Arthritis
Pain Management and Treatment Options
Arthritis involves inflammation of one or more joints and the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk or otherwise bear weight. Without the usual amount of cartilage, the bones rub together, causing pain, swelling, and stiffness.
Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include being overweight, previously injuring the affected joint, and using the affected joint in a repetitive action that puts stress on the joint.
Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people. Other types or cause of arthritis include: Rheumatoid arthritis (in adults), Juvenile rheumatoid arthritis (in children), Systemic lupus erythematosus (SLE), Gout, Scleroderma, Psoriatic arthritis, Ankylosing spondylitis, Reiter’s syndrome (reactive arthritis), Adult Still’s disease, Viral arthritis, Gonococcal arthritis, other bacterial infections (non-gonococcal bacterial arthritis), Tertiary Lyme disease (the late stage), Tuberculous arthritis, fungal infections such as blastomycosis.
Symptoms of Arthritis
If you have arthritis, you may experience:
- Joint pain
- Stiffness, especially in the morning
- Joint swelling
- Warmth around a joint
- Redness of the skin around a joint
- Reduced ability to move the joint
Signs and Test for Arthritis
First, your doctor will take a detailed medical history to see if arthritis
or another musculoskeletal problem is the likely cause of your symptoms.
Next, a thorough physical examination may show that fluid is collecting around the joint. The joint may be tender when it is gently pressed, and may be warm and red (especially in infectious arthritis and autoimmune arthritis). It may be painful or difficult to rotate the joints in some directions. This is known as “limited range-of-motion. ”In some autoimmune forms of arthritis, the joints may become deformed if the disease is not treated. Such joint deformities are the hallmarks of severe, untreated rheumatoid arthritis.
Tests vary depending on the suspected cause. They often include blood tests and joint x-rays. To check for infection and other causes of arthritis (like gout caused by crystals), joint fluid is removed from the joint with a needle and examined under a microscope.
Treatment of Arthritis
Treatment of arthritis depends on the particular cause, which joints are
affected, severity, and how the condition affects your daily activities.
Your age and occupation will also be taken into consideration when your
doctor works with you to create a treatment plan.
If possible, treatment will focus on eliminating the underlying cause of the arthritis. However, the cause is NOT necessarily curable, as with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at reducing your pain and discomfort and preventing further disability.
It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications. In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to lifestyle changes such as exercise, diet and rest. You should also:
- Avoid positions or movements that place extra stress on affected joints.
- Avoid holding one position for too long.
- Reduce stress, which can aggravate your symptoms. Try meditation or guided imagery. And talk to a physical therapist about yoga or tai chi.
- Modify your home to make activities easier. For example, have grab bars in the shower, the tub, and near the toilet.
Medications
Your doctor will choose from a variety of medications as needed. Generally,
the first drugs to try are available without a prescription. These include
over the counter medications like Acetaminophen, Aspirin, ibuprofen, or
naproxen as well as prescription medicines such as Cyclo-oxygenase-2 (COX-2)
inhibitors, Corticosteroids (“steroids”), Disease-modifying
anti-rheumatic drugs, Anti-biologics, Immunosuppressants.
It is very important to take your medications as directed by your doctor.
If you are having difficulty doing so (for example, due to intolerable
side effects), you should talk to your doctor.
Surgery and Joint Fluid Therapy
In some cases, surgery to rebuild the joint (arthroplasty) or to replace
the joint (such as a total knee joint replacement) may help maintain a
more normal lifestyle. The decision to perform joint replacement surgery
is normally made when other alternatives, such as lifestyle changes and
medications, are no longer effective.
Normal joints contain a lubricant called “synovial fluid.” In joints with arthritis, this fluid is not produced in adequate amounts. A relatively recent treatment approach is to inject arthritic joints with a manmade version of joint fluid known as hylan G-F 20 (Synvisc). This synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for arthritis patients.
Call your health care provider if:
- Your joint pain persists beyond 3 days.
- You have severe unexplained joint pain.
- The affected joint is significantly swollen.
- You have a hard time moving the joint.
- Your skin around the joint is red or hot to the touch.
- You have a fever or have lost weight unintentionally.
If arthritis is diagnosed and treated early, you can prevent joint damage. Find out if you have a family history of arthritis and share this information with your doctor, even if you have no joint symptoms.