Contents of this article:
You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Here are some key points about arthritis. More detail and supporting information is in the main article.
- "Arthritis" defines around 200 rheumatic disease and conditions that affect joints.
- Rheumatic diseases include various types of arthritis, as well as osteoporosis and systemic connective tissue diseases.
- Types of arthritis such as lupus and rheumatoid arthritis affect multiple organs and cause a long list of symptoms.
- According to the Centers for Disease Control and Prevention (CDC), 52.5 million adults report having been diagnosed by their doctor with some form of arthritis.
- Arthritis can impair a person's ability to perform "everyday" tasks.
- Physical activity has a positive effect on arthritis and can improve pain, function and mental health.
- The most common comorbid condition experienced with arthritis is heart disease.
- Factors in the development of arthritis include injury, abnormal metabolism, genetic makeup, infections and immune system dysfunction.
- Treatment for arthritis aims to control pain, minimize joint damage and improve or maintain quality of life.
- Arthritis is treated with a combination of medications, physical therapies and patient education and support.
What is arthritis?
The term "arthritis" is used to describe numerous rheumatic diseases and conditions that affect joints.
Rheumatic conditions are typically characterized by pain, aching, stiffness and swelling in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.6
Some forms of arthritis, such as rheumatoid arthritis and lupus (SLE), can affect multiple organs and cause widespread symptoms.
Arthritis is more common among adults aged 65 years or older, but people of all ages (including children) can be affected.
Types of arthritis
There are around 200 types of arthritis - or musculoskeletal conditions - which are split into seven main groups:26
- Inflammatory arthritis
- Degenerative or mechanical arthritis
- Soft tissue musculoskeletal pain
- Back pain
- Connective tissue disease
- Infectious arthritis
- Metabolic arthritis.
Inflammation is a normal part of the body's healing process. The inflammation tends to occur as a defense against viruses and bacteria or as a response to injuries such as burns. However, with inflammatory arthritis, inflammation occurs in people for no apparent reason.26
Inflammatory arthritis can affect several joints, damaging the surface of the joints and the underlying bone.
Inflammatory arthritis is characterized by damaging inflammation that does not occur as a normal reaction to injury or infection. This type of inflammation is unhelpful and instead causes damage in the affected joints, resulting in pain, stiffness and swelling.
The word "arthritis" means "joint inflammation," but inflammation may also affect the tendons and ligaments surrounding the joint - known as enthesitis.
Inflammatory arthritis can affect several joints, and the inflammation can damage the surface of the joints and also the underlying bone.
Examples of inflammatory arthritis include:
Degenerative or mechanical arthritis
Degenerative or mechanical arthritis refers to a group of conditions primarily involving damage to the cartilage that covers the ends of the bones. The main job of the smooth, slippery cartilage is to help the joints glide and move smoothly. This type of arthritis causes the cartilage to become thinner and rougher.26
To compensate for the loss of cartilage and changes in joint function, the body begins to remodel the bone in an attempt to restore stability. This can cause undesirable bony growths to develop (osteophytes), or cause the joint to become misshapen. This condition is commonly called osteoarthritis.
Osteoarthritis can also result from previous damage to the joint such as a fracture or previous inflammation in the joint.
Soft tissue musculoskeletal pain
Soft tissue musculoskeletal pain is felt in tissues other than the joints and bones. The pain often affects a part of the body following injury or overuse, such as tennis elbow, and originates from the muscles or soft tissues supporting the joints.
Sometimes if the pain is more widespread and associated with other symptoms, it could be diagnosed as fibromyalgia.
Back pain can arise from the muscles, discs, nerves, ligaments, bones or joints. Back pain may even be caused by problems with organs inside the body, and can be a result of referred pain, i.e. a problem elsewhere in the body that causes a sensation of pain in the back.26
Back pain may have a specific cause, such as osteoarthritis - often called spondylosis when it occurs in the spine - which may be visible on diagnostic imaging or physical examination. A "slipped" disc is another cause of back pain, as is osteoporosis (thinning of the bones). In most cases it is not possible for a doctor to identify the exact cause of back pain - this is often described as "non-specific" pain.
Connective tissue disease (CTD)
Connective tissues are tissues that support, bind together or separate other body tissues and organs. They include tendons, ligaments and cartilage.26
Joint pain is a symptom of CTD, but the inflammation that characterizes CTD may also occur in other tissues including the skin, muscles, lungs and kidneys. This can result in a diverse range of symptoms besides painful joints and require consultation with a number of different specialists.
Examples of CTD include:
- Scleroderma (systemic sclerosis)
A bacterium, virus or fungus entering the joint can sometimes cause inflammation. Organisms that can infect joints include:27
- Salmonella and Shigella (food poisoning or contamination)
- Chlamydia and gonorrhea (sexually transmitted diseases)
- Hepatitis C (a blood-to-blood infection, often through shared needles or transfusions).
