxiety. A combination of these factors contributes to the intensity of the pain, which varies greatly from person to person. You and your doctor can develop a management plan designed to minimize your specific pain and improve the function of your joints.
Short-Term Pain Relief
Medications: People with OA have very little inflammation, therefore pain relievers such as acetaminophen may be effective. Those with RA generally have pain caused by inflammation and often benefit from aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Heat and cold: The use of either heat or cold depends on the type of arthritis. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce the swelling and pain. If you have poor circulation, do not use cold packs.
Joint Protection: Using a splint or a brace to allow joints to rest and protect them from injury can be helpful.
Transcutaneous electrical nerve stimulation (TENS): A small device directs mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS seems to work by blocking pain messages to the brain and modifying pain perception.
Acupuncture: Thin needles are inserted at specific points on the body. Scientists believe that this stimulates the nervous system to release endogenous, pain-relieving chemicals. This procedure should only be preformed by a licensed acupuncturist.
Massage: A massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. Arthritic joints are very sensitive, so the therapist should be familiar with this disease.
OA and RA are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life.
Long-Term Pain Relief
Medications: NSAIDs are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with OA and RA. Disease-modifying anti-rheumatic drugs (DMARDS) are used to treat people with RA who have not responded to NSAIDs. Some of these are methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like RA. Treatment with these medications requires careful monitoring by the physician to avoid side effects.
Corticosteroids are hormones that decrease inflammation and suppress the immune system. They may be given orally, topically, or injected. Prednisone is the most common oral corticosteroid. In both OA and RA, corticosteroids may be injected into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year.
Weight Loss: Excess pounds put extra stress on weight-bearing joints such as the hips or knees. Weight reduction improves existing OA and decreases the likelihood of other joints becoming affected. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of OA in their knees.
Exercise: Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength, and endurance. It also helps with weight reduction, stress reduction, and contributes to an improved sense of well-being. Swimming or other water exercises, walking, low-impact aerobic exercises, range-of-motion exercises, and stretching are helpful. It is important to strike a balance between activity and rest.
Nutrition: Eating a well balanced, low fat diet, in addition to appropriate exercises, is one way to reach or maintain a desired body weight. The benefits dont stop there. A nutritious diet helps to keep the immune system functioning properly and contributes to overall health. Additionally, some people appear to be sensitive to certain foods or diets; however, there is no single diet that will help large groups of people. Be cautious with any diet that recommends the elimination of large groups of foods or that relies on only a few select foods.
Surgery: In select patients, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or replace the damaged joint with an artificial one. Total joint replacement has provided dramatic pain relief and improvement in motion for many people with arthritis.
Remember to consult your health care practitioners for personalized advice on all lifestyle changes, including medications, diet, and exercise.
- Ankylosing spondylitis: One of a group of rheumatic diseases that affect the spine (spondyloarthropathies).
- Gout: A type of arthritis caused by the reaction of the body to needle-like crystals of uric acid that accumulate in joint spaces. This reaction causes inflammation, swelling, and pain in the affected joint, most commonly the big toe.
- Inflammatory processes: Typical reactions of tissues to injury or disease, marked by four signs: swelling, redness, heat, and pain.
- Juvenile rheumatoid arthritis: A chronic arthritis of childhood that causes pain, stiffness, swelling, and loss of function in the joints and may also affect other parts of the body.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): A group of medications, including aspirin, ibuprofen, and related drugs, used to reduce inflammation that causes joint pain, stiffness, and swelling.
- Psoriatic arthritis: Joint inflammation that occurs in about 5 to 10 percent of people with psoriasis (a common skin disorder).
- Synovium: The same as synovial membrane. It
is a thin membrane that lines a joint and releases a fluid
that allows the joint to move easily.
- Systemic lupus erythematosus: Lupus is an autoimmune disease, a type of immune system disorder which causes the body to harm its own healthy cells and tissues. This leads to inflammation and damage of various body tissues, especially connective tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.
Janet L. Padgett, Ph.D.
- CSA Senior Life Science Editor
- B.S. (Physics), University of Virginia
- Ph.D. (Biophysics), Johns Hopkins University
- M.Ac. (Master of Acupuncture), Traditional Acupuncture Institute
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