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
