Nature Creation ArticlesHealth, Pain, Therapy, Solution

Arthri­tis is inflam­ma­tion of one or more joints, which results in pain, swelling, stiff­ness, and lim­ited move­ment. There are over 100 dif­fer­ent types of arthritis.

Causes, inci­dence, and risk factors

Arthri­tis involves the break­down of car­ti­lage. Car­ti­lage nor­mally pro­tects the joint, allow­ing for smooth move­ment. Car­ti­lage also absorbs shock when pres­sure is placed on the joint, like when you walk. With­out the usual amount of car­ti­lage, the bones rub together, caus­ing pain, swelling (inflam­ma­tion), and stiffness.

You may have joint inflam­ma­tion for a vari­ety of rea­sons, including:

* Bro­ken bone
* Infec­tion (usu­ally caused by bac­te­ria or viruses)
* An autoim­mune dis­ease (the body attacks itself because the immune sys­tem believes a body part is for­eign)
* Gen­eral “wear and tear” on joints

Often, the inflam­ma­tion goes away after the injury has healed, the dis­ease is treated, or the infec­tion has been cleared.

With some injuries and dis­eases, the inflam­ma­tion does not go away or destruc­tion results in long-term pain and defor­mity. When this hap­pens, you have chronic arthri­tis. Osteoarthri­tis is the most com­mon type and is more likely to occur as you age. You may feel it in any of your joints, but most com­monly in your hips, knees or fin­gers. Risk fac­tors for osteoarthri­tis include:

* Being over­weight
* Pre­vi­ously injur­ing the affected joint
* Using the affected joint in a repet­i­tive action that puts stress on the joint (base­ball play­ers, bal­let dancers, and con­struc­tion work­ers are all at risk)

Arthri­tis can occur in men and women of all ages. About 37 mil­lion peo­ple in Amer­ica have arthri­tis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthri­tis include:

* Rheuma­toid arthri­tis (in adults)
* Juve­nile rheuma­toid arthri­tis (in chil­dren)
* Sys­temic lupus ery­the­mato­sus (SLE)
* Gout
* Scle­ro­derma
* Pso­ri­atic arthri­tis
* Anky­los­ing spondyli­tis
* Reiter’s syn­drome (reac­tive arthri­tis)
* Adult Still’s dis­ease
* Viral arthri­tis
* Gono­coc­cal arthri­tis
* Other bac­te­r­ial infec­tions (non-gonococcal bac­te­r­ial arthri­tis )
* Ter­tiary Lyme dis­ease (the late stage)
* Tuber­cu­lous arthri­tis
* Fun­gal infec­tions such as blastomycosis

Symptoms

If you have arthri­tis, you may experience:

* Joint pain
* Joint swelling
* Stiff­ness, espe­cially in the morn­ing
* Warmth around a joint
* Red­ness of the skin around a joint
* Reduced abil­ity to move the joint

Signs and tests

First, your doc­tor will take a detailed med­ical his­tory to see if arthri­tis or another mus­cu­loskele­tal prob­lem is the likely cause of your symptoms.

Next, a thor­ough phys­i­cal exam­i­na­tion may show that fluid is col­lect­ing around the joint. (This is called an “effu­sion.”) The joint may be ten­der when it is gen­tly pressed, and may be warm and red (espe­cially in infec­tious arthri­tis and autoim­mune arthri­tis). It may be painful or dif­fi­cult to rotate the joints in some direc­tions. This is known as “lim­ited range-of-motion.”

In some autoim­mune forms of arthri­tis, the joints may become deformed if the dis­ease is not treated. Such joint defor­mi­ties are the hall­marks of severe, untreated rheuma­toid arthritis.

Tests vary depend­ing on the sus­pected cause. They often include blood tests and joint x-rays. To check for infec­tion and other causes of arthri­tis (like gout caused by crys­tals), joint fluid is removed from the joint with a nee­dle and exam­ined under a micro­scope. See the spe­cific types of arthri­tis for fur­ther infor­ma­tion.
Treatment

Treat­ment of arthri­tis depends on the par­tic­u­lar cause, which joints are affected, sever­ity, and how the con­di­tion affects your daily activ­i­ties. Your age and occu­pa­tion will also be taken into con­sid­er­a­tion when your doc­tor works with you to cre­ate a treat­ment plan.

If pos­si­ble, treat­ment will focus on elim­i­nat­ing the under­ly­ing cause of the arthri­tis. How­ever, the cause is NOT nec­es­sar­ily cur­able, as with osteoarthri­tis and rheuma­toid arthri­tis. Treat­ment, there­fore, aims at reduc­ing your pain and dis­com­fort and pre­vent­ing fur­ther disability.

