Aches and Pains – What is Arthritis Anyway? 
By: Dr. Deborah Morris

Past the age of forty or so, virtually everyone has at least some arthritis.  But the word arthritis encompasses a number of diseases and types of pain, so we are going to discuss some of the different types of arthritis and why they occur.  The word arthritis means inflammation of a joint.  Joints are areas where separate bones meet, and where mobility occurs.  Examples of joints include knees, hips, ankles, shoulders, small joints in the hand where fingers bend and the discs between the bones of the back. 

Rheumatoid arthritis is quite different from the aches and pains that come with aging.   Our immune systems normally protect our bodies from infections and other invaders (like certain cancer cells).  Sometimes the immune system gets confused and begins to see parts of ourselves as similar to these invading cells.  Rheumatoid arthritis results from an immune system error that results in the immune cells making antibodies to joint tissues and other normal body tissues.  When these antibodies attach to the joint lining, they call in a sequence of immune system events that result in inflammation and damage to the joints.  This is called auto-immunity, or immunity to self.

 RA can occur in young people including children, as well as in older people.  It can cause severe and progressive joint destruction that, untreated and in a worse case scenario, leads to painful joint deformities.  Rheumatoid arthritis is usually symmetrical, often involving both hands, and can affect both large and small joints. 

While much is understood about the mechanisms of the joint destruction in RA, we do not really understand what causes it.  These are certainly some genetic components, since autoimmune diseases do run in families.  There must also be environmental causes.  Some scientists who study RA think that exposure to certain infections at an earlier point in life may trigger the immune problems that lead to RA. 

The diagnosis of Rheumatoid Arthritis is made by a combination of clinical signs and symptoms, lab work (including detecting certain antibodies) and X-Ray findings.  Certain other autoimmune disorders, such as Systemic Lupus Erythematosis (SLE or lupus) can also cause arthritis. 

There are many treatments for RA and other types of autoimmune arthritis, some of which slow progression of joint destruction.  These treatments are generally prescribed by a rheumatologist, a doctor who specializes in joint diseases and autoimmunity.  Many of these treatments require close follow-up as they have an effect on the immune system. 

The most common type of arthritis is degenerative joint disease also known as osteoarthritis or DJD.  Doctors often say that this kind of arthritis results from wear and tear, but it is not as simple as that.  Some types of osteoarthritis have genetic components.  Hand osteoarthritis clearly runs in families.  Fractures and other injuries in the past (like recurrent sprains) can also make some joints more prone to osteoarthritis.

 DJD can affect any joint, though some joints are more prone than others.  It often results in thinning of cartilage, the material that cushions bone ends where they meet at joints.  Bone spurs are also common with DJD and can contribute to pain and to loss of mobility. 

There are no medicines that can slow or change the progression of DJD.  Anti-inflammatory drugs such as ibuprofen (Motrin), naproxyn (Aleve and Naprosyn) and Celebrex can help pain, but even though they reduce inflammation joint destruction is often progressive.  Other oral pain relievers such as acetaminophen (Tylenol) may be used for comfort.  Resting a joint can be helpful.  Ice and/or heat can make a patient with DJD more comfortable.  Physical and Occupational therapies may help to improve function and mobility. 

 There are even topical medicines, or medicines applied to the skin, that can help with the pain of osteoarthritis.  Many people respond to sports creams that contain chemicals like menthol and methyl salicylate that cause a sensation of heat or coolness on the skin.  Capsaicin, the hot chemical in hot peppers, is available in creams that reduce the sensation of pain in arthritic joints.

Some types of DJD respond to surgical procedures done by orthopedic surgeons.  In extreme cases, joint replacement can decrease pain and improve function, especially in severe DJD of knees and hips. 

Arthritis of the back and neck can be DJD involving what are known as facet joints, but it may also be degenerative disc disease or DDD.  Degenerative disc disease occurs when the soft tissue in the joints between vertebrae, or vertebral discs, become dry or desiccated, and/or develop tears in the leathery exterior.  Spinal DDD and DJD may cause either constant or intermittent pain but in many cases causes no symptoms at all. 

Again, oral medicines including anti-inflammatories, pain relievers and topical creams and gels may help with the discomfort of spinal DJD and DDD.  Prescription medicines can be helpful, and sometimes specialized care (by a neurologist, neurosurgeon or pain management doctor) is important, especially if X-Rays or MRI show pressure on the spinal cord or nerves to the arms or legs. 

It is hard to escape the pain of arthritis, but there are many ways to help cope with it.  Exercise and activity are an important component of the care of all types of arthritis.  Your health care provider can help to diagnose what is causing your joint pain, and help you make decisions for treating it.