In most of these cases, the joint infection can be cleared with antibiotics or other antimicrobial medication. However, the arthritis can sometimes become chronic, and/or joint damage may be irreversible if the infection has persisted for some time.
Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in human cells and several foods.27
Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine. Some people have elevated levels of uric acid because they either naturally produce more than is needed or their body cannot clear the uric acid quickly enough.
Uric acid builds up and accumulates in some people and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout attack.
Gout can either come and go in episodes or become chronic if uric acid levels are not reduced. It commonly affects a single joint or a small number of joints, such as the big toe and hands, and usually affects the extremities. This is thought to be due in part to the increased formation of uric acid crystals in cooler joints, i.e. those not close to the main warmth of the body.
Some of the more common types of arthritis are discussed below.
There are an estimated 1.5 million adults in the US with RA.4 The prevalence of RA is believed to range from 0.5-1.0% in the general population.
Persistent inflammation in the synovia leads to the degeneration of cartilage and bone, which can then lead to joint deformity, pain, swelling and redness.
RA causes premature mortality, disability and compromises quality of life.12 The onset of RA can occur at any age and is associated with fatigue and prolonged stiffness after rest.
Individuals with RA have a more severe functional status than those with osteoarthritis. Diagnosing RA early gives people a better chance to learn how to manage symptoms successfully, which can reduce the impact of the disease on quality of life.
RA accounts for around 22% of all deaths due to arthritis and other rheumatic conditions (AORC). Approximately 40% of all deaths in people with RA are attributed to cardiovascular conditions, including ischemic heart disease and stroke.
For more information on rheumatoid arthritis, see our article: All about rheumatoid arthritis.
Rheumatoid arthritis and osteoarthritis are different types of arthritis. They share some similar characteristics, but each has different symptoms and etiology.
There are an estimated 26.9 million adults living with osteoarthritis in the US. Osteoarthritis affects 13.9% of adults aged 25 years and older, and 33.6% (12.4 million) of those over 65. Disease onset is gradual and often begins after the age of 40.55
Osteoarthritis is a degenerative joint disease of the entire joint involving the cartilage, joint lining and ligaments and underlying bone. The breakdown of these tissues eventually leads to pain and joint stiffness.11
The joints most commonly affected by osteoarthritis are the joints that get heavy use, such as hips and knees, hands, the spine and also often the base of the thumb and the big toe joint.
Nearly 1 in 2 people develop symptomatic knee osteoarthritis by the age of 85, and 1 in 4 people develop hip arthritis in their lifetime.4 Knee osteoarthritis is one of the five leading causes of disability among non-institutionalized adults. Weight loss of 11 pounds can halve a woman's risk of developing knee osteoarthritis.56
Taking part in moderate physical activity 3 times or more per week can reduce the risk of arthritis-related disability by 47% in older adults with knee osteoarthritis.4
Between 1979 and 1988, osteoarthritis was responsible for an average 0.2 to 0.3 deaths per 100,000 people. This figure has increased over the years, with OA accounting go around 6% of all arthritis-related deaths in 2003, working out to around 500 deaths per year.57
These calculations are likely to be underestimates as they do not include deaths related to things such as gastrointestinal bleeding caused by medications used to treat OA.
For more information on osteoarthritis, see our article: What is osteoarthritis? What causes osteoarthritis?
There are an estimated 294,000 children (or 1 in 250 children) under the age of 18 in the US that have been diagnosed with AORC.
"Childhood arthritis" is an umbrella term that covers a number of types of arthritis.
There are at least three clinical classification schemes of childhood arthritis including:
- Juvenile rheumatoid arthritis (JRA)
- Juvenile chronic arthritis (JCA)
- Juvenile idiopathic arthritis (JIA).
All classifications define childhood arthritis as occurring in people younger than 16 years.
The most common form of childhood arthritis is JRA. JRA involves at least 6 weeks of incessant arthritis in children younger than 16 years with no other type of noticeable childhood arthritis.
Many of the numerous conditions that are counted as AORC in adults can also occur in children, although much more rarely.
During 2008-2010, physician visits for juvenile arthritis averaged more than1 million per year, and there were around 282,500 outpatient clinic visits for juvenile arthritis.59
There are an estimated 20,000 cases of septic arthritis in the US per year.37 The incidence of septic arthritis is around 2-10 cases per 100,000 in the general population and as high as 30-70 cases per 100,000 in patients with RA.38
Septic arthritis is joint inflammation due to a bacterial or fungal infection. If the septic arthritis is due to the bacteria that cause gonorrhea, it is described as gonococcal arthritis.23 The incidence of arthritis due to gonococcal infection is 2.8 cases per 100,000 persons per year.
Joints commonly affected with septic arthritis include the knee and hip. Septic arthritis develops either when bacteria or other tiny disease-causing germs (micro-organisms) spread through the blood to a joint or when the joint is directly infected with a microorganism through injury or surgery.
