Arthritis: What is it, what causes it, how to diagnose and treatment

Arthritis is an umbrella term for conditions that cause pain in one or more joints. This pain may be associated with swelling and stiffness. Broadly speaking, arthritis falls into one of two categories:

• Osteoarthritis is due to ‘wear and tear’ of the joints
• Inflammatory arthritis is arthritis due to a number of conditions that cause inflammation within the joint. 

Osteoarthritis is extremely common. To some extent, a degree of osteoarthritis can be considered a normal part of ageing but how much of a problem this causes varies a lot from person to person. 

As you might expect with arthritis that is due to wear and tear, age is the biggest risk factor for developing osteoarthritis and it is unusual for people to suffer with significant osteoarthritis below the age of 45. Other risk factors for osteoarthritis include obesity as the excess weight puts more strain on the joint, a previous injury to the joint or the bones around it, family history of osteoarthritis, low bone density (osteoporosis), and activities that put excess and repetitive strain on the joints whether that is occupational or due to hobbies such as sports.

Any joint may be affected by osteoarthritis but it commonly affects the hips, knees, spine and hands. People suffering with osteoarthritis usually complain of pain in the joint which may be accompanied by stiffness and worsening mobility. Sometimes people find that the joint in question may swell up intermittently. When the arthritis becomes more severe, the shape of the joint can actually change and the joint can become fixed in a slightly bent position. 

Diagnosing osteoarthritis is usually straightforward. Your doctor will often suspect the condition based on how you describe your symptoms and the way your joint looks. They may want to confirm the diagnosis with an x-ray of the joint that will show loss of ‘joint space’ (which means the cartilage between the bones has been worn away), little boney overgrowths around the joint, and small cysts below the bone surface. Sometimes the x-ray features don’t match well with the severity of symptoms so that, occasionally, joints look very badly damaged on x-ray but there us little pain, or the pain is very severe although the x-ray doesn’t look too bad. Treatment choices are usually guided by how the issue affects you, rather than just the x-ray appearances. 

Most people believe that osteoarthritis is an inexorably worsening condition, but this is not necessarily the case. Pain and function in an arthritic joint can often be maintained or improved and sufferers will often find that they go through better and worse times with their joint pain.

Maintaining the strength of the muscles around the joint, and improving the flexibility of the joint, will both help to improve pain and maintain function and physiotherapy can help with this. Pain relief is often necessary and should be used to increase activity levels and help to engage with physiotherapy. Counter-intuitively, worn out joints are best kept active. If pain cannot be managed with pain relief alone, other options include steroid injections into the joint and, ultimately, badly damaged joints can be replaced. Whilst knee and hip replacements have been common for many years, other joints are increasingly being replaced by orthopaedic surgeons including shoulder joints or even the small joints of the hand. 

The other major category of arthritis is inflammatory arthritis, a term that also encompasses many different conditions such as:

• Autoimmune Conditions
• Crystal formation (Gout & Pseudogout)

Some forms of inflammatory arthritis are autoimmune conditions, where the body’s immune system attacks the soft tissues of the joints causing the joints to become swollen and tender. These conditions are typified by significant stiffness in the morning that can take over an hour to improve. They may be associated with other features such as skin rashes, features of inflammatory bowel disease, mouth ulcers, hair loss, or problems with other organs. Common forms of inflammatory arthritis include rheumatoid arthritis or psoriatic arthritis, but there are many others. 

If your doctor suspects you have one of these conditions then you will usually need to have blood tests. These tests include inflammatory markers (CRP and ESR), autoantibody tests and, in the case of rheumatoid arthritis, rheumatoid factor. X-rays and ultrasound scans may also help with the diagnosis. Treatment for these conditions usually requires immunosuppressant medication and is normally conducted by a rheumatologist. 

Another form of inflammatory arthritis is arthritis related to crystal formation in the joints. This includes gout and pseudogout. Pseudogout is fairly uncommon, but gout is very common. In gout, uric acid crystals form in the joint which causes the joint to suddenly become very painful and swollen. The joint most commonly affected is the big toe joint but any joint can be affected. In severe cases the joints can become damaged by repeated bouts of inflammation and uric acid can form chalky deposits under the skin called ‘tophi’ and may even damage the kidneys. 

Gout is so common because it is strongly related to diet as the uric acid in our blood comes from the breakdown of purines in our diet. 

Foods high in purines increase blood uric acid levels and this increases the chances of an attack of gout. These foods include red meats, organ meats like liver and kidneys, seafoods such as anchovies, prawns and mussels, food and drinks high in fructose such as fizzy drinks and fruit juices, and alcoholic drinks, especially beer. 

This list is not exhaustive and anybody suffering from gout should look at the diet changes they can make because the condition can often be controlled through diet and lifestyle. 

Gout often occurs in people who are suffering with other features of the ‘metabolic syndrome’ such as diabetes, high blood pressure or fatty liver disease, and the same diet changes that will improve gout will usually improve these other conditions too. 

In terms of medication for gout, there are two ways to manage it. The first is to take an anti-inflammatory medication when you have an attack. This strategy is fine if you have very occasional episodes that you find manageable. However, if you are having frequent or severe attacks, then you should consider a preventative strategy. This involves taking a daily medication that lowers uric acid levels and so prevents attacks of gout. 

As you can see, there are many different causes of arthritis and each requires a different approach to diagnosis and management. However, in each case, there are treatment options to improve joint pain and prevent deterioration. 

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