Frequently Asked Questions about Arthritis.

Last updated Tuesday, January 25, 2005

About arthritis

What is arthritis?

The word arthritis literally means joint inflammation ("arthr-" means joint; "-itis" means inflammation). It refers to more than 100 different diseases. These diseases usually affect the area in or around joints, such as muscles and tendons. Some of these diseases can also affect other parts of the body, including the skin and internal organs.

There are many types of arthritis. Most forms of arthritis are chronic, which means they may last a lifetime.

Who gets arthritis?

How does arthritis feel?

Arthritis usually causes stiffness, pain and fatigue. The severity varies from person to person, and even from day to day. In some people, only a few joints are affected and the impact may be small. In other people, the entire body system may be affected.

The joints of the body are the site of much of the action in arthritis. Many types of arthritis show signs of joint inflammation: swelling, stiffness, tenderness, redness or warmth. These joint symptoms may be accompanied by weight loss, fever or weakness.

When these symptoms last for more than two weeks, inflammatory arthritis, such as rheumatoid arthritis may be the cause. Joint inflammation may also be caused by infection, which can lead to septic arthritis. Degenerative joint disease (osteoarthritis) is the most common type of arthritis; joint inflammation is not a prominent feature of this condition. While normal joints can support a vast amount of use, mechanical abnormalities of a joint make it susceptible to degeneration.

It is healthy for you to keep active and move your joints. If you do not move a joint regularly, the muscles around it weaken and/or become tight. The joint can stiffen or even freeze. When you do try to move, the joint and muscles hurt because they have been still for so long.

Many things affect how your joints and muscles feel. Pain may be caused by swelling, joint damage, muscle tightness or spasm. Muscles hurt after doing exercise or activities you aren't used to; sometimes when the joint is damaged, simple activities stress the joint.

When your joints are inflamed or damaged, you need to take certain precautions as you do all your daily activities. Your doctor or therapist can teach you exercises and the correct use of heat and cold to decrease pain. You can also learn how to use your body with the least stress to your joints for less pain, easier movement and even more energy.

Arthritis can make it hard to do the movements you rely on every day for work or taking care of your family.

Can arthritis cause numbness?

Why do joints make popping and cracking noises?

Joints can make different noises--some are serious and some are not.

Some people learn how to "pop their knuckles." By pushing or pulling a joint in a certain way, an air bubble can suddenly appear in the joint with a "pop." Once the bubble is there the joint cannot be popped again until the air has been reabsorbed.

Some joints crack as the ligaments and tendons that pass over them slide past bumps on the bones. Individuals who "crack their neck" make noise in this way.

Other joints lock up intermittently--often with a loud pop--because something gets caught in between the joint surfaces. A torn cartilage in the knee or a loose piece of bone or cartilage in the joint can do this. Once a joint is stuck in this way, it may need to be wiggled around to unlock it. This may also cause a pop.

Finally, joints that are arthritic may crack and grind. These noises usually occur each time the joint is moved. This noise is due to the roughness of the joint surface due to loss of the smooth cartilage.

Can cracking knuckles cause arthritis?

What are the warning signs of arthritis?

Pain from arthritis can be ongoing or can come and go. It may occur when you're moving or after you have been still for some time. You may feel pain in one spot or in many parts of your body.

Your joints may feel stiff and be hard to move. You may find that it's hard to do daily tasks you used to do easily, such as climbing stairs or opening a jar. Pain and stiffness may be more severe during certain times of the day or after you've done certain tasks.

Some types of arthritis cause swelling, or inflammation. The skin over the joint may appear swollen and red, and feel hot to the touch. Some types of arthritis can also cause fatigue.

What causes arthritis?

There are more than 100 different types of arthritis. What causes most types is unknown. Because there are so many different types, there are likely to be many different causes.

Scientists are currently researching what roles three major factors play in certain types of arthritis. These include the genetic factors you inherit from your parents, what happens to you during your life and how you live. The importance of these factors varies for every type of arthritis.

Can arthritis be prevented?

There are things you can do to reduce your risk for getting certain types of arthritis or to reduce disability if you already have arthritis.

People who are overweight have a higher frequency of arthritis. Excess weight increases your risk for developing osteoarthritis in the knees, and possibly in the hips and hands. Women are at special risk for this. In men, excess weight increases your risk for developing gout. It's important to maintain your recommended weight, especially as you get older.

