The term ‘arthritis’ is derived from the Greek roots
‘arthro-’ and ‘-itis’.
‘Arthro-’ means joint, and
‘-itis’ means inflammation, so
arthritis literally means inflammation of the joint(s).
Most commonly, when people see the word ‘arthritis,’ they think of
the most common form of arthritis, osteoarthritis, which
literally means ‘inflammation of bone and joint’
and refers to degenerative joint disease resulting from normal wear and tear
of the joint cartilage and underlying bone. The prevalence of
osteoarthritis is 7% worldwide, affecting over half a billion people and is
one of the leading causes of disability.
Acute gouty arthritis (or gout) affects almost 4% of the US
population (over 8 million people).
‘Gout’ comes from the Latin word, ‘gutta,’ meaning
‘drop’ and refers to the fact that it is caused by ‘drops of
humors’ spilling into the joints from the blood.
Gout is caused by sharp uric acid crystals being deposited into the joints and
typically results in severe pain, redness, and swelling in the affected
joints.
The most common joint affected is the big toe, but gout can attack knees,
ankles, hands, wrist, elbows, and feet. Gout typically flares up at
times (flares last 1-2 weeks), often triggered by dietary changes.
Rheumatoid Arthritis is a less common form of arthritis, and
unlike osteoarthritis, rheumatoid arthritis does not involve normal wear and
tear or degenerative joint disease, rather it is an autoimmune process in
which the immune system attacks its own joints, causing pain, swelling, and
deformity.
Just over a million people in the USA (about 1% of the population) suffer from
Rheumatoid arthritis.
Reactive Arthritis is a less common form of autoimmune
arthritis, usually triggered by an infection. Symptoms typically develop after
the infection symptoms resolve and can last several months.
Septic Arthritis is a medical emergency, caused by a
bacterial (and less commonly viral or fungal) infection in the joint. It
requires immediate treatment with antibiotics and surgical drainage.
Pain, swelling, aching, redness, stiffness, and loss of function (limited
range of motion) are all symptoms of arthritis.
Osteoarthritis symptoms tend to involve multiple joints and develop over time,
and symptoms typically worsen throughout the day, while rheumatoid arthritis
symptoms typically start with stiff joints in the morning that improve
throughout the day.
The onset of acute gouty arthritis is often sudden and severe, lasting for 1-2
weeks and then resolving. Gout flares can recur several times a year.
After obtaining a thorough history and physical exam, your physician may order
lab testing and imaging studies (X-rays/CT scans/MRIs) to determine which type
of arthritis you are suffering from.
Laboratory tests may include a complete blood count, chemistry panel,
rheumatoid factor (Rf), anti-nuclear antibody (ANA), erythrocyte sedimentation
rate (ESR), and uric acid level, depending on which type of arthritis is
suspected.
X-rays or other imaging studies can also help determine if osteoarthritis or
rheumatoid arthritis or a combination of the two is present.
If gout is suspected, uric acid levels will be elevated, and your primary care
provider may refer you to a specialist for definitive diagnosis. To
definitively diagnose gout, the affected joint is aspirated, and if uric acid
crystals are seen microscopically, the diagnosis is confirmed.
There are certain radiologic changes that are associated with rheumatoid
arthritis. For example, X-rays of the hands often reveal ulnar
deviation, in which the fingers bend away from the thumb. An elevated
Rheumatoid factor (Rf) coupled with certain radiographic findings are usually
enough to confirm a diagnosis of Rheumatoid arthritis.
Depending on the type of arthritis, there are several treatment options
available, but first, it’s important to diagnose the type of arthritis,
so the appropriate treatment can be prescribed.
Many arthritis treatments are routinely prescribed by primary care providers,
however some treatments, specifically rheumatoid arthritis treatments, are
normally referred to a rheumatologist for treatment.
Non-steroidal anti-inflammatory medications, such as ibuprofen (Motrin/Advil),
naproxen (Aleve), indomethacin, meloxicam (Mobic), celecoxib (Celebrex), and
topical diclofenac (Voltaren), are all examples of non-steroidal
anti-inflammatory medications.
These medications are routinely prescribed for osteoarthritis, rheumatoid
arthritis, and gout and help ease the pain and swelling associated with
arthritis. It is important to understand however, that these medications
carry certain risks, especially with long-term use. NSAIDs can be very
hard on the kidneys and are not recommended for people with chronic kidney
disease. NSAIDS can also increase bleeding risk and are not recommended
for people with peptic ulcer disease or gastritis.
Steroids like prednisone,
methylprednisolone (Solu-Medrol), and
hydrocortisone (Cortef) also can be used to treat
arthritis. Unlike NSAIDs, steroids are not hard on the kidneys, though
the bleeding risk is somewhat higher than from NSAIDs. Steroids also
raise blood sugar and can result in many complications with long-term
use. Injectable steroids (injected directly into the affected joint)
also can be used to bring temporary relief to specific joints. Locally
injected steroids don’t result in as many side effects as taking steroid
pills, since the medication mostly remains in the joint and doesn’t
travel throughout the body.
Acetaminophen (Tylenol) is relatively safe when used at
appropriate doses and can help treat the pain from arthritis, but pain relief
is often minimal.
Supplements like turmeric,
hyaluronic acid, and
glucosamine may help with pain and inflammation and have
less side effects than NSAIDs and steroids. Other natural treatments
such as cryotherapy and even stem cell or Wharton's Jelly injections may
have a role in treating certain types of arthritis.
Colchicine is another type of anti-inflammatory medication
usually used for acute gout flares. Indomethacin and steroids are the other
anti-inflammatories typically used to treat gout flares.
Depending on which joints are involved, physical therapy is often prescribed
for people suffering from osteoarthritis.
Strengthening muscles around affected joints can often result in pain relief
and improve function while reducing inflammation. It’s not
uncommon for someone to experience chronic knee pain due to gait abnormalities
resulting from stiffness in the back and hips.
Physical therapy can improve range of motion in these areas, allowing for
proper body mechanics and reduction in pain.
For gouty arthritis, it is important to reduce serum
uric acid levels to under 6mg/dL.
Allopurinol and Uloric are medications that
are normally taken daily to reduce uric acid levels when changes in diet fail
to do so. These medications are normally taken between flares and lower
uric acid levels over time.
The goal is to reduce uric acid crystals in the joints and eliminate future
gout flares.
Disease-modifying anti-rheumatic drugs such as methotrexate,
sulfasalazine, hydroxychloroquine, and
leflunomide are often prescribed by
rheumatologists to treat
rheumatoid arthritis (and other autoimmune disorders).
‘Biologics’ or ‘biologic disease-modifying
anti-rheumatic drugs’ or ‘targeted biologic agents’ are
newer medications used by rheumatologists to treat rheumatoid arthritis and
other autoimmune disorders.
Tumor necrosis factor (TNF) inhibitors:
and
Other Biologics:
To request your appointment, please call (469) 414-9660 or contact us online today!
Pure Medicine
4645 Avon Lane, Suite 200
Frisco, TX 75033
Phone: (469) 414-9660