Pain Management

Arthritis

The following information is provided by the Centers for Disease Control. For more information, visit www.cdc.gov/arthritis.

Forty-six million Americans report that a doctor told them they have arthritis or other rheumatic conditions. Arthritis is the leading cause of disability in the United States, limiting the activities of nearly 19 million adults.

The word arthritis actually means joint inflammation. The term arthritis is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Osteoarthritis (OA)

Osteoarthritis is a disease characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands and spine. The specific causes of osteoarthritis are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Disease onset is gradual and usually begins after the age of 40. There is currently no cure for OA. Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, and use of medications.

Rheumatoid Arthritis (RA)

Rheumatoid arthritis is a systemic inflammatory disease which manifests itself in multiple joints of the body. The inflammatory process primarily affects the lining of the joints (synovial membrane), but can also affect other organs. The inflamed synovium leads to erosions of the cartilage and bone and possibly joint deformity. Pain, swelling, and redness are common joint manifestations. Although the definitive causes are unknown, RA is believed to be the result of a faulty immune response. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest. There is no cure for RA, but new drugs are increasingly available to treat the disease. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability.

Gout

Gout is a rheumatic disease resulting from deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process is caused by an overproduction or under excretion of uric acid. Certain common medications and dietary foods are known to be contributory factors. Acute gout will typically manifest itself as an acutely red, hot, and swollen joint with excruciating pain. These acute gouty flare-ups respond well to treatment with oral anti-inflammatory medicines and may be prevented with medication and diet changes. Recurrent bouts of acute gout can lead to a degenerative form of arthritis called gouty arthritis.

Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus is an autoimmune disease in which the immune system produces antibodies to cells within the body leading to widespread inflammation and tissue damage. The causes of SLE are unknown but are believed to be linked to genetic, environmental, and hormonal factors. SLE may be characterized by periods of illness and remissions. SLE has a variety of clinical manifestations and can affect joints, skin, brain, lungs, kidneys, and blood vessels. People with SLE may experience fatigue, pain or swelling in joints, skin rashes, and fevers. SLE predominately affects women between the ages of 15 and 40 and blacks more than whites. A team approach in treating lupus if often warranted due to the number of organ systems involved.

Fibromyalgia

Fibromyalgia is a syndrome predominately characterized by muscular pains and fatigue. The causes of fibromyalgia are unknown; however researchers hypothesize that genetics and, physical and emotional stressors are possible contributory factors to the development of the illness. There are difficulties in diagnosing fibromyalgia, since its clinical picture can overlap other illnesses and there are no definitive diagnostic tests. Patient education, pharmacologic agents, and other nonpharmacologic therapies are used to treat fibromyalgia. Exercise has been found to improve outcomes for people with fibromyalgia.

Treatment

The focus of treatment for arthritis is to control pain, minimize joint damage, and improve or maintain function and quality of life. According to the American College of Rheumatology, the treatment of arthritis might involve the following:

• Medication.
• Nonpharmacologic therapies.
• Physical or occupational therapy.
• Splints or joint assistive aids.
• Patient education and support.
• Weight loss.
• Surgery.

In conjunction with medical treatment, self-management of arthritis symptoms is very important as well.

Risk Factors

Certain factors have been shown to be associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.
Non-modifiable risk factors

* Age: The risk of developing most types of arthritis increases with age.

* Gender: Most types of arthritis are more common in women; 60% of all people with arthritis are women. Gout is more common in men.

* Genetic: Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematous (SLE).

Modifiable risk factors

* Overweight and Obesity: Excess weight can contribute to both the onset and progression of knee osteoarthritis.

* Joint Injuries: Damage to a joint can contribute to the development of osteoarthritis in that joint.

* Infection: Many microbial agents can infect joints and potentially cause the development of various forms of arthritis.

* Occupation: Certain occupations involving repetitive knee bending are associated with osteoarthritis of the knee.

Frequently Asked Questions

What causes arthritis?

Elevated uric acid levels cause gout, and specific infections can cause certain forms of arthritis. The causes of many of the other forms of arthritis are unknown. Scientists are studying the role of factors such as genetics, lifestyle, and environment in the various types of arthritis.

