1. What is Arthritis?

Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more
than 100 different types of arthritis, with different causes and treatment methods. Two of the most
common types are osteoarthritis (OA) and rheumatoid arthritis (RA). The symptoms of arthritis usually
develop over time, but they may also appear suddenly. Arthritis is most commonly seen in adults over
the age of 65, but it can also develop in children, teens, and younger adults. Arthritis is more common in
women than men and in those who are overweight.
Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of
motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the
same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain,
inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent
joint changes. These changes may be visible, such as knobby finger joints, but often the damage can
only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well
as the joints.

There are four important warning signs that should prompt you to talk to a health care provider.
 Pain. Pain from arthritis can be constant or it may come and go. It may occur when at rest or
while moving.
 Swelling. Some types of arthritis cause the skin over the affected joint to become red and
swollen, feeling warm to the touch.
 Stiffness. This is a classic arthritis symptom, especially when waking up in the morning or after
sitting at a desk or riding in a car for a long time.
 Difficulty moving a joint. It shouldn’t be that hard or painful to get up from your favorite chair.

Causes of arthritis?
There is no single cause of all types of arthritis; the cause or causes in any given case vary
according to the type or form of arthritis.
Potential causes for arthritis may include:
• Injury - leading to degenerative arthritis
• Abnormal metabolism - leading to gout and pseudogout
• Inheritance - such as in osteoarthritis
• Infections - such as in the arthritis of Lyme disease
• Immune system dysfunction - such as in RA and SLE.
Most types of arthritis are caused by a combination of many factors working together, although some
arthritis conditions have no obvious cause and appear to be unpredictable in their emergence.
Some people may be more susceptible to certain arthritic conditions due to their genetic makeup.
Additional factors, such as previous injury, infection, smoking and physically demanding occupations,
can interact with a person's genes to further increase the risk of arthritis. Diet and nutrition can play a
role in managing arthritis and the risk of arthritis, although specific foods, food sensitivities or
intolerances are not known to cause arthritis. Foods that increase inflammation, particularly animal-
derived foods and diets high in refined sugar, can exacerbate arthritis. Similarly, eating foods that
provoke an immune system response can exacerbate arthritis symptoms.
2. Different Types of Arthritis

a. Osteoarthritis/ Degenerative Arthritis

 Osteoarthritis is the most common chronic condition of the joints, affecting approximately 27
million Americans. Over time, joints can lose strength and pain may become chronic. Risk factors
include excess weight, family history, age and previous injury. OA can affect any joint, but it occurs
most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb
and big toe.

When the joint symptoms of osteoarthritis are mild or moderate, they can be managed by:
- balancing activity with rest
- using hot and cold therapies
- regular physical activity
- maintaining a healthy weight
- strengthening the muscles around the joint for added support
- using assistive devices
- taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines
- avoiding excessive repetitive movements

If joint symptoms are severe, causing limited mobility and affecting quality of life, some of the above
management strategies may be helpful, but joint replacement may be necessary.
Osteoarthritis can prevented by staying active, maintaining a healthy weight, and avoiding injury and
repetitive movements.

