What is arthritis?
The word arthritis literally means ‘inflammation of the joints’; arthritis is a rheumatic condition that causes pain, tenderness, stiffness and inflammation in the joints. Patients typically have this pain and swelling in more than one joint in their body, in any joint in the body.
What types of arthritis are there?
The term arthritis covers over 100 rheumatoid conditions as explained here. These types of arthritis can be divided into seven types:
- Degenerative arthritis
This type of arthritis is defined by damage to the joints which worsens or degenerates over time. Osteoarthritis is a form of degenerative arthritis.
- Inflammatory arthritis
Arthritis itself means ‘joint inflammation’. Inflammation is usually used by the body to protect against viruses, illnesses and injury; it’s part of the normal healing process. However, with types of inflammatory arthritis, inflammation is occurring without a reason, and instead of being helpful, causes damage.
Types of inflammatory arthritis include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and reactive arthritis.
- Infectious arthritis
This type of arthritis is caused by a virus, infection or bacteria which affects the joints. Sometimes if caught early, the infection can be stopped, but often this becomes chronic.
- Soft tissue musculoskeletal pain
This covers conditions wherein pain is felt in areas other than the joints such as in the tissues which support the joints.
- Arthritis which affects the back
Pain in the back can be caused by problems in other areas of the body which can be transferred to the back. Spondylosis is a type of arthritis that is often under this classification, as well as osteoporosis.
- Connective tissue disease
This type of arthritis affects the tissues that connect systems, organs and other tissues in your body. With this sort of arthritis, pain and inflammation can occur both in the joints and in other tissues, for example the lungs, skin and muscles among many. Lupus is a type of connective tissue disease.
- Metabolic arthritis
Purines are chemicals that can be found in our cells and in the food that we eat. When the body breaks down purines, it produces a chemical called uric acid. This uric acid in a healthy body is passed out of the body and causes no problem; however, when there is an excess build up of uric acid, it can form crystals of this acid in joints which leads to pain. This type of arthritis is known as gout.
In this post we will be focusing on the most common types of arthritis: Osteoarthritis and Rheumatoid arthritis. This is not to say that the other types of arthritis are any less important; the information and guidance provided to cope with arthritis can be applied to all types of the condition. You can find a comprehensive list of the types of arthritis and more information about them here.
What is osteoarthritis?
Osteoarthritis is the most common type of arthritis; this study states that, “The prevalence of arthritis is high, with osteoarthritis being one of the most frequent disorders in the population.”
Osteoarthritis is the type of arthritis which myself and my mother suffer from. It is common in older people although can be found in younger individuals. You might have heard this type of arthritis referred to as ‘wear and tear’, as the joint is worn down.
Normally throughout our life, our joints are used to dealing with damage on a very minimal level; they are constantly repairing themselves, dealing with growth and the pressure that is put on them through our daily activities. In a healthy joint, you have something called cartilage; cartilage is like a cushion, a protective layer on the end of your bones to stop bone rubbing against bone, essentially to stop wear and tear.
When the cartilage breaks down, it becomes thinner and rougher meaning it isn’t protecting your joint and helping it heal as it should. This then causes the tendons and ligaments to be overworked which in turn leads to pain, swelling and problems with how the joint functions when it is moved. The tissues in the joint then start to work over time to try and repair the joint. Sometimes, this repair process will work adequately enough that the joint will function normally, and the person may not even be aware that there was any problem with their joint. However more often than not this repair process is not sufficient, and the joint is damaged.
As a result of this damage, bony growths can then develop on the joint called osteophytes, which makes it harder for the joint to move properly; this causes pain and stiffness in the joints. These osteophytes are the lumps and swellings you might see when arthritis is in the fingers.
The lining of the joint which is called the synovium, often becomes thicker and produces more fluid in its attempt to compensate, but this causes the joint to swell which can feel very uncomfortable and contribute to pain. The tissues around the joint then need to stretch to accommodate this swelling, and this in turn makes them weaker and less supportive; this leads to the joint being less stable.
For the majority, Osteoarthritis is a normal part of aging as our bodies cope with the strain of daily life; often people don’t even know that their bodies have arthritis! However when arthritis becomes more severe, that’s when people often start to experience symptoms.
If the breakdown of cartilage is severe, then bone will literally rub on bone with nothing between it to provide a cushion; this wears the bone down, it changes the shape of the joint and means that the bones don’t sit in the position that they should.
While the damage to the joints can be the cause of pain, more often than not what is causing pain is being stuck in the pain cycle; once pain becomes chronic it changes our neural pathways and essentially learns to continue producing pain! While this sounds worrisome, the good news is that while the brain has learnt to produce pain, it can also be taught to break the cycle and no longer experience pain.
