Arthritis overview

What is arthritis?

Arthritis means inflammation in one or more joints. It is a general term covering more than 100 different conditions.

The usual symptoms of arthritis are pain, stiffness and sometimes swelling.

Although arthritis is often thought of as a disabling condition of older people, 2 out of every 3 people with arthritis are aged between 15 and 60 years and most lead normal, or near-normal, lives.

How are the joints affected?

Joints are places where one bone moves against another. The surface of the bone in these areas is covered with cartilage, a smooth 'gristly' material. The whole joint is contained in a capsule, which is lined with a tissue called the synovial membrane. This membrane secretes a fluid - synovial fluid - which nourishes and lubricates the cartilages' surfaces as they move against each other, rather like oil lubricating the pistons in an engine, allowing them to slide smoothly. Arthritis occurs when something is wrong in this system.

Common forms of arthritis

Of the many types of arthritis, the most common is osteoarthritis. Sometimes called degenerative joint disease, this can be thought of as the 'wear and tear' form of arthritis. It tends to affect people as they get older and particularly affects joints that have to take a lot of stresses and strains, such as the weight-bearing joints in the hips and knees. The hands, neck and lower back are also commonly affected. In osteoarthritis, the cartilage surfaces become damaged and worn, sometimes to the point where the underlying bone surfaces are in direct contact with each other.

In rheumatoid arthritis the body's immune system attacks the joint and causes inflammation of the synovial membrane. And in gout (which many people don't realise is a form of arthritis), inflammation occurs in the synovial fluid due to tiny crystals of uric acid.

Arthritis treatment

Although there is currently no cure for most types of arthritis, most types can be effectively controlled. Treatment aims to relieve symptoms such as pain and to improve joint flexibility and function. There are many aspects to the treatment of arthritis.

Exercise is very important because it can help keep joints flexible and also strengthen the surrounding muscles, reducing the stress on joints. Exercise in heated swimming pools - hydrotherapy - can bring enormous relief from pain and stiffness. The water's buoyancy reduces stress on weight-bearing joints.

If you are overweight or obese, losing weight can help reduce the stress on joints.

Medicines are usually necessary for painful arthritis. Simple over-the-counter pain relief medicines (analgesics), such as paracetamol, may be enough, but sometimes specific medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs) are used. Some of these are available over-the-counter, while others require a prescription. NSAIDs can be very effective, but must be taken with care by those who are prone to indigestion and stomach ulcers.

A certain group of NSAIDs, called COX-2 inhibitors, or coxibs, are said to cause less stomach irritation than NSAIDs. However, coxibs may raise your risk of having a heart attack or stroke. This is more likely in people who already have heart disease and those who use the medicine for a long time or take high doses. You can discuss the risks and benefits of these medicines with your doctor, who will be able to tell you whether or not they are suitable for you.

For some types of arthritis, there are specific medicines available. In rheumatoid arthritis, corticosteroids, disease-modifying anti-rheumatic drugs (DMARDS) and biologics (e.g. tumour necrosis factor - TNF - inhibitors) are often used to slow or stop the immune system attacking the joints.

An occupational therapist or physiotherapist can advise on devices and gadgets to make tasks easier and help protect the joints. And some people find complementary therapies such as acupuncture and transcutaneous electrical nerve stimulation (TENS) can help relieve arthritis symptoms.

Surgery now has an increasing place in the treatment of arthritis. Replacement of badly affected joints such as the hips and the knees can dramatically improve the outlook of people with arthritis, and techniques are continually improving the management of hand and shoulder problems.

Can special diets treat arthritis?

Because arthritis is a common, chronic (long-lasting) disease there are many misconceptions about effective treatments. In particular, special diets or particular foods may be recommended. There is little scientific evidence that diet can affect arthritis. It is also not clear whether glucosamine and chondroitin supplements are effective treatment. However, there is some evidence that eating foods rich in omega-3 fish oils can help reduce inflammation in rheumatoid arthritis.

Overweight people should try to lose some weight through dieting and exercise, but people should beware of paying high prices for special foods or supplements sold as 'cures' for arthritis.

Last Reviewed: 1 September 2010
Your Doctor. Dr Michael Jones, Medical Editor.

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References

1. Arthritis Australia, Australian Rheumatology Association. What is arthritis? (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_WhatisArthritis.pdf (accessed Mar 2011).
2. MayoClinic.com. Arthritis (updated 22 Jan 2011). http://www.mayoclinic.com/health/arthritis/DS01122 (accessed Mar 2011).
3. Arthritis Australia, Australian Rheumatology Association. Ostoearthritis (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_Osteoarthritis.pdf (accessed Mar 2011).
4. Arthritis Australia, Australian Rheumatology Association. Rheumatoid arthritis (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_RheumatoidArthritis.pdf (accessed Mar 2011).
5. Arthritis Australia, Australian Rheumatology Association. Medicines and arthritis (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_MedicinesandArthritis.pdf (accessed Mar 2011).
6. Arthritis Australia, Australian Rheumatology Association. Gout (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_Gout.pdf (accessed Mar 2011).
7. Arthritis Australia, Australian Rheumatology Association. Healthy eating and arthritis (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_HealthyEatingandArthritis.pdf (accessed Mar 2011).
8. Arthritis Australia, Australian Rheumatology Association. Glucosamine and chondroitin. (reviewed Apr 2010). http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/english/colour/template_GlucosamineandChondroitin.pdf (accessed Mar 2011).
9. Rossi S, editor. Australian medicines handbook. Adelaide: Australian Medicines Handbook Ltd; 2009.
Dr Michael Jones

Dr Michael Jones

Medical Editor, Your Doctor.