Symptoms and treatment for arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Information, in part, from the Arthritis Foundation

Symptoms of arthritis include pain and limited range of motion of joints. Prolonged joint stiffness is another symptom.

Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth. Tenderness of the inflamed joint can be present. Fluid may accumulate within a joint as a result of inflammation, trauma, and degeneration. It can occur spontaneously. This latter situation may occur in patients who have hemophilia or who are on anticoagulant therapy. Blood may accumulate within a joint.

A few definitions...

“Arthralgias” refers to when a patient has joint pain but no evidence of joint inflammation.

“Arthritis” refers to when signs of inflammation (swelling, heat, redness, pain) are present.

Some forms of arthritis are symmetric meaning the joints on both sides of the body are involved relatively equally. Other types are asymmetric meaning one side is affected more than the other.

Surprisingly, patients with arthritis may have symptoms that aren’t joint related.

Many forms of arthritis, because they are systemic rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints. Therefore, symptoms in some patients with arthritis can also include nonspecific fever, weight loss, fatigue, and feeling unwell.

Some types of arthritis will affect the skin leading to rash or ulcers. Nodules under the skin can be seen in rheumatoid arthritis and gout.

Eye involvement may be seen with diseases like juvenile rheumatoid arthritis, ankylosing spondylitis, sarcoidosis, and Reiter’s disease.

Dry eyes may be seen in a condition called Sjogren’s disease.

Some forms of arthritis such as rheumatoid arthritis and lupus can cause inflammation of the heart, lungs, brain, and kidneys.

Another potentially serious form of arthritis, giant-cell arteritis, may cause blindness.

Treatment for arthritis consists of measures that both relieve symptoms as well as slow down the progression of disease.

Short-term relief for pain and inflammation may include pain relievers (analgesics) such as acetaminophen or non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naprosyn, or celecoxib (Celebrex), among others.

Heat and cold
Whether to use hot or cold applications on affected joints depends on the type of arthritis present and the recommendation of the physician. Pain relief may be obtained temporarily by using moist heat (warm bath or shower) or dry heat (heating pad) on the joint. Pain relief may also be obtained by placing an ice pack wrapped in a towel on the joint. Cold applications help reduce swelling, as well. However, people who have poor circulation should not use ice packs.

Joint immobilization
The use of a splint or brace can help a joint rest and protect it from further injury. Walking devices, such as canes, crutches, and assistive devices with extra large or longer handles help keep stress off certain joints.

Light stroking and/or kneading of painful muscles may increase blood flow and bring warmth to the muscle.

Transcutaneous electrical nerve stimulation (TENS)
Pain may be temporarily relieved with the use of a small TENS device that directs mild, electrical pulses to nerve endings beneath the skin in the painful joint area. TENS blocks pain messages to the brain and modifies pain perception.

Physical Therapy and Occupational Therapy
A cornerstone of therapy of any form of arthritis is physical therapy and occupational therapy to maintain joint mobility and range of motion. The proper kind and amount of this therapy will vary depending upon the underlying cause and upon individual factors that your physician will discuss with you.

Performed by a licensed acupuncture therapist, acupuncture is the use of thin needles that are inserted at specific points in the body. Acupuncture seems to stimulate the release of natural, pain-relieving chemicals produced by the brain or nervous system.

Maintaining ideal weight is critical. Also, more research into the role of foods and their role in improving or worsening arthritis is being conducted.

The use of various herbal remedies is exciting. While the work is preliminary, there may be some important developments on the horizon. Meanwhile, nutritional supplements such as glucosamine and chondroitin are effective in osteoarthritis. The issue here is potency and purity. Dietary fish oil, SAM-e, MSM, and others are also being evaluated.

Many rheumatic diseases are chronic, making long-term management of the disease very important.

There are several types of medications that may be used long-term to reduce pain and symptoms, including the following:

Non-steroidal anti-inflammatory medications
As mentioned above, these medications, such as aspirin and ibuprofen, help to reduce pain and inflammation.

Disease-modifying anti-rheumatic medications
These prescription medications may affect the course of the disease, by slowing down its progress and influence, and/or by correcting immune system abnormalities that are linked to the disease. Examples of disease-modifying anti-rheumatic medications include methotrexate, hydroxychloroquine, leflunomide, azathioprine, and cyclosporine.

More recently, biologic agents aimed at blocking tumor necrosis factor (TNF)- examples of which are etanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), and infliximab (Remicade) or anti- interleukin 1 therapy like Kineret have been used. Second generation biologic therapies like abatacept )Orencia), tociluzimab (Actemra) and rituximab (Rituxan) are also excellent choices.

Recently, tofacitinib (Xeljanz), an oral, small molecule biologic was approved by the FDA for use in rheumatoid arthritis.

Corticosteroids are hormones used to treat rheumatic diseases. These medications, an example of which is prednisone, can be taken orally or as an injection.

Pacing yourself
To conserve energy and reduce stress on your joint(s), pacing yourself (alternating periods of activity with periods of rest) can help protect your joints and minimize symptoms of arthritis.

Weight reduction
Extra weight puts more stress on weight-bearing joints, such as the hips and knees. Weight loss in overweight people has shown to reduce the chance of developing certain types of rheumatic disease, including osteoarthritis.

Certain exercises, such as swimming, walking, low-impact aerobic exercise, and range-of-motion exercises, may help reduce joint pain and stiffness. Stretching exercises may be helpful in keeping the joints flexible. Strengthening may also be of benefit.

In severe cases of rheumatic disease, surgery may be necessary to repair or replace a joint. There are two main types of surgery for arthritis and other rheumatic diseases, including the following:

• repair - surgery to repair a damaged joint may include removing debris in the joint, fusing bones, or correcting a bone deformity.

• replace - if a joint is too damaged for repair, it may need to be replaced with an artificial joint.

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