Diagnosis
To diagnose osteoarthritis, the doctor will collect information on personal and family medical
history, perform a physical examination and order diagnostic tests.
Physical Examination. During the exam, the doctor will examine the joints and test their range of
motion (how well each joint moves through its full range). He will be looking for areas that are tender,
painful or swollen as well as signs of joint damage. The doctor will examine the position and alignment
of the neck and spine.
Diagnostic Tests. A diagnosis of osteoarthritis may be suspected after a medical history and physical
examination is done. Blood tests are usually not helpful in making a diagnosis. However, the following
tests may help confirm it:
 Joint aspiration. The doctor will numb the affected area and insert a needle into the joint to
withdraw fluid. The fluid will be examined for evidence of crystals or joint deterioration. This
test can help rule out other medical conditions or other forms of arthritis.
 X-ray. X-rays can show damage and other changes related to osteoarthritis to confirm the
diagnosis.
 MRI. Magnetic resonance imaging (MRI) does not use radiation. It is more expensive than X-
rays, but will provide a view that offers better images of cartilage and other structures to detect
early abnormalities typical of osteoarthritis.
Treatment
There is no cure, but treatments are available to manage symptoms. Long-term management of the
disease will include several factors:
 Physical Activity
One of the most beneficial ways to manage OA is to get moving. Studies show that simple activities like
walking around the neighborhood or taking a fun, easy exercise class can reduce pain and help maintain
(or attain) a healthy weight. Strengthening exercises build muscles around OA-affected joints, easing the
burden on those joints and reducing pain. Aerobic exercise helps to improve stamina and energy levels
and also help to reduce excess weight.
 Weight Management
Excess weight adds additional stress to weight-bearing joints, such as the hips, knees, feet and back.
Losing weight can help people with OA reduce pain and limit further joint damage.
 Stretching
Slow, gentle stretching of joints may improve flexibility, lessen stiffness and reduce pain. Exercises
such as yoga and tai chi are great ways to manage stiffness.
 Pain and Anti-inflammatory Medications
- Analgesics. These are pain relievers and include acetaminophen, opioids (narcotics) and an
atypical opioid called tramadol.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to
ease inflammation and related pain.
- Corticosteroids. Corticosteroids are powerful anti-inflammatory medicines, taken by mouth
or injected directly into a joint at a doctor’s office.
- Hyaluronic acid. Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber and
lubricant.
 Physical and Occupational Therapy
Physical and occupational therapists can provide a range of treatment options for pain management
including: ways to properly use joints; heat and cold therapies; range of motion and flexibility exercises;
assistive devices
 Assistive Devices
Assistive devices can help with function and mobility. These include items, such as like scooters,
canes, walkers, splints, shoe orthotics or helpful tools, such as jar openers, long-handled shoe horns or
steering wheel grips.
 Natural and Alternative Therapies
Many people with OA use natural or alternative therapies to address symptoms and improve their
overall well-being.
 Surgery
Joint surgery can repair or replace severely damaged joints, especially hips or knees.
 Positive Attitude
Many studies have demonstrated that a positive outlook can boost the immune system and increase a
person's ability to handle pain.

b. Gout
Gout is a form of inflammatory arthritis that develops in some people who have high levels of uric
acid in the blood. The acid can form needle-like crystals in a joint and cause sudden, severe episodes of
pain, tenderness, redness, warmth and swelling.
Stages of gout:
- Asymptomatic hyperuricemia is the period prior to the first gout attack. There are no
symptoms, but blood uric acid levels are high and crystals are forming in the joint.
- Acute gout, or a gout attack, happens when something (such as a night of drinking) causes uric
acid levels to spike or jostles the crystals that have formed in a joint, triggering the attack.
- Interval gout is the time between attacks. There’s no pain, the gout isn’t gone. Low-level
inflammation may be damaging joints.
 - Chronic gout develops in people with gout whose uric acid levels remain high over a number of
years.
Diagnosis
To diagnose gout, the doctor will take a patient's medical history, examine the affected joint and do a
blood test. He or she will also ask about:
- Other symptoms
- What medications the patient is taking
- The patient's diet
- How quickly and intensely the gout attack came on
Details of the attack the doctor is looking for: severity of pain, length of attack and joints affected.
The doctor will need to rule out other potential causes of joint pain and inflammation such as infection,
injury or another type of arthritis. He will take a blood test to measure the level of uric acid in your
blood. A high level of uric acid in your blood doesn’t necessarily mean you have gout, just as a normal
level doesn’t mean you don’t have it. He may take an X-ray, ultrasound, CT or MRI to examine soft
tissue and bone. The doctor might also remove fluid from the affected joint and examine it under a
microscope for uric acid crystals. Finding uric acid crystals in the joint fluid is the surest way to make a
gout diagnosis.
Treatment
 Treating an Acute Gout Attack
- Here are the steps for getting the pain and swelling of a gout attack under control:
- Take an anti-inflammatory medication as soon as possible
- Ice and elevate the joint
- Drink plenty of fluids (no alcohol or sweet sodas)
- Call your doctor and make an appointment
- Relax; stress can aggravate gout.
- Ask friends and family to help you with daily tasks.
 Medications for Treating An Acute Gout Attack
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are frequently used to quickly relieve
the pain and swelling of an acute gout episode and can shorten the attack, especially if taken in
the first 24 hours.
- Corticosteroids. Corticosteroids (such as prednisone) can be taken by mouth or injected into an
inflamed joint to relieve the pain and swelling of an acute gout attack. They can also be injected
systemically if the attack doesn’t respond to other medications or if many joints are affected.
- Colchicine. It helps to relieve the pain and swelling of acute attacks. Colchicine’s most common
side effects are diarrhea, nausea and abdominal cramp, but more severe side attacks can occur.
Reducing Uric Acid Levels
Medications that lower uric acid are intended to prevent gout attacks and keep the condition from
becoming chronic.
- Allopurinol reduces the production of uric acid. It is often prescribed at a low daily dose at first,
with the dose gradually increasing over time.
- Febuxostat may be an option if you develop side effects from allopurinol or have kidney
disease. Like allopurinol, febuxostat decreases the amount of uric acid made in the body.
- Probenecid acts on the kidneys to help the body eliminate uric acid. The medication is taken
daily and may be combined with antibiotics to boost effectiveness
 - Pegloticase is used when standard medications are unable to lower the uric acid level, a
condition known as refractory chronic gout. Pegloticase reduces uric acid quickly and to lower
levels than other medications

c. Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system – which
normally protects its health by attacking foreign substances like bacteria and viruses – mistakenly
attacks the joints. This creates inflammation that causes the tissue that lines the inside of joints (the
synovium) to thicken, resulting in swelling and pain in and around the joints. The synovium makes a
fluid that lubricates joints and helps them move smoothly.
Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and
ankles. Rheumatoid arthritis can affect body systems, such as the cardiovascular or respiratory systems,
it is called a systemic disease. Systemic means “entire body.”
Diagnosis
A primary care physician may suspect RA based in part on a person's signs and symptoms. If so,
the patient will be referred to a rheumatologist – a specialist with specific training and skills to diagnose
and treat RA. In its early stages, RA may resemble other forms of inflammatory arthritis. No single test
can confirm RA. To make a proper diagnosis, the rheumatologist will ask questions about personal and
family medical history perform a physical exam and order diagnostic tests.
- Medical History. The doctor will ask about personal and family medical history as well as
recent and current symptoms (pain, tenderness, stiffness, difficulty moving).
- Physical Exam. The doctor will examine each joint, looking for tenderness, swelling, warmth
and painful or limited movement.
- Blood Tests. The blood tests will measure inflammation levels and look for biomarkers such as
antibodies (blood proteins) linked with RA.
- Inflammation. Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein
(CRP) level are markers of inflammation.
- Antibodies. Rheumatoid factor (RF) is an antibody found in about 80 percent of people with RA
during the course of their disease.
- Imaging Tests. An X-ray, ultrasound or magnetic resonance imaging scan may be done to look
for joint damage, such as erosions – a loss of bone within the joint – and narrowing of joint
space.
Treatment
The goals of rheumatoid arthritis (RA) treatment are to:
- Stop inflammation (put disease in remission)
- Relieve symptoms
- Prevent joint and organ damage
- Improve physical function and overall well-being
- Reduce long-term complications
To meet these goals, the doctor will follow these strategies:
- Early, aggressive treatment. The first strategy is to reduce or stop inflammation as quickly as
possible – the earlier, the better.
- Targeting remission. Doctors refer to inflammation in RA as disease activity. The ultimate goal
is to stop it and achieve remission, meaning minimal or no signs or symptoms of active
inflammation. One strategy to achieve this goal is called “treat to target.”
 - Tight control. Getting disease activity to a low level and keeping it there is what is called having
“tight control of RA.” Research shows that tight control can prevent or slow the pace of joint
damage.
Medications for Rheumatoid Arthritis
 Drugs That Ease Symptoms
Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over-the-counter and by prescription.
They are used to help ease arthritis pain and inflammation. For people who have had or are at risk of
stomach ulcers, the doctor may prescribe celecoxib, a type of NSAID called a COX-2 inhibitor, which is
designed to be safer for the stomach.
 Drugs That Slow Disease Activity
- Corticosteroids. Corticosteroid medications, including prednisone, prednisolone and
methyprednisolone, are potent and quick-acting anti-inflammatory medications.
- DMARDs. An acronym for disease-modifying antirheumatic drugs,DMARDs are drugs that
work to modify the course of the disease.
- Biologics. These drugs are a subset of DMARDs. Biologics may work more quickly than
traditional DMARDs, and are injected or given by infusion in a doctor’s office.
- JAK inhibitors. A new subcategory of DMARDs known as “JAK inhibitors” block the Janus
kinase, or JAK, pathways, which are involved in the body’s immune response. Tofacitinib
belongs to this class. Unlike biologics, it can be taken by mouth
Surgery
May never be needed, but it can be an important option for people with permanent damage that
limits daily function, mobility and independence. Joint replacement surgery can relieve pain and restore
function in joints badly damaged by RA. The procedure involves replacing damaged parts of a joint with
metal and plastic parts. Hip and knee replacements are most common. However, ankles, shoulders,
wrists, elbows, and other joints may be considered for replacement.

