Understanding Arthritis: Types, Causes, and Effective Treatment Options
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 9, 2024
Arthritis refers to a group of conditions that cause joint inflammation, leading to pain, stiffness, and reduced mobility. It affects over 350 million people globally, making it a leading cause of disability (Olanrewaju et al. 2022). In Australia, around 3.6 million people, or 15% of the population, live with arthritis (AIHW, 2021).
The impact on quality of life is profound, as arthritis can hinder daily activities like walking and dressing, leading to reduced physical activity and associated health risks. Additionally, the chronic pain and functional limitations can contribute to mental health issues, such as depression and anxiety (Matcham et al., 2013).
This article aims to inform readers about arthritis, including its types, causes, symptoms, and treatment options, to help them manage the condition and improve their quality of life.
What is arthritis?
Arthritis refers to a group of over 100 diseases that cause inflammation in the joints, leading to pain, stiffness, and swelling. It affects not only the joints but also surrounding tissues such as muscles, tendons, and ligaments. The disease damages cartilage, which normally cushions joints, causing bones to rub together and leading to pain and reduced mobility.
A common misconception is that arthritis only affects the elderly; however, it can impact people of all ages. Another is that it only involves minor pain, when in fact, it can lead to significant disability.
In autoimmune types of arthritis, like rheumatoid arthritis, the immune system mistakenly attacks the joints, causing chronic inflammation and joint damage. This immune response is driven by a combination of genetic and environmental factors.
Understanding that arthritis is a complex group of diseases is essential for effective diagnosis and treatment.
Causes and risk factors of arthritis
Age-related wear and tear
As people age, the natural wear and tear on joints becomes a significant cause of arthritis, particularly osteoarthritis. Over time, the cumulative effects of daily movements lead to the gradual breakdown of cartilage, the tissue that cushions joints. This process results in pain, stiffness, and reduced joint function.
Autoimmune factors
In certain types of arthritis, such as rheumatoid arthritis, the immune system mistakenly attacks healthy joint tissues. This autoimmune response triggers chronic inflammation, leading to joint damage. These responses are often influenced by a combination of genetic predispositions and environmental factors, such as infections or stress.
Genetic predisposition
Genetics play a crucial role in the development of various types of arthritis. Specific genes have been linked to a higher risk of conditions like rheumatoid arthritis and ankylosing spondylitis. A family history of arthritis increases the likelihood of developing the disease, indicating a hereditary component.
Lifestyle factors
Lifestyle choices significantly impact arthritis risk. Obesity, for instance, puts extra stress on weight-bearing joints like the knees and hips, accelerating cartilage wear and increasing the likelihood of developing arthritis. Occupational hazards, particularly jobs involving repetitive motions or heavy lifting, can also contribute to joint stress. Smoking has been shown to worsen joint health and increase the severity of arthritis symptoms.
Previous joint injuries
Injuries to a joint, such as fractures or ligament tears, can lead to a form of arthritis known as post-traumatic arthritis. Even after the initial injury heals, the affected joint may develop arthritis over time due to the long-term impact on joint stability and cartilage health.
Signs and symptoms of arthritis
Joint pain and stiffness
Pain is a hallmark of arthritis, varying in intensity and character depending on the type. Osteoarthritis often causes pain that worsens with activity and eases with rest, while rheumatoid arthritis tends to cause pain and stiffness that are most pronounced in the morning or after periods of inactivity. Morning stiffness lasting longer than 30 minutes is particularly associated with inflammatory types of arthritis.
Swelling and inflammation
Swelling is another common sign, often accompanied by visible signs of inflammation like warmth, redness, and tenderness around the affected joints. Inflammatory types of arthritis, such as rheumatoid arthritis, typically cause pronounced swelling in multiple joints, while osteoarthritis may cause swelling in one or a few joints.
Reduced range of motion
Arthritis can significantly reduce a joint’s range of motion, making it difficult to perform daily tasks such as walking, dressing, or gripping objects. This limitation often progresses over time, leading to increasing dependency on others or assistive devices for daily activities.
Fatigue and general weakness
Chronic inflammation from arthritis can lead to systemic symptoms like fatigue and general weakness. The persistent pain associated with arthritis can disrupt sleep, further exacerbating fatigue and reducing overall energy levels.
