Dimming the Flame of Pain: Arthritis and All That

Explaining inflammatory arthritis and its treatments

March 13, 2012 / Author:  / Reviewed by: Joseph V. Madia, MD

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Your joints may feel tight. Your hips might hurt so bad that you can barely walk. Your back may feel so weak that you cannot even sit up straight. If you are experiencing these symptoms, you might have arthritis.

Arthritis comes in many forms. In fact, there are more than 100 types of arthritis - the most common of which is osteoarthritis, or the "wear and tear" form of the disease. People typically develop osteoarthritis from overusing their joints, or with age as their joints have had time to grind away.

Osteoarthritis is one of the easier kinds of arthritis to diagnose. Other types, however, involve slightly more complex processes. Diseases like rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis develop because of problems with the immune system, making it harder to pinpoint their origin.

Although many aspects of autoimmune or inflammatory forms of arthritis remain unclear, scientists and doctors know a fair amount about how these diseases work and how to treat them.

This article will give you an idea of what these diseases look like and how patients are typically treated.

If you feel you may be experiencing the symptoms described in the following sections, go to your doctor for a proper diagnosis. He or she may be able to get you the early treatment you need to protect your body from irreversible damage.

Rheumatoid Arthritis

The exact cause of rheumatoid arthritis is unknown. Be that as it may, scientists do know that it is an autoimmune disease, meaning your immune system mistakenly attacks your own body's healthy tissues.

In rheumatoid arthritis, this autoimmune attack typically affects the small joints in your hands and feet. As a result of the inflammation caused by the disease, your joints become painful and swollen. Eventually, your bone may erode and your joints may become deformed.

Unfortunately, there is no cure for rheumatoid arthritis. However, depending on your symptoms and how far the disease has progressed, your doctor can help you control the pain and the disease itself.

What are the signs and symptoms of rheumatoid arthritis?

In the early stages of rheumatoid arthritis, your smaller joints are likely to be affected first. These are the joints that connect your fingers and toes to your hands and feet.

Eventually, the disease may spread to your larger joints, such as the shoulders, elbows, hips, knees, and ankles.

The signs and symptoms of rheumatoid arthritis will vary from patient to patient. For some people, the symptoms can come and go. For others, the pain is ever-present. In most cases, patients will experience symptoms in the same joints on both sides of the body.

When your joints become inflamed as the result of rheumatoid arthritis, you may experience a number of symptoms, including:

  • morning stiffness, in which the joints may feel warm, fragile, and stiff if they are not used for an hour
  • deformity and the loss of the normal range of motion
  • pain in the same joint on both sides of the body (e.g. left wrist and right wrist)

In addition to joint pain, rheumatoid arthritis patients may suffer from other symptoms such as:

  • dry eyes and mouth
  • burning eyes
  • itching
  • chest pain when taking a breath
  • tingling, numbness, or burning in the hands and feet

Over time, rheumatoid arthritis can weaken patients to the point at which doing day-to-day tasks is a struggle. Patients may feel discomfort and fatigue that can make most physical activities unbearable.

Luckily, rheumatoid arthritis patients have a variety of treatment options to help them both deal with the pain and prevent permanent damage.

Medications, physical therapy, exercise, and surgery are all used in the treatment of rheumatoid arthritis.

What types of medications are used to treat rheumatoid arthritis?

There are many types of drugs that rheumatoid arthritis patients can take. Some of these drugs treat symptoms only, while others slow down the progression of the disease itself.

Disease-modifying antirheumatic drugs (DMARDs) are one of the most commonly prescribed drugs for rheumatoid arthritis patients. They are designed to prevent permanent joint damage.

Most rheumatoid arthritis drugs are designed to treat symptoms such as pain, swelling, and stiffness. DMARDs, on the other hand, slow down the progression of the disease itself. In other words, these drugs treat the underlying processes that lead to the failure of the immune system and rheumatoid arthritis.

Patients used to begin rheumatoid arthritis treatment by taking drugs that addressed symptoms, eventually working their way to DMARDs. Now, experts believe that method works too slowly to stop permanent joint damage.

Today, the recommended course of action is to start DMARD treatment early. Some studies have shown that early treatment can even put rheumatoid arthritis into remission.

Examples of DMARDs include:

  • Arava (leflunomide)
  • Trexall (methotrexate)
  • Rheumatrex (methotrexate)
  • Plaquenil (hydroxychloroquine)
  • Azulfidine (sulfasalazine)
  • Dynacin (minocycline)
  • Minocin (minocycline)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are also commonly used in the treatment of rheumatoid arthritis. While DMARDs slow the progression of the disease, NSAIDs are designed to address symptoms.

