Arthritis
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Arthritis is a general medical term used to describe a disorder that affects
joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...
s.
Symptoms Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...
generally include
joint pain Arthralgia () literally means 'joint pain'. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication Medication (also called medicament, medicine, pharmaceutic ...
and stiffness. Other symptoms may include redness, warmth, swelling, and decreased
range of motion Range of motion (or ROM) is the linear or angular distance that a moving object may normally travel while properly attached to another. In biomechanics and strength training, ROM refers to the angular distance and direction a joint can move be ...
of the affected joints. In certain types of arthritis, other organs such as the skin are also affected. Onset can be gradual or sudden. There are several types of arthritis. The most common forms are
osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...
(most commonly seen in weightbearing joints) and
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
. Osteoarthritis usually occurs as an individual ages and often affects the hips, knees, shoulders, and fingers. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet. Other types of arthritis include
gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and Joint effusion, swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crysta ...
,
lupus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...
, and
septic arthritis Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typica ...
. These are inflammatory based types of rheumatic disease. Early treatment for arthritis commonly includes resting the affected joint and conservative measures such as heating or icing. Weight loss and exercise may also be useful to reduce the force across a weightbearing joint. Medication intervention for symptoms depends on the form of arthritis. These may include anti-inflammatory medications such as
ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It can be taken oral administration, ...
and
paracetamol Paracetamol, or acetaminophen, is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely available over-the-counter drug sold under various brand names, including Tylenol and Panadol. Parac ...
(acetaminophen). With severe cases of arthritis,
joint replacement Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pai ...
surgery may be necessary. Osteoarthritis is the most common form of arthritis affecting more than 3.8% of people, while rheumatoid arthritis is the second most common affecting about 0.24% of people. In Australia about 15% of people are affected by arthritis, while in the United States more than 20% have a type of arthritis. Overall arthritis becomes more common with age. Arthritis is a common reason people are unable to carry out their work and can result in decreased ability to complete activities of daily living. The term arthritis is derived from '' arthr-'' (meaning 'joint') and ''
-itis Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
'' (meaning 'inflammation').


Classification

There are several diseases where joint pain is the most prominent symptom. Generally when a person has "arthritis" it means that they have one of the following diseases: *
Hemarthrosis Hemarthrosis is a bleeding into joint spaces. It is a common feature of hemophilia. Causes It usually follows injury but occurs mainly in patients with a predisposition to hemorrhage such as those being treated with warfarin (or other anticoagu ...
*
Osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...
*
Rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
*
Gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and Joint effusion, swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crysta ...
and pseudo-gout *
Septic arthritis Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typica ...
*
Ankylosing spondylitis Ankylosing spondylitis (AS) is a type of arthritis from the disease spectrum of axial spondyloarthritis. It is characterized by long-term inflammation of the joints of the spine, typically where the spine joins the pelvis. With AS, eye and bow ...
*
Juvenile idiopathic arthritis Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common chronic rheumatic disease of childhood, affecting approximately 3.8 to 400 out of 100,000 children. ''Juvenile'', in this context, ref ...
* Still's disease *
Psoriatic arthritis Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that may occur in some people affected by the autoimmune disease psoriasis. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers ...
Joint pain can also be a symptom of other diseases. In this case, the person may not have arthritis and instead have one of the following diseases: *
Psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
*
Reactive arthritis Reactive arthritis, previously known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infect ...
*
Ehlers–Danlos syndrome Ehlers–Danlos syndromes (EDS) is a group of 14 genetic connective-tissue disorders. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Co ...
*
Iron overload Iron overload is the abnormal and increased accumulation of total iron in the body, leading to organ damage. The primary mechanism of organ damage is oxidative stress, as elevated intracellular iron levels increase free radical formation via the ...
*
Hepatitis Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...
*
Lyme disease Lyme disease, also known as Lyme borreliosis, is a tick-borne disease caused by species of ''Borrelia'' bacteria, Disease vector, transmitted by blood-feeding ticks in the genus ''Ixodes''. It is the most common disease spread by ticks in th ...
* Sjögren's disease *
Hashimoto's thyroiditis Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, Hashimoto's disease and autoimmune thyroiditis, is an autoimmune disease in which the thyroid gland is gradually destroyed. Early on, symptoms may not be noticed. Over ti ...
*
Celiac disease Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine. Patients develop intolerance to gluten, which is present in foods such as wheat, rye, spel ...
*
Non-celiac gluten sensitivity Non-celiac gluten sensitivity (NCGS) or gluten sensitivity is a controversial disorder which can cause both gastrointestinal and other problems. NCGS is included in the spectrum of gluten-related disorders. The definition and diagnostic criteria ...
*
Inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine ...
(including
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...
and
ulcerative colitis Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary sympto ...
) * Henoch–Schönlein purpura * Hyperimmunoglobulinemia D with recurrent fever *
Sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...
*
Whipple's disease Whipple's disease is a rare systemic infectious disease caused by the bacterium '' Tropheryma whipplei''. First described by George Hoyt Whipple in 1907 and commonly considered as a gastrointestinal disorder, Whipple's disease primarily causes ...
* TNF receptor associated periodic syndrome *
Granulomatosis with polyangiitis Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), after Nazi German physician Friedrich Wegener, is a rare, long-term, systemic disorder that involves the formation of granulomas and vasculitis, inflammatio ...
(and many other
vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...
syndromes) * Familial Mediterranean fever *
Systemic lupus erythematosus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...
An ''undifferentiated arthritis'' is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease.


