One woman, old woman having back knee while sitting in armchair at home.

Introduction

Arthritis is a complex medical condition that affects millions of individuals worldwide, causing pain, stiffness, and reduced mobility in the joints. Whether you are a patient seeking information or a concerned family member looking to support your loved one, understanding arthritis is crucial.

What is Arthritis?

Arthritis is a broad term encompassing various conditions characterized by joint inflammation, pain, and stiffness. The term “arthritis” itself is derived from the Greek words “arthron,” meaning joint, and “itis,” meaning inflammation. It is important to note that arthritis is not a single disease but rather a group of related conditions, each with its unique features and treatment approaches. These conditions can affect people of all ages, although they are more commonly associated with aging.

Types of Arthritis:

Osteoarthritis

Osteoarthritis is the most common type of arthritis, affecting 1 in 7 adults, and this is likely to affect more and more adults as the population ages and the obesity trend continues. It occurs when the protective cartilage that cushions the ends of bones gradually deteriorates, leading to joint pain, stiffness, and reduced mobility. Although osteoarthritis is typically thought of as ‘wear and tear’ type of arthritis related to cartilage degeneration, it really is much more complex than that, as local inflammation is an important aspect of the arthritis. Osteoarthritis often affects weight-bearing joints such as the knees, hips, and spine, but can also impact the hands and fingers.

Rheumatoid Arthritis

Rheumatoid arthritis, in contrast to osteoarthritis, is an autoimmune disease in which the body’s immune system mistakenly attacks the joints. This chronic condition primarily affects the lining of the joints, leading to inflammation, joint deformity, and potential systemic effects on other organs. Rheumatoid arthritis can occur at any age and is more prevalent in women.

Other Types of Arthritis

In addition to osteoarthritis and rheumatoid arthritis, there are other types of arthritis including crystalline types of arthritis such as gout or pseudogout which can manifest as joint pain and swelling affecting various joints, and can be associated with significant debility if not treated. Other types of arthritis include the spondyloarthropathies, such as psoriatic arthritis, reactive arthritis, inflammatory bowel disease related arthritis and ankylosing Spondylitis. Ankylosing Spondylitis is a chronic inflammatory arthritis primarily affecting the spine and sacroiliac joints, causing pain and stiffness. Juvenile idiopathic arthritis (JIA) is actually a group of chronic arthritic conditions that affects children. This inflammatory disease also causes joint pain, swelling and stiffness. Although JIA is not fully understood, it is believed to result from a combination of genetic predisposition and environmental triggers, like infections or exposure to certain substances.

Arthritis Causes and Risk Factors

Arthritis can be influenced by a combination of genetic, environmental, and lifestyle factors.

Environmental factors
Environmental factors can play a significant role in triggering or worsening arthritis symptoms. Infections, such as bacterial or viral infections, can activate the immune system and lead to joint inflammation in susceptible individuals. Exposure to environmental toxins or pollutants may also contribute to arthritis development, as certain substances can induce an autoimmune response. Additionally, lifestyle choices, such as diet and physical activity, can affect inflammation levels in the body, potentially influencing arthritis symptoms. It is well known that tobacco use is a risk factor rheumatoid arthritis and the progression of the disease. There is well established data also linking periodontal infections to rheumatoid arthritis development. There is increasing interest as well into the role of the gut microbiome and the link between gut dysbiosis and joint inflammation. Identifying and understanding these triggers will be essential in better understanding and managing arthritis and reducing its impact on affected individuals.

Age & Gender
Age and gender play crucial roles in the prevalence and severity of arthritis. As individuals age, the risk of developing degenerative arthritis or osteoarthritis increases, and gender disparity does exist particularly after women reach menopause. Rheumatoid arthritis affects women more frequently than men, with women being two to three times more likely to develop the condition, and we are gaining increasing understanding of the role hormonal influences, particularly estrogen, play on both the development and activity of inflammatory arthritis. As an example, it is not uncommon for rheumatoid arthritis to manifest in the post-partum period due to hormonal shifts in the body.