What if you're already overweight? Research shows that middle-age and older women of average height who lose 11 pounds or more over 10 years cut their risk for developing knee osteoarthritis in half. To lose weight, try exercising and eating fewer calories on a healthy diet. If you're having trouble with weight control, ask your doctor or a registered dietitian for help.

Joint injuries caused by accidents or overuse increase your risk for some types of arthritis. You can also inherit certain genes that may increase your risk for some types of arthritis. More research is needed to find out how to reduce your risk from these factors.

Can arthritis be managed?

What can you do to maintain your independence if you already have arthritis? Studies show that exercise helps reduce the pain and fatigue of many different kinds of arthritis. Exercise keeps you moving, working and doing daily activities that help you remain independent.

It's also important to control your weight if you have knee osteoarthritis. Being overweight puts you at risk for worse disease, and for getting osteoarthritis in your other knee if only one is affected now.

How is arthritis diagnosed?

It's important to find out if you have arthritis and what type it is because treatments vary for each type. Early diagnosis and treatment are important to help slow or prevent joint damage that can occur during the first few years for several types.

Only a doctor can tell if you have arthritis and what type it is. When you see your doctor for the first time about arthritis, expect at least three things to happen. Your doctor will ask questions about your symptoms, examine you, and take some tests or X-rays.

You can help your doctor by writing down information about your symptoms before your appointment. Bring your answers when you see your doctor.

Arthritis may limit how far or how easily you can move a joint. Your doctor may move the joint that hurts or ask you to move it. This is to see how far the joint moves through its normal range of motion. Your doctor may also check for swelling, tender points, skin rashes or problems with other parts of your body.

Finally, your doctor may conduct some laboratory tests. These may include tests of your blood, muscles, urine or joint fluid. They also may include X-rays or scans of your body. The tests will depend on what type of arthritis your doctor suspects. They help confirm what type of arthritis your doctor suspects based on your medical history and physical exam and help rule out other diseases that cause similar symptoms.

The overall results from your medical history, physical exam and tests help your doctor match your symptoms to the pattern for a specific type of arthritis.

It may take several visits before your doctor can tell what type of arthritis you have. Symptoms for some types of arthritis develop slowly and may appear similar to other types in early stages. Your doctor may suspect a certain type of arthritis, but may watch how your symptoms develop over time to confirm it.

What type of doctors treat arthritis?

Part of your treatment plan may involve working with different health-care specialists. Some common health-care professionals and their role in your treatment are described below. Most doctors make referrals to one of a group of health professionals with whom they work. But you, too, can ask your doctor to request medical services you think might help you.

Your family doctor may be an excellent source of medical care for your arthritis. Besides having your medication records, your family doctor already has your medical history, is familiar with your general physical health and knows of any past illnesses or injuries. All these facts will give your family doctor a head start in prescribing a treatment plan most suited to your needs.

If your arthritis affects many joints or other parts of the body, or seems resistant to treatment, you may benefit from seeing a rheumatologist. This is a doctor with special training and experience in the field of arthritis. Your family doctor, the local chapter of the Arthritis Foundation, or the county medical society can refer you to a rheumatologist. You can also search for a rheumatologist on the American College of Rheumatology web site.

• Family physicians and general practitioners provide medical care for adults and for children with different types of arthritis. These doctors also can help you find a specialist, if necessary.
• Internists specialize in internal medicine and in the treatment of adult diseases. They provide general care to adults and often help select specialists. Internists should not be confused with interns, who are doctors doing a year's training in a hospital after graduating from medical school.
• Rheumatologists and orthopaedists specialize in treating people with arthritis or related diseases that affect the joints, muscles, bones, skin and other tissues. Most rheumatologists are internists who have had further training in the care of people with arthritis and related diseases. Some rheumatologists also have training in pediatrics. Orthopaedists can offer treatment methods including surgery.
• Ophthalmic specialists provide eye care and treatment.
• Pediatricians treat childhood diseases.
• Physiatrists are doctors who specialize in physical medicine and rehabilitation. They may be asked to evaluate your conditions and may direct or prescribe your physical therapy and rehabilitation.
• Podiatrists are experts in foot care. If arthritis affects your feet, a podiatrist can prescribe special supports and shoes.
• Psychiatrists treat mental or emotional problems that need special attention.
• Nurses trained in arthritis care assist your doctor with your treatment. They also help teach you about your treatment program and can answer many of your questions. Nurses also provide care during hospitalization.
• Occupational therapists can teach you how to reduce strain on your joints while doing everyday activities. They can teach you how to manage stress more effectively, recommend and show you how to use self-help devices, suggest ways to make everyday and work activities easier, and teach you how to reduce strain on your joints and conserve energy. They may also provide you with splints and other joint protection devices.
• Pharmacists fill your prescriptions for medicines and can explain the drugs' actions and side effects. Pharmacists can tell you how different medicines work together, when and how to take your medications, and can answer questions about over-the-counter medicines.
• Physical therapists can show you exercises to help keep your muscles strong and your joints from becoming stiff. They can help you learn how to use special equipment to move better. Some physical therapists also are trained to design personal fitness programs, such as prescribed muscle strengthening and range of motion exercises, for cardiovascular health maintenance and weight control. They can also show you non-medication ways to control pain. If you've had surgery, they can give you pre- and post-surgical care and show you the correct use of devices such as walking aids.
• Psychologists can help you solve emotional or mental problems. They can offer counseling for individual or family support and help you discover effective ways to cope with the emotional aspects of having arthritis.
• Social workers are specially trained to understand situations that may be difficult to deal with or to talk about. People often meet with a social worker to discuss personal, family, social, or financial issues that occur as a result of having arthritis. They often suggest appropriate community resources.
• Certified dietitians (nutritionists) can help by teaching you about any special dietary programs or about healthier ways to eat.
• X-ray and laboratory technologists perform tests which help your doctor make a diagnosis or follow the effects of certain medications.