Specific symptoms for different types of wrthritis
Rheumatoid Arthritis: Often involves symmetrical joint pain (affecting the same joints on both sides of the body), along with the development of rheumatoid nodules—firm lumps under the skin near the affected joints.
Psoriatic Arthritis: May cause unique symptoms such as changes in the nails (pitting or separation from the nail bed) and the presence of skin plaques associated with psoriasis.
Gout: Characterized by sudden, severe attacks of pain, often starting in the big toe. The affected joint may become intensely painful, red, and swollen, with the attacks typically occurring at night.
Diagnosis of arthritis
Physical examination
The diagnosis of arthritis often begins with a physical examination. This involves assessing the affected joints for pain, swelling, and tenderness. The healthcare provider will evaluate the range of motion and muscle strength around the joints to determine the extent of functional impairment.
Imaging tests
X-rays: X-rays are commonly used to visualize joint damage, such as cartilage loss and bone spurs, and to assess joint alignment. They are useful for detecting the progression of conditions like osteoarthritis.
MRI: Magnetic Resonance Imaging (MRI) provides detailed images of soft tissues, including cartilage, ligaments, and muscles. It helps in detecting early changes and more subtle soft tissue involvement, which is particularly valuable for diagnosing conditions like rheumatoid arthritis.
Ultrasound: This imaging technique is used to assess inflammation, fluid buildup, and synovial membrane thickening in the joints. It can also guide joint injections and aspirations.
Blood tests
Markers of inflammation: Tests such as the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels measure inflammation in the body, helping to indicate the presence of an inflammatory arthritis.
Rheumatoid factor and anti-CCP antibodies: These tests are used to help diagnose rheumatoid arthritis. The presence of rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies can support the diagnosis.
Uric acid levels: Elevated uric acid levels in the blood can indicate gout, a type of arthritis caused by the buildup of uric acid crystals in the joints.
Joint fluid analysis
Joint fluid analysis involves aspirating fluid from an affected joint with a needle. This fluid is examined for the presence of crystals, bacteria, or other abnormalities. This test helps diagnose conditions such as gout, pseudogout, and joint infections.
Maintaining a healthy weight
Maintaining a healthy weight reduces stress on joints, especially weight-bearing ones like the knees and hips. Weight management involves a balanced diet with fruits, vegetables, lean proteins, and whole grains, and regular physical activity to control caloric intake.
Regular exercise and joint-friendly activities
Low-impact exercises such as swimming, cycling, and yoga are gentle on joints while improving strength and flexibility. Strength training also helps support and stabilize joints, reducing the risk of injury.
Proper nutrition and supplements
An anti-inflammatory diet, including omega-3 fatty acids from fish, and vitamins D and calcium, supports joint health. Consult a healthcare provider before starting supplements.
Protecting joints during daily activities
Use ergonomic adjustments at work and home, such as supportive chairs and proper desk heights, and practice good body mechanics to prevent joint strain and injuries.
Treatment options for arthritis
Medications
NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen reduce pain and inflammation but may have side effects such as gastrointestinal issues.
DMARDs: Disease-modifying antirheumatic drugs (DMARDs) like methotrexate slow disease progression in autoimmune arthritis by suppressing the immune system.
Corticosteroids: Used for short-term relief during flare-ups, corticosteroids reduce inflammation and pain but may have side effects with long-term use.
Biologics: Advanced treatments for severe cases of arthritis, such as TNF inhibitors, target specific components of the immune system to reduce inflammation.
Lifestyle modifications
Balancing rest and activity: Alternate between periods of rest and activity to manage pain and prevent joint damage.
Stress management techniques: Practices such as mindfulness, meditation, and relaxation techniques can help manage arthritis-related stress.
Sleep hygiene: Good sleep habits can improve pain management and overall health, including maintaining a regular sleep schedule and creating a comfortable sleep environment.
Physical and occupational therapy
Maintaining joint function: Therapists help preserve joint function and mobility through exercises and manual therapy.
Joint protection techniques: Therapists teach techniques to reduce joint stress and prevent injury.
Assistive devices: Recommendations for devices like braces or modified tools can aid in daily activities and reduce joint strain.
Surgery
Joint replacement: For severely damaged joints, options include partial or total joint replacement to restore function and relieve pain.