Signs and symptoms

Pain in varying severity is a common symptom in most types of arthritis. Other symptoms include swelling,
joint stiffness Joint stiffness may be either the symptom of pain on moving a joint, the symptom of loss of range of motion or the physical sign of reduced range of motion. * Pain on movement is commonly caused by osteoarthritis, often in quite minor degrees, ...
, redness, and aching around the joint(s). Arthritic disorders like
lupus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...
and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms including: * Inability to use the
hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the Koala#Characteristics, koala (which has two thumb#O ...
or
walk Walking (also known as ambulation) is one of the main gaits of terrestrial locomotion among legged animals. Walking is typically slower than running and other gaits. Walking is defined as an "inverted pendulum" gait in which the body vaults over ...
* Stiffness in one or more joints * Rash or itch *
Malaise In medicine, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. It is considered a vague termdescribing the state of simply not feeling well. The word has exist ...
and fatigue *
Weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
* Poor sleep * Muscle aches and pains * Tenderness * Difficulty moving the joint


Causes

Several factors contribute to the development of arthritis, differing on the type of arthritis. Osteoarthritis occurs from damage to joint cartilage from prior injury or long-term wear-and-tear, resulting in bone-to-bone contact and grinding. The resulting arthritis can occur over years, or be worsened by further injury or infection. If joint cartilage is severely damaged, inflammation and swelling may add to the extent and pain of osteoarthritis. In rheumatoid arthritis, the
immune system The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...
itself, which normally serves to protect against infection and diseases, attacks the lining of the
joint capsule In anatomy, a joint capsule or articular capsule is an envelope surrounding a synovial joint.Gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and Joint effusion, swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crysta ...
is a form of arthritis caused by excessive
uric acid Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the Chemical formula, formula C5H4N4O3. It forms ions and salts known as urates and acid urates, such as ammonium acid urate. Uric acid is a product of the meta ...
production, resulting in urate crystals depositing in joints, particularly in extremities, such as toes. Urate levels in the blood may increase from consuming
purine Purine is a heterocyclic aromatic organic compound that consists of two rings (pyrimidine and imidazole) fused together. It is water-soluble. Purine also gives its name to the wider class of molecules, purines, which include substituted puri ...
-rich foods or from body factors affecting urate clearance from the blood, a topic remaining under study. Arthritis types may also include
ankylosing spondylitis Ankylosing spondylitis (AS) is a type of arthritis from the disease spectrum of axial spondyloarthritis. It is characterized by long-term inflammation of the joints of the spine, typically where the spine joins the pelvis. With AS, eye and bow ...
,
juvenile idiopathic arthritis Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common chronic rheumatic disease of childhood, affecting approximately 3.8 to 400 out of 100,000 children. ''Juvenile'', in this context, ref ...
,
psoriatic arthritis Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that may occur in some people affected by the autoimmune disease psoriasis. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers ...
, and
reactive arthritis Reactive arthritis, previously known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infect ...
, among others.


