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Arthritis

Arthritis

Arthtritis

The term “arthritis” is taken from two Latin words:
• “arthro” means joint, or a part of the body where bones meet
• “itis” means inflammation; symptoms are redness, heat, swelling, and pain

Who gets arthritis and why?

People of all ages can have arthritis, but it occurs more often among older people. Nearly 43 million Americans
are affected by this condition. We do not know the cause of most types of arthritis, but probably there
are many different causes.

What are the symptoms?

There are six main signs of arthritis. They usually occur in or around a joint.
1. Pain
2. Stiffness
3. Swelling (sometimes)
4. Difficulty moving a joint
5. Redness around the joints
6. Decreased range of motion

Arthritis symptoms can vary widely among individuals. For example:
• Symptoms can develop suddenly or slowly
• Pain can be constant or can come and go
• Pain may occur when the person is moving or has been still for some time
• Pain may be felt in one spot or in many parts of the body
• The skin over the joint may appear swollen and red and feel warm to the touch
• Some types of arthritis are associated with fatigue
• Often the pain and stiffness are more severe in the morning or after a period of inactivity

Arthritis is usually chronic, which means it lasts a long time and may never go away.

This condition can make it hard for people to do many of the daily tasks they used to do easily by themselves. This causes a loss of independence and a need to rely on others for assistance.

What happens in arthritis?

Arthritis usually affects areas in or around joints. Joints are parts of the body where bones meet. The ends of the bones are covered by cartilage, which is a spongy material that works as a shock absorber to keep bones from rubbing together.

Joints are enclosed in a capsule, called the joint capsule. The joints are lined with tissue, called the synovium or synovial membrane. The synovial membrane releases a slippery fluid that “greases” the joint and helps it move smoothly and easily.

Muscles and tendons are connected to the bones. They support the joints and help with movement. Different types of arthritis can affect one or more different parts of a joint. When arthritis affects a joint, it can change the shape and alignment of the bones or the joints. Certain types of arthritis can also affect other parts of the body besides the joints, such as the skin and internal organs.

Types of arthritis

There are more than 100 different types of arthritis and related conditions. The following are a few of the more common kinds.

Osteoarthritis (OA) is the most common kind. It is also called degenerative arthritis or degenerative joint disease. OA affects many older people. It usually occurs after age 45 in both men and women.

In osteoarthritis, the cartilage and bones begin to deteriorate or break down. This means the bones might rub together or not move smoothly within the capsule. The result is pain and stiffness. OA usually affects the fingers and the weight-bearing joints, such as the knees, feet, hips, and back.

Rheumatoid arthritis (RA) is another common form. It occurs three times more often in women than in men and usually begins in the young or middle adult years. Morning stiffness that usually lasts more than one hour is common with RA, and over time joints may lose their range of motion and may become deformed.

In this type of arthritis, something goes wrong with the body’s immune system. The immune system is usually the way the body defends itself against bacteria and viruses. In RA, the immune system works improperly and attacks the body’s own joints and organs. This problem causes warmth and swelling (inflammation) of the joint lining (synovium). This can cause damage to the cartilage, bone, and tendons of the joint. RA often affects the same joints on both sides of the body. If the right knee is swollen, then the left knee will probably be swollen also. The hands, wrists, feet, knees, ankles, shoulders, neck, jaw, and elbows are frequently affected.

Fibromyalgia is a common condition that usually afflicts women. It affects muscles and the points where they attach to bones. Fibromyalgia creates tender points in the body that are more sensitive to pain and touch. It also causes pain throughout the entire body. Fatigue and stiffness are part of this problem, along with restless sleep and psychological distress.

Lupus is a type of arthritis that causes inflammation of the skin, body tissues, and organs such as the kidneys, lungs, or heart. Lupus affects women 8–10 times more often than men and often first appears between the ages of 18 and 45. Arthritis in the joints can also be a symptom of lupus. Lupus can be fatal, but there are treatments that can help.