What is the patient's role in treating or managing arthritis?

The patient is the most important member of the health care team.

The patient plays an important role in his or her medical care. The patient can contribute to the success of a treatment plan by:

• learning about arthritis
• following through with treatment
• reporting progress and setbacks to health team
• keeping a positive attitude
• developing relationships with the rest of the health care team

Keeping a positive attitude, though sometimes difficult, is an important ingredient in overcoming arthritis. Asking questions and finding out as much as you can about of arthritis and its treatment is important. So, talk over your concerns with your doctor. If you still need more information (or if you have difficulty talking to your doctor) ask the nurse, physical therapist, social worker, occupational therapist to help you find answers to your questions.

What are the types of arthritis?

Arthritis most often affects areas in or around joints. Joints are parts of the body where bones meet, such as your knee. The ends of the bones are covered by cartilage, a spongy material that acts as a shock absorber to keep bones from rubbing together. The joint is enclosed in a capsule called the synovium. The synovium's lining releases a slippery fluid that helps the joint move smoothly and easily. Muscles and tendons support the joint and help you move. Different types of arthritis can affect one or more parts of a joint. This often results in a change of shape and alignment in the joints.

Certain types of arthritis can also affect other parts of the body such as the skin and internal organs. There are more than 100 different types of arthritis. It is important to know which type of arthritis you have so you can treat it properly. If you don't know which type you have, call your doctor or ask during your next visit. Some common types of arthritis are described below.

Osteoarthritis

The most common type of arthritis is osteoarthritis. It affects many of us as we grow older. It is sometimes called degenerative arthritis because it involves the breakdown of cartilage and bones. This causes pain and stiffness. Osteoarthritis usually affects the fingers and weight-bearing joints, including the knees, feet, hips and back. It affects both men and women, and usually occurs after age 45. Treatments include pain relievers or anti-inflammatory drugs, exercise, heat or cold, joint protection, pacing your efforts, self-help skills and sometimes surgery.

Fibromyalgia

Fibromyalgia affects muscles and their attachments to bone. It results in widespread pain and tender points, which are certain places on the body that are more sensitive to pain. It also may result in fatigue, disturbed sleep, stiffness and sometimes psychological distress. Fibromyalgia affects mostly women. It is common and often misdiagnosed. Treatments include exercise, relaxation techniques, pacing your activities and self-help skills.

Rheumatoid arthritis

In rheumatoid arthritis, a fault in the body's defense or immune system causes inflammation or swelling. Inflammation begins in the joint lining and then damages both cartilage and bone. Rheumatoid arthritis often affects the same joints on both sides of the body. Hands, wrists, feet, knees, ankles, shoulders and elbows can be affected. Rheumatoid arthritis is more common in women than in men. Treatments include anti-inflammatory and disease-modifying drugs, exercise, heat or cold, saving energy, joint protection, self-help skills and sometimes surgery.

Gout

Gout results when the body is unable to get rid of a natural substance called uric acid. The uric acid forms needle-like crystals in the joint that cause severe pain and swelling. Gout usually affects the big toe, knees and wrists. More men than women have gout. Treatments include anti-inflammatory and special gout drugs, and sometimes a diet low in purines. Foods such as organ meats, beer, wine and certain types of fish contain high levels of purines.