Risk factors

There are common risk factors that increase a person's chance of developing arthritis later in adulthood. Some of these are modifiable while others are not. Some common risk factors that can increase the chances of developing osteoarthritis include obesity, prior injury to the joint, type of joint, and muscle strength. The risk factors with the strongest association for developing inflammatory arthritis (such as rheumatoid arthritis and lupus arthritis) are the female sex, a family history, age, obesity, joint damage from a previous injury, and exposure to tobacco smoke. Smoking has been linked to an increased susceptibility of developing arthritis, particularly rheumatoid arthritis.


Diagnosis

Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by tests such as radiologic imaging and blood tests, depending on the type of suspected arthritis. Pain patterns may vary depending on the type of arthritis and the location.
Rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
is generally worse in the morning and associated with stiffness lasting over 30 minutes. On the other hand, with osteoarthritis, the pain tends to initially be related to activity and then becomes more constant over time. Important features to look out for include the following: * Rate of onset of symptoms * Pattern of joint involvement * Symmetry of symptoms * Early morning stiffness * Associated tenderness around the joint * Locking of joint with inactivity * Aggravating and relieving factors, and/or * Presence of systemic symptoms Physical examination may include observing the affected joints, evaluating gait, and examining the skin for findings that could be related to rheumatological disease or pulmonary inflammation. Physical examination may confirm the diagnosis or may indicate systemic disease. Chest radiographs are often used to follow progression or help assess severity. Screening blood tests for suspected arthritis include: rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen, and specific antibodies. Rheumatoid arthritis patients often have elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) levels, which indicates the presence of an inflammatory process in the body. Anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) are two more common blood tests when assessing for rheumatoid arthritis. Imaging tests like X-rays are commonly utilized to diagnose and monitor arthritis. Other imaging tests for rheumatoid arthritis that may be considered include computed tomography (CT) scanning, positron emission tomography (PET) scanning, bone scanning, and dual-energy X-ray absorptiometry (DEXA).


Osteoarthritis

Osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...
(OA) is the most common form of arthritis. It affects humans and other animals, notably dogs, but also occurs in cats and horses. It can affect both the larger (i.e. knee, hip, shoulder, etc.) and the smaller joints (i.e. fingers, toes, foot, etc.) of the body. The disease is caused by daily wear and tear of the joint. This process can progress more rapidly as a result of injury to the joint. Osteoarthritis is caused by the break down of the smooth surface between two bones, known as cartilage, which can eventually lead to the two opposing bones coming in direct contact and eroding one another. OA symptoms typically begin with minor pain during physical activity, but can eventually progress to be present at rest. The pain can be debilitating and prevent one from doing activities that they would normally do as part of their daily routine. OA typically affects the weight-bearing joints, such as the back, knee and hip due to the mechanical nature of this disease process. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. The strongest predictor of osteoarthritis is increased age, likely due to the declining ability of
chondrocytes Chondrocytes (, ) are the only cells found in healthy cartilage. They produce and maintain the cartilaginous matrix, which consists mainly of collagen and proteoglycans. Although the word '' chondroblast'' is commonly used to describe an immatu ...
to maintain the structural integrity of cartilage. More than 30 percent of women have some degree of osteoarthritis by age 65. One of the primary tools for diagnosing OA are X-rays of the joint. Findings on X-ray that are consistent with OA include those with joint space narrowing (due to cartilage breakdown), bone spurs, sclerosis, and bone cysts.