It is pos­si­ble to greatly improve your symp­toms from osteoarthri­tis and other long-term types of arthri­tis with­out med­ica­tions. In fact, mak­ing lifestyle changes with­out med­ica­tions is prefer­able for osteoarthri­tis and other forms of joint inflam­ma­tion. If needed, med­ica­tions should be used in addi­tion to lifestyle changes.

Exer­cise for arthri­tis is nec­es­sary to main­tain healthy joints, relieve stiff­ness, reduce pain and fatigue, and improve mus­cle and bone strength. Your exer­cise pro­gram should be tai­lored to you as an indi­vid­ual. Work with a phys­i­cal ther­a­pist to design an indi­vid­u­al­ized pro­gram, which should include:

* Range of motion exer­cises for flex­i­bil­ity
* Strength train­ing for mus­cle tone
* Low-impact aer­o­bic activ­ity (also called endurance exercise)

A phys­i­cal ther­a­pist can apply heat and cold treat­ments as needed and fit you for splints or orthotic (straight­en­ing) devices to sup­port and align joints. This may be par­tic­u­larly nec­es­sary for rheuma­toid arthri­tis. Your phys­i­cal ther­a­pist may also con­sider water ther­apy, ice mas­sage, or tran­scu­ta­neous nerve stim­u­la­tion (TENS).

Rest is just as impor­tant as exer­cise. Sleep­ing 8 to 10 hours per night and tak­ing naps dur­ing the day can help you recover from a flare-up more quickly and may even help pre­vent exac­er­ba­tions. You should also:

* Avoid posi­tions or move­ments that place extra stress on your affected joints.
* Avoid hold­ing one posi­tion for too long.
* Reduce stress, which can aggra­vate your symp­toms. Try med­i­ta­tion or guided imagery. And talk to your phys­i­cal ther­a­pist about yoga or tai chi.
* Mod­ify your home to make activ­i­ties eas­ier. For exam­ple, have grab bars in the shower, the tub, and near the toilet.

Other mea­sures to try include:

* Tak­ing glu­cosamine and chon­droitin — these form the build­ing blocks of car­ti­lage, the sub­stance that lines joints. These sup­ple­ments are avail­able at health food stores or super­mar­kets. While some stud­ies show such sup­ple­ments may reduce osteoarthri­tis symp­toms, oth­ers show no ben­e­fit. How­ever, since these prod­ucts are regarded as safe, they are rea­son­able to try and many patients find their symp­toms improve.
* Eat a diet rich in vit­a­mins and min­er­als, espe­cially antiox­i­dants like vit­a­min E. These are found in fruits and veg­eta­bles. Get sele­nium from Brewer’s yeast, wheat germ, gar­lic, whole grains, sun­flower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mack­erel, and her­ring), flaxseed, rape­seed (canola) oil, soy­beans, soy­bean oil, pump­kin seeds, and wal­nuts.
* Apply cap­saicin cream (derived from hot chili pep­pers) to the skin over your painful joints. You may feel improve­ment after apply­ing the cream for 3–7 days.

MEDICATIONS

Your doc­tor will choose from a vari­ety of med­ica­tions as needed. Gen­er­ally, the first drugs to try are avail­able with­out a pre­scrip­tion. These include:

* Aceta­minophen (Tylenol) — rec­om­mended by the Amer­i­can Col­lege of Rheuma­tol­ogy and the Amer­i­can Geri­atrics Soci­ety as first-line treat­ment for osteoarthri­tis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can pro­vide sig­nif­i­cant relief of arthri­tis pain with­out many of the side effects of pre­scrip­tion drugs. DO NOT exceed the rec­om­mended doses of aceta­minophen or take the drug in com­bi­na­tion with large amounts of alco­hol. These actions may dam­age your liver.
* Aspirin, ibupro­fen, or naproxen — these non­s­teroidal anti-inflammatory (NSAID) drugs are often effec­tive in com­bat­ing arthri­tis pain. How­ever, they have many poten­tial risks, espe­cially if used for a long time. They should not be taken in any amount with­out con­sult­ing your doc­tor. Poten­tial side effects include heart attack, stroke, stom­ach ulcers, bleed­ing from the diges­tive tract, and kid­ney dam­age. In 2005, the U.S. Food and Drug Admin­is­tra­tion (FDA) asked mak­ers of NSAIDs to include a warn­ing label on their prod­uct that alerts users of an increased risk for heart attack, stroke, and gas­troin­testi­nal bleed­ing. If you have kid­ney or liver dis­ease, or a his­tory of gas­troin­testi­nal bleed­ing, you should not take these med­i­cines unless your doc­tor specif­i­cally rec­om­mends them.