Bacteria such as Staphylococcus, Streptococcus, or Neisseria gonorrhoeae cause most cases of acute septic arthritis. Organisms such as Mycobacterium tuberculosis and Candida albicans cause chronic septic arthritis - which is less common than acute septic arthritis.
Septic arthritis may occur at any age. In children, it arises most often in those younger than 3 years. The hip is a common site of infection in infants.
Septic arthritis is uncommon from age 3 to adolescence. Children with septic arthritis are more likely than adults to be infected with Group B Streptococcus or Haemophilus influenzae if they have not been vaccinated. The incidence of bacterial arthritis caused by infection with H. influenzae has decreased almost 70% to 80% since the widespread use of H. influenzae b vaccine.38
The following conditions increase the risk of developing septic arthritis:
- Artificial joint implants
- Bacterial infection elsewhere in the body
- Presence of bacteria in the blood
- Chronic illness or disease (such as diabetes, RA and sickle cell disease)
- Intravenous (IV) or injection drug use
- Medications that suppress the immune system
- Recent joint injury
- Recent joint arthroscopy or other surgery.
Septic arthritis is a rheumatologic emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality.37 Septic arthritis in RA is associated with a higher mortality rate of 25-30% due to delays in diagnosis and initiation of treatment.38
Fibromyalgia affects an estimated 5.0 million adults in the U.S.4 The prevalence of fibromyalgia is around 2% in North America, with prevalence significantly higher among women (3.4%) than men (0.5%). Children can also have the disorder.
In 25-65% of cases, fibromyalgia co-occurs with other rheumatic conditions such as RA, SLE and ankylosing spondylitis.9
Individuals are usually diagnosed with fibromyalgia during middle age and prevalence increases with age.
Fibromyalgia is a disorder of unknown cause characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often, psychological distress.8
People with fibromyalgia have abnormal pain perception processing and react strongly to things that other people would not find painful.
While the causes and risk factors of fibromyalgia are unknown, there are some factors that have been loosely associated with disease onset:
- Stressful or traumatic events, including car accidents and post-traumatic stress disorder (PTSD)
- Repetitive injuries
- Illness - viral infections
- Certain diseases - SLE, RA, chronic fatigue syndrome
- Genetic predisposition
Mortality among adults with fibromyalgia is similar to that of the general population. However, death rates from suicide and injuries are higher among fibromyalgia patients.8
For more information on fibromyalgia, see our article: What is fibromyalgia? What causes fibromyalgia?
Estimates of the prevalence of psoriatic arthritis in the US population vary between 0.3-1%, with a reported prevalence of 7-42% in patients with psoriasis.40
Psoriatic arthritis is a joint problem that often occurs with a skin condition called psoriasis.18
While most people with psoriatic arthritis develop psoriasis first and are later diagnosed with psoriatic arthritis, joint problems can occasionally occur prior to the emergence of psoriasis skin lesions.
Psoriatic arthritis occurs when the immune system attacks healthy cells and tissue. The abnormal immune response causes inflammation in the joints and an overproduction of skin cells.31
Several factors can increase the risk of psoriatic arthritis, including:32
- Psoriasis: having psoriasis is the greatest risk factor for developing psoriatic arthritis
- Family history: many people with psoriatic arthritis have a parent or a sibling with the disease. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis
- Age: although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30-50.
The severity of psoriatic arthritis is reflected not only in the accrual of joint damage but also in increased mortality. Patients with psoriatic arthritis are at an increased risk for death with a standardized mortality ratio of 1.62 (meaning that 62% more deaths occur in people with the condition than in the general population).
The causes of death are similar to those in the general population, with cardiovascular causes being the most common.40 People with psoriatic arthritis tend to have a higher number of risk factors for cardiovascular disease than the general population, including increased BMI, triglycerides and C-reactive protein.60
There are around 8.3 million individuals that suffer from gout each year in the US; 6.1 million of whom are men and 2.2 million women.10 The incidence of gout among black men is almost twice that among white men.
Gout is a rheumatic disease that occurs due to the formation of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process occurs because of an overproduction or under excretion of uric acid from the body.
Acute gout will typically manifest itself as a severely red, hot and swollen joint with agonizing pain. Gout may go into remission for long periods, followed by flares for days to weeks, or can become chronic. Recurrent attacks of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis.
Gout causes agonizing pain in the joint, with the area becoming red, hot and swollen.
Contributory risk factors for gout include:
- Being overweight or obese
- Diuretic use
- A diet rich in meat and seafood
- Common medicines
- Poor kidney function.
Weight loss of 10 pounds or more has been associated with a 39% reduction in the relative risk of gout in men.63 In contrast, higher consumption of alcohol, meat and seafood increase risk by 253%, 41% and 51% respectively.61, 62
On average, the annual incremental cost of care for a gout patient is estimated at greater than $3,000 compared with a non-gouty individual.41
A systematic review of six studies found that gout increases the risk of mortality from cardiovascular disease and coronary heart disease, but not myocardial infarction (heart attack), independently of vascular risk factors.64
For more information on gout, see our article: What is gout? What causes gout?
