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Arthritis

Arthritis is an umbrella term that includes more than 100 types of ailments that can affect your joints, connective tissue, and the tissues surrounding your joints. Arthritis symptoms can be mild, medium, or severe and could impact everyday activities like walking, getting dressed, and even bathing. Because there are so many different kinds of arthritis, the symptoms, causes, and treatments can vary greatly. Each type could almost be considered its own unique disease, except that they have one thing in common: all types of arthritis affect your joints.

Understanding How a Joint Works

A joint is where two bones meet or join. They allow your bones to move smoothly in order for you to perform your daily activities. It enables you to bend forward, pick something up, and hold an object in your hand. Something called a joint capsule surrounds most of the joints in your body. These capsules are filled with fluid and work with your ligaments to keep your bones in place. Inside the joint, your bones are lined with cartilage. The cartilage allows your bones to slide over each other with little to no friction as you move.

Arthritis

Arthritis is a disease that affects your joints. It causes your joints to become swollen and sore. The symptoms caused by arthritis could be due to many factors, and the symptoms typically worsen as you get older. Although it is quite a common condition, it is not very well understood. Symptoms can differ between types of arthritis, and the causes are still somewhat obscure. While most symptoms are related to inflammation and pain in the joints, ailments of the heart, eyes, kidneys, skin, and lungs can also accompany it.

Different Kinds of Arthritis

There are over 100 different kinds of arthritis, all with slightly different symptoms, causes, and prognoses. Typically, different types of arthritis will affect various areas in the body.

Degenerative Arthritis or Osteoarthritis

Cartilage covers the ends of your bones. This cartilage allows your bones to move without friction. With osteoarthritis, a degenerative joint disease, this cartilage becomes worn out and rough, and eventually breaks down. If this happens, there is nothing to protect your bones, and they could end up rubbing against each other as you move. This rubbing of bone-on-bone makes the movement of the joints difficult and often painful. Osteoarthritis tends to show up in shoulders, knees, hips, back, and wrists or hands. It is possible to have it without experiencing any symptoms. On the other hand, osteoarthritis in the hip might require you to have a hip replacement, while osteoarthritis in your back could lead to spinal stenosis – a narrowing of the spinal canal.

Inflammatory Arthritis (Rheumatoid Arthritis)

Your immune system creates an inflammatory response to protect your body against viruses or bacteria, or when you sustain an injury. In rheumatoid arthritis, an autoimmune disease, your immune system attacks your joints and the underlying bone, much like they would an infection. The focus of the inflammation in rheumatoid arthritis usually starts with the lining of your joint capsule - the membrane that covers all your joints. It could affect several joints at the same time and usually occurs on both sides of the body. The wrists, fingers, knees, feet, and ankles are often affected by rheumatoid arthritis.

Infectious Arthritis

If bacteria, a virus, or fungus enter a joint, it could cause inflammation in that joint. Antibiotics or antimicrobial medication can treat this inflammation, but the infection-induced arthritis could become chronic and lead to irreversible joint damage.

Metabolic Arthritis

Metabolic arthritis is commonly referred to as gout, a rheumatic disease that affects the joints. It occurs when you have high levels of uric acid in your body. Uric acid forms when your body breaks down purines – a substance that naturally occurs in your body’s cells and some types of food. It is usually broken down in your body and excreted. Some people's bodies naturally produce higher than average amounts of uric acid, and their bodies cannot dispose of it quickly enough. The build-up of uric acid creates needle-like crystals in their joints, which causes severe joint pain.

Gout attacks can come and go, or become chronic if the uric acid levels aren't reduced. Gout could cause chronic pain, often experienced in a single joint, like your big toe or several small joints like in your hands.

Juvenile Arthritis

Children can suffer from several different types of arthritis; most commonly, they can have juvenile rheumatoid arthritis (also called juvenile idiopathic arthritis). Juvenile idiopathic arthritis refers to rheumatoid arthritis diagnosed before the child's 16th birthday. Children who have arthritis could suffer permanent damage to their joints, and while there is no cure, it is possible that the condition can go into remission with treatment. Children and young people are also more susceptible to reactive arthritis – caused by an infection. This type of arthritis usually only lasts between a few weeks and six months.

Psoriatic Arthritis

Psoriatic arthritis is a condition that targets the joints as a result of a skin condition called psoriasis. Usually, symptoms related to psoriasis emerge first, followed by psoriatic arthritis symptoms. Although the cause of psoriatic arthritis has not been established yet, it is believed to be linked to an immune response that causes inflammation in the joints.