d. Inflammatory Arthritis
Inflammatory arthritis is a group of diseases characterized by inflammation of the joints and often
other tissues. A healthy immune system is protective. Rheumatoid arthritis and psoriatic arthritis are
examples of inflammatory arthritis. Researchers believe that a combination of genetics and
environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor
that can trigger rheumatoid arthritis in people with certain genes.
Diagnosis
A doctor makes a diagnosis of inflammatory arthritis based largely on a medical history and
physical exam. Depending on the particular form of arthritis, the diagnosis may be confirmed through
other tests including lab tests and X-rays or other imaging tests.
Treatment
Treatment for inflammatory arthritis is based to the specific disease; several drugs are used for
different forms of inflammatory arthritis. These include nonsteroidal anti-inflammatory drugs (NSAIDs)
to relieve pain and inflammation and disease-modifying anti rheumatic drugs (DMARDs) or biologic
agents to slow or stop the progression of the disease and damage to the joints. Less commonly,
corticosteroids are used to quickly stop inflammation that threatens the joints or internal organs.

e. Infectious Arthritis
Infectious arthritis is a form of arthritis caused by an infection in the joint. It is also called septic
arthritis. The infection itself is not present in the joint. A bacterium, virus or fungus can enter the joint
and trigger inflammation. The organisms that can infect joints are salmonella and shigella (food
poisoning or contamination), chlamydia and gonorrhea (sexually transmitted diseases) and hepatitis C (a
blood-to-blood infection, often through shared needles or transfusions). In many cases, timely treatment
with antibiotics may clear the joint infection, but sometimes the arthritis becomes chronic.
Diagnosis
The diagnosis of infectious arthritis will include a complete medical history, physical exam and
laboratory tests. In analyzing a sample of joint fluid can determine what organism is causing the
infection and help the doctor plan treatment. X-rays and other imaging tests of the affected joint also
may be ordered to assess any damage to the joint.
Treatment
The treatment will depend on the type of germ causing the infection. Those bacterial infections
are almost always treated with antibiotics. The type of antibiotic used will depend on the specific
bacterium causing the infection. Antibiotics may be taken by mouth or given by intravenous injection.
Antibiotics often stop the infection in a few days to a few weeks, but in some cases, they must be given
over several months. It is caused by a fungus can be hard to treat, often requiring several months of
antifungal medicine and sometimes surgery to remove the infected tissue. Also, it caused by a virus, on
the other hand, usually goes away on its own with no specific treatment.
The treatment may also be necessary to relieve pain and inflammation of infectious arthritis. In some
cases, the doctor may drain the infected joint by inserting a needle into it and withdrawing fluid.

f. Metabolic Arthritis
Uric acid is formed as the body breaks down purines, a substance found in human cells and in many
foods. Some people have high levels of uric acid because they naturally produce more than is needed or
the body can’t get rid of the uric acid quickly enough. In some people the uric acid builds up and forms
needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain, or a gout attack. Gout
can come and go in episodes or, if uric acid levels aren’t reduced, it can become chronic, causing
ongoing pain and disability.
Diagnosis
Usually, physicians can diagnose gout based on the physical examination and medical history
(the patient's description of symptoms and other information). Doctors can also administer a test that
measures the level of uric acid in the blood. While normal uric acid levels don't necessarily rule out gout
and high levels don't confirm it, the presence of hyperuricemia increases the likelihood of gout. The
development of a tophus can confirm the diagnosis of gout. The most definitive way to diagnose gout is
to take a sample of fluid from the joint and test it for urate crystals.
Treatment
The goals of treatment for gout consist of alleviating pain, avoiding severe attacks in the future,
and preventing long-term joint damage. In addition to taking pain medications as prescribed by their
doctors, people having gout attacks are encouraged to rest and to increase the amount of fluids that they
drink. Acute attacks of gout can be treated with nonaspirin, nonsteroidal anti-inflammatory drugs
(NSAIDs) such as naproxen sodium (Aleve), ibuprofen (Advil), or indomethacin (Indocin). In some
cases, these drugs can aggravate a peptic ulcer or existing kidney disease and cannot be used. Doctors
sometimes also use colchicine (Colbenemid), especially in cases where nonsteroidal anti-inflammatory
drugs cannot be used. Colchicine may cause diarrhea, which tends to go away once the patient stops
taking it. Corticosteroids such as prednisone (Deltasone) and adrenocorticotropic hormone (Acthar) may
be given orally or may be injected directly into the joint for a more concentrated effect.
3. Preventive measures, Alternative treatment and management to this disease

