- Dr. Mike Purdon
Pain in the joints is one of the most common reasons to visit a family doctor, and this can result in the diagnosis of arthritis. The definition of the word arthritis is simple: inflammation or degeneration of one or more joints that causes pain and swelling. Understanding the cause and the best treatments for arthritis is a little more complicated.
Let’s start by reviewing some anatomy. Joints form wherever the end of one bone meets another bone and arthritis happens when the hard, slippery cartilage tissue that covers those surfaces breaks down. Arthritis can affect the joints formed at the knees, hips and fingers, but it can also occur at any joint in our body such as the shoulders, ankles, toes, or in the joints formed in the low back, or where the collar bone meets the breast bone, for example. Sometimes we can get a good sense of what type of arthritis you might have by considering which joints are involved and by whether the symptoms are occurring on one side or on both sides of your body.
Arthritis has two main causes: osteoarthritis and inflammatory arthritis. Osteoarthritis happens when joints wear out and the cartilage breaks down. This process of aging is a little like when the tread on your car tire wears out with use, and it can happen faster than expected in people who have had injuries or joint abnormalities that speed the process. Osteoarthritis commonly occurs in joints that bear big forces, like the knees and hips and even at the tips of the fingers. Rheumatoid arthritis is the most common form of inflammatory arthritis, but there are other causes of inflammation in the joints. Rheumatoid, or inflammatory arthritis occurs when our immune system attacks our joints, and treats the joint tissue as if it was a foreign material that needs to be removed by the immune system. This can happen at any age, even in children, and it is more common in people who have other diseases that involve an overactive immune system or a family history of inflammatory arthritis. Inflammation can occur in any joint, but it is commonly seen in the hands.
There are other causes of arthritis such as gout and infections of the joints, but we will review those in another article.
I like how the Cleveland Clinic puts it: “Different types of arthritis have different symptoms. They can be mild in some people and severe in others. Joint discomfort might come and go, or it could stay constant.”
Depending on the type of arthritis, the symptoms may include:
Decreased range of motion
Now that we have reviewed a little about the anatomy, causes and symptoms of arthritis, let’s talk about making the diagnosis. Being prepared for our meeting really helps us make the correct diagnosis. Here are some common questions we are going to ask:
Which joints are causing you pain?
How long has the pain been there?
Have you had an injury to the joint(s) recently, or in the past?
Do you feel pain and stiffness in the morning and need to loosen the joint(s) up? Or does the pain get worse when you move around?
Do you have swelling or redness over the joint(s)?
What is the pain stopping you from doing?
Have you had any disease of the immune system, such as psoriasis, colitis or lupus? Or has any member of the family had rheumatoid, or inflammatory arthritis?
When you come into the office, it is really helpful if you wear clothing that lets us see, touch and move the joint that is giving you trouble. X-rays and blood tests are commonly used to get the right diagnosis and we may ask you to undergo these tests, depending on what you tell us and what we find when we examine you. Have a look at this article from Johns Hopkins to understand more about these tests.
The treatment plan for your arthritis will depend on the severity of the arthritis, the type of arthritis, its symptoms and your overall health.
Medication: topical or oral anti-inflammatory medications and pain medications such as acetaminophen may help relieve your arthritis symptoms. More advanced prescription medications can be very effective for the treatment of rheumatoid or inflammatory arthritis. A nice review of supplements for the treatment of arthritis can be found here.
Physiotherapy and Kinesiology: Working with a physiotherapist can help improve strength, flexibility, range of motion and overall mobility. Therapists can also teach you how to adjust your daily activities to lessen the pain caused by arthritis.
Therapeutic injections: Cortisone shots may help temporarily relieve pain and inflammation in your joints, but there are risks to these shots. Arthritis in certain joints, such as the knee, can sometimes be treated with viscosupplementation injections or with platelet rich plasma injections, although these treatments remain controversial.
Surgery: Surgeons can replace joints with artificial components when non surgical treatments are ineffective. This is most commonly done for arthritis involving the hips and knees, but it is also done less commonly for other joints. Estimated wait times for surgery in our region can be found here.
For those who like to read more detailed information about treatment options and the scientific study of the effectiveness of various treatments for arthritis, have a look at this Orthoevidence article.
Finally, let’s review some things that can be confusing in discussing arthritis
“Rheumatism” is a confusing term that was commonly used by our parents to describe joint and soft tissue pain. It is not the same as rheumatoid arthritis.
“Rheumatic fever” is a disease associated with strep throat that is much less common now than in the past. It is not the same as rheumatoid arthritis.
Osteoporosis is a condition in which the bones are weak and brittle. People can have both osteoporosis and osteoarthritis, but they are not the same and they cause different symptoms. Osteoporosis and osteoarthritis are diagnosed with different tests and need different treatments.