NSAIDs work to reduce pain and inflammation - the hallmarks of rheumatoid arthritis.

You probably have taken NSAIDs. In fact, it is possible you were already taking NSAIDs before you were diagnosed. They come in both over-the-counter and prescription forms.

Examples of over-the-counter NSAIDs include:

  • Advil (ibuprofen)
  • Motrin (ibuprofen)
  • Aleve (naproxen)
  • Bayer (aspirin)
  • Bufferin (aspirin)

Examples of prescription NSAIDs include:

  • Mobic (meloxicam)
  • Lodine (etodolac)
  • Relafen (nabumetone)
  • Clinoril (sulindac)
  • Celebrex (celecoxib)

Steroids, or corticosteroids, are also used to treat symptoms of rheumatoid arthritis. They work well to reduce pain, swelling, and inflammation. However, they can cause serious and long-term side effects, such as weight gain and diabetes.

Examples of steroids used in the treatment of rheumatoid arthritis include:

  • Deltasone (prednisone)
  • Liquid Pred (prednisone)
  • Meticorten (prednisone)
  • Decadron (dexamethasone)
  • Medrol (methylprednisolone)

Tumor necrosis factor (TNF) inhibitors are another rheumatoid arthritis medication.

Tumor necrosis factor is a substance made by the body that causes inflammation. TNF inhibitors block this substance, thus reducing inflammation, joint pain, stiffness, tenderness, and swelling.

Examples of TNF inhibitors include:

  • Humira (adalimumab)
  • Enbrel (etanercept)
  • Remicade (infliximab)
  • Simponi (golimumab)
  • Cimzia (certolizumab)

Immunosuppressants are used to control the overactive immune system that leads to rheumatoid arthritis.

Examples of immunosuppressants include:

  • Imuran (azathioprine)
  • Azasan (azathioprine)
  • Neoral (cyclosporine)
  • Sandimmune (cyclosporine)
  • Gengraf (cyclosporine)
  • Cytoxan (cyclophosphamide)
How do patients benefits from physical therapy and exercise?

Upon first thought, you may think that exercise is going to make your joints ache even more. However, exercise is a very important part of arthritis treatment.

If you do not exercise, your joints may get even more painful and stiff.

There are three main types of physical activity that can help arthritis patients deal with their symptoms. These include flexibility exercises, strengthening exercises, and aerobic exercises.

Flexibility exercises, or stretching and range-of-motion exercises, are made to keep your joints from becoming too stiff.

Strengthening exercises - such as lifting light weights or pulling elastic bands - are designed to build muscle around your affected joints. By strengthening these muscles, you can provide more support to your affected joints.

Rheumatoid arthritis can take a toll on your overall health and fitness. Aerobic exercises - such as walking or bicycling - are made to counteract that. These exercises can improve your heart and lung health, increase muscle function, and help you lose weight.

What kind of surgeries are used to treat rheumatoid arthritis?

Eventually, your doctor may recommend surgery if your medications failed to prevent or slow joint damage. Over time, rheumatoid arthritis may make your joints unusable. Surgery can repair these damaged joints.

Surgery for rheumatoid arthritis may involve procedures such as:

  • total joint replacement, in which the damaged joint is removed and replaced by an artificial joint
  • tendon repair, which may be needed if inflammation and joint damage caused your joints to loosen up or rupture
  • joint fusion, which is used stabilize a joint and relieve pain if joint replacement is not an option

Ankylosing Spondylitis

Ankylosing spondylitis is no small pain in the back.

This form of arthritis mainly affects the spine, but it can spread to other joints. It can even affect other parts of the body, including your eyes, heart, and lungs.

Like rheumatoid arthritis, ankylosing spondylitis is an inflammatory disease. In some cases, inflammation can become so severe that new bone forms, making the spine stiff and immobile.

Also like rheumatoid arthritis, there is currently no cure for ankylosing spondylitis. However, there is a number of treatments for the disease, including drugs and physical therapy. Patients can also make certain lifestyle changes to control the pain of ankylosing spondylitis.

What are the signs and symptoms of ankylosing spondylitis?

Ankylosing spondylitis can, in a sense, sneak up on you. At first, you might think the pain is merely the result of a bad night's rest. Eventually, though, the symptoms can become unbearable.

The earliest symptoms of ankylosing spondylitis typically include pain and stiffness in the lower back and hips. You are likely to feel these symptoms most strongly in the morning or after long periods of not moving.