The fact is there is no sure way to prevent arthritis. There are more than 100 types of arthritis and
related conditions, and have all have risk factors, individual features, behaviors and circumstances that
are associated with the disease. There are risk factors that are not modifiable. That means there is
nothing you can do about them. Being female and having a family history of arthritis (genetic profile)
are two examples of factors that make people more likely – but not certain -- to get some types of
arthritis.
In contrast, some risk factors are considered to be modifiable. They are the behaviors and
circumstances that can be changed in order to reduce risk, delay onset or altogether prevent arthritis.
Few examples arthritis and related diseases and associated modifiable risk factors:
 Osteoarthritis – Maintain a healthy weight
 Rheumatoid arthritis – Do not smoke
 Gout – Eat a healthful diet, low in sugar, alcohol and purines
In some cases, preventing a prior incident can significantly reduce the risk of arthritis. Right
now, because scientists don’t fully understand the causes or mechanisms behind these diseases, true
prevention seems to be impossible. Many types of arthritis are thought to result from a combination of
genetic predisposition and an environmental trigger, such as a virus or toxin. Discovery of the trigger for
a type of arthritis may be the key to its prevention, even in someone with genetic risk.

Medication:
Non-inflammatory types of arthritis such as osteoarthritis are often treated with pain medications,
physical activity, weight loss if the person is overweight and self-management education. Medications
that are used to treat arthritis depend on the type of arthritis. Commonly used arthritis medications
include:

 Analgesics: these reduce pain, but have no effect on inflammation.

 Non-steroidal anti-inflammatory drugs (NSAIDs): these reduce both pain and inflammation.
 Counterirritants: rubbing these preparations on the skin over a painful joint can modulate pain
signals from the joint and lessen pain
 Disease-modifying antirheumatic drugs (DMARDs): used to treat RA, DMARDs slow or stop
your immune system from attacking your joints.
 Biologics: used in conjunction with DMARDs, biologic response modifiers are genetically
engineered drugs that target various protein molecules involved in the immune response.
 Corticosteroids: this class of drug reduces inflammation and suppresses the immune system.

Physical therapies
Doctors will often recommend a course of physical therapy to help patients with arthritis overcome
some of the challenges of arthritis and to reduce limitations on mobility. Forms of physical therapy that
may be recommended include:

 Warm water therapy - exercises in a warm-water pool. The water supports weight and puts less
pressure on the muscles and joints
  Physical therapy - specific exercises tailored to the condition and individual needs, sometimes
combined with pain-relieving treatments such as ice or hot packs and massage
 Occupational therapy - practical advice on managing everyday tasks, choosing specialized aids
and equipment, protecting the joints from further damage and managing fatigue.

Physical activity
People with arthritis can participate in joint-friendly physical activity on their own or with friends. As
many people with arthritis have a co-morbidity, such as heart disease, it is important to ensure that
physical activity is appropriate for each condition. Some of the joint-friendly physical activities that are
appropriate for adults with arthritis and heart disease include: (Walking, Swimming, or Riding a bike).

References:

 http://www.arthritis.org/about-arthritis/understanding-arthritis/do-i-have-arthritis.php
 http://www.arthritis.org/about-arthritis/understanding-arthritis/diagnosing-arthritis.php
 http://www.arthritis.org/about-arthritis/types/osteoarthritis/
 http://www.arthritis.org/about-arthritis/types/gout/
 http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-
arthritis.php
 http://www.arthritis.org/about-arthritis/types/inflammatory-arthritis/
 http://www.arthritis.org/about-arthritis/types/infectious-arthritis/
 http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-
arthritis.php
 http://www.arthritis.org/about-arthritis/understanding-arthritis/arthritis-prevention.php
 http://www.medicalnewstoday.com/articles/7621.php?page=2
 http://www.healthline.com/health/arthritis#causes
 http://www.medicalnewstoday.com/articles/7621.php#what_causes_arthritis
 http://www.medicalnewstoday.com/articles/7621.php
 http://www.medicalnewstoday.com/articles/7621.php?page=3#treatments_for_arthritis