Sjögren's syndrome affects 1-2 million people in the US. The reported prevalence is between 0.05-4.8% of the population.42
Sjögren's syndrome is an autoimmune disorder that sometimes occurs alongside RA and SLE. The condition is characterized by the destruction of the glands that produce tears and saliva, which causes dryness in the mouth and eyes, and may cause dryness in other areas that usually need moisture, such as the nose, throat and skin.
The condition can affect other parts of the body, including the joints, lungs, kidneys, blood vessels, digestive organs and nerves.21
Sjögren's syndrome typically occurs in adults aged 40 and over and nine out of 10 sufferers are women.20
No increased all-cause mortality has been detected in patients with primary Sjögren's syndrome compared with the general population.43
According to a study in Clinical and Experimental Rheumatology, around 40-50% of patients with primary Sjögren's syndrome develop extraglandular disease, i.e. the condition affects tissues other than the glands.
This may manifest as either epithelial lymphocytic invasion of lung, liver, or kidney or as skin vasculitis, peripheral neuropathy, glomerulonephritis and low C4 levels - conditions which represent an immune-complex mediated disease.44
Patients in the latter category have a high risk for development of non-Hodgkin's lymphoma and have a worse prognosis with higher mortality rates.
For more information on Sjögren's syndrome, see our article: What is Sjögren's syndrome? What causes Sjögren's syndrome?
The prevalence of scleroderma in adults in the US is 240 per million. There are an estimated 300,000 adults with all forms of scleroderma in the US.46
Scleroderma refers to a group of diseases that affect connective tissue in the body.45 Scleroderma involves the buildup of scar-like tissue in the skin. It also damages the cells that line the walls of the small arteries.22
The cause of scleroderma is currently unknown. However, the build-up of collagen in the skin and organs is responsible for the symptoms of the condition.
Scleroderma often affects people between the ages of 30-50, with women developing the disease more than men.
Cases of widespread scleroderma that occur with other autoimmune diseases such as SLE and polymyositis are called mixed connective diseases.
The course of scleroderma varies with each individual, and, as a result, mortality figures vary vastly. Broadly, 10-year survival is 60-70%. Deaths from kidney disease have decreased over recent years, and most mortality is caused by severe cardiac or pulmonary complications.47
For more information on scleroderma, see our article: What is scleroderma? What causes scleroderma?
Systemic lupus erythematosus (SLE)
Older estimates put the prevalence of systemic lupus erythematosus (SLE) as high as 1.5 million in the US, although other estimates cite a likely prevalence of 161,000 definite cases of SLE and 322,000 with definite or probable SLE.14
SLE is an autoimmune disease where the immune system produces antibodies to cells within the body leading to widespread inflammation and tissue damage.13 The disease is characterized by periods of illness and remissions.
Although the peak occurrence of SLE is between the ages of 15-40 and more common in women, SLE can occur from infancy to old age in people of any gender.
SLE can affect the joints, skin, brain, lungs, kidneys, blood vessels and other tissues. People with SLE may experience fatigue, pain or swelling in joints, skin rashes and fevers.
The causes of SLE are not confirmed, but they could be linked with factors such as genetics, environment and hormones.
A study released in 2008 found that the average annual direct health care cost of patients with lupus was $12,643.48
Between the years of 1979-1998, the annual number of deaths with lupus as the underlying cause increased from 879 to 1,406. SLE has a relatively high mortality rate among rheumatic disease, accounting for 14.5% of deaths from rheumatic disease in 1997.14
For more information on systemic lupus erythematosus, see our article: Lupus: What is lupus?
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:
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.
Osteoarthritis is caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life.
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.
Gout is one type of arthritis that is closely linked to diet as it is caused by elevated levels of uric acid which can be a result of a diet high in purines. As such, diets that contain high-purine foods, such as seafood, red wine and meats can trigger a gout flare-up. Vegetables and other plant foods that contain high levels of purines do not appear to exacerbate gout symptoms, however.
Cartilage is a flexible, connective tissue in joints that absorb the pressure and shock created from movement like running and walking. It also protects the joints and allows for smooth movement.34
Rheumatoid arthritis occurs when the body's immune system attacks the tissues of the body, specifically connective tissue, leading to joint inflammation and pain and degeneration of the joint tissue.
Risk factors for arthritis
Certain factors have been shown to be associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.
Non-modifiable arthritis risk factors:
- Age: the risk of developing most types of arthritis increases with age
- Sex: most types of arthritis are more common in females; 60% of all people with arthritis are female. Gout is more common in males than females
- Genetic: specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis.
Modifiable arthritis risk factors:
- Overweight and obesity: excess weight can contribute to both the onset and progression of knee osteoarthritis
- Joint injuries: damage to a joint can contribute to the development of osteoarthritis in that joint
- Infection: many microbial agents can infect joints and trigger the development of various forms of arthritis
- Occupation: certain occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.
