Understanding Arthritis: Causes, Symptoms, & Treatments
According to the CDC, about 1 in 4 American adults have some form of arthritis, making it one of our most common and yet sometimes overlooked and/or misunderstood health conditions. In today’s blog post, we’ve created a helpful introduction to understanding all facets of arthritis, including what causes it, how to recognize it, and what treatments to seek out and be skeptical of. To guide us along the way is Southeastern Med’s Dr. Bill Kumler, a board certified orthopedic surgeon with more than 20 years of experience.
- What Is Arthritis?
“Arthritis is the process of a joint surface breaking down,” Dr. Kumler explains. “It is almost like old paint gradually bubbling, cracking, and flaking off on the outside of a building. Arthritis first changes the normal appearance of the joint, but it may not necessarily cause pain initially. Your body’s response is to send cells to the area to remove debris and attempt to heal the joint surface, but when it cannot restore the joint to normal, it results in repeated cases of inflammation, as temporary bone and cartilage is built, breaks down, and needs to be replaced again. This can result in “bone spurs,” or in medical language, “osteophytes”. Again, because these conditions develop gradually over years, you cannot always see it happening nor feel it happening. How quickly arthritis happens, and at what age, is different for everyone and can be inherited (genetically determined). Some people notice arthritis in their 30s and others not until they are over 60 or 70 years old.”
- What are Signs and Symptoms That I Might Have Arthritis?
According to Dr. Kumler, “The most common signs of arthritis are stiffness, swelling, pain, increased joint warmth, and crackling sounds in the joints as you move them (almost like the crackling of Rice Krispies). However, it’s important to note that normal joints can make popping and cracking sounds too. Studies trying to find out where loud popping sounds from normal joints come from have not been fruitful.”
In Dr. Kumler’s experience, stiffness is often the first thing arthritis patients notice, particularly when getting up in the morning, after sitting for a long time, or during long car rides. “Usually, as you move the joint and it warms-up, the stiffness gets better, and you can go about your business without much trouble,” he says. “As the arthritis gets worse, so does the stiffness, so much it can even limit the normal motion of your joint.”
As the once smooth, lubricated joint breaks down to more of a rough and uneven surface, it will often lead to the familiar crackling and popping sounds and general discomfort associated with arthritis. “Swelling can also occur,” Dr. Kumler says, “because the inflammation causes excess fluid production in the joint, trying to heal and lubricate the joint. The cartilage in your joint gets its nutrition from the fluid in the joint rather than blood flow like the rest of your body. Blood flows to the lining of your joint (creating a warming of the joint) and that lining produces the joint fluid to nourish and lubricate your joint cartilage.”
Along with the pain that can occur from added inflammation and pressure on the bone, Dr. Kumler notes that deformity of the joint can also happen in later stages, sometimes in the form of crooked fingers, knocked knees, bowlegs, shortened extremities, or abnormal posture.
- Is All Arthritis the Same?
“No,” says Dr. Kumler. “There are many different pathways that can all lead to arthritis and problems with your joints. The most common type of arthritis is Osteoarthritis, associated with aging and often determined by your genetics. There are several types of ‘secondary’ Osteoarthritis.
Post-traumatic arthritis can happen as a result of an old sports injury, car accident, or other injury to a joint. Infections, chemicals, congenital deformities, and even surgeries intended to fix other problems can fit under this category, as well. The consistent element is that a joint has been broken down in some way, and inflammation happens in an attempt to heal the joint.
Inflammatory Arthritis, such as Rheumatoid Arthritis (RA), Psoriatic Arthritis, Lupus, and many other autoimmune conditions, works in reverse to Osteoarthritis. Rather than your body trying to heal a damaged joint, it starts when the immune system wrongly responds to a normal body tissue type as a threat. Your own immune system then attacks the normal tissue that was misidentified as abnormal tissue, causing a renegade form of inflammation that actually causes a breakdown in the joint that wouldn’t have otherwise occurred. Other examples of this effect include gout, pseudo-gout, Crohn’s disease, Ankylosing Spondylitis, and many more.”
- How is Arthritis Cured or Fixed?
