Arthritis Demystified: A Complete Handbook on Types and Medications

The word "Arthritis" is derived from Greek words where "artho" means "joint" and "itis" means "inflammation." It simply means acute or chronic inflammation of the joint and its effects. Arthritis can impact any joint, but the most common areas are hands, wrists, hips, knees, shoulders, feet, ankles, and lower back (lumbar spine). This article explains the types, causes, symptoms, risk factors, diagnosis, and management of arthritis.

Types and Causes of Arthritis:

Generally, joints wear down over ages, leading to the development of arthritis; some types may develop after injuries damaging the joints, while some may develop due to certain health conditions. There are more than 100 types of arthritis affecting people of various ages. Some of the most common ones include:

• Osteoarthritis (wear and tear that develops with age)

• Rheumatoid arthritis (autoimmune disease)

• Psoriatic arthritis (occurs in people with psoriasis)

• Gout (arthritis due to uric acid crystals in joints)

• Juvenile arthritis (arthritis in kids and adolescents less than 16 years of age)

• Ankylosing spondylitis (arthritis of the lower back)

Symptoms and signs of arthritis:

The most common symptoms and signs include:

• Inflammation (swelling)

• Joint pain

• Joint stiffness

• Skin discoloration

• Tenderness around the joint (sensitivity to touch)

• Warmth around the joint

Prevalence in India:

Arthritis is an extremely common medical condition around the world. 

Osteoarthritis is the second most common rheumatological problem, and it accounts for 22% to 39% of prevalence in India.

Risk factors for developing arthritis:

Anyone can develop arthritis; while there are a few risk factors that may make you more likely to develop arthritis, including;

• Tobacco use (smoking)

• Family history 

• Inactive lifestyle

• Other health conditions (autoimmune disorders, obesity, or any condition that affects joints)

• Athletes

• People older than 50 years of age

• People assigned female at birth

• People working in physically demanding jobs

Diagnosis of Arthritis:

Physical examination of your joints by your healthcare provider will provide the initial provisional diagnosis by looking into the signs and symptoms of arthritis.

Later, to confirm and get the final diagnosis, your doctor may perform below tests;

• X-ray

• Ultrasound

• MRI scan

• CT scan

• Blood test (to determine the uric acid level for gout and blood count for autoimmune causes)

Managment of Arthritis:

There is no cure for arthritis; however, the symptoms can be managed by certain medications, therapies, and surgeries. The list of medications used for different types of arthritis is given below:

Analgesics

Analgesics are medications that reduce mild to moderate pain without treating inflammation. A common over-the-counter option is acetaminophen (paracetamol), often used for symptomatic relief of arthritis, as it's less harmful to the heart and stomach compared to nonsteroidal anti-inflammatory drugs (NSAIDs). However, excessive use of acetaminophen can result in liver damage, so dosage must be optimal as directed by a healthcare provider. 

For more severe pain, opioids, which require a prescription, are used for arthritis. These are potent pain relievers but come with a higher risk of side effects, dependency, and addiction. There are also medications available that combine acetaminophen with opioids.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

These are medications used to reduce pain and inflammation. They act by inhibiting the production of prostaglandins, hormone-like substances involved in pain and inflammation. Common over-the-counter NSAIDs include naproxen, aspirin, and ibuprofen, while prescription options include indomethacin and celecoxib. However, NSAIDs carry a risk of increased heart attack, stroke, and stomach bleeding, so their use should be carefully considered after consulting with a physician.

Corticosteroids

These, also known as steroids or glucocorticoids, are anti-inflammatory drugs that mimic the act of cortisol, a natural hormone in the body. They are effective for rapid, short-term relief of inflammation. However, prolonged use of corticosteroids can lead to side effects such as weight gain, cataract, and high blood pressure. Therefore, doctors usually prescribe a low daily dosage for long-term treatment to minimize these risks.

Disease-modifying medications

Disease-modifying antirheumatic drugs (DMARDs) are primarily used to slow down or halt the progression of inflammation in diseases like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, and lupus. While effective, DMARDs can compromise the immune system, increasing the risk of infections. They may take weeks or months to show results, and sometimes, a combination of different DMARDs, known as combination therapy, is necessary for effective treatment.

There are various types of DMARDs, including conventional synthetic DMARDs like methotrexate, often the first choice for rheumatoid arthritis. Other categories include biologics and targeted synthetic DMARDs, with examples like tyrosine kinase inhibitors such as baricitinib, tofacitinib, and upadacitinib. These drugs can be prescribed as pills or as injections.

For example, Xeljanz 5mg tablet contains the active substance tofacitinib. This disease-modifying anti-rheumatoid drug (DMARD) belongs to the class of immunomodulators. It is either used alone or with other medications to treat rheumatoid arthritis and psoriatic arthritis in adults. In addition, it is also indicated to treat moderate to severe active ulcerative colitis in adult patients.

Physical therapy

To improve your strength of joints and motion.

Arthritis surgery

Surgery is performed only when the nonsurgical treatment doesn't help to relieve your symptoms. The two common types used in arthritis surgery are 

• Joint fusion (joining bones together surgically)

• Joint replacement (arthroplasty-artificial joint replacement)

Conclusion:

Arthritis may happen naturally, because of certain conditions, or by both, which can't be changed. However, you can reduce the risk of developing arthritis by reducing or eliminating tobacco use, as smoking can exacerbate joint damage and inflammation. Adopting a healthy diet plan and regular exercise routine is also crucial; this maintains joint flexibility and strength and helps manage weight, thereby reducing stress on the joints. Additionally, wearing protective gear during activities that pose a risk of injury is important, as joint injuries can increase the likelihood of developing arthritis. By incorporating these lifestyle changes, individuals can play an active role in minimizing their risk of arthritis, leading to better joint health over time.