The joints that "crack" are often the knuckles, knees, ankles, back and neck, and there are numerous reasons why these joints "sound off." However, can your knuckle-cracking habit that aggravates the masses give you arthritis? Or is it just another harmless habit?
Children prescribed courses of antibiotics were found to have twice the risk of developing juvenile arthritis than children who did not receive antibiotics, according to the findings of a new study published in Pediatrics.
Signs and symptoms
Just as the causes of different types of arthritis can vary widely, the pattern and location of symptoms of arthritis can also vary depending on the type.
Warning signs of arthritis include pain, swelling, stiffness and difficulty moving a joint.
Arthritis symptoms can develop gradually or suddenly, and as arthritis is most often a chronic disease, symptoms may come and go, or persist over time.
There are four key warning signs of arthritis that should prompt a discussion with a health care provider. These include:28
- Pain. Pain from arthritis can be constant, or it may come and go. Pain might be isolated to one place or felt in many parts of the body
- Swelling. Some types of arthritis cause the skin over the affected joint to become red and swollen, and to feel warm to the touch
- Stiffness. Stiffness is a typical arthritis symptom, with some forms of arthritis causing increased stiffness upon waking up in the morning, after sitting at a desk, or after sitting in a car for a long time, and others resulting in stiffness after exercise or characterized by persistent stiffness
- Difficulty moving a joint. Moving a joint or getting up from a chair should not be hard or painful and can indicate arthritis or other joint problem.
As it is a systemic disease, RA usually affects the joints on both sides of the body equally. The joints of the wrists, fingers, knees, feet and ankles are the most commonly affected.15 This can help a physician to differentiate osteoarthritis from RA, as osteoarthritis typically affects some joints more than others, such as the left or right knee, shoulder or wrist.
Joint symptoms may include:
- Morning stiffness, lasting more than 1 hour, is common
- Joint pain is often felt on the same joints on both sides of the body
- Over time, joints may lose their range of motion and may become deformed.
Other symptoms of RA include:
- Chest pain when taking a breath (from pleurisy)
- Dry eyes and mouth (Sjögren's syndrome)
- Eye burning, itching and discharge
- Nodules under the skin (usually a sign of more severe disease)
- Numbness, tingling or burning in the hands and feet
- Sleep difficulties.
Osteoarthritis is usually a result of wear and tear on the joints, meaning that joints that have been overworked are more affected than others. People with osteoarthritis may experience the following symptoms:16
- Pain and stiffness in the joints
- Pain that becomes worse after exercise or pressure on the joint
- Rubbing, grating or crackling sound when a joint is moved
- Morning stiffness
- Pain that causes sleep disturbances.
In some people, X-rays can show changes characteristic of osteoarthritis but they may not experience symptoms.
Symptoms of childhood arthritis include:17
- Swollen, red, or warm joint
- Limping or problems using a limb
- Sudden high fever
- Rash (on trunk and extremities) that comes and goes with fever
- Stiffness, pain and limited movement in a joint
- Body-wide symptoms such as pale skin, swollen lymph gland and a sickly appearance.
Juvenile RA can also cause eye problems including uveitis, iridocyclitis or iritis. There may be no symptoms, but when eye symptoms do occur they can include:
- Red eyes
- Eye pain made worse by looking at light (photophobia)
- Vision changes.
Symptoms of septic arthritis occur rapidly. There is often fever, joint swelling in one joint and intense joint pain that becomes more severe with movement.23
Symptoms in newborns or infants include:
- Cries when infected joint is moved
- Inability to move the limb with the infected joint (pseudoparalysis)
Symptoms in children and adults include:
- Intense joint pain
- Joint swelling
- Joint redness
Chills sometimes occur but are an uncommon symptom.
People with fibromyalgia may experience the following symptoms:8
Fibromyalgia has many symptoms that tend to vary from person to person. The main symptom is widespread pain.
- Widespread pain (specific tender points are common)
- Sleep disturbance
- Psychological stress
- Morning stiffness
- Tingling or numbness in hands and feet
- Headaches, including migraines
- Irritable bowel syndrome
- Cognitive problems with thinking and memory - sometimes called "fibro fog"
- Painful menstrual periods and other pain syndromes.
Symptoms of psoriatic arthritis may be mild and involve only a few joints such as the end of fingers or toes.18
In people with severe psoriatic arthritis, the disease may affect multiple joints, including the spine. Spinal symptoms are usually felt in the lower spine and sacrum and consist of stiffness, burning and pain.
People with psoriatic arthritis often have the skin and nail changes of psoriasis, and the skin gets worse at the same time as the arthritis.
Symptoms of gout involve:19
- The big toe, knee or ankle joints (most often)
- Sudden pain, often during the night, described as throbbing, crushing or excruciating
- The joint feeling warm and tender, and appearing red and swollen
- Occasional fever.
