Arthritis 101

According to the CDC, 24% of people in the United States have arthritis. It is an incredibly common diagnosis, but many do not understand what arthritis actually is or that there are several different forms. Likewise, it can be discouraging and hard to navigate treatment options. In this article, we’ve provided you with all the details surrounding the various types of arthritis, symptoms, treatment options, and how physical therapy can help ease your pain and your mind when it comes to combating arthritis.

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Definition of Arthritis

Arthritis is swelling and inflammation of the joint that is often painful and hinders range of motion. Arthritis can occur from age-related changes to the protective cartilage or injury to the joint (osteoarthritis), as well as health conditions that result in inflammatory responses (such as rheumatoid arthritis).

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Risk Factors for Arthritis

Age: With some types of arthritis (especially osteoarthritis) there is an increased risk of developing the condition with increase in age.
Sex: Different types of arthritis are more prevalent in one sex versus another. For example, females are more likely to be diagnosed with rheumatoid arthritis whereas males are more likely to experience gout arthritis.
Lifestyle: Smoking and decreased physical activity put you at an increased risk for developing multiple types of arthritis. Obesity in particular increases the risk of developing arthritis due to the excess weight increasing stress on the joints. Additionally, performing activities that also place repetitive stress on your joints will increase the likelihood of arthritis.
Family History: Some types of arthritis have a genetic disposition and those with a family history are more likely to receive a diagnosis themselves.
Previous Injury: Suffering an injury to a joint increases the chances of developing arthritis at that joint in the future.

What are symptoms and findings indicative of Arthritis?

The symptoms for each type of arthritis can vary. However, in general arthritis can be characterized by the following symptoms at the joint:

• Pain (with pressure or movement)
• Stiffness
• Limited mobility/ROM (both passively and actively)
• Sensation of crepitus (a crunching or grinding feeling)
• Swelling
• Redness
• Warmth
• Deformity (change in anatomical structure)

There are also some findings that can be seen on medical imaging, specifically radiographs or x-rays, such as a decrease in joint space or the presence of bony spurs (growths), indicating there is a loss of cartilage within the joint and the presence of arthritis. Additionally, some types of arthritis may be diagnosed using blood work and joint fluid analysis.
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Common Types and Causes of Arthritis

Osteoarthritis (OA)

OA is the most common type of arthritis and occurs when the protective cartilage within a joint gradually wears away, leaving the joint vulnerable to pain, stiffness, and swelling. Bone spurs or growths may develop over time due to the additional stress and friction within the joint, causing further impairment and joint deformity. OA is most likely to occur in larger, weight bearing joints such as the knees and the hips.

There are two main types of OA: primary and secondary. Primary OA occurs when the cartilage within the joint wears away without a known secondary cause. This is due to the normal changes that occur with aging, typically in individuals over the age of 50. Secondary OA occurs when there is a specific trigger or cause that can be identified such as a traumatic injury, obesity, or another medical condition.

Inflammatory Arthritis

Rheumatoid Arthritis (RA)
RA is the most common type of inflammatory arthritis and can impact many body systems, in addition to the joints. It is most prevalent in people between the ages of 30-50 years of age and is more so in women than men. RA is an autoimmune disease in which the body’s immune system targets the lining of the joints, causing damage and swelling of the joint lining. While RA can affect all joints, it is most commonly seen bilaterally and in the hands, feet, wrists, ankles, and knees. RA can result in joint deformities and nodules that form over joints. Treatment typically involves a combination of medication and physical therapy.

Juvenile Arthritis
Juvenile arthritis is a type of inflammatory arthritis that affects children under the age of 18 and may be suspected if children complain of persistent aches and demonstrate swollen joints for more than six weeks. This is another type of inflammatory arthritis that is chronic in nature, however, in some cases the condition does not progress into more serious joint deformity and impairment. It is important to monitor this condition to ensure proper growth and development in children.

Psoriatic Arthritis
Psoriatic arthritis is a specific type of arthritis linked to psoriasis, typically known as a skin disease. It is another type of chronic inflammatory disease that impacts the joints and where connective tissues (like ligaments and tendons) connect to the bones. Similar inflammatory symptoms include swelling, redness, and joint pain. However, with this particular type of arthritis there may also be changes to the nail beds and presence of eye pain. This condition is typically managed with medication and physical therapy.

