Arthritis—Some Basics

By Arline Kaplan © 2000 (All Rights Reserved)

Your right knee feels achy and sore, particularly after a long walk. Your spouse missed work for three months because of low back pain. Your father complains of swelling in his big toe. Each of you has symptoms of arthritis in its different forms. More than 100 forms of arthritis exist. Currently, 40 million Americans (one in seven) have arthritis, and that number will climb to some 60 million by 2020.

What is it?
Arthritis, which afflicted Neanderthal as well as modern man, is inflammation of the joint. Swelling, redness, heat, pain and loss of function typify inflammation. A joint is where the ends of two or more bones meet (e.g., knee or elbow). Cartilage, a smooth material that covers and cushions the bones, allows the joint to move easily. Enclosing the joint is a fiber-like envelope (the synovium) that produces a fluid to reduce friction and wear in the joint. Ligaments connect the bones and keep the joint stable. Muscles and tendons power the joint and enable it to move.

Selected Arthritis Signs and Symptoms*
Inflammation of joints (e.g., pain, swelling, redness, warmth)
Limited movement and increased pain with movement
Joint deformity
Loss of appetite
Fever
Fatigue
Anemia
Bumps or nodules under the skin
*Signs and symptoms may vary with form of arthritis

The most common forms of arthritis in older adults are osteoarthritis, rheumatoid arthritis and gout.

Osteoarthritis (OA), also called degenerative arthritis, occurs in more than half of adults aged 65 and older. In OA, the cartilage covering the bone ends gradually wears away. As bone rubs against bone, the joint loses shape and alignment. Bone growths called "spurs" may form around the edges of the joint, making it look knobby and swollen. OA can cause pain and stiffness, particularly in the hands, knees, feet and hips. Risk factors for OA include family members with it, being overweight, experiencing a serious injury to the joint and lack of activity.

Rheumatoid arthritis (RA) occurs when the immune system attacks the lining or synovial membrane of the joint. The lining swells, invading surrounding tissues and producing chemical substances that attack and destroy the joint’s surface. Many joints of the body, particularly elbows and shoulders, may be involved at the same time. RA is often accompanied by fatigue, weight loss, fever and anemia.

Gout is a metabolic disorder in which uric acid, one of the body’s waste products, builds up in the blood, causing crystals to accumulate around small joints. Episodic attacks usually occur in the big toe, but other joints (e.g., feet, and wrist) can be affected.

How is it treated?
Arthritis treatment seeks to reduce the pain and inflammation in the joints, improve movement, strengthen muscles to provide increased joint support and educate you about the disease. Approaches include
- Medications. If you have OA, your physician may recommend acetaminophen (Tylenol,) to control pain. For RA or gout, your physician may recommend nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin) or naproxen (Aleve). Corticosterioids (synthetic versions of the hormone cortisone) are usually reserved for intense flareups of arthritis or when other drugs cannot control it.
- Exercise. A daily walk or swim, for example, keeps your joints moving, reduces pain and strengthens the muscles around your joints.
- Heat/cold therapy. Soaking in a warm bath or applying towel-wrapped cold packs to your joints reduces pain.
- Weight control. Losing weight reduces stress on your weight-bearing joints .
- Joint protection and proper body mechanics. Using canes, crutches, walkers or splints relieves strain or stress on your joints. Physical and occupational therapists can show you how to carry groceries, sit at your desk and do other tasks with a minimum of discomfort or exertion.
- Surgery. Possible surgical procedures your orthopaedic surgeon may recommend include removal of the diseased or damaged joint lining; realignment of the joints; total joint replacement and fusion of the bone ends of the joint to relieve joint pain.
- Support groups and education. The more you know about your illness, the more successful your treatment is likely to be. Contact your local chapter of the Arthritis Foundation or the national office at (800) 283-7800 or call the National Institute of Arthritis and Musculoskeletal and Skin Diseases at (301) 495-4484 or toll free at (877) 226-4267.

(Sources: Information for this handout came from the Arthritis Foundation, the American Medical Association, the National Institute on Aging, Harvard Medical School’s Consumer Health Information, and the American Academy of Orthopaedic Surgeons.)