Arthritis Symptoms and Causes
Arthritis is one of over 100 types of rheumatic diseases that affects one of more joints and their connective tissues. The word "arthritis" literally means inflammation of a joint (from the Greek "arthro" for joint and "itis" for inflammation). Along with inflammation, arthritis causes pain, swelling and limited movement of joints and connective tissues. Arthritis of the hip and arthritis of the knee are more common than arthritis of any other joints, because hips and knees are the body's major weight-bearing joints. Depending on the type of arthritis, symptoms can range from mild pain and discomfort to severe pain and disability that can affect your job, your favorite activities and your overall quality of life.
Arthritis causes the cartilage in your joints to become stiff and lose its elasticity. The stiffness makes the cartilage more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage deteriorates, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.
You may experience one or more of these common symptoms of arthritis:
- Joint pain, aching and soreness, especially with movement
- Joint swelling
- Joint tenderness when you apply light pressure to it
- Pain after overuse or after long periods of inactivity
- Joint stiffness, especially after sleeping or inactivity
- Limited joint movement as the disease progresses
- Grinding of joints when moved (in more advanced stages of osteoarthritis) as the cartilage wears away
- Extra bits of bones known as bone spurs, which feel like hard lumps, may form around the affected joint
- Bony enlargements in the middle and end joints of the fingers which may or may not be painful
The symptoms of arthritis may resemble other medical conditions or problems. Always consult your physician for an accurate diagnosis.
Why Arthritis Is Painful
Arthritis causes joint damage. Joints consist of three parts:
- Cartilage – This is the slick, hard coating on the ends of bones that allows the bones of a joint to slide smoothly over each other.
- Joint capsule – This is a tough membrane that encloses all the parts of the joint.
- Synovium – This is a thin membrane that lines the joint capsule and secretes synovial fluid. The fluid's function is to nourish the cartilage and keep the joint lubricated.
The two main types of arthritis—osteoarthritis and rheumatoid arthritis—damage joints differently.
- Osteoarthritis causes wear-and-tear damage to the cartilage. As the cartilage thins and the bones lose their protective layer, they begin to grind against one another, causing pain and restricting movement.
- Rheumatoid arthritis is an autoimmune disease which means that the body's immune system attacks joints and inflames the synovium, the thin membrane that lines the joint capsule. This type of arthritis causes swelling, redness and pain and can eventually destroy cartilage and bone within the joint.
Arthritis and 50 Million Americans
Arthritis affects 50 million Americans, according to the Centers for Disease Control and Prevention. The American Academy of Orthopaedic Surgeons (AAOS) reports that arthritis is the leading cause of disability in the United States. Even though there is no cure for arthritis, great progress has been made in the variety and effectiveness of nonsurgical and surgical treatment options available. With a personalized nonsurgical treatment regimen, many people with arthritis are able to avoid surgery and successfully manage their pain, stay active and live fulfilling lives.
Common Types of Arthritis
The two most common types of arthritis are osteoarthritis and rheumatoid arthritis:
- Osteoarthritis – The most prevalent form of arthritis, osteoarthritis is also known as "wear and tear" arthritis. This chronic rheumatic disease damages and thins the knee joint's articular cartilage, the smooth and glistening covering on the ends of your bones that enables your knee joint to glide smoothly. Osteoarthritis also narrows the space in which the knee joint moves. Osteoarthritis predominantly affects older people, but it can also occur in young people as a result of a knee injury or overuse.
Osteoarthritis most often affects the joints in the knee, hip, spine and hand, because those joints are often overused and abused. Increasingly, people who work at computers every day are developing osteoarthritis because of the repetitious nature of keyboard entry for hours at a time. In addition, the joints in the knee, hip and spine have to carry your body weight. That's why people who are overweight or obese are at higher risk for developing osteoarthritis. Osteoarthritis predominantly affects people 45 years of age and older, but it can also occur in young people as a result of a knee injury or overuse in recreational or job-related activities. For more information, visit Osteoarthritis of the Hip and Knee.
The Centers for Disease Control and Prevention reports that osteoarthritis affects 27-million American adults. A painful joint disease, osteoarthritis can interfere with your ability to work as well as limit your daily activities and quality of life. The CDC predicts that one in two Americans will get some form of osteoarthritis in their lifetime. One in two Americans will develop symptoms of osteoarthritis in their knees and eventually may need knee replacement surgery.
- Rheumatoid arthritis – This inflammatory disease attacks the lining of your joints (synovium) and is one of a group of inflammatory arthritis diseases, known as inflammatory arthritides. Rheumatoid arthritis is a systemic autoimmune disease that can attack any joint in your body. A chronic disease, it is characterized by periods of flare-ups and remissions and can affect people of all ages. Rheumatoid arthritis can cause permanent destruction and deformity of your joints even before symptoms are severe. The cause of rheumatoid arthritis is unknown.
Other less common types of arthritis and related diseases of the joints and connective tissues are:
- Post-traumatic arthritis – This type of arthritis can develop after a knee injury even though you received the proper treatment for the injury and fully recovered from it. Post-traumatic arthritis may develop years after a fracture, ligament injury or meniscus tear (a tear in the connective tissue of the knee).
- Fibromyalgia – This chronic condition causes pain, stiffness and tenderness of the muscles, tendons and joints without detectable inflammation as can be easily noticed in many other rheumatoid diseases that affect the joints.