Osteoarthritis can affect any joint in the body, but most commonly affects the joints that bear weight, like your hips, knees and feet.
What is rheumatoid arthritis?
Rheumatoid arthritis is a very prevalent condition; this type of arthritis is an autoimmune condition, which means that the immune system is attacking itself. In a functioning immune system, antibodies are released when there is a threat such as a virus, and they attack this virus to protect the body.
The immune system in patients with rheumatoid arthritis is sending antibodies to the lining of the joints without an appropriate reason; these antibodies are then attacking tissue of the joints and breaking down the lining. The exact cause of this is not yet known although some theories do suggest that an infection could trigger the start of this autoimmune reaction; this needs further investigation as explained in this study.
This attacking of the joint tissue leads to the synovium becoming painful and inflamed, which in turn causes damaging chemicals to be released in nearby bones, cartilage, tendons and ligaments. If this is left untreated, it breaks down the joint completely.
Some people find that only one or two of their joints are affected with rheumatoid arthritis. Often the arthritis seems to move around to different joints and can vary in position and severity on different days.
What causes arthritis and who can have it?
The definitive causes of osteoarthritis and rheumatoid arthritis are yet to be confirmed but a greater understanding is being gained all the time. Depending on the type of arthritis a patient suffers from, causes may vary. Anyone can have arthritis but there are some common factors that can make an individual more predisposed to develop arthritis:
- Genetics: in many forms of arthritis, particularly osteoarthritis and rheumatoid, there seems to be a genetic factor involved. You are much more likely to suffer from arthritis in your life if a relative has it. This study found that, “39% to 65% of the variance of osteoarthritis in the hand and knee can be attributed to genetic factors.”
- Gender: some forms of arthritis are more commonly seen in men or women; in general arthritis is found to be more common in women as indicated in this study, research is being done into why this is.
- Age: osteoarthritis tends to be seen more often in older adults, usually starting when people are over 40, whereas rheumatoid arthritis often begins in young adults.
- Injury: an injury can make it more likely that you may develop osteoarthritis later in your life.
- Infections: some forms of arthritis can be triggered by infections; this is a theory with rheumatoid arthritis.
- Obesity: being overweight puts more pressure on the joints which they are not designed to deal with; this can lead to osteoarthritis and can contribute to symptoms.
- Stress: stress and emotional trauma have been proven to influence the start of arthritis as shown here; we already know that stress worsens chronic pain.
- Lifestyle factors: poor diet, smoking, lack of exercise, and repetitive physical strain can contribute to the onset and progression of arthritis. Normal exercising and movement don’t cause arthritis, but if you are overworking your joints in a repetitive way then this can lead to arthritis developing.
- Other health issues: often other health issues, such as high blood pressure and heart disease, are associated with arthritis. Other joint problems or abnormalities, especially those which a patient was born with or developed in early childhood, can lead to the body compensating and arthritis developing. This study found that comorbid illnesses are higher among those with arthritis.
What are the symptoms?
Generally, symptoms of arthritis include:
- Pain in the joints especially when you’re moving or trying to exercise and directly afterwards.
- Tenderness in the joints; they can be tender to the touch and other sensations.
- Stiffness in joints, particularly in the morning when the joints haven’t been moved overnight, and in colder weather.
- A creaking or friction sound when you’re moving your joints, this is also called crepitus.
- Inflammation in and around the joints.
- Problems with movement and mobility around the affected joints.
- Warm, red or irritated skin around affected joints.
- Weakness in muscles, joints and the body in general as it is overworked; this means that the muscles and joints can’t do the jobs they should. An example of this would be losing grip strength if arthritis is in your fingers.
- Mental health issues: as with many chronic conditions, arthritis can take a toll on your mental health. It can often lead to depression and anxiety.
How is it diagnosed?
Firstly, your doctor will look back over your clinical history, talk to you about the symptoms you are experiencing and determine how severe they are. Then a physical examination will take place to look for symptoms such as swelling, crepitus, pain and stiffness and to determine where in your body these symptoms are affecting you.
From there a series of tests will be done, typically one or more of the following depending on what your doctor feels is needed:
- Blood, urine sample and joint fluid tests to look for indications of inflammation and other symptoms
- X-rays which can show cartilage and bone damage as well as osteophytes
- MRI (Magnetic Resonance Imaging) which gives a clearer image of the soft tissues
- CT (Computerized Tomography) scans which give cross-sectional views of bones and soft tissues
- Ultrasound to give images of the soft tissues, fluid around the joints and cartilage.
With the results of these tests, your doctor will determine whether you have arthritis and establish the type of arthritis you have, as well as eliminate other causes.
How does arthritis affect people?