Pre­scrip­tion med­i­cines include:

* Cyclooxygenase-2 (COX-2) inhibitors — These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was ini­tially believed to work as well as tra­di­tional NSAIDs, but with fewer stom­ach prob­lems. How­ever, numer­ous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and ben­e­fits of the COX-2s. Cele­coxib (Cele­brex) is still avail­able, but labeled with strong warn­ings and a rec­om­men­da­tion that it be pre­scribed at the low­est pos­si­ble dose for the short­est dura­tion pos­si­ble. Talk to your doc­tor about whether COX-2s are right for you.
* Cor­ti­cos­teroids (“steroids”) — these are med­ica­tions that sup­press the immune sys­tem and symp­toms of inflam­ma­tion. They are com­monly used in severe cases of osteoarthri­tis, and they can be given orally or by injec­tion. Steroids are used to treat autoim­mune forms of arthri­tis but should be avoided in infec­tious arthri­tis. Steroids have mul­ti­ple side effects, includ­ing upset stom­ach and gas­troin­testi­nal bleed­ing, high blood pres­sure, thin­ning of bones, cataracts, and increased infec­tions. The risks are most pro­nounced when steroids are taken for long peri­ods of time or at high doses. Close super­vi­sion by a physi­cian is essen­tial.
* Disease-modifying anti-rheumatic drugs — these have been used tra­di­tion­ally to treat rheuma­toid arthri­tis and other autoim­mune causes of arthri­tis. These drugs include gold salts, peni­cil­lamine, sul­fasalazine, and hydrox­y­chloro­quine. More recently, methotrex­ate has been shown to slow the pro­gres­sion of rheuma­toid arthri­tis and improve your qual­ity of life. Methotrex­ate itself can be highly toxic and requires fre­quent blood tests for patients on the med­ica­tion.
* Bio­log­ics– these are the most recent break­through for the treat­ment of rheuma­toid arthri­tis. Such med­ica­tions, includ­ing etan­er­cept (Enbrel), inflix­imab (Rem­i­cade) and adal­i­mumab (Humira), are admin­is­tered by injec­tion and can dra­mat­i­cally improve your qual­ity of life. Newer bio­log­ics include Oren­cia (abat­a­cept) and Rit­uxan (rit­ux­imab).
* Immuno­sup­pres­sants — these drugs, like aza­thio­prine or cyclophos­phamide, are used for seri­ous cases of rheuma­toid arthri­tis when other med­ica­tions have failed.

It is very impor­tant to take your med­ica­tions as directed by your doc­tor. If you are hav­ing dif­fi­culty doing so (for exam­ple, due to intol­er­a­ble side effects), you should talk to your doctor.

SURGERY AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthro­plasty) or to replace the joint (such as a total knee joint replace­ment) may help main­tain a more nor­mal lifestyle. The deci­sion to per­form joint replace­ment surgery is nor­mally made when other alter­na­tives, such as lifestyle changes and med­ica­tions, are no longer effective.

Nor­mal joints con­tain a lubri­cant called syn­ovial fluid. In joints with arthri­tis, this fluid is not pro­duced in ade­quate amounts. In some cases, a doc­tor may inject the arthritic joint with a man-made ver­sion of joint fluid. The syn­thetic fluid may post­pone the need for surgery at least tem­porar­ily and improve the qual­ity of life for per­sons with arthritis.

Expec­ta­tions (prognosis)

A few arthritis-related dis­or­ders can be com­pletely cured with treat­ment. Most are chronic (long-term) con­di­tions, how­ever, and the goal of treat­ment is to con­trol the pain and min­i­mize joint dam­age. Chronic arthri­tis fre­quently goes in and out of remis­sion.
Complications

* Chronic pain
* Lifestyle restric­tions or disability

Call­ing your health care provider

Call your doc­tor if:

* Your joint pain per­sists beyond 3 days.
* You have severe unex­plained joint pain.
* The affected joint is sig­nif­i­cantly swollen.
* You have a hard time mov­ing the joint.
* Your skin around the joint is red or hot to the touch.
* You have a fever or have lost weight unintentionally.

Prevention

If arthri­tis is diag­nosed and treated early, you can pre­vent joint dam­age. Find out if you have a fam­ily his­tory of arthri­tis and share this infor­ma­tion with your doc­tor, even if you have no joint symptoms.

Osteoarthri­tis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to over­work a dam­aged or sore joint. Sim­i­larly, avoid exces­sive repet­i­tive motions.

Excess weight also increases the risk for devel­op­ing osteoarthri­tis in the knees, and pos­si­bly in the hips and hands. See the arti­cle on body mass index to learn whether your weight is healthy.

