ARTHRITIS

Osteoarthritis

It’s the “wear and tear” that happens when your joints are overused. It usually happens with age, but it can also result from joint injuries or obesity (which puts extra stress on your joints).

Symptoms depend on which joint or joints are affected. You may have:

• Deep, aching pain
• Trouble dressing, combing hair, gripping things, sitting, or bending over
• Joint is warm to the touch
• Morning stiffness for less than an hour
• Pain when walking
• Stiffness after resting
• Joint swells and becomes harder to move

Rheumatoid Arthritis

It is an autoimmune disease that  attacks parts of the body, especially the joints. This leads to inflammation, which can cause severe joint damage if you don’t treat it.

Symptoms can come on gradually or start suddenly. They are often more severe than in osteoarthritis:

• pain and
• stiffness that usually starts in the morning may later last for hours or even most of the day
• swelling in your hands, wrists, elbows, shoulders, knees, ankles, feet, jaw, and neck
• fever or rash and involve the heart, lungs, and eyes.

Psoriatic Arthritis

People with this condition have inflammation of the skin (psoriasis) and joints (arthritis).

Symptoms: Psoriatic arthritis can swell the fingers and toes. People who have it often have fingernails that are pitted or discolored, too.

DIAGNOSIS

During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also want to see how well you can move your joints. Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.

Laboratory tests

The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid (aspiration).

Imaging

These types of tests can detect problems within your joint that may be causing your symptoms. Examples include:

• X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but they are often used to track progression of the disease.
• Computerized tomography (CT). CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues.
• Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRI can produce more-detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments.
• Ultrasound. This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid-containing structures such as bursae. Ultrasound also is used to guide needle placement for joint aspirations and injections.
• Arthroscopy. In some cases, your doctor may look for damage in your joint by inserting a small, flexible tube — called an arthroscope — through an incision near your joint. The arthroscope transmits images from inside the joint to a video screen.

RECOMMENDED MEDICATIONS

Treatment of arthritis generally includes rest, occupational or physical therapy, exercise, drugs, and sometimes surgery to correct joint damage.

Arthritis Treatment: Occupational Therapy

Protecting your joints is an important part of arthritis treatment. With the help of an occupational therapist, you can learn easier ways to do your normal activities.

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

• Analgesics. These types of medications help reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol, others), tramadol (Ultram, others) and narcotics containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Vicodin, Lortab, others).
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on 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 your aching joint may interfere with the transmission of pain signals from the joint itself.
• Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
• Biologics. Typically used in conjunction with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules that are involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).
• Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected directly into the painful joint.