Rheumatoid arthritis

Rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
(RA) is a disorder in which the body's own immune system starts to attack body tissues specifically the cartilage at the end of bones known as articular cartilage. The attack is not only directed at the joint but to many other parts of the body. RA often affects joints in the fingers, wrists, knees and elbows, is symmetrical (appears on both sides of the body), and can lead to severe progressive
deformity A deformity, dysmorphism, or dysmorphic feature is a major abnormality of an organism that makes a part of the body appear or function differently than how it is supposed to. Causes Deformity can be caused by a variety of factors: *Arthritis a ...
in a matter of years if not adequately treated. RA usually onsets earlier in life than OA and commonly effects people aged 20 and above. In children, the disorder can present with a skin
rash A rash is a change of the skin that affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracke ...
,
fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...
,
pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...
, disability, and limitations in daily activities. With earlier diagnosis and appropriate aggressive treatment, many individuals can obtain control of their symptoms leading to a better quality of life compared to those without treatment. One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the synovium (lining of the joint capsule), caused in part by the production of pro-inflammatory
cytokine Cytokines () are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are produced by a broad range of cells, including immune cells like macrophages, B cell, B lymphocytes, T cell, T lymphocytes ...
s and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts. Osteoclast activity can be directly induced by osteoblasts through the RANK/RANKL mechanism.


Lupus

Lupus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...
is an autoimmune
collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...
vascular Vascular can refer to: * blood vessels, the vascular system in animals * vascular tissue Vascular tissue is a complex transporting tissue, formed of more than one cell type, found in vascular plants. The primary components of vascular tissue ...
disorder that can be present with severe arthritis. In fact, about 90% of patients with Lupus have musculoskeletal involvement. Symptoms in these patients can often mimic those of rheumatoid arthritis with similar stiffness and pain patterns. Joints in the fingers, wrist, and knee tend to be the most affected. Other features commonly seen in patients with Lupus include a skin rash (pictured on the right), extreme
photosensitivity Photosensitivity is the amount to which an object reacts upon receiving photons, especially visible light. In medicine, the term is principally used for abnormal reactions of the skin, and two types are distinguished, photoallergy and phototoxicit ...
,
hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarring ...
,
kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...
problems, and shortness of breath secondary to scarring that occurs in the lungs.


Gout

In the early stages of gout, usually only one joint is affected; however over time, many joints can become affected. Gout most commonly occurs in joints located in the big toe, knee, and/or fingers. During a gout flare, the affected joints often become swollen with associated warmth and redness. The resulting pain can be significant and potentially debilitating. When one of these flares occurs, management involves the use of anti-inflammatories, such as NSAIDs, colchicine, or glucocorticoids. In between gout flares, it is recommended that patients take medications that decrease the production of uric acid (i.e. allopurinol, febuxostat) or increase the elimination of uric acid from the body (i.e. probenecid). Gout has been associated with excessive intake of alcohol and food, such as red meat. Thus, it is also recommended that patients with gout adhere to a diet rich in fiber, vegetables, and whole grains, while limiting the intake of alcohol and fatty foods. There is also an uncommon form of gout that is known as
pseudogout Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy, is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate cr ...
, which is caused by the formation of calcium pyrophosphate crystals in the joint. Unlike gout, no targeted treatments are currently available. At this time, management is aimed at decreasing inflammation in order to reduce the intensity and frequency of flares.