After a person has had gout for many years they can develop tophi. Tophi are lumps below the skin, typically around the joints or apparent on fingertips and ears. Multiple, small tophi may develop, or a large white lump can grow, causing deformation and stretching the skin.
In some cases, tophi may burst and drain spontaneously, oozing a white, chalky substance. Tophi that are beginning to break through the skin can lead to infection or osteomyelitis, with some patients requiring urgent surgery to drain the tophus.
Symptoms of Sjögren's syndrome include:
- Dry eyes
- Itching eyes
- Feeling that something is in the eye
- Dry mouth
- Difficulty swallowing or eating
- Loss of sense of taste
- Problems speaking
- Thick or stringy saliva
- Mouth sores or pain
- Change in color of hands or feet
- Joint pain or joint swelling
- Swollen glands.
Symptoms of scleroderma may include:
- Fingers or toes that turn blue or white in response to cold temperatures (Raynaud's phenomenon)
- Hair loss
- Skin that becomes darker or lighter than normal
- Stiffness and tightness of skin on the fingers, hands, forearm and face
- Small white lumps beneath the skin that sometimes ooze a white substance that looks like toothpaste
- Sores (ulcers) on the fingertips or toes
- Tight and mask-like skin on the face
- Joint pain
- Numbness and pain in the feet
- Pain, stiffness and swelling of fingers and joints
- Wrist pain
- Dry cough
- Shortness of breath
- Bloating after meals
- Difficulty swallowing
- Esophageal reflux or heartburn
- Problems controlling stools.
Systemic lupus erythematosus (SLE)
The most common signs of SLE are:49
- Red rash or color change on the face, often in the shape of a butterfly across the nose and cheeks
- Painful or swollen joints
- Unexplained fever
- Chest pain with deep breathing
- Swollen glands
- Extreme fatigue
- Unusual hair loss
- Pale or purple fingers or toes from cold or stress
- Sensitivity to the sun
- Low blood count
- Depression, trouble thinking or memory problems.
Other signs are mouth sores, unexplained seizures, hallucinations, repeated miscarriages, and unexplained kidney problems.
Most cases of arthritis are diagnosed with a detailed medical history of current and past symptoms, physical examination and particular radiographic and laboratory studies. It is possible to have more than one form of arthritis at the same time, and only a few rheumatic diseases have a definitive diagnosis, such as gout.9
The tests ordered during the diagnostic process will depend on the type of arthritis suspected. Some tests that may be completed to make a diagnosis are:15,16,17,19,22
In evaluating arthritis, the doctor uses X-rays to rule out injury or other diseases of the joint, to have a baseline for comparison while being treated for arthritis and to look at the structures of a particular joint or joints.
- Rheumatoid factor
- Anti-CCP antibody
- Complete blood count (CBC)
- C-reactive protein
- Erythrocyte sedimentation rate (ESR)
- Joint ultrasound or MRI
- Joint X-ray
- Bone scan
- Synovial fluid analysis
- Antinuclear antibody (ANA)
- HLA antigens for HLA B27
- Electrocardiogram (ECG)
- Aspiration of joint fluid for cell count, examination of crystals under the microscope, gram stain and culture
- Blood culture
- Thyroid function tests
- Synovial biopsy
- Uric acid - urine
- Uric acid - blood
- Schirmer's test of tear production
- Salivary gland biopsy
- Tear test
- Slit lamp examination of the eyes
With osteoarthritis, a physical exam can show:16
- Joint movement that causes a crackling (grating) sound, called crepitation
- Joint swelling (bones around the joints may feel larger than normal)
- Limited range of motion
- Tenderness when the joint is pressed
- Pain upon normal movement.
RA is diagnosed clinically, but classified according to the 2010 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis.12
Diagnosis of SLE can be very difficult. The gold standard is a rheumatologist's diagnosis. The American College of Rheumatology (ACR) uses a standard classification scheme requiring 4 of 11 criteria for research definition, although this is recognized to miss early and mild cases.
Whether you have a non-inflammatory or inflammatory type of arthritis or even a painful case of gout, there are numerous medications and recommendations to relieve pain and ensure that your joints do not become damaged further.
The doctor will likely recommend a course of physical therapies to help you manage some of the symptoms of arthritis.
The focus of treatment for arthritis is to control pain, minimize joint damage and improve or maintain function and quality of life. According to the American College of Rheumatology, the treatment of arthritis might involve the following:14
- Non-pharmacologic therapies
- Physical or occupational therapy
- Splints or joint assistive aids
- Patient education and support
- Weight loss
- Surgery - joint replacement and joint surgery.
Non-inflammatory types of arthritis such as osteoarthritis are often treated with pain-reducing medications, physical activity, weight loss if the person is overweight and self-management education.9
These treatments are also applied to inflammatory types of arthritis (such as RA) along with anti-inflammatory medications such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and a relatively new class of drugs known as biologics.