Gout Arthritis
A type of crystalline arthropathy, gout arthritis occurs when there is a buildup of uric acid within the body (as there is with gout), and thus crystals form and may collect within the joints, resulting in increased inflammation and swelling. It is more common in men and within the big toe, elbow, knee, and ankle joints. It is most often treated with medication and dietary changes to address the root of the cause.

Lyme Arthritis
Lyme disease may result in swelling of the joints, causing pain and tenderness to the area. Since lyme disease is systemic, this type of arthritis is often treated with a course of antibiotics. However, physical therapy is an option to address the accompanying musculoskeletal impairments and help with pain management.

Spondylitic Arthritis
Spondylitic arthritis primarily occurs within the spine, just as the name suggests, with ankylosing spondylitis being the most common form. This type of arthritis typically begins as low back pain and causes changes to the sacroiliac joints first, then gradually travels up the spine as it progresses. These changes can be observed on imaging, and a formal diagnosis is confirmed with blood testing. Symptoms are often treated with physical therapy and medication for pain management.

Septic Arthritis

Septic arthritis occurs when there is an infection within the joint that likely occurred due to bacteria that was present somewhere else within the body and found its way inside the joint. Infections typically cause warmth, swelling, and redness at the joint and are treated with antibiotics due to the underlying bacterial infection. The joint may also require draining.
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How To Treat Arthritis

Surgical Interventions

Depending on the progression of the arthritic changes, surgery may be warranted. The specific type of surgery is dependent upon each individual, however common interventions include total joint replacements, partial joint replacements, fusions, removing the damaged joint lining, and realignment of the joint. However, not everyone will need surgery. Conservative treatments are implicated first and surgical interventions are only considered if there is limited response to other options.

Non Surgical Interventions

Medication and Injections
Providers may prescribe or suggest over-the-counter medication to manage pain, reduce inflammation, and mitigate the immune responses associated with the various forms of arthritis discussed above. Cortisone injections into the joint are also commonly used to decrease inflammation and pain. Additionally, there is limited research that suggests injecting lubricating substances, such as hyaluronic acid, into the joint might provide additional lubrication and ease pain.

Physical Therapy
Physical therapy is a key component of non-surgical interventions for arthritis. Physical therapists work with patients to not only address pain, but to perform exercises that increase muscle strength and joint range of motion. Strengthening the muscles offloads stress on the joints and makes movement feel easier. Joint movement and flexibility training keeps the body limber and able to move freely with less pain and stiffness. Physical therapists can also help you correct your form not only with exercises, but everyday movements like lifting and bending to protect your joints from unnecessary strain and injury.

Weight loss can help relieve excess stress on your joints, which is something your physical therapist is also qualified to assist in and provide you with further resources. In general, increasing physical activity has been shown to be an effective solution in the short and long term to decrease levels of pain and improve functional mobility so that those diagnosed with arthritis can get back to the activities they love with less pain and limitation.

Struggling to find relief from arthritis? Download the OneStep Digital Physical Therapy app to connect with a licensed PT who’s here to support you, help you reach your goals, and create a customized program addressing your unique concerns.

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References:
Arthritis. CDC. Updated Nov 2021. Accessed February 28, 2022.

Arthritis: An Overview. OrthoInfo from the American Academy of Orthopedic Surgeons. Updated September 2021. Accessed February 28, 2022.

Rheumatoid Arthritis. Johns Hopkins Medicine. Updated 2022. Accessed February 28, 2022.

Juvenile Arthritis. OrthoInfo from the American Academy of Orthopedic Surgeons. Updated January  2018. Accessed February 28, 2022.

About Psoriatic Arthritis. National Psoriasis Foundation. Updated November 2021 . Accessed February 28, 2022.

Arthritis. Cleveland Clinic. Updated April 2021. Accessed February 28, 2022.

Arthritis. Mayo Clinic. Updated September 2021. Accessed February 28, 2022.

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