Comparison of types


Other

Infectious arthritis is another severe form of arthritis that is sometimes referred to as septic arthritis. It typically occurs when a patient is ill or has an infection. Common symptoms include the sudden onset of chills, fever, and joint pain. The condition is caused by bacteria that spread through the blood stream from elsewhere in the body. This bacteria can travel to specific joints and start to erode cartilage. Infectious arthritis must be rapidly diagnosed and treated promptly in order to prevent irreversible joint damage. Only about 1% of cases of infectious arthritis are a result of
virus A virus is a submicroscopic infectious agent that replicates only inside the living Cell (biology), cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea. Viruses are ...
es. Within recent years, the virus
SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19, the respiratory illness responsible for the COVID-19 pandemic. The virus previously had the Novel coronavirus, provisional nam ...
, which causes
Covid-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. The symptoms of COVID‑19 can vary but often include fever ...
, has been added to this list. SARS-CoV-2 tends to cause
reactive arthritis Reactive arthritis, previously known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infect ...
rather than local septic arthritis.
Psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
can develop into psoriatic arthritis. With psoriatic arthritis, most individuals first develop skin symptoms (such as scaly patches and itchiness) and then begin to experience joint related symptoms. They typically experience continuous joint pain, stiffness and swelling like other forms of arthritis. This disease can go into remission, but there is currently no known cure for the disorder. Treatment current revolves around decreasing autoimmune attacks with immune suppressive medications. A small percentage of patients with psoriatic arthritis can develop a severely painful and destructive form of arthritis which destroys the small joints in the hands and sometimes lead to permanent disability and loss of hand function.


Treatment

There is no known cure for arthritis and rheumatic diseases. Treatment options vary depending on the type of arthritis and include
physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
, exercise and diet, orthopedic bracing, and oral and topical medications. Joint replacement surgery may be required to repair damage, restore function, or relieve pain.


Physical therapy

In general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person. Individuals with arthritis can benefit from both physical and
occupational therapy Occupational therapy (OT), also known as ergotherapy, is a healthcare profession. Ergotherapy is derived from the Greek wiktionary:ergon, ergon which is allied to work, to act and to be active. Occupational therapy is based on the assumption t ...
. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay the need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities. Assistive technology is a tool used to aid a person's disability by reducing their physical barriers by improving the use of their damaged body part, typically after an amputation. Assistive technology devices can be customized to the patient or bought commercially.


Medications

There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective. Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for
osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...
is acetaminophen (paracetamol) while for
inflammatory arthritis Inflammatory arthritis is a group of diseases which includes: rheumatoid arthritis, psoriatic arthropathy, inflammatory bowel disease, adult-onset Still's disease, scleroderma, juvenile idiopathic arthritis, and systemic lupus erythematosus (SLE). ...
it involves
non-steroidal anti-inflammatory drug Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s (NSAIDs) like
ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It can be taken oral administration, ...
.
Opioid Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...
s and NSAIDs may be less well tolerated. However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular
corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...
injections may also be considered. The drugs to treat
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
(RA) range from
corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...
s to
monoclonal antibodies A monoclonal antibody (mAb, more rarely called moAb) is an antibody produced from a Lineage (evolution), cell lineage made by cloning a unique white blood cell. All subsequent antibodies derived this way trace back to a unique parent cell. Mon ...
given
intravenously Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...
. Due to the
autoimmune In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an " autoimmune disease" ...
nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called
disease-modifying antirheumatic drug Disease-modifying antirheumatic drugs (DMARDs) comprise a category of otherwise unrelated disease-modifying drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroida ...
s (DMARDs). csDMARDs, TNF biologics and tsDMARDs are specific kinds of DMARDs that are recommended for treatment. Treatment with DMARDs is designed to slow down the progression of RA by initiating an adaptive immune response, in part by CD4+ T helper (Th) cells, specifically Th17 cells. Th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17).


Surgery

A number of
surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...
interventions have been incorporated in the treatment of arthritis since the 1950s. The primary surgical treatment option of arthritis is joint replacement surgery known as arthroplasty. Common joints that are replaced due to arthritis include the shoulder, hip, and knee.
Arthroscopic surgery Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgery, surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted in ...
for osteoarthritis of the knee provides no additional benefit to patients when compared to optimized physical and medical therapy. Joint replacement surgery can last anywhere from 15 to 30 years depending on the patient. Following joint replacement surgery, patients can expect to get back to several physical activities including those such as swimming, tennis, and golf.