Ankylosing spondylitis most commonly affects the following parts of the body:

  • the sacroiliac joint (the joint between the pelvis and the spine)
  • lower back vertebrae (small bones that make up the spine)
  • the place where ligaments and muscle attach to bone, usually in the spine
  • the cartilage between the breastbone and ribs
  • the hips
  • the shoulder joints

Most patients experience symptoms of ankylosing spondylitis in painful episodes, or "flares." That is, symptoms can improve, get worse, or completely stop at irregular intervals throughout the course of the disease.

In the worst cases of the disease, the spinal bones can fuse together, giving patients a hunched-over posture. Some patients may not even be able to lift their head high enough to look forward.

Besides affecting certain joints, ankylosing spondylitis can also affect the eyes. About one third of patients with ankylosing spondylitis will experience iritis or uveitis (inflammation of the eyes) at least once.

Symptoms of eye inflammation include:

  • eye pain
  • red and watery eyes
  • blurred vision
  • sensitivity to bright light

In rare cases, ankylosing spondylitis can lead to bowel inflammation similar to that of patients with Crohn's disease and ulcerative colitis.

What types of medications are used to treat ankylosing spondylitis?

Similar to therapies for rheumatoid arthritis, NSAIDs and TNF inhibitors play a key role in ankylosing spondylitis treatment. Although they work in different ways, both NSAIDs and TNF inhibitors work to control symptoms and reduce inflammation.

In other words, rather than slowing down the progression of the disease, these drugs are designed to reduce pain, stiffness, and swelling.

Examples of NSAIDs used in the treatment of ankylosing spondylitis include:

  • Aleve (naproxen)
  • Naprosyn (naproxen)
  • Indocin (indomethacin)

Examples of TNF inhibitors used in the treatment of ankylosing spondylitis include:

  • Humira (adalimumab)
  • Enbrel (etanercept)
  • Remicade (infliximab)
  • Simponi (golimumab)
How does physical therapy help patients with ankylosing spondylitis?

Treatment for ankylosing spondylitis typically involves a combination of drug therapy and physical therapy.

Even if your symptoms come and go, the pain and stiffness of ankylosing spondylitis will be especially overpowering if you are not active. For this reason, physical activity and exercise are a key part of treatment.

By working with a physical therapist, you can learn exercises that improve both physical strength and flexibility. Your physical therapist may also walk you through breaking exercises that can maintain and improve your lung capacity.

How can surgery help patients with ankylosing spondylitis?

Surgery is a sort of worst-case-scenario treatment for ankylosing spondylitis. It is an option used in only the most severe cases of pain and joint damage.

In some cases, patients experience such bad hip damage that they need their entire hip replaced, which requires an expensive surgery and a time-consuming recovery.

Psoriatic Arthritis

Psoriasis is a skin condition characterized by red patches of skin along with silver-white patches, or "scales." Doctors believe the disease is the result of an autoimmune response in which the immune system mistakes healthy cells for dangerous invaders.

Some psoriasis patients go on to develop psoriatic arthritis - a form of arthritis that has the expected symptoms of joint pain, stiffness, and swelling.

What are the signs and symptoms of psoriatic arthritis?

The signs and symptoms of psoriatic arthritis are similar to those of rheumatoid arthritis.

Psoriatic arthritis, as well as psoriasis, are both chronic diseases, meaning they get worse over time.

Many patients go through periods in which their symptoms get better followed by periods in which they get worse.

Throughout these alternating episodes, you may experience symptoms on only one side of your body. But it is also possible to have symptoms on both sides of your body.

Common symptoms of psoriatic arthritis include:

  • red or silver-white patches of irritable skin
  • swollen fingers and toes
  • swelling and deformities in the hands and feet, even before joint symptoms begin
  • foot pain, especially in the back of the heel or sole of the foot
  • lower back pain resulting from spondylitis
What types of medications are used to treat psoriatic arthritis?

As with ankylosing spondylitis, there is no cure for psoriatic arthritis. As such, the main goals of treatment are to control symptoms and stop joint damage.

The drugs used to treat psoriatic arthritis are basically the same as those used in the treatment of rheumatoid arthritis.

These include DMARDs, NSAIDs, TNF inhibitors, and immunosuppressant medications.

How can physical activity help patients with psoriatic arthritis?

As with rheumatoid arthritis and ankylosing spondylitis, physical activity is a major part of treatment. Exercise not only keeps your joints flexible and strong, but also helps you control your weight. Being overweight can put strain on your joints, leading to increased pain and decreased mobility.

Reviewed by: 
Review Date: 
March 8, 2012
Last Updated:
April 9, 2012