The many faces of arthritis

Are aches and pains inevitable as we get older? Perhaps… but experts say we shouldn’t ignore the symptoms, or underestimate the potential dangers of arthritis.

"Arthritis" may sound like a single condition but it’s actually an umbrella term for over 100 conditions involving the musculoskeletal system. Our joints aren’t the only areas affected — arthritis can affect the joints and muscles as well. Worse yet, some types can attack any part of the body including vital organs like the heart and lungs.

When we first experience aches and pains, we often reach for painkillers rather than heading to the doctor. However, knowing which type of arthritis you have matters: different forms have different symptoms and different disease processes — and respond to different treatment strategies. Some forms are even preventable, or lifestyle habits like diet and exercise can make a difference.

Here’s a look at some common types:

Osteoarthritis

What is it? It’s the most common form of arthritis, and often shows up as we age. Our joints rely on cartilage (an elastic material that cushions the ends of our bones) to absorb shock and allow us to move more easily. In OA, the cartilage breaks down and the bones begin to rub against each other — causing pain, swelling and stiffness. Often the culprit is the normal "wear and tear" we experience as we age, but OA can also start as the result of an injury. OA is considered a non-inflammatory form of arthritis — though recent research suggests inflammation might play a role.

OA most often affects the lower back, hips, knees and feet, but the fingers and neck can be affected too. Unfortunately, the disease gets worse over time.

How is it treated? Cutting edge options like stem cell therapy are in the works, but currently OA management focuses on controlling pain so you can keep using the joint. Exercise and physiotherapy can help you keep up with your usual activities, but they also keep the surrounding muscles and tissues healthy too. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDS) are the first defense against pain, but stronger medications and eventually joint replacement surgery may be needed.

Complementary and alternative medicine (CAM) therapies such as acupuncture and Transcutaneous electrical nerve stimulation (TENS) can also offer relief for some patients, as can supplements like glucosamine or chondroitin supplements which can help with joint health.

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Rheumatoid arthritis and systemic forms of arthritis

What is it? Our immune systems are supposed to help us fight illness, but sometimes they can be the cause. RA is what’s known as an autoimmune disease — a condition where the immune system attacks the body’s healthy tissues (in this case, the joints and connective tissues). Symptoms are often more severe than aching and stiffness, and can involve redness, swelling, fever, loss of appetite and fatigue. The disease can move on to other parts of the body too, causing rashes and affecting other organs too.

RA isn’t the only form of arthritis involving the immune system. Other types include lupus, reactive arthritis, juvenile arthritis, ankylosing spondylitis and Sjogren’s syndrome (which can effect the eyes and mouth).

How are they treated?An analgesic like acetaminophen often isn’t enough: NSAIDS may be required to help control pain and inflammation but stronger medications are needed. While these medications treat the symptoms, patients often need something to tackle the disease process itself — a class of medications known as disease modifying anti-rheumatic drugs (DMARDS).

Experts still don’t know for certain what causes the immune system to react this way, but it’s crucial to properly diagnose these diseases because they can be dangerous — and even deadly — when they affect the heart, lungs and kidneys.  (For more information, see Autoimmune diseases: a primer and The mystery of Lupus.)

Tendonitis

What is it? This inflammation may feel like it’s affecting the joints, but it’s actually harming your tendons — the connective tissue or "sinew" that connects bone to muscle. You’ve likely heard of "Tennis Elbow" or "Pitcher’s Shoulder", but tendonitis is also common in the wrists and heels too. It can be caused by an injury, but a more likely cause is repetitive use — performing the same motions over and over again at work or play.

Tendonitis can also contribute to another common condition: carpal tunnel syndrome, which is characterized by numbness and tingling in the hand.

How is it treated?Usually rest and pain medications are all that is needed to resolve the inflammation. Physiotherapy can offer protection with exercises that stretch and strengthen the muscles around the tendon. However, severe cases may require surgery to repair.