Low back pain

Low back pain results from a back injury or certain types of arthritis. Back pain is one of the most common health problems in the United States. It can occur at any age in both men and women. Treatments include pain relievers or anti-inflammatory drugs, exercise, heat or cold, joint protection, pacing your activities and self-help skills.

Bursitis and tendinitis

Bursitis and tendinitis result from irritation caused by injuring or overusing a joint. Bursitis affects a small sac that helps muscles move easily; tendinitis affects the tendons that attach muscle to bone. Treatments include anti-inflammatory drugs, heat or cold and exercise.

Other types

There are many more types of arthritis and related diseases, including ankylosing spondylitis, juvenile rheumatoid arthritis, polymyalgia rheumatica and lupus erythematosus. See the Arthritic Conditions page for a list of the types of arthritis described in this web site.

What are bone spurs?

Bone spurs are of two basic types. One is the kind that arises near a joint with osteoarthritis or degenerative joint disease. In this situation, the cartilage has been worn through and the bone responds by growing extra bone at the margins of the joint surface. These "spurs" carry the formal name "osteophytes." They are common features of the osteoarthritic shoulder, elbow, hip, knee and ankle. Removing these osteophytes is an important part of joint replacement surgery, but removing them without addressing the underlying arthritis is usually not effective in relieving symptoms.

The second type of bone spur is the kind that occurs when the attachment of ligaments or tendons to bone become calcified. Thus can occur on the bottom of the foot, around the Achilles Tendon, and in the coroacoacromial ligament of the shoulder. Thus spurs often look impressive on X-rays, but because they are in the substance of the ligaments, rarely cause sufficient problems to merit excision.

What are common arthritis treatments?

There are many things that help reduce pain, relieve stiffness, and keep you moving. Your care may involve more than one kind of treatment. Your doctor may recommend medications, but there are many things you can do on your own to help manage pain and fatigue and move easier.

Finding the right treatment takes time. It can involve trial and error until you and your healthcare team or therapist find what works best. Be sure to let your doctor know if a treatment is not working. Your treatment may also change as your arthritis changes.

Treatments for arthritis can be divided into several categories: medication, exercise, heat/cold, pacing, joint protection, surgery and self-help skills. You can do things in each of these areas to help yourself feel better and move easier.

Medication

Many different drugs are used to treat arthritis. Some are available without a prescription; others must be prescribed by your doctor. You should always check with your doctor before taking any medication, even over-the-counter drugs. Your doctor can tell you how much and when to take them for best relief, as well as how to avoid any drug-related problems.

These are some of the common medications used to treat arthritis. Your doctor may prescribe other medication to treat specific forms of arthritis or in specific situations.

Anti-inflammatories reduce both pain and swelling. These medications are called nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs such as aspirin, ibuprofen and naproxen sodium are available without a prescription; others are only available by prescription. The most common side effect of these medications is stomach upset. Call your doctor if stomach pain is more than mild and lasts.

Aspirin is commonly used to treat many forms of arthritis. Aspirin-free pain relievers may be recommended by your doctor if you just need pain relief, are allergic to aspirin, or have had an ulcer. Acetaminophen gives temporary relief of common arthritis pain, but does not reduce swelling. It is available without a prescription.

Corticosteroids are prescribed to reduce severe pain and swelling. They are given by injection or in pill form. Injections can bring quick relief, but can only be used several times in one year because they weaken bone and cartilage. Because of potentially serious side effects, corticosteroids must be prescribed and monitored by a doctor.

Disease modifiers tend to slow down the disease process in rheumatoid arthritis. Researchers do not know how this happens. These drugs are available only by prescription and may take several weeks or months to work. Your doctor will carefully monitor you for side effects.

Sleep medications may promote deeper sleep and help relax muscles. These drugs may help people with fibromyalgia sleep better. They are available by prescription and are used in very low doses at bedtime.

Questions you should ask about your medications:

• What is its name?
• How much do I take?
• How and when do I take it?
• How long will it be before it works?
• What benefits can I expect?
• When should I contact my doctor if I don't get relief?
• What side effects should I watch for?
• What other drugs should I not take with it?

Exercise

Regular exercise is important to keep you moving and independent. Exercise helps lessen pain, increases movement, reduces fatigue and helps you look and feel better. Three types of exercises can help people with arthritis.

