Understanding Arthritis

As you age, you become more susceptible to various forms of arthritis and rheumatic diseases. Rheumatic diseases are those that affect the bones, tissues and joints. There are more than 100 forms of arthritis and other rheumatic diseases. Generally, people use the word “arthritis” to refer to all rheumatic diseases. The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis.

Rheumatoid Arthritis

Rheumatoid arthritis is a systemic disease that affects joints. It is an inflammatory disease of the synovium—or lining of the joint—that results in pain, stiffness, swelling, deformity and loss of function. Inflammation often affects joints of the hands and feet and tends to be symmetrical (occurring equally on both sides of the body). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis. About one percent of the U.S. population (about 2.1 million people) has rheumatoid arthritis.

Osteoarthritis

Osteoarthritis, also known as degenerative joint disease, is the most common type of arthritis, affecting an estimated 20.7 million adults in the United States. Osteoarthritis primarily affects cartilage, which is the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when cartilage begins to fray, wear and decay. In extreme cases, the cartilage may wear away entirely, leaving a bone-on-bone joint. Bony spurs (pointy bulges of bone) may form at the edges of the joint. Osteoarthritis can cause joint pain, reduced joint motion, loss of function and disability. Disability results most often when the disease affects the spine and the weight-bearing joints, such as the knees and hips.

Symptoms

Osteoarthritis comes on slowly. Early in the disease, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint, but it most often affects the hands, hips, knees, spine and shoulders.

Hands

Osteoarthritis of the fingers seems to be hereditary. More women than men have it, especially after menopause. Small, bony knobs appear on the end joints of the fingers. Fingers can become enlarged and may ache or be stiff and numb. This kind of osteoarthritis can be helped by medications, splints, heat treatment and eating the right foods.

Knees

The knees are important weight-bearing joints for the body. For this reason, they are among the joints most commonly affected by osteoarthritis. They may be stiff, swollen and painful, making it hard to walk, climb and get in and out of chairs. If not treated, osteoarthritis in the knees can lead to disability. Medications, weight loss, exercise and walking aids can reduce pain and disability. If pain persists, joint replacement surgery may be needed.

Hips

The hips are important weight-bearing joints of the body. Osteoarthritis in the hip can cause pain, stiffness and severe disability. People may feel pain in their hips, groin, inner thigh, buttocks or knees, which can limit moving and bending. This can make daily activities, such as walking, dressing and putting on shoes, a real challenge.

Spine

Stiffness and pain in the neck or lower back can result from osteoarthritis of the spine. Weakness or numbness of the arms or legs can also result. Some people feel better when they sleep on a firm mattress or sit using back support pillows. Others find help from heat treatment or an exercise program to strengthen the back and stomach muscles. In severe cases, surgery to reduce pain and restore function may be necessary.

Warning Signs

Not everyone with osteoarthritis feels pain. In fact, only a third of people with osteoarthritis in their X-rays report pain or other symptoms. However, the typical warning signs include:

  • Steady or intermittent pain in a joint.
  • Pain at night.
  • Stiffness after getting out of bed.
  • Swelling or tenderness in one or more joints.
  • A crunching feeling or sound of bone rubbing on bone.

Diagnosis

No single test can diagnose osteoarthritis. That's why we use a combination of the following methods to diagnose the disease and rule out other conditions:

  • Clinical history: Your primary care physician will likely assess your condition by asking a series of questions related to your symptoms, such as how they started and whether they've changed over time.
  • Physical exam: Your doctor will check your general health, painful joints, reflexes, muscle strength, and your ability to stand, bend, walk and carry objects.
  • X-rays: An X-ray will show how much joint damage has been done, including cartilage loss, bone damage and bone spurs.
  • MRI: Magnetic resonance imaging (MRI) uses a very large magnet, a radiowave transmitter and a computer to create detailed pictures.
  • CT scan: A computed tomography (CT) scan uses X-rays to obtain pictures of your body. A CT scan sends very narrow X-ray beams through your body, which are collected by a camera that rotates around you. This information is sent to a computer that produces cross-sectional pictures of your body.
  • Other tests: We may order blood tests to determine the cause of symptoms. Your doctor may also remove fluid from your joint for inspection and analysis.

Treatment Approaches

There are various treatment plans to manage pain and improve function of joints. These may include exercise, rest and joint support, pain relief, weight control, medications, surgery and nontraditional approaches, such as acupuncture.

  • Exercise: Research shows exercise is one of the best treatments for osteoarthritis. Exercise can improve flexibility and blood flow, provide weight control and decrease pain. High-impact exercises such as running and jumping are not advised for patients with hip and knee osteoarthritis. Biking or stair machines are better choices.
  • Rest and joint support: Treatment includes regularly scheduled rest. The use of a cane, crutches or walker may decrease pain. Patients learn to recognize warning signals and stop or slow down. Stress reduction techniques and biofeedback may also be helpful. Splints or braces can provide extra support for weakened joints. They also keep the joint in proper position during sleep and activities.
  • Pain relief: People use various techniques to reduce pain, including warm towels, heat pads, warm baths and water therapy.
  • Weight control: Osteoarthritis patients who are overweight or obese should try to lose weight. Weight loss can reduce stress on weight-bearing joints and limit further injury. The stress that goes through your weight-bearing joints is up to five times your body weight. A dietitian can help patients develop healthy eating habits.
  • Medicines: Doctors use medicines to reduce pain and improve functioning. Doctors consider a number of factors when choosing medicines for patients, including the nature of the pain and potential side effects.
  • Surgery: When these techniques don't eliminate pain and restore function, patients seek joint replacement surgery. This surgery helps relieve pain and disability of osteoarthritis and may be performed to:
    • Resurface (smooth out) bones
    • Reposition bones
    • Replace joints
    • Remove loose pieces of bone or cartilage to improve function

Joint Replacement Benefits

You don't have to live with chronic pain. In fact, you shouldn't. Contrary to popular belief, people shouldn't feel chronic pain as a normal part of the aging process. Since you can further damage joints by delaying treatment, medical attention is needed. Our patients have found that joint replacements, such as those of the hip and knee, enable them to resume walking, bending and performing routine tasks with little to no pain.

During joint replacement, an orthopedic surgeon will replace damaged bones with artificial joints called prostheses. These joints are made from metal alloys, high-density plastic and ceramic materials that are joined to bone surfaces. We will ask you lots of questions to help us determine which components to use based on your weight, sex, age, activity level and other medical conditions. Artificial joints used today last about 15 to 20 years. About 10 percent of joint replacements need revision (repair) at some point during this time.

When it comes time for you to have this type of surgery, be certain to select an experienced orthopedic surgeon who has a low complication rate. Your primary care physician can be a good resource to guide this referral process. We're proud to have one of the lowest complication rates in the country. For more information or to schedule an appointment, please call IU Health On-Call at 800.265.3220.