Many people think arthritis is a single disease, but it’s not. Arthritis literally means “joint inflammation” and refers to a group of more than 100 rheumatic diseases and related conditions that are associated with joint pain, joint stiffness and swelling.
Key Points
Certain arthritic conditions can affect parts of the body other than the joints.
For example: tendons, muscles, and skin can become inflamed and painful. Some rheumatic conditions can affect internal organs and result in debilitating or even life-threatening complications.
“The two most common types of arthritis are osteoarthritis and rheumatoid arthritis”. While they are both classified as arthritis, osteoarthritis and rheumatoid arthritis are very different and must be distinguished.
Many people believe arthritis is a disease that only affects old people. In fact, arthritis can affect anyone at any age, including children. The incidence of arthritis increases with age, but nearly 3 out of 5 people with arthritis are under age 65.
If left undiagnosed and untreated, many types of arthritis can cause irreversible damage to the joints, bones, organs, and skin. It is essential to be diagnosed early in the course of the disease and treated appropriately. Knowing your type of arthritis is essential.
Types of Arthritis
Osteoarthritis
Osteoarthritis, also known as degenerative joint disease, results from wear and tear on the joint. Cartilage damage develops which can lead to decreased joint function.
The first signs of osteoarthritis are:
- joint pain
- joint tenderness
- joint swelling
- decreased range of motion
Usually, osteoarthritis onset is subtle and gradual, involving one or only a few joints. The joints most often affected are the:
- knees
- hips
- hands
- spine
The risk of developing osteoarthritis increases with age. Other risk factors include: joint injury, obesity, and repetitive use of the joint.
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease which occurs when the body’s own immune system mistakenly attacks the synovium (cell lining inside the joint). Rheumatoid arthritis is an inflammatory type of arthritis, chronic and potentially disabling. The first signs of the disease are:
- joint pain
- joint stiffness
- joint swelling
- loss of joint function
While the cause remains elusive, doctors suspect that genetic factors play some role in predisposition to the disease. But there is more than genetic predisposition. It is thought that there are also environmental triggers for rheumatoid arthritis.
Juvenile Arthritis
Juvenile arthritis is a general term for all types of arthritis that occur in children, 16 years old or younger. Juvenile rheumatoid arthritis is the most prevalent type of arthritis in children.
There are three major types of JRA:
- Polyarticular (affecting many joints)
- Pauciarticular (pertaining to only a few joints)
- Systemic (affecting the entire body)
Signs and symptoms of juvenile rheumatoid arthritis vary from child to child. No single test can conclusively establish a diagnosis.
Juvenile arthritis must be present consistently for six or more consecutive weeks before a correct diagnosis can be made.
Psoriatic Arthritis
Psoriatic arthritis is similar to rheumatoid arthritis. About 5% of people with psoriasis (a chronic skin disease) also develop psoriatic arthritis. In psoriatic arthritis, there is inflammation of the joints and sometimes the spine.
Fibromyalgia
Fibromyalgia syndrome is a painful condition characterized by:
- muscle pain
- chronic fatigue
- poor sleep
Fibromyalgia is characterized by pain in the muscles, ligaments and tendons. Fibromyalgia is a type of soft tissue or muscular rheumatism and does not cause joint deformities.
Gout
Gout is a painful type of arthritis that causes sudden, severe attacks of pain, tenderness, redness, warmth, and swelling in the joints, especially the big toe. The pain and swelling associated with gout are caused by uric acid crystals that precipitate out of the blood and are deposited in the joint.
Pseudogout / CPPD
Pseudogout, which is also known as Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD), is caused by deposits of calcium phosphate crystals (not uric acid) in the joints. CPPD is often mistaken for gouty arthritis. Since CPPD is a different disease than gout, treatment is not the same.
Know Your Type of Arthritis.
It’s not uncommon to hear people say “I have arthritis.” Generally speaking, they are correct, but more accurately, they have a specific type of arthritis. There are over 100 types of arthritis.
Most of the 100 types are rare diseases. You can count on two hands the types you have probably heard of at all, and on two fingers the ones most referred to and considered most common: (osteoarthritis and rheumatoid arthritis).
Symptoms That Suggest Arthritis
People who are experiencing early, vague symptoms related to joint pain, joint stiffness, joint swelling, or limited range of motion may suspect arthritis. But arthritis symptoms, especially early arthritis symptoms, can overlap with other conditions.
It is important to have a doctor assess your symptoms and accurately diagnose your condition. Before x-rays are taken or blood tests are ordered, you may not know if you are dealing with an acute joint injury or a chronic disease. To determine the cause of your symptoms, your doctor must take your medical history, perform a physical examination, and order diagnostic tests. While the pattern of symptoms will give
clues, symptoms alone do not formulate a diagnosis.
The Importance of Diagnosing the Right Condition
When it comes to initial symptoms, people tend to self-treat before consulting a doctor. Perhaps no harm comes from taking a stab at self-treatment, but there’s likely no significant benefit either. Typically, people try common over-the-counter treatments, hoping something will make a difference. Many people who choose to self-treat find that symptoms persist. They realize they are treading water, if not getting worse, without doctor’s input. Others continue to self-treat or just live with their symptoms, risking the consequences that come from delaying appropriate treatment.
The Centers for Disease Control and Prevention estimate that while more than 10 million Americans have chronic joint symptoms, most have not been evaluated or treated by a doctor. Of the 2.2 million people
believed to have rheumatoid arthritis in the U.S., more than 700,000 have not been diagnosed or treated. Of the 1.5 million who have been diagnosed with rheumatoid arthritis, more than 800,000 are under the
care of a primary care physician, not a rheumatologist (a specialist in arthritis and rheumatic diseases).
Few joints may be involved at the initial consultation with a doctor. There may not be much revealed when results come back from blood tests or x-rays. But your doctor will order more extensive tests until a diagnosis can be made.
Early, Disease-Modifying Treatment Brings Best Results
Some types of arthritis are inflammatory, while others are non-inflammatory.
Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis are examples of inflammatory arthritis. Osteoarthritis is a type of arthritis that has been classified as non-inflammatory (although newer research has suggested there may be an inflammatory process involved with osteoarthritis).
A class of drugs known as disease-modifying anti-rheumatic drugs (DMARDs) are effective for many patients with inflammatory types of arthritis.
When DMARDs are indicated, early treatment is essential. A meta-analysis of 14 clinical trials involving more than 1,400 patients established that early DMARD use was important, and that held true regardless of the
type of DMARD prescribed. Patients who received DMARD therapy early had a better outcome than those who delayed treatment — and the best chance for preventing joint damage.
Researchers are working on the development of disease-modifying osteoarthritis drugs (DMOADs), too. At this point, there are no osteoarthritis drugs that can slow progression of the disease. Drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and pain medications mostly impact symptoms, not disease progression. When only one or few joints are involved, injections of (cortisone or hyalgan may be used to bring inflammation under control).
The Bottom Line
It’s important to know your type of arthritis so that you can receive the proper treatment. Early, aggressive treatment is essential for bringing arthritis under control and slowing progression of the disease.
Your doctor will guide you to the best treatment option with the goal of controlling symptoms and preventing permanent joint damage.
Whether you start with NSAIDs (nonsteroidal anti-inflammatory drugs), corticosteroids, DMARDs, biologics, or a combination – early treatment is the way to go.