Medications that are used to treat arthritis depend on the type of arthritis. Commonly used arthritis medications include:24
- Analgesics: these reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab)
- Non-steroidal anti-inflammatory drugs (NSAIDs): these reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Some NSAIDs are available as creams, gels or patches which can be applied to specific joints
- Counterirritants: some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. 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. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil)
- Biologics: used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade)
- Corticosteroids: includes prednisone and cortisone, this class of drug reduces inflammation and suppresses the immune system.
There is no specific diet that treats arthritis. However, there are several types of food that can help people with the condition by reducing inflammation.
The following foods are all found in a Mediterranean diet and can provide many nutrients that are good for joint health:
- Nuts and seeds
- Fruits and vegetables
- Olive oils
- Whole grains
There are also some foods that people with arthritis may want to avoid. Nightshade vegetables contain a chemical called solanine that some studies have linked with arthritis pain. Research findings are mixed when it comes to these vegetables, but some people have reported a reduction in arthritis symptoms when avoiding nightshade vegetables.
In combination with medical treatment, self-management of arthritis symptoms is also important.29
Key self-management activities include:
- Developing arthritis management strategies
- Staying physically active
- Achieving and maintaining a healthy weight
- Getting regular check-ups with the doctor
- Protecting joints from unnecessary stress.
There are seven important self-management habits that can help you successfully manage your disease:25
- Be organized: keep track of symptoms, pain levels, medications, and possible side effects for consultations with your doctor
- Manage pain and fatigue: a medication regimen can be combined with non-medical pain management. Learning to manage fatigue is key to living comfortably with arthritis
- Stay active: exercise is beneficial for managing arthritis and overall health
- Balance activity with rest: in addition to remaining active, rest is equally important when your disease is active
- Eat a healthy balanced diet: a healthy diet can help you achieve a healthy weight and control inflammation. Avoid refined, processed foods and pro-inflammatory animal-derived foods and choose whole plant foods that are high in antioxidants and that have anti-inflammatory properties
- Improve sleep: poor sleep can aggravate arthritis pain and fatigue. Take steps to improve sleep hygiene so you find it easier to fall asleep and stay asleep - avoid caffeine and strenuous exercise in the evenings and restrict screen-time prior to bedtime
- Joint care: tips for protecting joints include using your stronger, larger joints as levers when opening doors, using several joints to spread the weight of an object such as using a backpack and gripping as loosely as possible by using padded handles.
Do not sit in the same position for long periods; take regular breaks to keep mobile.
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.
Research suggests that although individuals with arthritis may experience short-term increases in pain when first beginning exercise, continued physical activity can be an effective way to reduce symptoms long-term.3,6
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:3
- Riding a bike.
Living with arthritis is not easy and carrying out simple, everyday tasks can often be painful and difficult. However, there are many things you can do to relieve symptoms and it is important to discuss with your doctor ways to make sure you live a healthy lifestyle and have a better quality of life.
A new study by researchers from the Washington University School of Medicine in St. Louis claims fatty acids associated with obesity and diabetes may also contribute to the development of arthritis and leukemia, paving the way for new treatments for these diseases.
There is currently no cure for rheumatoid arthritis - an autoimmune disease that causes inflammation and bone erosion in the joints - although it can be controlled. Now, a new approach that targets drugs directly to affected joints while avoiding side effects shows promise in a mouse study.
A new study published in the journal Science Translational Medicine reveals how patients with arthritis could be treated using their own "microvesicles."
Prevalence and impact
There are 52.5 million adults in the US, equating to 22.7% of the population, reported to have a form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia.1
With people living longer in the US, the prevalence of doctor-diagnosed arthritis is expected to increase. It has been estimated that by the year 2030, 67 million, 25% of the projected total adult population aged 18 years and older, will have doctor-diagnosed arthritis.
Arthritis has a significantly higher age-adjusted prevalence in women (23.9%) than men (18.6%), with the prevalence increasing with age and higher among women than men in every age group. According to the CDC, 60% of people with arthritis are women, and most forms of arthritis are more common in women, with the exception of gout, which is more common in men.
An estimated 294,000 children under the age of 18 have some form of arthritis or rheumatic condition; this represents approximately 1 in every 250 children in the US.4
Impact of arthritis
Arthritis has a significant impact on individuals, for example:1
- Almost 43.2% (22.7 million) of adults with arthritis report limitations in their usual activities
- 40% report that it is "very difficult" or they "cannot do" at least 1 of 9 important daily functional activities
- Almost 8 million adults who report an activity limitation due to arthritis also report severe limitation in their ability to stoop, bend, or kneel, and 6 million cannot walk 0.25 miles
- 31% (8.3 million) of working age adults with arthritis report limitations in work.
Impairment in the ability of people with arthritis to perform essential daily tasks may interfere with their work, their sense of purpose in their community, or the care they can provide for their family.