“The bottom line is that arthritis cannot be fixed or cured, short of finding the fountain of youth,” Dr. Kumler says. “There is a great deal of research being done to address this problem, but a cure is a long way off at this point in time. It may very well require some of the same techniques that will allow us to cure cancer, controlling the body at a cellular level.”
- What Can I Do to Treat Arthritis?
“As you have undoubtedly noticed, inflammation is a central theme around arthritis of all types. Just like eating healthy and exercising regularly help prevent heart attacks and inflammation in your arteries, it also helps to control arthritis problems. Many studies have shown those with arthritis who exercise regularly have less arthritis pain and maintain function longer. Similarly, the more excess weight you carry, the more arthritis pain you will tend to have. Sometimes going to physical therapy can help you get started on an exercise program personalized for you to decrease your pain and improve your function. It usually takes weeks to months of persistence to succeed. Anti-inflammatory medications will help to control excess inflammation, too. Like all medications, there can be many side-effects, so check with your doctor to see what medication and at what dose is best for you. Patients with auto-immune disorders can benefit from medications that partially suppress their immune systems (immunosuppressive medications).”
Dr. Kumler further explains that there isn’t a single universal approach to combating arthritis, and “each person needs to figure out what works best for them. In general, walking, biking, elliptical machines, and water exercises are best tolerated by patients with arthritis. Yoga will help maintain strength, balance, and flexibility. One of the oldest arthritis treatments, believe it or not, is the rocking chair. Before we had all these modern treatments, rocking chairs helped older individuals keep their joints moving and reduced pain.”
Other more common treatment options are compression braces that can help warm and support joints, and Tylenol (acetaminophen) to help reduce pain (it will not stop inflammation). “Too much Tylenol can harm your liver,” Dr. Kumler warns, “so be sure to check with your doctor to see if Tylenol is right for you. Also, be aware that there is no actual difference between Tylenol and ‘Tylenol Arthritis’ in terms of the medication. It is the same medicine; just different doses and released into your system over more time so that a single pill might last longer. Pay very close attention to doses and instructions. Every Tylenol pill is not the same, so be sure you know how much you are taking and what your personal limits per 24 hours should be.”
- I Have Heard There are Injections I Can Get for Arthritis?
“There are many different injections for joints that can help with arthritis pain and just as many misconceptions about these injections,” Dr. Kumler says. “Not a single one of the injections available have been proven to change the progression of arthritis and restore or preserve the life of a joint, and all have potential side-effects.
“Steroid injections are among the most common. These will help with pain and inflammation, allowing you to be more active with less pain. If you are diabetic, however, it can make your blood-sugar go up.
“Gel injections were first developed with the hope of helping your body to rebuild cartilage, but have shown little evidence of benefit, especially for their cost.
“Stem cell injections are similar to gel injections in that there is hope but no evidence or science to demonstrate any significant benefits. Some patients are paying large sums of money out of their own pocket for these treatments based on flashy marketing and well-drawn cartoon pictures implying an effect that has not been proven to help arthritis patients. This is not to say that stem cells will not be part of the answer, but it is still a long way off and we are talking about the same kind of complexity at the cellular level that will be needed to cure cancer.”
- Do I Have to Have Surgery for Arthritis?
“No,” says Dr. Kumler, “but surgery is an option if all the above options do not help. Surgery can be a good option for the right patient. See our knee replacement blog for an example.”
Dr. Kumler’s Key Points on Arthritis:
- Arthritis and pain are part of life. Physicians want to make people better. Physicians want to and can help to relieve arthritis and pain. This applies to medicine as it does to life; all pain cannot be relieved and attempting to relieve all pain can sometimes cause more harm than good.
- Millions of people across our country have arthritis. Someone just needs to sell a product to a fraction of that number to make a great deal of money. Even though you are in pain, take some time to explore your options and be willing to get multiple opinions, especially if you are considering paying large sums of cash.
- Ask questions and become informed. The solution is not the same for everyone. Shared decision making between patients, their families, and their physicians (plural) is important for forming the best plan for you as a patient. That means both patient and physician must be actively engaged and freely communicating – thoughts, questions, and answers flowing in both directions.