- Ankylosing spondylitis -- This inflammatory disease is one of the inflammatory arthritides, a group of inflammatory diseases that attacks the lining of your joints (synovium). Ankylosing spondylitis is a chronic inflammation of the spine and the sacroiliac joint (the point where the spine meets the pelvic bone) that can also cause inflammation in other joints
- Systemic lupus erythematosus -- This autoimmune disease is one of the inflammatory arthritides, a group of inflammatory diseases that causes inflammation of the body's connective tissues.
- Gout – This painful condition most often attacks small joints, but can also attack the hip. Gout is a result of a defect in body chemistry such as uric acid in the joint fluid.
- Scleroderma – A very serious disease of the connective tissues, scleroderma causes thickening and hardening of the skin.
- Juvenile rheumatoid arthritis (JRA) – This form of arthritis in children ages 16 or younger causes inflammation and stiffness of the joints for more than six weeks. Unlike adult rheumatoid arthritis which lasts a lifetime, children often outgrow JRA.
There are no known causes of arthritis, but there are certain risk factors that can make you more susceptible to arthritis, including:
- Heredity – Slight joint defects or double-jointedness (laxity) and genetic defects may contribute to the development of arthritis.
- Obesity – Excessive weight can place undue stress on joints such as the knees, hips and spine over time.
- Injury or overuse – A significant injury to a joint, such as the knee, can later result in arthritis even if your injury was treated properly at the time. Repeated overuse or misuse of a joint may also cause injury.
- Occupation – Certain occupations involving repetitive movements of the joints are associated with arthritis.
Arthritis Nonsurgical Treatment
Nonsurgical treatments for arthritis include:
- Analgesics and pain relievers
- Anti-inflammatory medicines
- Cortisone shots
- Lubrication injections of hyaluronic acid derivatives to provide some cushioning for your joint
- Physical therapy
- Assistive devices such as a cane or walker, splints, braces and shoe inserts help reduce the pain and discomfort of arthritis.
Arthritis Surgery Treatment
If nonsurgical treatments for arthritis fail to provide substantial relief, your orthopaedist may recommend surgical procedures such as:
- Arthroscopic surgery – A minimally invasive procedure that uses very small incisions and fiber optic technology to see inside a joint and remove debris or repair torn cartilage. An arthroscope is inserted in one incision, and very thin surgical instruments are inserted in one of more of the other incisions. The arthroscope is a small tube, thinner than a pencil, containing a system of lenses, a light and a small video camera. The camera sends large real-time images to a video monitor next to the operating table, thus allowing the surgeon to make precise movements with the special surgical instruments. Thanks to the miniaturized camera, the surgeon can see more detail than could be seen with a larger incision (open surgery) and the naked eye.
- Osteotomy – Osteotomies are performed more frequently for arthritis of the knee or hip. Osteotomy of the knee, for example, is a surgical procedure that involves removing a wedge of bone from one of the leg bones right below or above your knee in order to improve alignment of the knee joint. This may be done to relieve symptoms of arthritis of the knee or trauma. A tibial osteotomy makes a cut in the shin bone (lower leg), while a femoral osteotomy makes a cut in the thigh bone. According to the National Institutes of Health, arthritis most often affects the inside part of your knee, not the outside part. That's because the inside of the knee holds more of your weight than the outside of the knee when you walk and stand.
Osteotomy surgery works by shifting the weight away from the damaged part of your knee to the other side of the knee when you stand. When your surgeon removes a wedge of your shinbone from underneath the healthy side of your knee, the shinbone and thighbone can then bend away from the damaged cartilage. For the surgery to be successful, the side of the knee where the weight is being shifted should have little or no arthritis.
The benefits of an osteotomy are twofold: You'll be able to stay active as a result of better knee alignment, less painful symptoms of arthritis. Additionally, when you have an osteotomy, you may be able to delay a total knee replacement surgery for up to 10 years.
- Total joint replacement surgery – Knee and hip joints are the most commonly replaced joints due to their weight-bearing function. During total knee or hip replacement surgery, your orthopaedic surgeon resurfaces your joint by removing the diseased bone and cartilage. These surfaces are replaced with a metal and plastic implant, which mimics natural knee or hip motion and function. Total joint replacement surgery can help put an end to painful arthritis in your knee or hip and enable you to resume a functional and active lifestyle.
- Hip resurfacing – If you have advanced arthritis of the hip, you may be a candidate for either traditional total hip replacement (arthroplasty) or hip resurfacing (hip resurfacing arthroplasty). Each of these procedures is a type of hip replacement, but there are important differences that should be discussed with your orthopaedic surgeon.
- Synovectomy – This surgical procedure removes part or all of the hip or knee joint lining. It is usually recommended for people with rheumatoid arthritis or ankylosing spondylitis, if the disease is limited to the joint lining and hasn't affected the cartilage.
- Cartilage grafting – This surgical procedure is an option for some knees or hips that have limited or contained articular cartilage loss from arthritis or trauma. Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy cartilage makes it easier for you to move your body and allows your bones to glide over each other with very little friction. When cartilage is damaged by arthritis or injury, cartilage grafts can be used to stimulate the growth of new cartilage. The benefits of cartilage grafting are pain relief and better joint function.
The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute's Joint Replacement Services in New York treats arthritis as well as a broad range of conditions that affects the bones, joints, connective tissues, tendons and ligaments.
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We're your partner in a safe, healthy, more rapid recovery.