What is Arthritis?
Arthritis is a painful condition involving inflammation and degeneration of the joints. Symptoms of arthritis include pain and swelling in one or more joints, difficulty moving the joint, redness and warmth around the joint, and stiffness – especially in the morning. It is also common for people with arthritis to notice more pain with certain types of weather. It can involve any joint in the body. Unfortunately, we do not completely understand what causes arthritis at this time. It does tend to run in families. There are several different types of arthritis, including osteoarthritis, rheumatoid, juvenile, psoriatic, gouty, infectious and many others. There are many similarities between the different types and some differences.
Whatever causes the inflammation in the joint generally causes pain and swelling. In some cases, like gout, we understand what causes the inflammation, and can treat the abnormal blood uric acid and help to remove the crystals that have formed in the joint. If you have an infection in your joint, antibiotics may clear up the inflammatory process, but may leave damage behind.
Many of the other processes that cause arthritis are not curable. We do know that there is usually a breakdown of cartilage inside the joint. It can be from trauma, “wear and tear”, overuse, infection, or an autoimmune disease. Cartilage is supposed to cushion the joint. It keeps the bones from rubbing together.
There are many things you can try at home before you go to a doctor, especially if your arthritis is mild or early. Make sure you are exercising and moving. Try ice or heat for your joints. You can try Tylenol or over the counter anti-inflammatories like ibuprofen or naproxen. Be careful not to exceed the recommended maximum per day for these medications. You might also try capsaicin or menthol creams. Some people get relief with glucosamine or chondroitin. Don’t forget that the less weight the joints in your legs are carrying, the less stress there is on these joints. So weight loss is a part of arthritis treatment, too. If these things don’t work, you may need to see a doctor.
If you see the doctor
Most people can be seen by their internist or family practitioner early in their disease. As arthritis progresses, you may need to see a rheumatologist, a physical medicine and rehabilitation specialist or even an orthopedist, depending on exactly what happens to your disease. Physical therapists can also be very helpful with arthritis.
If you have tried all the over the counter medications, your physician may recommend some prescription NSAIDS (nonsteroidal anti-inflammatory drugs). These medications are stronger than the over the counter medications and may give you better relief. There are many different types of these medications. Don’t give up if the first one doesn’t work. It took several to find one that worked for me. Remember that they also have side effects, including stomach problems. So call your doctor if you have problems.
A subtype of these medications is the COX-2 inhibitors. Currently, Celebrex is the only one of these on the market. This medication is specifically designed to help in people who have stomach problems on NSAID medications. Because there are other risks with this medication, you should discuss this with your doctor.
Sometimes a course of steroids are needed if the joint is inflamed. These are not usually a long term oral medication. Often they are injected into a particular painful joint. From personal experience, the relief from these injections can be long lasting and make a big difference. There are other injections besides steroids that may help. You can ask your physician about these if you have progressed to this point.
Motion and Physical Therapy
The pain and swelling of arthritis often cause stiffness and problems with moving the joint. It is important to try to get the joint moving. If you hold the joint still for extended periods of time, it may stiffen. It is possible to get scar tissue inside the joint that makes it difficult to move later. So, no matter how much it hurts, if your doctor tells you that you need to “move it or lose it”, he or she is not really being funny. A physical therapist can be involved at this point to help you with an exercise program. Usually these involve stretching and flexibility, low impact and strength training for muscle tone.
Your physical therapist may also help by fitting you with a splint for certain joints or support garments. They also use something called a TENS unit. TENS stands for transcutaneous nerve stimulation. These devices are helpful for many patients with chronic pain. They require a prescription and may be covered by your insurance.
Especially for Rheumatoid Arthritis
Some other prescription medicines include injections for rheumatoid arthritis called biologics. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), Orencia (abatacept) and Rituxan (rituximab). Most of these medications would be monitored by a rheumatologist, but can give arthritis sufferers amazing relief. They are not first line medications. They are expensive and have many side effects, so you should definitely discuss these with your doctor. They will usually be used with other medications.
There are other medications that are used mostly for rheumatoid arthritis. Some are called DMARDs, short for Disease Modifying Anti-Rheumatic Drugs. These medications do not have any immediate pain relieving effect. They are known to slow the progression of rheumatoid and other autoimmune arthritis and to control some of the other symptoms. They include gold salts, penicillamine, sulfasalazine, hydroxychloroquine and methotrexate. All of them require monitoring by a physician with specialized training. You will most likely at least be consulting a rheumatologist at this point.
Can Surgery Help?
Arthritic joints can become so deformed or so damaged that surgery is necessary. Sometimes the inflamed tissue can be removed. Other times the entire joint may need to be replaced. This would be something that you would need to discuss with your orthopedic surgeon. Many people say that they feel much better after joint replacement, but there are always risks with surgery.
Arthritis is a common problem. There are some things that you can do at home without seeking medical attention. Your doctor has many other things that may help you with your pain and keep this disease from progressing. There are new discoveries, medications and procedures every day.