Arthroscopic procedures: Minimally invasive surgery to address specific issues like meniscal tears or cartilage damage, improving joint function and reducing pain.
Physiotherapy's effectiveness in treating arthritis
Benefits of physiotherapy for arthritis management
Physiotherapy offers several benefits for managing arthritis, including pain reduction, improved joint mobility, and enhanced muscle strength around affected joints. Physiotherapists use various techniques and modalities to address these needs, helping to manage symptoms and improve overall function.
Specific exercises and techniques
Range of motion exercises: These exercises maintain or improve joint flexibility and prevent stiffness.
Isometric and isotonic strengthening: Isometric exercises involve contracting muscles without joint movement, while isotonic exercises involve muscle contraction with movement. Both types help build strength around the joints, supporting and stabilizing them.
Aquatic therapy: Exercise performed in water reduces joint stress due to buoyancy, making it easier to perform movements and build strength.
Pain management strategies
Manual therapy techniques: Techniques such as joint mobilizations and soft tissue massage help alleviate pain and improve joint function.
Heat and cold therapy: Applying heat can relax muscles and improve circulation, while cold therapy helps reduce inflammation and numb pain.
TENS and electrotherapy: Transcutaneous electrical nerve stimulation (TENS) and other electrotherapy methods can help manage pain by disrupting pain signals and stimulating muscle contractions.
Improving joint function and mobility
Gait training and balance exercises: These exercises help improve walking patterns and stability, reducing the risk of falls and enhancing mobility.
Functional training for daily activities: Physiotherapists teach techniques and modifications to perform daily activities more efficiently and with less pain.
Individualized exercise programs: Tailored exercise plans are designed based on individual needs and limitations, ensuring exercises are safe and effective for each person's specific condition.
Living with arthritis
Coping strategies
Mindfulness and relaxation techniques: Practices such as mindfulness, meditation, and deep breathing can help manage stress and pain associated with arthritis.
Importance of social support and communication: Engaging with friends, family, and support groups can provide emotional support and practical advice. Open communication about your condition can also foster understanding and assistance.
Setting realistic goals and pacing activities: Break tasks into manageable steps and set achievable goals to avoid overexertion and prevent fatigue.
Assistive devices and home modifications
Adaptive equipment for daily tasks: Use tools like grabbers, ergonomic kitchen utensils, and modified clothing to simplify daily tasks and reduce joint strain.
Home safety modifications: Install grab bars in bathrooms, remove tripping hazards, and ensure good lighting to prevent falls.
Ergonomic adjustments: Modify your work and leisure environments to reduce strain on your joints, such as using supportive chairs and adjusting workstation heights.
Importance of self-care and stress management
Developing a self-management plan: Create a personalized plan that includes medication management, exercise, and regular check-ups to maintain joint health.
Recognizing and managing flare-ups: Identify early signs of flare-ups and implement strategies to manage them, such as resting and using pain relief methods.
Maintaining overall health and well-being: Focus on a balanced diet, regular physical activity, and adequate sleep to support overall health and enhance your ability to manage arthritis.
Conclusion
Arthritis encompasses a range of conditions characterized by joint inflammation, leading to pain, stiffness, and reduced mobility. Early diagnosis and treatment are crucial for managing symptoms effectively and slowing disease progression.
It’s essential to seek professional help to create a comprehensive management plan, including medications, lifestyle modifications, and physiotherapy. Physiotherapy, in particular, plays a vital role in reducing pain, improving joint function, and enhancing overall quality of life.
With appropriate treatment and proactive management, individuals with arthritis can maintain a positive outlook and lead fulfilling lives.
References:
Australian Institute of Health and Welfare [AIHW]. (2021). Arthritis. Retrieved from https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/arthritis
Olanrewaju, O., Trott, M., Smith, L., López Sánchez, G. F., Carmichael, C., Oh, H., Schuch, F., Jacob, L., Veronese, N., Soysal, P., Shin, J. I., Butler, L., Barnett, Y., & Koyanagi, A. (2022). Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries. Quality of Life Research, 32(4), 1031–1041. https://doi.org/10.1007/s11136-022-03317-6
Matcham, F., Scott, I. C., Rayner, L., Hotopf, M., Kingsley, G. H., Norton, S., ... & Steer, S. (2013). The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 43(2), 123-130.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.