Arthritis

Arthritis is a very common condition that I treat, which makes sense, because it can strike any joint in the body and cause a lot of pain. It can be confusing, though, because there are different types of arthritis, and the treatments differ between them.  

The two major kinds of arthritis that I see in my clinic are rheumatoid arthritis and osteoarthritis.  I’ll start with osteoarthritis, because it is by far the most common type that occurs in people as they age. The main symptoms of osteoarthritis are joint pain, stiffness and sometimes bony swelling or enlargement of the joints (think about how people with arthritis in their hands start to get large knuckles).  

What causes osteoarthritis and the pain from it?  Basically, the space between the bones- which is called the joint- starts to degenerate.  The most marked area where the degeneration occurs is in the cartilage, but it also occurs in the surrounding bone and soft tissue.  This can lead to issues like narrowing of the space in the joint and cysts. Because the joint is no longer functioning normally, this causes pain and stiffness.  

Rheumatoid arthritis is a little different in the sense that it is an autoimmune disease that attacks the joints.  It can be distinguished from osteoarthritis in a few different ways- different joints are normally affected, and sometimes patients have positive tests for rheumatoid arthritis on blood tests.  It is important to known that rheumatoid arthritis is much rarer than osteoarthritis. As far as the diagnosis of osteoarthritis, there is no specific blood test for it. It is mainly what we call a clinical diagnosis, meaning we make the diagnosis based on the patient interview and physical exam, although imaging will confirm the joint changes I discussed above.  

There is some overlap between the treatment of these two types of arthritis, but rheumatoid arthritis actually now has more disease targeted treatments.  This means, rather than just trying to generally relieve pain, there are treatments that are tailored to this specific disease process. These treatments, usually managed by a rheumatologist, try to adjust how the immune system is functioning in order to calm down the rheumatoid arthritis.  

Let’s talk in a little bit more detail about treatments for osteoarthritis.  Remember those different modalities I talked about in my first blog post? I divide things up into my mind by categorizing treatments as medications, other modalities, and interventions/injections. As far as medications, the options are mainly anti-inflammatory medications like Ibuprofen or prescription cousins of it, pain relievers like Acetaminophen, and topical medications like Lidocaine, which is a numbing medication that goes on the skin.  These medications all have pros and cons that depend on the individual patient.

Other modalities to control the pain from arthritis include physical therapy to strengthen supporting muscles and improve range of motion in the joints, and weight loss.  Weight loss is really important for the health of large joints like the hips and knees, because they bear a lot of weight with thousands of steps every day. If the load is reduced, the wear and tear in the joint is slowed.  Weight loss can be really hard for patients who are in a lot of pain from arthritis though, which is why a lot of times I will recommend an aquatherapy program for patients, where exercise can be completed in the water with no gravity to deal with.  

Injections can also be helpful for the pain from arthritis.  Most traditionally, we think about injecting steroids into the larger joints, like knees, shoulders and hips.  I normally perform this kind of injection using an ultrasound machine, which allows me to see the needle in real-time to ensure that it is going precisely into the joint. Steroids can be really powerful pain relievers, but they also have downsides when they are used on a regular basis, like the potential to weaken bones and affect how blood sugar is regulated.  

However, there are also some other newer types of injections available for arthritis.  The first, called viscosupplementation, involves injecting an artificial substance that is meant to serve as a lubricant for the joint.  This is trying to mimic the way that a healthy joint normally glides as it moves. The injections are done either once, or as a series of a few injections, and most often are done under ultrasound guidance.  The second type of procedure, called a nerve block or radiofrequency ablation, is a procedure that actually turns off the nerves that sense the pain from the joint that has arthritis. There have been a lot of exciting developments with this type of procedure especially for knee pain, which I am going to discuss in a separate post.  

I hope this overview helped to explain a little better what arthritis is, and some of the general treatments available.  I’ll be covering pain conditions affecting many of the larger joints in more detail, as well as several of these treatment options. The best way to figure out what kind of arthritis you have is to go see a pain management doctor in person!