Around 18% of total disabilities are caused by arthritis or rheumatism, making it the most common cause of disability in the US.
Arthritis has a strong association with major depression, with an attributable risk of 18.1% according to the CDC. This is thought to be most likely caused by the limitations arthritis can place on function and enjoyment of life. Around 6.6% of adults with arthritis report severe psychological distress.51
According to the CDC, the prevalence of arthritis increases with body mass index (BMI): almost 16% of adults who are under/normal weight have arthritis; almost 23% of overweight adults have arthritis; and almost 31% of obese adults have arthritis.5
Arthritis can place limitations on everyday activities. Having a higher BMI is associated with an increase in activity limitations related to arthritis, with such limits reported by:2
- 38.2% of people who are under/normal weight
- 37.2% of people who are overweight
- 44.8% of people who are obese.
Arthritis and exercise
Physical activity and exercise have been shown to benefit people with arthritis by improving pain, function and mental health. However, around 24% of adults with arthritis report being physically inactive compared with 18.6% of adults without arthritis.2
By partaking in low levels of exercise, individuals with arthritis face placing themselves at risk of conditions associated with lack of activity such as cardiovascular disease, diabetes, obesity and functional limitations.
The cost of arthritis
Cost attributable to arthritis and other rheumatic conditions (AORC) in the US in 2003 was approximately:2
- $128 billion in total costs - 1.2% of the 2003 US gross domestic product (GDP)
- $80.8 billion direct costs - the largest components were for ambulatory care (52.1%), inpatient care (20.0%) and prescription drugs (19.3%)
- $47.0 billion indirect costs - lost earnings
- By state, a total ranging from $226 million in the District of Columbia to $12.1 billion in California.
The CDC reports that 47% of US adults with arthritis also have at least one comorbid condition (the presence of more than one disease or condition in the same person at the same time).3
Among people with arthritis the most common comorbidities are:
- Heart disease - 24% (11.2 million)
- Chronic respiratory conditions - 19% (9.0 million)
- Diabetes - 16% (7.3 million)
- Stroke - 6.8% (3.2 million).
Risk factors for other chronic conditions are common among US adults with arthritis, such as:
- High blood pressure - 53%
- Physical inactivity - 47%
- High cholesterol - 47%
- Obesity - 36%
- Smoking - 19%.
More than half (53%) of US adult with arthritis report high blood pressure. High blood pressure is associated with heart disease - the most common comorbidity among adults with arthritis.
Approximately 1 in 5 (19%) of US adults with arthritis are smokers. Smoking is associated with chronic respiratory conditions - the second most common comorbidity among adults with arthritis.
Smoking also adversely affects the synthesis of collagen, the key protein making up connective tissue and the scaffolding of bone, as well as increasing oxidative damage and decreasing circulation and the supply of nutrients to the joint tissues and bone. As such, smoking is detrimental to the health of joints and bone and contributes to arthritis development and progression.
Hospitalizations from arthritis
In 2004, there were an estimated:4
- 744,000 hospitalizations with a principal diagnosis of arthritis
- 5 million hospitalizations with a principal or secondary diagnosis of arthritis
- 78 million ambulatory care visits with a primary diagnosis of AORC.
Data from the Healthcare Cost and Utility Project (HCUP) 2011 Nationwide Inpatient Sample (NIS) estimates that in 2011:52
- 6.7 million hospitalizations (17.3% of all hospitalizations) were associated with a diagnosis of arthritis or rheumatic condition (AORC)
- Most of the 6.7 million hospitalizations were associated with osteoarthritis (OA), gout, rheumatoid arthritis and other less specific disorders
- OA accounts for 47.4% of all arthritis-related hospitalizations; 3,161,100 hospitalizations for OA as principal diagnosis.
In 2011, knee and hip joint replacement procedures (usually for OA) accounted for 35% of total arthritis-related procedures during hospitalization.53
In 2004, joint replacements for arthritis included:4
- 454,652 total knee replacements
- 232,857 total hip replacements
- 41,934 shoulder replacements
- 12,055 other joint replacements.
Between 1992 and 2011, there was an increase of 217% in the rate of total knee replacements (from 203.6 to 645.1 per 100,000 people). There was also a 119% increase in the rate of total hip replacement (from 139.9 to 306.6 per 100,000).52
Between 1979 and 1998, deaths related to arthritis or rheumatic conditions (AORC) increased from 5,537 to 9,367.4 The approximate death rate from AORC in 1979 was 2.46 per 100,000 population, rising to 3.48 per 100,000 population in 1998. Both rates age-standardized to the year 2000 population were 2.75 and 3.51, respectively.
Using 10 categories of AORC, just three categories accounted for almost 80% of deaths:9
- Diffuse connective tissues diseases: 34% - mostly systemic lupus erythematosus (SLE) and systemic sclerosis
- Other specified rheumatic conditions: 23% - mostly vasculitis
- RA: 22%.