Septic Arthritis

Septic arthritis causes inflammation in the joints due to a bacterial or fungal infection. People who have rheumatoid arthritis are at a higher risk of developing septic arthritis. Bacteria or microorganisms can either enter the joint through the blood or infect the joint directly during surgery or injury. Septic arthritis can be acute or chronic, although chronic septic arthritis is less common. Septic arthritis can cause rapid destruction of joints and, in some cases, could be fatal.

Causes

In some cases of arthritis, there might not be an exact cause; other times, a number of factors can combine to trigger the development of arthritis. There is not a lot of clarity on the causes of arthritis, but some of the following factors could cause the development of arthritis:

  • A joint injury could cause inflammation that can trigger the development of degenerative arthritis.
  • Abnormal metabolism and a higher than average level of uric acid could lead to gout.
  • Salmonella and shigella can cause joint infections through the spread of food. Sexually transmitted diseases like chlamydia, gonorrhea, and hepatitis C can also cause joint infections.
  • Immune system dysfunctions often lead to the development of rheumatoid arthritis.

What Makes You More at Risk for Developing Arthritis

Arthritis can affect anyone, regardless of age, sex, and race. While the causes of arthritis are still unclear, it makes establishing risk factors difficult. There are, however, some things that you can look out for when considering whether you are at a higher risk of developing arthritis. Here are a few things to look at:

  • Age: Although arthritis can affect people of all ages, the risk generally increases with age.
  • Genetics: Individuals who have family members with arthritis are more predisposed to developing arthritis.
  • Weight: Excess body weight can place a lot of stress and strain on your joints, mainly your knees, hips, and spine. Increased stress and strain on joints could put overweight individuals at a higher risk of developing arthritis.
  • History: A history of joint injuries could increase the risk of developing arthritis in the affected joint.
  • Sex: Women are more likely to develop rheumatoid arthritis, while men are more at risk of experiencing gout flares.
  • Repetitive movement: Consistent, repetitive movements over long periods could cause stress in the joints that might lead to the development of arthritis.

Symptoms of Arthritis

The symptoms of arthritis vary, but most types of arthritis have a few things in common. Here are a few things to look out for:

Joint Pain

Joint pain could be constant, or you might only experience it every now and then. You could also experience pain after exercise or putting pressure on the joint, and it does not go away after an hour or two. Joint pain that could indicate the presence of arthritis can also develop during the night, keeping you awake. With rheumatoid arthritis, you will likely experience pain in the same joints on both sides of your body as it affects your whole system.

Joint Stiffness

In some types of arthritis, joint stiffness is especially noticeable after long periods of inactivity, like when you wake up in the morning or after sitting or standing in one position for some time. This stiffness usually lasts more than an hour. In other types of arthritis, the stiffness could be more pronounced after exercise or felt for long periods after exercising.

Swelling of the Joints

You might experience swelling of the joint due to inflammation. In some cases, the skin might become red and swollen and feel warm to the touch. The deformation of the joints could also accompany this. With gout, your skin might look shiny and start to peel.

Decreased Range of Motion

Pain and stiffness could lead to a decreased range of motion in the affected joints. Sometimes this could be accompanied by rubbing or grating sensations and crackling sounds in your joints when you move them. Symptoms could be mild, moderate, or severe and be constant or come and go. In some cases, symptoms can stay consistent, or they can progressively get worse over time.

Diagnosing Arthritis

There are different steps involved with diagnosing arthritis. Your doctor will begin with a physical exam. They will look for swelling, warmth, and redness around your joints. They will also check to see how well you can move your joints, the range of motion you have, and whether you experience any pain with movement.

Laboratory Tests

Your doctor could run some lab tests on different body fluids to see if there are any abnormalities. Usually, the fluids tested for arthritis are blood, urine, and joint fluid. Joint fluid is obtained by inserting a needle into your joint space and withdrawing some of the fluid found there.

Imaging

X-rays create images of bones that can show bone damage, bone spurs, and cartilage loss. These images might not pick up early signs of arthritis, but could be used to track the condition's progression.

Computerized tomography (CT) scans combine the information from several x-rays to create cross-sectional views of the area. These images show the bones as well as the soft tissue around them.

Magnetic resonance imaging (MRI) combines radio waves with a powerful magnetic field to create cross-sectional images of our soft tissues like your cartilage, tendons, and ligaments.

Ultrasounds create images of the soft tissues, cartilage, and structures containing fluid around your joints using high-frequency sound waves. An ultrasound will also assist your medical practitioner when they need to insert a needle into your joints.