Gout causes severe pain and swelling in the big toes, ankles, and knees. Gout results when the body produces or retains too much uric acid, which is a natural substance in the body. The excess uric acid forms needlelike crystals in the joint, causing pain. It is more common in men than women because men more frequently have higher uric acid levels. Weight loss and limited alcohol intake help this condition, along with medication.

Can you prevent arthritis?

There are things we can do to reduce the risk of getting certain kinds of arthritis. These things also help reduce the level of disability in people who have arthritis and may keep the condition from getting worse. They are:
• Maintain recommended weight
–– People who are overweight have a higher frequency of osteoarthritis, especially in the weight-bearing joints (knees and hips)
–– Women are especially at risk for developing osteoarthritis from being overweight
–– In men, excess weight increases the risk of developing gout
• Guard against injury
–– Joint injuries caused by accidents or overuse increase the risk of osteoarthritis
–– Keep the muscles around joints strong by exercising, to reduce the risk of wear on the joint and to help prevent injury
–– Get adequate calcium and vitamin D to protect against bone fractures

Treatments that work

There are several things we can do to help most types of arthritis. First, anyone who has symptoms of arthritis should see a doctor for a correct diagnosis. Only a doctor can decide if a person has arthritis or not and what kind it is. It is important to know the type of arthritis because there are different treatments for different types.

Medication is important for reducing the pain and inflammation of arthritis. Doctors often prescribe:
• Aspirin-free pain relievers such as acetaminophen (Tylenol).
• Anti-inflammatory drugs such as aspirin, ibuprofen (Advil), and naproxen (Aleve). These reduce the warmth and redness (inflammation) in the joints or skin and also relieve pain.
• Prescription medication such as corticosteroids may be prescribed to reduce inflammation. This can be given orally or by injection.
• Biologic medications were introduced in 1998 this includes etanercept (Enbrel), adalimumab (Humira), rituximab (Rituxan), and others. Biologics work by interfering with the immune system signals and ultimately reducing inflammation.
• Sleep aids.

If you are helping someone take medication, you should know the name of the medicine, how much the individual is supposed to take, how and when the person should take it, how quickly it works, what it does, and side effects to watch for. Anti-inflammatory drugs can cause stomach pain and bleeding and can also thin the blood so that a person bleeds excessively. Always report complaints of stomach pain.

Exercise is one of the best treatments for arthritis. There are different ways to exercise (see Figure 3.2).

Heat and cold applications can provide relief from some of the symptoms of arthritis. Heat relaxes aching muscles and can be applied with warm compresses and warm water soaks. Cold numbs the area and reduces pain and can be applied with ice or cold packs. Either heat or cold is fine to use, depending on the individual’s preference. When using either type of application, it’s important to remember:
• Never use heat with rubs or creams. The combination of heat and creams can burn the skin.
• It is helpful to use heat or cold before exercising, to prepare the joints and muscles.
• Be safe! Don’t leave a hot or cold treatment on the skin for more than 20 minutes at a time. Let the skin return to its normal temperature between treatments.

Pacing activities also save energy, reduce fatigue, and protect joints from stress and injury. Keep the following in mind:
• Alternate heavy or repeated tasks with easy tasks
• Switch periods of activity with periods of rest
• Change tasks often so the joints don’t stay in one position for a long time

Joint protection uses the joints in ways that avoid stress and can make it easier to do tasks. Pay attention to joint position and use the joints in the best way. Use larger or stronger joints to carry things, such as carrying a grocery bag with the forearms, not the hands. Use walking or assistive devices to reduce stress on the joints and to make tasks easier, such as canes, walkers, and reachers. Use thick pens for writing, and only carry lightweight items.

Self-care skills mean taking care of oneself by planning activities for the best times, when feeling more flexible or in less pain. The person should do enjoyable things and learn how to manage stress.