What is arthritis?

What is Arthritis?

Arthritis is a disorder characterized by inflammation of the joints, typically presenting with joint pain, swelling, stiffness, and reduced range of motion. 1 There are several types of arthritis, with the most common being osteoarthritis and inflammatory arthritis (such as rheumatoid arthritis).

Types of Arthritis

Inflammatory Arthritis

Inflammatory arthritis is characterized by:

• Joint pain with associated swelling
• Morning stiffness lasting more than 30 minutes to 1 hour
• Improvement of symptoms with NSAIDs or corticosteroids 1
• May affect multiple joints simultaneously

Key types include:

• Rheumatoid Arthritis: A chronic, progressive autoimmune disease affecting synovial joints 1
• Inflammatory Bowel Disease-related Arthritis:
  • Type I: Acute pauciarticular arthritis affecting large joints, usually associated with active IBD
  • Type II: Polyarticular arthritis affecting multiple joints, independent of IBD activity 1
• Axial Spondyloarthritis: Characterized by inflammatory low back pain and sacroiliitis 1

Osteoarthritis

Osteoarthritis is characterized by:

• Progressive joint damage related to cartilage breakdown
• Pain that worsens with activity and improves with rest
• Less pronounced inflammatory features compared to inflammatory arthritis
• Often affects weight-bearing joints 1

Clinical Presentation

Common symptoms across arthritis types include:

• Joint pain
• Joint swelling
• Stiffness (particularly morning stiffness)
• Reduced range of motion
• Functional limitations

Diagnostic Approach

For suspected arthritis:

• Clinical examination is the method of choice for detecting synovitis 1
• Laboratory tests may include:
  • Complete blood count
  • Inflammatory markers (ESR, CRP)
  • Rheumatoid factor (RF)
  • Anti-CCP antibodies
  • Antinuclear antibodies 1
• Imaging:
  • Plain X-rays to assess joint damage
  • Ultrasound and MRI for detecting early synovitis in doubtful cases 1
  • MRI particularly useful for early sacroiliitis 1

Management Principles

Core Treatments for Osteoarthritis

• Patient education about the condition
• Exercise (both strengthening and aerobic)
• Weight loss if overweight or obese 1

Pharmacological Management

• For Osteoarthritis:

  • First-line: Paracetamol (acetaminophen) and/or topical NSAIDs
  • Second-line: Oral NSAIDs, COX-2 inhibitors, opioids
  • Intra-articular corticosteroid injections for moderate to severe pain 1

• For Inflammatory Arthritis:

  • NSAIDs for symptom control
  • Disease-modifying antirheumatic drugs (DMARDs) for patients at risk of persistent disease 1
  • Systemic or intra-articular corticosteroids 1
  • Biological agents for severe disease 2

Non-pharmacological Approaches

• Physical therapy
• Occupational therapy
• Assistive devices
• Joint protection techniques
• Heat or cold applications 1

Important Considerations

• Early diagnosis and treatment are crucial, especially for inflammatory arthritis, to prevent joint damage and disability 1
• Patients with suspected persistent synovitis should be referred to a rheumatologist, ideally within six weeks of symptom onset 1
• Pain management should address both inflammatory and non-inflammatory pain mechanisms 2
• Regular monitoring of disease activity and treatment response is essential 1

Complications

If left untreated, arthritis can lead to:

• Progressive joint damage
• Functional disability
• Reduced quality of life
• Psychological impacts (depression, anxiety)
• Work disability

Early recognition and appropriate management can significantly improve outcomes and quality of life for people with arthritis.