Treatment Options

There are a few different treatment options available to treat arthritis. Most of the treatment options focus on treating the symptoms and not the disease. The main aim is to give you the best quality of life possible.

Medications

Pain medication, or analgesics, only provides pain relief and is unlikely to treat inflammation in your joints. You might only need some over-the-counter pain medication for mild pain symptoms. More severe pain symptoms could require more potent pain medication like opioids. These kinds of pain medications work on your central nervous system and could be both mentally and physically addictive.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation. NSAIDs can be taken orally or come in the form of a patch, cream, or gel that you can apply directly to the affected area.

Counterirritants are creams or ointments that contain either menthol or capsaicin. Capsaicin is the component that makes hot peppers spicy. As the name says, it essentially creates a slight irritation that causes inflammation in the area where it is applied. This then decreases the inflammation in other areas in your body. Applying a counterirritant to your skin could cause a hot and cold effect on your skin, which can interrupt the pain signals to your brain.

Disease-modifying antirheumatic drugs (DMARDs) slow down, or in some cases, stops your immune system from attacking your joints. These are usually used to treat rheumatoid arthritis.

DMARDs are often used along with biological response modifiers. These modifiers are drugs that are genetically engineered to target specific protein molecules that are involved in your immune response, especially the ones that play a role in your inflammation.

Corticosteroids can reduce inflammation and suppress your immune system. Corticosteroids can either be injected directly into your joint or taken orally.

Physical therapy for arthritis focuses on strengthening the muscles around your joints and improving your range of motion. It usually includes exercises that target the specific joints affected, and you can combine it with hot or cold packs and massages.

Exercises could be done in water to include warm water therapy. The water supports your body so that you have less pressure on your joints, while soothing and relaxing your muscles.

Occupational therapy can accompany your physical therapy to give you advice on how to approach everyday tasks. It could also guide you in deciding whether you need to use aids or equipment to support and protect your joints and reduce fatigue during your daily activities.

Joint repair is a procedure where your doctor smoothens or realigns your joint. This could give you better movement in your joints and lower the pain that you experience. Joint repairs are usually performed through small incisions over the affected joint (arthroscopically).

Joint replacement surgery involves removing damaged joints and replacing them with artificial ones. This procedure is most common for knee and hip joints.

With a joint fusion, the joint ends of two adjacent bones are removed. The two bones are then connected to each other. Over time these two bones grow together. Because the joint is removed, you will no longer have movement in this area. Joint fusion is usually done with smaller joints like the ones in your wrist, ankles, and fingers.

Natural remedies

Natural remedies, pharmacological treatments focus on treating the symptoms of arthritis. It aims at promoting and maintaining good joint health while supporting joints that might already be affected.

Diet

While the food you eat cannot treat arthritis, some foods can help you maintain good joint health and decrease inflammation. These foods include:

  • Olive oil.
  • Beans.
  • Nuts and seeds.
  • Fish.
  • Fresh fruit and vegetables.
  • Whole grains.

Other foods might increase inflammation and should be taken in moderation or avoided. These include:<>

  • Nightshades like tomatoes, potatoes, eggplants, bell peppers, and spices from peppers like paprika and cayenne.
  • A high intake of refined sugar.
  • Some animal-derived foods.
  • Seafood, red wine, and meat could cause gout to flare up.

Physical Activity

Exercise might be counter-intuitive, especially if you're experiencing pain and stiffness relating to arthritis. However, there are a number of ways that exercise can help you manage your symptoms.

  • Regular exercise helps your muscles become stronger, and stronger muscles can provide better support to your joints.
  • Regular movement and especially moving your joints in ways that you do not usually use them during your daily activities will help you keep your joints' range of motion. It can also help your joints become supple and flexible, helping to reduce the stiffness experienced when you have arthritis.
  • Exercising increases a chemical called endorphins in your body. Endorphins are a natural painkiller and can uplift your mood.
  • You are more likely to maintain a healthy body weight when you exercise regularly. A healthy body weight could avoid excessive stress on your joints. It can also lower the risk of inflammation that could be caused by being overweight.
  • Exercising helps you to sleep better, allowing your body more opportunity to repair yourself while you're at rest.

Low impact exercise is best when you are experiencing symptoms of arthritis. These kinds of exercises put little to no stress on your body, and especially your joints. Low impact exercises include swimming, walking, cycling, yoga, Tai chi, and Pilates. You could also include activities that focus on strengthening your muscles and increase your flexibility and balance.

While it's normal to experience some discomfort during or after exercise, extreme pain might require you to see your doctor. It's a good idea to discuss any new exercise program with your medical professional before you start.