1. Range-of-motion exercises reduce stiffness. They keep your joints flexible by moving them to their fullest extent. Most people should do these exercises daily.
2. Strengthening exercises increase or maintain muscle strength. Strong muscles help keep your joints stable and make it easier to move. Most people should do these exercises daily or every other day.
3. Endurance exercises build fitness. They help keep your heart healthy and control your weight. You should exercise for a total of 20 to 30 minutes, three times a week, at a pace that raises or sustains your heart rate. Most people can build your endurance by exercising for shorter periods of time several times a day.

Plan your exercises at times of the day when you have less stiffness or pain. Start slowly. Build up the amount of time you exercise and the number of repetitions you do. Exercise at a level that allows you to talk comfortably during the activity. If pain from exercise lasts more than two hours, you may have done too much. Reduce your level of activity next time. Stop exercising right away if you have chest pains, severe dizziness or shortness of breath, or if you feel sick to your stomach.

Heat and cold

Using heat or cold over joints or muscles may give you short-term relief from pain and stiffness. You can also use heat or cold to help prepare for exercise. Some people feel better using heat; others prefer cold.

Heat helps relax aching muscles. Sources of heat include heating pads, hot packs, hot tubs or heated pools. Cold numbs the area so you don't feel as much pain. You can apply cold with ice, cold packs or even bags of frozen vegetables.

It's important to use heat and cold safely. Don't use either treatment for more than 20 minutes at a time. Let your skin return to normal temperature between applications. Don't use heat with rubs or creams since this can result in skin burns.

For more information on using heat and cold correctly, talk to your physical therapist.

Pacing yourself

Pacing yourself saves energy by switching periods of activity with periods of rest. Pacing helps protect your joints from the stress of repeated tasks and helps reduce fatigue.

Alternate heavy or repeated tasks with easy ones. Change tasks often so you don't hold joints in one position for a long time. Plan rest breaks during your daily activities.

Joint protection

You can protect your joints by using them in ways that avoid excess stress. Protecting your joints makes it easier to do daily tasks.

Joint position means using joints in the best way to avoid excess stress. Use larger or stronger joints to carry things. For instance, carry your grocery bags using your forearms or palms instead of your fingers.

Walking or assistive devices can keep stress off certain joints. Your doctor may suggest using a cane, crutches or a walker to reduce stress on your hips and knees.

Many assistive devices have special features that help make tasks easier. Special aids with larger handles, such as extra-thick pens, make it easier to hold and write. Longer handles and reachers give you better leverage. Lightweight items, such as plastic dishes, are easier to carry.

Weight control involves staying close to your recommended weight, or losing weight if you are overweight. Weight control helps reduce your risk for developing osteoarthritis in the knees or gout. If you already have knee osteoarthritis, losing weight may lessen pain by reducing stress on your joints. Exercise and reducing calories will help you lose weight. If you need to lose a lot of weight, work with your doctor and a registered or licensed dietitian to find the best weight-loss program for you.

Surgery

Most people with arthritis will never need surgery. However, surgery can help in some cases when other treatments have failed. It can reduce pain, increase movement and improve physical appearance.

Two kinds of surgery help people with arthritis. The first kind repairs the existing joint by removing debris, fusing or correcting bone deformity. The second replaces the joint with an artificial joint.

If your doctor suggests surgery, you may want to ask another doctor for a second opinion. Orthopaedic surgeons are the doctors who perform most joint replacements. Plastic surgeons may help with hand surgery.

What's new in arthritis research?

Progress is so fast in some areas of arthritis research today that the media often report new findings before the medical journal with the information reaches your doctor's office. As a result, you need to know how to evaluate reports on new arthritis research.

Arthritis researchers are looking at four broad areas of research. These include causes, treatments, education and prevention.

Researchers are learning more about certain conditions. For example, in osteoarthritis, researchers are looking for signs of early destruction of cartilage and ways to rebuild it. For rheumatoid arthritis and other types that involve inflammation, researchers are trying to understand the steps that lead to inflammation and how it can be slowed or stopped. An initial study suggests that fibromyalgia affects more older people than originally thought and often may be overlooked in this group. Your doctor can tell you about other new research findings. If you would like to take part in arthritis research, ask your doctor for a referral to a study in your area.

Many people help make arthritis research possible. The federal government, through its National Institutes of Health, is the largest supporter of arthritis research. Drug companies do the most research on new medications.

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

Adapted from several pamphlets originally prepared for the Arthritis Foundation, one of which is by Beth Ziebell, Ph.D. This material is protected by copyright.