The term ‘arthritis’ is derived from the Greek roots ‘arthro-’ and
‘-itis’.
‘Arthro-’ means joint, and
‘-itis’ means inflammation, so arthritis literally
means inflammation of the joint(s).
Most commonly, when people see the word ‘arthritis,’ they think of the most common
form of arthritis, osteoarthritis, which literally means ‘inflammation of bone and joint’ and refers to degenerative joint disease resulting from normal wear and tear of the joint
cartilage and underlying bone. The prevalence of osteoarthritis is 7% worldwide, affecting over
half a billion people and is one of the leading causes of disability.
Acute gouty arthritis (or gout) affects almost 4% of the US population (over 8
million people).
‘Gout’ comes from the Latin word, ‘gutta,’ meaning ‘drop’ and
refers to the fact that it is caused by ‘drops of humors’ spilling into the joints
from the blood.
Gout is caused by sharp uric acid crystals being deposited into the joints and typically results
in severe pain, redness, and swelling in the affected joints.
The most common joint affected is the big toe, but gout can attack knees, ankles, hands, wrist,
elbows, and feet. Gout typically flares up at times (flares last 1-2 weeks), often triggered by
dietary changes.
Rheumatoid Arthritis is a less common form of arthritis, and unlike
osteoarthritis, rheumatoid arthritis does not involve normal wear and tear or degenerative joint
disease, rather it is an autoimmune process in which the immune system attacks its own joints,
causing pain, swelling, and deformity.
Just over a million people in the USA (about 1% of the population) suffer from Rheumatoid
arthritis.
Reactive Arthritis is a less common form of autoimmune arthritis, usually
triggered by an infection. Symptoms typically develop after the infection symptoms resolve and can
last several months.
Septic Arthritis is a medical emergency, caused by a bacterial (and less commonly
viral or fungal) infection in the joint. It requires immediate treatment with antibiotics and
surgical drainage.
Pain, swelling, aching, redness, stiffness, and loss of function (limited range of motion) are all
symptoms of arthritis.
Osteoarthritis symptoms tend to involve multiple joints and develop over time, and symptoms
typically worsen throughout the day, while rheumatoid arthritis symptoms typically start with
stiff joints in the morning that improve throughout the day.
The onset of acute gouty arthritis is often sudden and severe, lasting for 1-2 weeks and then
resolving. Gout flares can recur several times a year.
After obtaining a thorough history and physical exam, your physician may order lab testing and
imaging studies (X-rays/CT scans/MRIs) to determine which type of arthritis you are suffering
from.
Laboratory tests may include a complete blood count, chemistry panel, rheumatoid factor (Rf),
anti-nuclear antibody (ANA), erythrocyte sedimentation rate (ESR), and uric acid level, depending
on which type of arthritis is suspected.
X-rays or other imaging studies can also help determine if osteoarthritis or rheumatoid arthritis
or a combination of the two is present.
If gout is suspected, uric acid levels will be elevated, and your primary care provider may refer
you to a specialist for definitive diagnosis. To definitively diagnose gout, the affected joint is
aspirated, and if uric acid crystals are seen microscopically, the diagnosis is confirmed.
There are certain radiologic changes that are associated with rheumatoid arthritis. For example,
X-rays of the hands often reveal ulnar deviation, in which the fingers bend away from the thumb.
An elevated Rheumatoid factor (Rf) coupled with certain radiographic findings are usually enough
to confirm a diagnosis of Rheumatoid arthritis.
Depending on the type of arthritis, there are several treatment options available, but first,
it’s important to diagnose the type of arthritis, so the appropriate treatment can be
prescribed.
Many arthritis treatments are routinely prescribed by primary care providers, however some
treatments, specifically rheumatoid arthritis treatments, are normally referred to a
rheumatologist for treatment.
Non-steroidal anti-inflammatory medications, such as ibuprofen (Motrin/Advil), naproxen (Aleve),
indomethacin, meloxicam (Mobic), celecoxib (Celebrex), and topical diclofenac (Voltaren), are all
examples of non-steroidal anti-inflammatory medications.
These medications are routinely prescribed for osteoarthritis, rheumatoid arthritis, and gout and
help ease the pain and swelling associated with arthritis. It is important to understand however,
that these medications carry certain risks, especially with long-term use. NSAIDs can be very hard
on the kidneys and are not recommended for people with chronic kidney disease. NSAIDS can also
increase bleeding risk and are not recommended for people with peptic ulcer disease or
gastritis.
Steroids like prednisone,
methylprednisolone (Solu-Medrol), and hydrocortisone (Cortef)
also can be used to treat arthritis. Unlike NSAIDs, steroids are not hard on the kidneys, though
the bleeding risk is somewhat higher than from NSAIDs. Steroids also raise blood sugar and can
result in many complications with long-term use. Injectable steroids (injected directly into the
affected joint) also can be used to bring temporary relief to specific joints. Locally injected
steroids don’t result in as many side effects as taking steroid pills, since the medication
mostly remains in the joint and doesn’t travel throughout the body.
Acetaminophen (Tylenol) is relatively safe when used at appropriate doses and can
help treat the pain from arthritis, but pain relief is often minimal.
Supplements like turmeric, hyaluronic acid, and
glucosamine may help with pain and inflammation and have less side effects than
NSAIDs and steroids. Other natural treatments such as cryotherapy and even stem cell or
Wharton's Jelly injections may have a role in treating certain types of arthritis.
Colchicine is another type of anti-inflammatory medication usually used for acute
gout flares. Indomethacin and steroids are the other anti-inflammatories typically used to treat
gout flares.
Depending on which joints are involved, physical therapy is often prescribed for people suffering
from osteoarthritis.
Strengthening muscles around affected joints can often result in pain relief and improve function
while reducing inflammation. It’s not uncommon for someone to experience chronic knee pain
due to gait abnormalities resulting from stiffness in the back and hips.
Physical therapy can improve range of motion in these areas, allowing for proper body mechanics
and reduction in pain.
For gouty arthritis, it is important to reduce serum
uric acid levels to under 6mg/dL.
Allopurinol and Uloric are medications that are normally taken
daily to reduce uric acid levels when changes in diet fail to do so. These medications are
normally taken between flares and lower uric acid levels over time.
The goal is to reduce uric acid crystals in the joints and eliminate future gout flares.
Disease-modifying anti-rheumatic drugs such as methotrexate,
sulfasalazine, hydroxychloroquine, and
leflunomide are often prescribed by rheumatologists to treat
rheumatoid arthritis (and other autoimmune disorders).
‘Biologics’ or ‘biologic disease-modifying anti-rheumatic
drugs’ or ‘targeted biologic agents’ are newer medications used by
rheumatologists to treat rheumatoid arthritis and other autoimmune disorders.
Tumor necrosis factor (TNF) inhibitors:
and
Other Biologics:
To request your appointment, please call (469) 414-9660 or contact us online today!
Pure Medicine
4645 Avon Lane, Suite 200
Frisco, TX 75033
Phone: (469) 414-9660