Living with arthritis can be very difficult; as with any other chronic condition it affects people to different degrees and varies in severity. Depending on the type of arthritis you live with and how severe your symptoms are, you may be able to function with very little pain or problems with mobility, or your pain may be severe and impact daily functioning significantly.
Arthritis can affect every aspect of daily life, including someone’s ability to work, to exercise and to engage in daily activities. This study found that, “Musculoskeletal disorders are associated with some of the poorest quality‐of‐life issues, particularly in terms of bodily pain and physical functioning.”
My mother has had arthritis since before I was born; growing up I remember how it affected her. She has always had a limp from arthritis combined with other comorbid health conditions, and this affected how she was able to work, to exercise, and to function. While she was in pain, she still managed to work throughout my life and to maintain an admirable level of functioning; for some people work is possible and for others arthritis is more disabling.
We have always cycled as a family, we used to go on many cycling holidays and while earlier in my life my mother was able to keep up with us, as her osteoarthritis progressed this became harder. Rather than letting it stop her, however, she had adapted bikes to help her keep going, often with motors that took some of the pressure of her joints. She also uses a stick to help her walk, a walk-in shower and an adapted car to allow her to drive; some arthritis patients will use mobility aids ranging from walking sticks, mobility scooters and wheelchairs.
I first noticed signs of osteoarthritis in my mid-twenties, in my knees, spine and feet. It is tough to live with and it’s something that you must consider in most aspects of your life. Sometimes I use a walking stick if I am struggling and other times, I can walk unaided; I have a handle in the shower to help me to get in and out of the bath if I am unsteady on my feet.
I can carry out most daily functions and I work full time; I ensure that I take breaks when I need them and ask for help with tasks if I feel that I have done too much. As my arthritis progresses, I may need to make other adjustments, but right now my functioning is at a high level.
How is arthritis treated?
Depending on the type of arthritis you have treatments may vary, but in general the following treatments are offered:
For rheumatoid arthritis medication to correct the autoimmune response and prevent any further damage to your joints is usually given; the sooner the problem is identified and medications are given, the less damage will be done. This study concluded that, “Successful treatment to limit joint damage and functional loss requires early diagnosis and timely initiation of disease‐modifying agents.”
Patient’s may be given one or more of these medications to get things under control. Usually the first type of medications used are called Disease-modifying antirheumatic drugs (DMARDs), which slow or stop the immune system from attacking the joints. Sometimes Biologic response modifiers are used along with DMARDs; these drugs target the molecules which are involved in the immune response specifically, to stop them from acting in a detrimental way.
Other medications that may be offered for arthritis include painkillers and anti-inflammatories; these help to reduce the pain and inflammation in the joints and make symptoms more manageable. As the inflammation goes down, joints may be more mobile making it easier for patients to function. These medications may be over the counter or prescribed by your doctor depending on the type.
Sometimes corticosteroids are used which can either be taken in a tablet form or are sometimes injected directly into the affected joint; they help to reduce inflammation as well as suppress the immune system.
Sometimes a topical cream will be offered which can be rubbed on the affected joints; these creams typically produce a tingling sensation which interrupts the pain signals being sent and provides some relief.
- Physical therapy
Working with a physical therapist can help to strengthen patient’s joints as well as their body in general. Stronger muscles around the joints can reduce pain and improve mobility.
- Occupational therapy
An occupational therapist will teach you how to optimize your surroundings at home or at work, in order to minimize your arthritis symptoms and increase functioning. They can teach you how to use positions to do daily activities that are going to put the least strain on your joints; they can advise on ways you can function using the muscles that are the strongest while gently working the weaker muscles.
Often, they will advise you on adaptations that could make your life easier. An example of this are grab rails to help pull yourself up steps or off the toilet. They may advise on braces and joint supports that can help you to protect your joints while functioning. They could suggest modifications to your kitchen or bathroom; essentially anything that can help you to function more and reduce symptoms could be suggested.
You may be referred to a podiatrist who can help you with specialized footwear and insoles for your shoes; these can be to accommodate worn joints, to provide more support and to reduce impact on joints when walking.
Arthritis can be challenging to live with and can often result in mental health issues; often counselling may be suggested to help patient’s talk through what they are going through and get a better handle on their mental health.
- Cognitive behavioural therapy (CBT)
CBT has proven to be very helpful in educating patients about their arthritis, giving them a deeper understanding of what is causing their pain and how they can deal with it. CBT helps patients to feel empowered, to replace unhelpful thoughts and behaviours with positive ones and to live a fuller life. By breaking the chronic pain cycle, CBT and other mindfulness therapies can help patients to reduce symptoms and even be free of pain!