Adaptive aids

People with hand arthritis can have trouble with simple
activities of daily living Activities of daily living (ADLs) is a term used in healthcare to refer to an individual's daily self-care activities. Health professionals often use a person's ability or inability to perform ADLs as a measure of their Performance status, functi ...
tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. There are adaptive aids or assistive devices (ADs) available to help with these tasks, but they are generally more costly than conventional products with the same function. It is now possible to 3-D print adaptive aids, which have been released as
open source hardware Open-source hardware (OSH, OSHW) consists of physical artifacts of technology designed and offered by the open-design movement. Both free and open-source software (FOSS) and open-source hardware are created by this open-source culture movemen ...
to reduce patient costs. Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.


Alternative medicine

Further research is required to determine if transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis is effective for controlling pain. Low level laser therapy may be considered for relief of pain and stiffness associated with arthritis. Evidence of benefit is tentative. Pulsed electromagnetic field therapy (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis. The FDA has not approved PEMFT for the treatment of arthritis. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.


Epidemiology

Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. Arthritis is more common in women than men at all ages and affects all races,
ethnic group An ethnicity or ethnic group is a group of people with shared attributes, which they collectively believe to have, and long-term endogamy. Ethnicities share attributes like language, culture, common sets of ancestry, traditions, society, re ...
s and cultures. In the United States, a CDC survey based on data from 2013 to 2015 showed 54.4 million (22.7%) adults had self-reported doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number is expected to increase. Adults with co-morbid conditions, such as heart disease, diabetes, and obesity, were seen to have a higher than average prevalence of doctor-diagnosed arthritis (49.3%, 47.1%, and 30.6% respectively). Disability due to
musculoskeletal disorder Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion (e.g. ...
s increased by 45% from 1990 to 2010. Of these, osteoarthritis is the fastest increasing major health condition. Among the many reports on the increased prevalence of musculoskeletal conditions, data from Africa are lacking and underestimated. A
systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on ...
assessed the prevalence of arthritis in Africa and included twenty population-based and seven hospital-based studies. The majority of studies, twelve, were from South Africa. Nine studies were well-conducted, eleven studies were of moderate quality, and seven studies were conducted poorly. The results of the systematic review were as follows: *
Rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
: 0.1% in Algeria (urban setting); 0.6% in Democratic Republic of Congo (urban setting); 2.5% and 0.07% in urban and rural settings in South Africa respectively; 0.3% in Egypt (rural setting), 0.4% in Lesotho (rural setting) *
Osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...
: 55.1% in South Africa (urban setting); ranged from 29.5 to 82.7% in South Africans aged 65 years and older ** Knee osteoarthritis has the highest prevalence from all types of osteoarthritis, with 33.1% in rural South Africa *
Ankylosing spondylitis Ankylosing spondylitis (AS) is a type of arthritis from the disease spectrum of axial spondyloarthritis. It is characterized by long-term inflammation of the joints of the spine, typically where the spine joins the pelvis. With AS, eye and bow ...
: 0.1% in South Africa (rural setting) *
Psoriatic arthritis Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that may occur in some people affected by the autoimmune disease psoriasis. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers ...
: 4.4% in South Africa (urban setting) *
Gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of pain in a red, tender, hot, and Joint effusion, swollen joint, caused by the deposition of needle-like crystals of uric acid known as monosodium urate crysta ...
: 0.7% in South Africa (urban setting) *
Juvenile idiopathic arthritis Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common chronic rheumatic disease of childhood, affecting approximately 3.8 to 400 out of 100,000 children. ''Juvenile'', in this context, ref ...
: 0.3% in Egypt (urban setting)


