Arthritis Awareness Month

The Centers for Disease Control and Prevention state that between the years of 2013 and 2015, there were approximately 54.4 million adults who had been diagnosed with some type of arthritis; this means that almost one-quarter of the adult population has been diagnosed with arthritis.

These numbers are expected to grow – by the year 2040, 78 million adults are expected to have some form of arthritis.

May is National Arthritis Awareness Month.  Why an awareness month? Because the various forms of arthritis affect so many Americans, it is the number one cause of disability in the United States.  According to the Arthritis Foundation, “The first steps in conquering arthritis are learning the facts, understanding your condition and knowing that help is by your side.”

Arthritis by the Numbers

Arthritis predominantly affects adults, but it can still affect children and teenagers; in fact, approximately 300,000 babies, children, and teenagers have an arthritic or rheumatic condition.

Arthritis can cause disability; approximately 1/3 of working age people with arthritis have limitations in their work, whether they are working full-time or part-time.

Between lost wages and medical expenses, arthritis costs the United States an estimated $156 billion annually.

Adults with arthritis seem to have coexisting conditions; 57% have heart disease, 52% have diabetes, 44% have hypertension, 36% are obese, and about 33% have anxiety or depression.

Arthritis seems to occur more often in those who are overweight or obese; 23% of those who are overweight and 31% of those who are obese report arthritis.  

Types of Arthritis

There are more than 100 types of arthritis.  The most common types are osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), fibromyalgia, and gout.

Osteoarthritis (OA) is caused by a breakdown of cartilage inside the joint.  Over time, the bones begin to rub against each other, causing varying degrees of pain.  This also makes movements difficult. This type of arthritis can occur in most joints, but occurs most commonly in the knees, spine, hips, and hands.

Rheumatoid arthritis (RA) is an autoimmune disease.  This means that the immune system perceives something in the body as foreign and attacks itself, and the organs and joints suffer, causing RA.  In the case of RA, the immune system attacks the lining of the joints – the synovium – causing inflammation. This inflammation causes permanent damage.  Although RA is often felt in the joints, it can affect various other parts of the body as well.

Psoriatic Arthritis (PsA) is another type of autoimmune arthritis.  According to the Arthritis Foundation, PsA not only affects the joints but also affects “…the connective tissue where tendons or ligaments attach to bones, causing enthesitis; and the skin, causing psoriasis.”

Fibromyalgia is a central pain syndrome, meaning that the brain and spinal cord process pain differently.  The Arthritis Foundation notes that “A touch or movement that doesn’t cause pain for others may feel painful to you (this is called allodynia). Something that is mildly painful to someone without fibromyalgia may hurt you even more (this is called hyperalgesia).”

Fibromyalgia can be difficult to diagnose because its symptoms are not always straightforward; it is characterized by widespread pain, but pain may be constant or may come and go.  In addition, other symptoms may include fatigue, mood issues, and sleep problems

Gout is an inflammatory arthritis, but it is not widespread like RA or PsA.  Gout is typically localized to one joint during a flareup. It occurs due to the buildup of uric acid crystals in the joints.  This happens when the body produces too much uric acid or if you’re unable to remove uric acid quickly enough. The buildup of crystals is extremely painful.  The most common place for gout to occur is in the big toe, although it can occur in other joints.

Diagnosis of Arthritis

Diagnosis of arthritis can be tricky.  Many of the aforementioned types of arthritis can mimic other diseases.  Diagnosis has also come a long way over the years.

Osteoarthritis diagnosis requires pain as a hallmark symptom.  The pain does not need to be bilateral. Generally, range of motion is limited.  Health care providers may use radiology and labwork to rule out other conditions.

Rheumatoid arthritis does not have definitive criteria.  Many people with RA have swollen, warm joints.  Labs will likely be drawn; an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) indicate inflammation.  Rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies can also be drawn; however, someone can still have RA without being positive for these labs.