Tendonitis is one of the few forms of arthritis that can be prevented. The key is to reduce repetitive stress by using proper form and motion for activities, taking breaks from repetitive activities, stretching before exercise and sports, and setting up an ergonomic workstation. Including muscle strengthening exercises as part of your fitness routine can also help protect tendons from injury.

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Gout

What is it?  If you’ve got too much uric acid in your body, it’s going to end up somewhere — often your big toe. Gout is caused by uric acid crystals building up in the joints and tissues — but they aren’t what cause the sudden onset of pain, heat, redness and swelling. The inflammation occurs when the immune system goes to work on the crystal deposits. It could be due to heredity or other factors like obesity or certain medications, but some people simply can’t process uric acid properly.

Unfortunately for sufferers, gout is a chronic and progressive disease — meaning it’s going to stick around and get worse over time. Patients offer experience repeated attacks in the same joint, and then in additional joints as well. It’s one of the few forms of inflammatory arthritis that affects more men than women.

How is it treated?  When an attack occurs, treatment focuses on alleviating the inflammation, usually with NSAIDS or corticosteroids such as prednisone. However, preventing attacks is no less important — and what you eat and drink plays a crucial role. There’s a reason gout is often associated with an excess of "good living": purine in certain foods like organ meats and legumes gets converted into uric acid in the body, and fructose can also trigger attacks. Overindulging in food or alcohol can lead to higher levels of uric acid in the body, and dehydration is another risk.

Your doctor may also prescribe certain medications to help control your uric acid levels, but be forewarned: these medications have to be taken long term. Taking them during an attack can make it worse.

Uric acid deposits can also end up in the bursa or sacks around the joint — a related condition known as bursitis.

Infectious or septic arthritis

What is it? While perhaps not as common as other types, it is one of the most serious. As the name suggests, this form is an infection in the joint caused by bacteria, virus or fungus. The offending organism came from anywhere in the body and find a home in a joint — especially one that already has some damage. The resulting inflammation can be painful, causing the joint to swell, appear red and feel warm to the touch. People might also experience a fever, fatigue and weakness, and may not be able to move the affected joint. 

Experts consider this form of arthritis to be a medical emergency that should be checked out right away. Not only can the infection cause permanent damage to the joint and cartilage, it can spread to other parts of the body and even cause septic shock.

How is it treated?  Luckily, septic arthritis is easier to diagnose than other types — an x-ray or blood test can detect the infection and help doctors pinpoint the strain of bacteria to treat it. Most cases can be successfully treated with a four to six week course of antibiotics. Believe it or not, exercise can help speed up recovery.

What about infections caused by a virus? They aren’t as common, and usually clear up on their own. Fungal infections in the joints are rare, according to experts.

Of course, these forms of arthritis are only a handful of the many varieties. Diagnosing certain types of arthritis like fibromyalgia and lupus can be a tricky and lengthy process, but it’s important to pinpoint the right kind so you can get the right treatment. Keeping a journal of your symptoms can often help reveal patterns that signal certain conditions — especially when there isn’t a definitive test to help determine the condition.

If you or someone you know experiences symptoms of arthritis, experts warn it’s important to talk to your doctor rather than relying on treating yourself at home. The one thing all forms of arthritis have in common is that they benefit from early treatment, and your doctor and specialist can help you tackle all facets of managing the disease — including its emotional impact.

ON THE WEB
We’ve offered a quick glimpse into the many kinds of arthritis and their treatment strategies, but there is a lot more to know. Here are some good places to find more information:

The Arthritis Society (Canada)
The Arthritis Foundation (U.S.)
WebMD: Arthritis Health Center

For a full list of the types of arthritis, go here.

Additional sources: About.com: Arthritis, Arthritis Today, Health Canada, The Mayoclinic.com, Medicinenet.com, the Public Health Agency of Canada, the U.S. National Library for Health

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