As I grew up I watched my mother implement CBT techniques to deal with her arthritis, even she wasn’t doing that consciously; for example, continuing to gently exercise, continuing to socialize, not avoiding activity, practicing self-care, facing fears head on and thinking in a positive way. Watching how much those approaches enriched my mother’s life and helped her to function more as I grew up influenced me. When I started to struggle with chronic conditions in adulthood, I knew how I wanted to approach it. I did more research into how to deal with my condition and implemented CBT techniques myself which have made a big positive difference in my life.
You can access CBT through a private therapist, through a referral from your doctor, online or through an app like Pathways Pain Relief (update Aug 2023: Pathways is now a web app! Start our program here).
If your arthritis is severe and other methods have not helped to get it under control, sometimes surgery is needed to deal with the damaged joints. Sometimes joints can be repaired during surgery; rough surfaces can be smoothed, and joints can be realigned to reduce symptoms and increase movement.
Joint fusion is sometimes used, usually for smaller joints, which fuses together two bones in a joint in order to reduce the pain of friction between the bones.
Often joint replacement is used for cases within which the joint is severely damaged; the damaged joint is removed completely and replaced with a new artificial joint. These artificial joints do need to be replaced every ten years or so depending on their wear but can improve mobility and reduce pain. My mother had a knee replacement when I was younger and has recently had that artificial knee joint replaced; the recovery is long but these advancements in science have enabled her to live a more fulfilled life.
Living beyond arthritis
As well as the many treatment options available from medical professionals, a lot of the management of arthritis comes from the individual in their home environment day to day, practicing self-care. This study explains that self management plays a big part in managing arthritis and defines this approach as, “learning and practicing the skills necessary to carry on an active and emotionally satisfying life in the face of a chronic illness”
If you struggle with arthritis, there are ways that you can help yourself and improve your quality of life.
- Eating well
There’s no one special diet for those with arthritis but eating a healthy and well-balanced diet helps to give your body the best chance it can to function well.
- Managing your weight
Being overweight puts more strain on the joints, so keeping your weight under control is something that you can be proactive with and can see a big difference in reduction of symptoms as you reach a healthier weight. Eating well, reducing sugar and fat in your diet and exercising regularly can help you to get your weight to a healthy level and to maintain a healthy weight.
- Regular gentle exercise
With arthritis, your joints typically feel more sore and stiff after exercise; this can lead to people withdrawing from exercise because they are afraid they are damaging their joints more. This worsening of symptoms after exercise does not mean that you are damaging your joints; in fact, gentle exercise is vital to strengthen the muscles around arthritic joints.
Exercise has even been proven to reduce pain and inflammation in arthritis patients, to reduce the risk of falling, to improve mood and so much more as explained here.
Exercises like walking, swimming and yoga can be great to keep your body moving without putting too much strain on your joints.
It’s a good idea to discuss a new exercise regime with your doctor to ensure that it works for your personal situation; talking about it first can also help increase your confidence and reassure you that you are doing the best thing for your health.
- Know your limits
It’s to learn how to balance gentle exercise with rest; there’s value to taking breaks and learning where your limits are regarding pain. While low impact activities with rests in between are positive, high impact activities and pushing yourself too far are detrimental to arthritis patients.
- Mindfulness techniques
Mindfulness techniques such as meditation can help you to release muscle tension and reduce stress; this in turn reduces pain.
- Maintain a good sleep pattern
If you struggle with a chronic condition, you’ll know that sleeping well is easier said than done. However, doing all you can to keep a good sleep routine is beneficial to reduce stress, to reduce inflammatory hormones and therefore to reduce pain. Not only that but it gives you the energy you need to keep functioning. Small changes like being more active during the day, not drinking caffeine before bed and winding down before you try to sleep can make a big difference.
- Social interaction
Social withdrawal is common when people are in pain; maintaining those social connections is good for your mood, it keeps you active and allows you to have the support that we all need, especially when we have extra challenges in our lives.
- Changing positions regularly
Sitting or lying in the same position can make joints more stiff; remember to stay active and change positions regularly to keep your joints supple.
- Using heat and cold
Arthritis patients often find that using heat like hot water bottles and heating pads can help to relieve pain. Sometimes cold compresses and ice can be effective. My mother swears by alternating between the two to gain relief from symptoms.
- Using mobility aids
If there are aids that have been advised by your medical professionals, then use them; there’s no shame in using mobility aids. They are designed to help you be more mobile, to help you increase functioning and are certainly not a sign of having given up. If there are aids you feel that you could use around the house, don’t be afraid to seek them out yourself or ask your doctor about them.
From my own experience watching my mother cope with arthritis and now dealing with it myself, I know that it can be hard, but I also know that it doesn’t have to stop you from living the life you want! You can learn to work around it, to reduce symptoms and to thrive.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.
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