Diseases & Conditions, Health

Understanding Arthritis

Arthritis is very common in the United States, with 1 in 4 adults diagnosed with arthritis and 1 in 10 adults limiting their activities because of it. Though it is incredibly common, the symptoms of arthritis vary significantly from case to case, and this condition is surprisingly misunderstood.

Here, we spoke with experts Dr. Elizabeth Simpson, Dr. Natalie Braggs, and Dr. Kyle Binkley to learn more about the different types of arthritis, how they are diagnosed, and what treatments are available to help.

What Is Arthritis?

Arthritis is characterized by inflammation of the joints, but there are over 100 different types of arthritis that can affect the joints and surrounding tissues. Arthritis falls into two main categories: degenerative, which includes osteoarthritis, and inflammatory, which includes rheumatoid arthritis and gout. Treatments for these different types can be similar, but they all affect the joints in different ways.

Non-Inflammatory Arthritis

Non-inflammatory, or degenerative arthritis, also known as osteoarthritis (OA), is the most common type of arthritis. “Osteoarthritis tends to affect people as they age,” says Dr. Braggs, a physician with CHI Memorial Rheumatology and Arthritis Associates. “There are multiple risk factors, with lifestyle being the biggest one. Genetics also plays a part, and repetitive work may also predispose someone to development of arthritis.”

Over the years, the cartilage that lines the ends of bones and cushions the joints wears down, creating increased friction and grinding in the joints. This wear and tear can also deteriorate the tissue that attaches muscle to bone and holds the joint together. Osteoarthritis can affect any joint, but most commonly affects the hands, knees, hips, and spine. Most kinds of arthritis are characterized by pain, stiffness, swelling, and loss of flexibility, but OA can also lead to bone spurs that develop around the joint.

Inflammatory Arthritis

The most common type of inflammatory arthritis, rheumatoid arthritis (RA), is an autoimmune disease, meaning that the body’s immune system attacks the lining of the joint and creates inflammation, which can eventually destroy the cartilage and bone. RA typically affects the smaller joints first – fingers and toes – then spreads to larger joints, and it is often experienced in flares and periods of remission. This inflammation can affect more than just joints, however. “Inflammatory arthritis types, such as rheumatoid arthritis, are associated with elevated risk of heart disease and even certain malignancies,” Dr. Braggs explains. Around 40% of people with RA also experience symptoms in other parts of the body, such as the heart, skin, eyes, and lungs. Beyond the painful swelling, people with RA may experience general fatigue, fever, and loss of appetite.

Diagnosis and Treatment

There are over 100 different types of arthritis that present a wide array of symptoms, many of which fly under the radar as patients write them off as normal aches and pains of aging. This can make diagnosis a bit tricky. According to Dr. Simpson, a physician with Arthritis Asociates, the first step is to determine if a patient is suffering from inflammatory or non-inflammatory arthritis. “We make that determination partly based on the patient’s history. Something that is more sudden onset – ‘I was fine yesterday and now I’m not’ – is more likely to be inflammatory,” she explains. “Inflammatory arthritis tends to cause the joints to swell, and that swelling will typically occur alongside other constitutional symptoms such as fever, fatigue, and weight loss in a case of inflammatory arthritis. From there, auto-immune testing can help determine if we are dealing with something that is systemic in nature or something that is primarily affecting the joint itself.”

Treatment for non-inflammatory arthritis is typically centered on maintaining mobility and reducing pain, and includes nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to reduce inflammation and pain. In severe cases, surgery for joint repair, replacement, or fusion may be required. According to Dr. Braggs, there is currently no medication that can reverse the effects of osteoarthritis or stop the condition from worsening, so it is important to focus on prevention. “There are multiple risk factors for developing arthritis, with lifestyle being the biggest one,” she says. “Controlling weight and aiming to keep your BMI under 25, following a healthy, anti-inflammatory diet, and regular movement can help.”

For inflammatory arthritis, additional treatments address the underlying, systemic medical issues that cause joints to be inflamed. There are disease-modifying antirheumatic drugs (DMARDs) that slow the progression of RA, but it is not reversible. According to Dr. Simpson, “Treatment depends on severity of the disease and how many systems are involved in addition to the joints. We also consider other medical problems they may have, which may require us to be more cautious with certain types of medications or using medications to lower the immune system.” Patients with inflammatory arthritis should be in routine contact with their physicians to monitor bloodwork and keep tabs on any new or worsening symptoms that may evolve.

The Benefits of Physical Therapy for Arthritis

According to Dr. Binkley, a physical therapist with Siskin Hospital for Physical Rehabilitation, physical and occupational therapy can also help alleviate the symptoms of arthritis and make it easier for patients to be more active. “Arthritis can be a normal part of our aging process, but if we do not continue to be active, it can get more and more painful. As we are less active, our joints can stiffen up, which can lead to more pain, which in turn can lead to more inactivity; it can be a vicious cycle,” he explains. Staying active with low-impact activities such as walking, biking, aerobics, or weight training is a good way to prevent symptoms from worsening. Dr. Binkley suggests pool-based therapy as well.

“Aquatic therapy is a great alternative for those who are dealing with difficulties exercising or walking on land, as it allows them to be in an unweighted environment while still getting the benefit of exercise,” he explains.

Physical therapy can help patients with arthritis regain mobility so they can get back to enjoying daily activities with less pain and more freedom. “We discuss the goals that our patients would like to accomplish, whether they want to play on the ground with grandchildren, climb the stairs without pain, or get back to a fitness program they enjoyed in the past,” Dr. Binkley says. “We also look at activity modifications that will allow our patients to be functional at home, like using a stool to sit on versus kneeling on their knees to work in their garden, or adapting a fitness program to fit their pain level.”

As with many conditions, the sooner you seek treatment for arthritis, the better. It is always a good idea to contact your doctor any time new symptoms show up rather than waiting until they become unbearable. “The earlier we can start physical therapy, the better the outcome. Unfortunately, we typically don’t see patients until they are struggling due to severe amounts of pain,” Dr. Binkley says. “I would encourage patients to reach out to a primary care provider, family doctor, or orthopedic doctor and ask for a referral to physical therapy when they start to feel stiffness, aching, and pains that appear to be limiting mobility and decreasing their ability to participate in activities that they enjoy.”

With any kind of arthritis, it’s crucial to educate yourself on the ins and outs of your disease and your own body so you can be in-tune enough to recognize your symptoms and triggers. Another key to living with arthritis is taking care of your emotional health, not just your physical health. Depression is common in people with arthritis, and studies have shown that treating it with antidepressants can also help reduce arthritis pain, in addition to making life easier in a multitude of other ways.