Psoriatic arthritis often is misdiagnosed as RA or gout.  A physician will assess for psoriasis on the skin, fingernails, and toenails.  Labs are drawn, such as ESR, CRP, rheumatoid factor. When labs that indicate inflammation, arthritis symptoms with swollen, warm joints, and symptoms of psoriasis are present, typically psoriatic arthritis is diagnosed.

Fibromyalgia diagnosis has changed over the years.  In the past, diagnosis used “tender points.”  Tender points are areas that are often painful for people with fibromyalgia; 11 out of 18 of these spots would require tenderness in order for a diagnosis of fibromyalgia.  However, practitioners realized that tenderness waxed and waned, so guidelines are now:

  • Widespread pain that lasts at least three months
  • The presence of other symptoms, such as fatigue and difficulty thinking
  • Other conditions have been ruled out

Gout has specific diagnostic criteria, as outlined by the American College of Rheumatology:

  • The presence of urate crystals in joint fluid OR
  • The presence of a tophus, or a deposit of urate crystals, that can be visualized through polarized light microscopy OR
  • The presence of six or more of the following findings:
    • Asymmetrical swelling of the joint
    • Attack of monoarticular arthritis
    • A culture of the affected joint that is negative for microorganisms that may cause inflammation
    • Inflammation that occurs rapidly, often in one day
    • Hyperuricemia (high levels of uric acid in the blood)
    • Redness of the affected joint
    • More than one attack of arthritis
    • Pain or redness of the joints in the fingers and toes

Treatment of Arthritis

Treatment of arthritis is, of course, dependent on the type of arthritis that you have.  One “treatment” us universal – activity. Of course, you should follow your healthcare providers recommendations.

In the past, activity may not have been emphasized as often, perhaps because experts didn’t understand that activity actually helps relieve most arthritic pain.

If you’re already exercising, keep it up!  Talk to your doctor to see if you need to make any modifications to your routine.  

If you’re not exercising and you’re not sure where to start, walking or a water routine is recommended by the Arthritis Foundation.  These are low-impact exercises that can keep the muscles strong. Start small and increase your workouts as you’re able. Patience White, MD, present of the Arthritis Foundation, says, “When muscles are strong, it takes pressure off them [joints].”  She also recommends weightlifting with light weights and stretches.

Resources

Arthritis-related statistics. (2018, July 18). Retrieved May 18, 2019, from https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm

Fibromyalgia: Understand the diagnosis process. (2017, August 19). Retrieved May 19, 2019, from https://www.mayoclinic.org/diseases-conditions/fibromyalgia/in-depth/fibromyalgia-symptoms/art-20045401

Hainer, B. L., MD, Matheson, E., MD, & Wilkes, R. T., MD. (2014). Diagnosis, treatment, and prevention of gout. American Family Physician, 90(12), 831-836. Retrieved May 19, 2019, from https://www.aafp.org/afp/2014/1215/p831.html.

Macha, A. (2017, January 30). 4 arthritis myths for National Arthritis Awareness Month. Retrieved May 18, 2019, from https://www.health.com/rheumatoid-arthritis/may-is-national-arthritis-awareness-month

May is National Arthritis Awareness Month. (n.d.). Retrieved May 18, 2019, from http://blog.arthritis.org/news/arthritis-awareness-month/

Psoriatic arthritis diagnosis. (n.d.). Retrieved May 19, 2019, from https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/diagnosing.php

Rheumatoid arthritis – diagnosis and treatment. (2019, March 1). Retrieved May 19, 2019, from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653

Sinusas, K. (2012). Osteoarthritis: Diagnosis and treatment. American Family Physician, 85(1), 49-56. Retrieved May 19, 2019, from https://www.aafp.org/afp/2012/0101/p49.html.

Sources of arthritis pain. (n.d.). Retrieved May 18, 2019, from https://www.arthritis.org/living-with-arthritis/pain-management/understanding/types-of-pain.php

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