History

Evidence of osteoarthritis and potentially inflammatory arthritis has been discovered in dinosaurs. The first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples. It was noted in skeletal remains of Native Americans found in
Tennessee Tennessee (, ), officially the State of Tennessee, is a landlocked U.S. state, state in the Southeastern United States, Southeastern region of the United States. It borders Kentucky to the north, Virginia to the northeast, North Carolina t ...
and parts of what is now
Olathe, Kansas Olathe ( ) is the county seat of Johnson County, Kansas, United States. It is the List of cities in Kansas#Highest population listing, fourth-most populous city in both the Kansas City metropolitan area and the state of Kansas, with a 2020 Uni ...
. Evidence of arthritis has been found throughout history, from
Ötzi Ötzi, also called The Iceman, is the natural mummy of a man who lived between 3350 and 3105 BC. Ötzi's remains were discovered on 19 September 1991, in the Ötztal Alps (hence the nickname "Ötzi", ) at the Austria–Italy border. He i ...
, a
mummy A mummy is a dead human or an animal whose soft tissues and Organ (biology), organs have been preserved by either intentional or accidental exposure to Chemical substance, chemicals, extreme cold, very low humidity, or lack of air, so that the ...
() found along the border of modern
Italy Italy, officially the Italian Republic, is a country in Southern Europe, Southern and Western Europe, Western Europe. It consists of Italian Peninsula, a peninsula that extends into the Mediterranean Sea, with the Alps on its northern land b ...
and
Austria Austria, formally the Republic of Austria, is a landlocked country in Central Europe, lying in the Eastern Alps. It is a federation of nine Federal states of Austria, states, of which the capital Vienna is the List of largest cities in Aust ...
, to the Egyptian mummies . In 1715, William Musgrave published the second edition of his most important medical work, ''De arthritide symptomatica'', which concerned arthritis and its effects. Augustin Jacob Landré-Beauvais, a 28-year-old resident physician at Salpêtrière Asylum in France was the first person to describe the symptoms of rheumatoid arthritis. Though Landré-Beauvais' classification of rheumatoid arthritis as a relative of gout was inaccurate, his dissertation encouraged others to further study the disease. John Charnley completed the first hip replacement (total hip arthroplasty) in England to treat arthritis in the 1960s.


Society and culture

Arthritis is the most common cause of
disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, d ...
in the United States. More than 20 million individuals with arthritis in the United States have severe limitations in function on a daily basis.
Absenteeism Absenteeism is a habitual pattern of absence from a duty or obligation without good reason. Generally, absenteeism refers to unplanned absences. Absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an ...
and frequent visits to the
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
are common in individuals who have arthritis. Arthritis can make it difficult for individuals to be physically active and some become home bound. It is estimated that the total cost of arthritis cases is close to $100 billion of which almost 50% is from lost earnings.


Terminology

The term is derived from '' arthr-'' (from ) and ''
-itis Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
'' (from , , ), the latter
suffix In linguistics, a suffix is an affix which is placed after the stem of a word. Common examples are case endings, which indicate the grammatical case of nouns and adjectives, and verb endings, which form the conjugation of verbs. Suffixes can ca ...
having come to be associated with
inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
. The word '' arthritides'' is the plural form of arthritis, and denotes the collective group of arthritis-like conditions.


See also

* Antiarthritics * Arthritis Care (charity in the UK) * Arthritis Foundation (US not-for-profit) * Knee arthritis * Osteoimmunology * Weather pains


References


External links


American College of Rheumatology
nbsp;– US professional society of rheumatologists
National Institute of Arthritis and Musculoskeletal and Skin Diseases
nbsp;- US National Institute of Arthritis and Musculoskeletal and Skin Diseases
The Ultimate Arthritis Diet
Arthritis Foundation {{Authority control Aging-associated diseases Inflammations Rheumatology Wikipedia neurology articles ready to translate Skeletal disorders Wikipedia medicine articles ready to translate