You might find that it's easier to exercise on some days than on others and that you can do more on some days than on others. Be flexible in your exercise program and adjust the level of intensity and amount of exercise you do depending on the arthritis symptoms you're experiencing that day.

Whenever you start a new exercise program, start slowly, and gradually increase the intensity and the amount of exercise you do. Some exercise is better than none, and only a few minutes, like 3 to 5 minutes twice a day, could help alleviate your symptoms. Gradually increase the amount of time you exercise, try adding 10 minutes at a time and give your body time to adjust to the new level activity.

You might consider working with a physical therapist, occupational therapist, or personal trainer. These individuals can provide you with tailor-made exercise programs that focus specifically on your arthritis symptoms and alleviating them. They can also advise you on which kinds of exercises to do, how to modify individual exercises, and how much exercise you should do depending on your condition.

How to Prevent Arthritis

There are a few things that you can do to assist your body in maintaining healthy joints and avoid (or limit) the development of arthritis.

  • Maintain a healthy weight. Since excess weight means that you put more stress and strain on your joints, maintaining a healthy weight can help you cultivate healthier joints.
  • Avoid injury, especially injury of the joints. Osteoarthritis can develop in any joint that has sustained an injury. Make use of the proper protective equipment, especially when conducting strenuous activities. Avoid activities that place undue pressure or strain on your joints.
  • Use alternate joints when making frequent, repetitive motions. Repetitive motions could increase the normal wear and tear of your joints. When doing activities that require frequent repetitive motions, try using alternate hands or changing the motion or pattern.
  • Practice good posture when sitting at a desk. Osteoarthritis is common in the joints of your spine. Good posture can help protect these joints from damage and injury.
  • Get exercise and stretch. Regular exercise can help you maintain healthy joints by keeping them supple and flexible. It also strengthens the muscles that support and protects your joints.
  • Keep an eye on your blood sugar. High blood sugar can stiffen the muscles and tissues that support your joints. When these tissues become stiff, they provide less support for your joints, making them more vulnerable to injury.

Arthritis and Your Feet

Each foot has 26 bones, and those bones are connected by 33 joints. That means that if you have arthritis, especially rheumatoid arthritis, you will likely experience complications in your feet.

Besides affecting the joints in your feet, rheumatoid arthritis also affects the fat pad underneath your heel. This fat pad is also called the plantar fat pad. It provides cushioning and absorbs shock when you engage in activities like walking and running.

Rheumatoid arthritis is believed to play a role in the thinning of this fat pad under your heel. Normally this fat pad would be between one and two centimeters thick. However, if you have experienced fat pad atrophy, this area could be significantly thinner - less than one centimeter. It could be extremely painful for some individuals with this condition to feel as if they're walking directly on the bone.

A non-invasive and conservative method to leave the symptoms of fat pad atrophy and sore heels is to wear supportive footwear. Proper footwear not only provides comfort for your entire foot, but it also cushions the most important parts. Shoes that provide adequate support and cushioning lessens the shock and stress placed on your fat pad. It also transfers less stress to the rest of your body – including your joints.

Arthritis is a common ailment that affects people of all ages and walks of life. While the causes are still not very well-known, maintaining good joint health could help you prevent or slow down arthritis development. Frequent exercise and protecting your joints from stress and shock can help you maintain strong and healthy joints.

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References:

https://www.cdc.gov/arthritis/basics/physical-activity-overview.html

https://www.cdc.gov/arthritis/basics/management.htm

https://www.healthdirect.gov.au/what-causes-arthritis#:~:text=Most%20forms%20of%20arthritis%20are,is%20called%20%27reactive%20arthritis%27.

https://www.versusarthritis.org/about-arthritis/conditions/arthritis/

https://www.nhs.uk/conditions/arthritis/

https://www.cdc.gov/arthritis/basics/types.html

https://www.arthritis-health.com/treatment/medications/over-counter-topical-arthritis-pain-relief

https://health.clevelandclinic.org/whats-the-deal-with-nightshade-vegetables/

https://creakyjoints.org/symptoms/how-rheumatoid-arthritis-affects-feet/

https://lermagazine.com/article/management-of-painful-plantar-fat-pad-atrophy

https://www.healthline.com/health/osteoarthritis/preventing-arthritis-in-the-hands#Tips-for-preventing-arthritis

https://www.healthdirect.gov.au/arthritis-prevention

https://www.bluecrossmn.com/wellbeing/preventive-care/how-prevent-arthritis-pain