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What is carpal tun­nel syn­drome?
Carpal tun­nel syn­drome is a painful dis­or­der of the wrist and hand. The carpal tun­nel is a nar­row tun­nel formed by the bones and other tis­sues of your wrist. This tun­nel pro­tects your median nerve. The median nerve gives you feel­ing in your thumb, and index, mid­dle and ring fin­gers. But when other tis­sues in the carpal tun­nel, such as lig­a­ments and ten­dons, get swollen or inflamed, they press against the median nerve. That pres­sure can make part of your hand hurt or feel numb.

What causes carpal tun­nel syn­drome?
Doing the same hand move­ments over and over can lead to carpal tun­nel syn­drome. It’s most com­mon in peo­ple whose jobs require pinch­ing or grip­ping with the wrist held bent. Peo­ple at risk include peo­ple who use com­put­ers, car­pen­ters, gro­cery check­ers, assembly-line work­ers, meat pack­ers, musi­cians and mechan­ics. Hob­bies such as gar­den­ing, needle­work, golf­ing and canoe­ing can some­times bring on the symptoms.

Carpal tun­nel syn­drome is linked to other things too. It may be caused by an injury to the wrist, such as a frac­ture. Or it may be caused by a dis­ease such as dia­betes, rheuma­toid arthri­tis or thy­roid dis­ease. Carpal tun­nel syn­drome is also com­mon dur­ing the last few months of pregnancy.

Symp­toms of carpal tun­nel syndrome

* Numb­ness or tin­gling in your hand and fin­gers, espe­cially the thumb and index and mid­dle fingers.

* Pain in your wrist, palm or forearm.

* More numb­ness or pain at night than dur­ing the day. The pain may be so bad it wakes you up. You may shake or rub your hand to get relief.

* More pain when you use your hand or wrist more.

* Trou­ble grip­ping objects.

* Weak­ness in your thumb.

How is carpal tun­nel syn­drome diag­nosed?
Your doc­tor will prob­a­bly ask you about your symp­toms. He or she may exam­ine you and ask you how you use your hands. Your doc­tor may also do these tests:

* Your doc­tor may tap the inside of your wrist. You may feel pain or a sen­sa­tion like an elec­tric shock.
* Your doc­tor may ask you to bend your wrist down for 1 minute to see if this causes symp­toms.
* Your doc­tor may have you get a nerve con­duc­tion test or an elec­tromyo­g­ra­phy (EMG) test to see whether the nerves and mus­cles in your arm and hand show the typ­i­cal effects of carpal tun­nel syndrome.

How seri­ous is carpal tun­nel syn­drome?
Carpal tun­nel syn­drome usu­ally isn’t seri­ous. With treat­ment, the pain will usu­ally go away and you’ll have no last­ing dam­age to your hand or wrist.

How is carpal tun­nel syn­drome treated?
If carpal tun­nel syn­drome is caused by a med­ical prob­lem, your doc­tor will prob­a­bly first treat that problem.

Your doc­tor may ask you to rest your wrist or change how you use your hand. Your doc­tor may also ask you to wear a splint on your wrist. The splint keeps your wrist from mov­ing but lets your hand do most of what it nor­mally does. A splint can help ease the pain of carpal tun­nel syn­drome, espe­cially at night.

Putting ice on your wrist, mas­sag­ing the area and doing stretch­ing exer­cises may help too.

Tips on reliev­ing carpal tun­nel syndrome

* Prop up your arm with pil­lows when you lie down.
* Avoid using your hand too much.
* Find a new way to use your hand by using a dif­fer­ent tool.
* Try to use the other hand more often.
* Avoid bend­ing your wrists down for long periods.

Can I pre­vent carpal tun­nel syn­drome?
Yes. See the box below for some tips on pre­vent­ing carpal tun­nel syndrome.

Many prod­ucts you can buy–such as wrist rests–are sup­posed to ease symp­toms of carpal tun­nel syn­drome. No one has proven that these prod­ucts really pre­vent wrist prob­lems. Some peo­ple may have less pain and numb­ness after using these prod­ucts, but other peo­ple may have increased pain and numbness.

Things that may help pre­vent carpal tun­nel syndrome

* Lose weight if you’re over­weight.
* Get treat­ment for any dis­ease you have that may cause carpal tun­nel syn­drome.
* If you do the same tasks with your hands over and over, try not to bend, extend or twist your hands for long peri­ods.
* Don’t work with your arms too close or too far from your body.
* Don’t rest your wrists on hard sur­faces for long peri­ods.
* Switch hands dur­ing work tasks.
* Make sure your tools aren’t too big for your hands.
* Take reg­u­lar breaks from repeated hand move­ments to give your hands and wrists time to rest.
* Don’t sit or stand in the same posi­tion all day.
* If you use a key­board a lot, adjust the height of your chair so that your fore­arms are level with your key­board and you don’t have to flex your wrists to type.

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