Lifestyle Factors
Lifestyle choices, including diet and exercise, can significantly impact the risk and progression of arthritis. A balanced and nutritious diet that includes anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, can help reduce inflammation in the body and alleviate arthritis symptoms. A Mediterranean diet has been shown to be beneficial in reducing pain and inflammation related to osteoarthritis. Regular physical activity can strengthen muscles and support joint health, while maintaining a healthy weight can ease the burden on weight-bearing joints, reducing the risk of osteoarthritis. Conversely, an unhealthy diet high in processed foods and sedentary habits can exacerbate inflammation and contribute to arthritis development and progression. Educating individuals on the importance of adopting a healthy lifestyle can empower them to take proactive steps in managing and preventing arthritis.

Common Symptoms of Arthritis

The hallmark symptoms associated with various types of arthritis include joint pain and stiffness. In advanced degenerative arthritis, mobility can be affected as a result. With inflammatory types of arthritis such as rheumatoid arthritis, there is profound morning stiffness lasting more than 30 minutes and joint warmth and swelling which is related to inflammation of the synovial lining. This prolonged morning stiffness or stiffness related to inactivity is often referred to as a ‘gelling’ phenomenon. In some cases, arthritis can lead to systemic symptoms, such as fatigue, fever, and overall malaise. Recognizing and understanding these shared symptoms can aid in early detection and appropriate management of arthritis, promoting better outcomes for patients.

Diagnosis and Treatment

Diagnosing arthritis involves a thorough physical examination, medical history assessment, and often the use of diagnostic tests like X-rays, blood tests, and MRI scans to confirm the presence and type of arthritis. Once diagnosed, the treatment approach varies depending on the specific type and severity of arthritis. Involving a rheumatologist as part of the treatment team may be important in order to initiate disease modifying treatments early depending on the type of arthritis that is present. Physical therapy and occupational therapy are vital components of arthritis management, helping to improve joint function and maintain mobility. Lifestyle changes, such as adopting a healthy diet, regular exercise, and stress management, play a crucial role in complementing medical treatments and promoting overall well-being for individuals with arthritis.

Living with Arthritis: Lifestyle Changes and Self-Care Practices

Lifestyle changes and self-care practices play a crucial role in managing arthritis effectively. Regular physical activity, such as low-impact exercises and stretching, can help improve joint flexibility and reduce stiffness. Exercise should focus not only on aerobic exercise as tolerated but also on strengthening exercises. Maintaining a balanced diet that includes anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, can aid in managing inflammation. Adequate rest, stress management, and practicing relaxation techniques are vital for reducing fatigue and promoting overall well-being. Furthermore, individuals with arthritis should be mindful of their joint health and avoid activities that may exacerbate symptoms, while also seeking support from healthcare professionals and support groups to enhance their coping mechanisms.

Conclusion

Arthritis, both degenerative and inflammatory, can significantly impact joint health and overall well-being. Early diagnosis through thorough physical examination and medical history is essential for timely intervention. Medications, physical therapy, lifestyle changes, weight management and self-care practices are all essential components of arthritis management, aiming to alleviate symptoms and improve joint function. In the end, the treatments should be personalized and engaging with one’s health team to best decide the appropriate treatment options, whether it be pharmacologic or non-pharmacologic, is always a good idea.

About Dr. Amy Kehl

Dr. Kehl is an adult rheumatologist with board certification in Rheumatology, Internal Medicine, and Musculoskeletal Ultrasound. Dr. Kehl is a native of Pasadena and graduated with honors and Phi Beta Kappa distinction from UCLA with a B.S. in Psychobiology and minors in Anthrolopology and Public Health. She went on to obtain her medical degree at UCSF and completed residency in internal medicine at UCSD. Following completion of fellowship in rheumatology at UCSD and Cedars Sinai Medical Center, Dr. Kehl began her career as a clinician educator at UCLA. She transitioned to a clinical rheumatology practice in the Bay Area for several years prior to relocating to the Los Angeles area.