What are the symptoms of arthritis?

The pattern and location of symptoms can vary depending on the type of arthritis. Generally, people with arthritis feel pain and stiffness in and around one or more joints. The onset of arthritis symptoms can develop gradually or suddenly. Arthritis is most often a chronic disease, so symptoms may come and go, or persist over time.

What should I do if I think I have arthritis?

If you have pain, stiffness, or swelling in or around one or more of your joints, talk to your doctor. It is important to keep in mind that there are many forms of arthritis, the specific diagnosis of the type of arthritis you have is necessary to direct the proper treatment. Although there is no cure for most types of arthritis, early diagnosis and appropriate management are important, especially for inflammatory types of arthritis. For example, early use of disease-modifying drugs can affect the course of rheumatoid arthritis. An early diagnosis and appropriate treatment can make a difference in pain and joint damage. The earlier you understand your arthritis, the earlier you can start managing your disease and making healthy lifestyle changes to help your arthritis.

Can I prevent arthritis?

Depending on the form of arthritis, there are steps that can be taken to reduce your risk of arthritis. Maintaining an appropriate body weight has been shown to decrease the risk of developing osteoarthritis and gout. Protecting your joints from injuries or overuse can reduce the risk of osteoarthritis.

How is arthritis diagnosed?

Diagnosing arthritis often requires a detailed medical history of current and past symptoms, physical examination, x-rays, and blood work. It is possible to have more than one form of arthritis at the same time.

What does the CDC recommend for people with arthritis?

The CDC recommends the following:

Early diagnosis and appropriate management of arthritis, including self-management activities, can help people with arthritis decrease pain, improve function, stay productive, and lower health care costs. Key self-management activities include the following:

Develop Your Skills—Self-management education, such as the Arthritis Foundation Self Help Program (AFSHP), or the Chronic Disease Self Management Program (CDSMP) help you develop the skills and confidence to manage your arthritis on a day to day basis. For example, AFSHP has been shown to reduce pain even 4 years after participating in the program.

Be Active—Research has shown that physical activity decreases pain, improves function, and delays disability. Make sure you get at least 30 minutes of moderate physical activity 3 days a week. You can get activity in 10-minute intervals.

Watch Your Weight—The prevalence of arthritis increases with increasing weight. Research suggests that maintaining a healthy weight reduces the risk of developing arthritis and may decrease disease progression. A loss of just 11 pounds can decrease the occurrence (incidence) of knee osteoarthritis.

See Your Doctor—Although there is no cure for most types of arthritis, early diagnosis and appropriate management are important, especially for inflammatory types of arthritis. For example, early use of disease-modifying drugs can affect the course of rheumatoid arthritis. If you have symptoms of arthritis, see your doctor and begin appropriate management of your condition.

Protect Your Joints—Joint injury can lead to osteoarthritis. People who experience sports or occupational injuries or have jobs with repetitive motions like repeated knee bending have more osteoarthritis. Avoid joint injury to reduce your risk of developing osteoarthritis.

Is exercise recommended for people who have arthritis?

Recent studies have shown that moderate physical activity 3 or more days a week can help to relieve arthritis pain and stiffness and give you more energy. Regular physical activity can also lift your mood and make you feel more positive.

An activity that produces a slight increase in heart rate or breathing is considered moderate physical activity. Low-impact activities performed at a moderate pace work best for people with arthritis. These include walking, swimming, and riding a bicycle. Everyday activities such as dancing, gardening, and washing the car can be good if done at a moderate pace that produces slight breathing and heart rate changes.

If you are having an acute flare-up of your inflammatory arthritis, it may be better to restrict your exercise to simple range of motion (carefully moving the joint as far as it can go) during the flare-up.

How does body weight influence arthritis?

Weight control is essential, because extra pounds put extra pressure on many joints. Research suggests that maintaining a healthy weight reduces the risk of developing osteoarthritis and may decrease disease progression. A loss of just 11 pounds can decrease the occurrence (incidence) of knee osteoarthritis.