How Is Arthritis Diagnosed?
A diagnosis of arthritis is the first step toward successful treatment. To diagnose arthritis, your doctor will consider your symptoms, perform a physical exam to check for swollen joints or loss of motion, and use blood tests and X-rays to confirm the diagnosis. X-rays and blood tests also help distinguish the type of arthritis you have. For example, most people with rheumatoid arthritis have antibodies called rheumatoid factors (RF) in their blood, although RF may also be present in other disorders.
X-rays are used to diagnose osteoarthritis, typically revealing a loss of cartilage, bone spurs, and in extreme cases, bone rubbing against bone. Sometimes, joint aspiration (using a needle to draw a small sample of fluid from the joint for testing) is used to rule out other types of arthritis. If your doctor suspects infectious arthritis as a complication of some other disease, testing a sample of fluid from the affected joint will usually confirm the diagnosis and determine how it will be treated.
How Is Arthritis Treated?
Treatments for osteoarthritis generally can help relieve pain and stiffness, but the disease may continue to progress. The same was true for rheumatoid arthritis in the past, but newer treatments for rheumatoid arthritis have been able to slow or stop the progression of arthritis damage.
Arthritis Treatment: Occupational Therapy
Protecting your joints is an important part of arthritis treatment. With the help of an occupational therapist, you can learn easier ways to do your normal activities. An occupational therapist can teach you how to:
- Avoid positions that strain your joints
- Use your strongest joints and muscles while sparing weaker ones
- Provide braces or supports to protect certain joints
- Use grab bars in the bath
- Use modified doorknobs, canes, or walkers
- Use devices to help you with tasks such as opening jars or pulling up socks and zippers
Arthritis Treatment: Medicine
Arthritis treatment will depend on the nature and seriousness of the underlying condition. The main goals are to reduce inflammation and improve the function of affected joints before more serious problems occur.
Your doctor may recommend corticosteroid joint injections to ease the pain and stiffness of affected joints. Depending on the individual, results range from temporary relief to long-lasting suppression of symptoms. Your doctor may also inject a hyaluronic acid solution into your joints. Hyaluronic acid mimics normal joint fluid and can reduce pain and increase mobility. Some examples are Hyalgan, Orthovisc, Supartz and Synvisc.
Additional drugs that may help preserve joint function in people with rheumatoid arthritis include abatacept (Orencia), adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, anakinra (Kineret), azathioprine (Imuran), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponia Aria), hydroxychloroquine (Plaquenil), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, leflunomide (Arava), methotrexate, rituximab (Rituxan), sulfasalazine (Azulfidine), tocilizumab (Actemra), and tofacitinib (Xeljanz). In general, these medications work by suppressing the overactive immune system.
Treatment of infectious arthritis typically involves large intravenous doses of antibiotics, as well as drainage of excess infected fluid from the joints.
Arthritis Treatment: Surgery
Various forms of surgery may be needed to reduce the discomfort of arthritis or to restore mobility or joint function. Synovectomy is the removal of damaged connective tissue lining a joint cavity.
If arthritic pain and inflammation become truly unbearable, or arthritic joints become so damaged, the answer may lie in surgical replacement. Today, knee and hip joints can be replaced with reliable artificial joints made of stainless steel, plastic and ceramic materials. Shoulder joints, as well as smaller joints in the elbows and fingers, can also be replaced.
Spinal surgery is sometimes performed for neck and lower spine arthritis. Although movement is limited after such surgery, the operations relieve excruciating pain and help prevent further damage to nerves or blood vessels.
Non-Medical Management of Arthritis Pain
Aside from medical treatments for arthritis, there are effective psychotherapeutic strategies to manage arthritic pain. The National Institutes of Health (NIH) has found that cognitive behavioral therapy, using education and behavior modification alongside relaxation techniques, is better than routine care for relieving pain associated with arthritis. Such programs focus on improving patients' emotional and psychological well-being by teaching them how to relax and conduct their daily activities at a realistic pace. Learning to overcome mental stress and anxiety can be the key to coping with the physical limitations that may accompany chronic rheumatoid arthritis and osteoarthritis. Cognitive therapy may include various techniques for activity scheduling, imaging, relaxation, distraction, and creative problem-solving.
Alternative Medicine for Arthritis
A variety of alternative therapies is used for arthritis. However, none of these has been approved by the FDA for the treatment of arthritis so they may not be effective or safe. It is important to let your doctor know if you're considering these types of treatments.
While some studies suggest that glucosamine and chondroitin supplements are as effective as NSAIDs for reducing pain, swelling, and stiffness in osteoarthritis, recent large studies funded by the NIH suggest these supplements are not very helpful, except perhaps in some cases. Typical daily doses are 1,500 milligrams for glucosamine and 1,200 milligrams for chondroitin.
The antibiotic doxycycline may have some potential to delay the progression of osteoarthritis by inhibiting enzymes that break down cartilage. More research is needed to confirm these results.
The NIH considers acupuncture an acceptable alternative treatment for osteoarthritis, especially if it affects the knee. Studies have shown that acupuncture helps reduce pain, may significantly lessen the need for painkillers, and can help increase range of motion in affected knee joints.
Available over-the-counter since 1999, the supplement SAMe has been shown in some studies to be as effective for osteoarthritis pain as NSAIDs.
Fish oil has been shown to reduce inflammation, lessen the need for painkillers, and possibly decrease joint stiffness. A diet low in animal and dairy fats may have similar effects. Excellent sources of fish oil include EPA/DHA capsules and oily fish such as salmon and mackerel.
At least a dozen different herbs have been used to ease the symptoms of both osteoarthritis and rheumatoid arthritis. Ask your doctor about using any herbs, since they can interact with each other or with medication you are taking. Herbs that have been used are powdered ginger, borage seed oil, or devil's claw to reduce pain and swelling. Stinging nettles or turmeric have also been used.
Ayurvedic medicine uses herbal compounds internally and externally for arthritis symptom relief. Topical curcumin may help relieve the inflammation of rheumatoid arthritis; if taken in capsule form, it can reduce morning stiffness and boost endurance. In one study, a combination of Withania somnifera, Boswellia serrata, and Cucurma longa caused a significant drop in pain and disability for people with osteoarthritis.
Home Remedies for Arthritis
In addition to treatments recommended by your doctor, you can use dry heat from a heating pad or moist heat in the form of a hot bath or a hot-water bottle wrapped in a towel to help relieve pain and stiffness. Heat and rest are very effective in the short run for most people with the disease. Regular exercise is also important to keep the joints mobile.
If you are overweight, losing weight is key, especially when arthritis affects the lower back, knees, and legs. Consult a registered dietitian who can help you plan a healthy weight loss program.
People with weakened, badly deformed fingers from rheumatoid arthritis benefit from specially designed utensils and door and drawer handles; people suffering weakness in the legs and arms can use special bathroom fixtures, especially tub rails and elevated toilet seats.
Although arthritis is not preventable, disability is -- with a well-designed treatment program, including medications, exercise, and physical therapy when needed.