Arthritis FAQs

Arthritis literally means inflammation inside the joint. It is a term usually used for degenerative or aging process of the joint which lead to loss of the cartilage lining of the joints. There are other rare forms of arthritis, which are associated with certain systemic diseases like rheumatoid arthritis, SLE or lupus, psoriasis, and many other inflammatory arthritis. The infective infection of the joint is also known as infective arthritis or septic arthritis. Occasionally age-related arthritis can be accelerated due to trauma or accident.

Arthritis usually presents with pain, swelling, grinding sensation on movement, hearing of crepitus, diminishing of range of movement, and stiffness. It may be associated with fluid in the joint also. This my lead to worsening quality of life. Use of stairs getting in and out of chair or bed are especially difficult. Pain and swelling are also worsened with prolonged activity like walking or standing.

The most common type of arthritis is the one caused by aging. It is called degenerative arthritis or Primary Osteoarthritis. It causes slow and gradual roughening or damage to the cartilage. Other forms of arthritis are called secondary arthritis and are related to trauma, systemic diseases like rheumatoid arthritis, SLE or lupus, psoriasis, and other forms of inflammatory arthritis etc. Secondary arthritis causes rapid deterioration of cartilage and progressively worsening symptoms.

The risk factor for arthritis includes gender, weight, age, family history, systemic diseases like SLE or lupus, rheumatoid arthritis, psoriasis, and other autoimmune disorders, smoking, comorbidities like diabetes mellitus.

The diagnosis of arthritis is made clinically by history and examination of the patient. Radiological examination in the form of x-rays can be helpful, especially in advanced cases of arthritis. In certain cases of arthritis with suspicion to other diseases, further investigations can be done to rule out other form of arthritis. Occasionally, advanced radiological imaging like MRI may be needed to confirm the diagnosis and rule out other pathologies.

Popping and cracking sounds from the joint may be a normal phenomenon, especially in younger age group. If they are associated with pain, with or without swelling, then there may be a pathological reason inside the joint that cause these sounds. They can be caused by soft tissue inside the joint called plica, rubbing of the cartilages against each other called the meniscus or due to a meniscal tear. Imaging techniques like x-rays and MRI can help rule out such diseases.

Multiple studies have been done in the past but have not conclude that weather does affect joint pain severity. Though, recently a study did find that the change in pressure levels do affect the joint pain, but a change in pressure effects are not easily measurable to common population. It is a change in weather, that is associated with the pressure change that causes difference in joint pain severity.

Though it feels that the joint pains are usually related to change in whether, especially rain. But recent findings have found that they are more due to change in pressure, rather than humidity or temperature. But, it is difficult to measure pressure and the change in pressure is more related to the rain.

Increased weight means increased stresses on the joints, especially the lower extremities: the hip, the knee and the ankle joint. Loss of few pounds of weight can have tremendous effects in reducing the symptoms of arthritis and improving the quality of life.

A desirable body mass index (BMI) of a patient should be around 25. Any weight over 25-30 BMI should be lost to help good relief in arthritis symptoms. Even a loss of 10-20 pounds can cause improvement in symptoms of arthritis.

We should try to minimize the twisting forces on the knee joint while getting in and outside the car. Person can first sit on the seat and then get their legs inside by turning the whole torso. The same should be getting done when getting out of the car.

If the patient has pain in their joint which persist for a few days at a time or is recurrent, it may be arthritis. They should initially treat it with short period of rest and anti-inflammatory medications, ice or heat, whichever is preferable, and a possible use of compression sleeves. If the pain is not improved or associated with other symptoms like swelling, locking or giving way then they should seek medical attention to know more about it. If they are associated with fever, or redness than urgent medical attention is warranted.

A knee pain can be usually treated with over the counter anti-inflammatory medication, usually. If the pain is not improved with these medications, rest, elevation, and use of ice or heat, then they should seek medical attention to rule out other pathologies. Sometimes, a cortisone injection in the knee may help decreasing the pain. The patient may also be sent for physical therapy to strengthen the muscles. If all the conservative treatment are not able to provide pain relief, then advanced imaging may be needed to find out the cause of pain that can be treated with minimal intervention.

Walking is a good exercise for arthritis of the knee, as it helps strengthen the muscles, as well improve the overall health. Walking should be practiced with good cushioned shoes and on a firm surface. Fast walking if tolerable is also a good exercise.

There are multiple drugs used to treat arthritis including anti-inflammatory medications which may range from over the counter medications like Advil or Aleve to prescription medications, cortisone shots, oral corticosteroids, some disease modifying drugs especially in the case of inflammatory and autoimmune arthritis. There are medications in the market like glucosamine and chondroitin sulfate, which are found to be equivocal in the treatment of arthritis and can be tried as over the counter drugs. Patient can also get gel (viscosupplementation) injections in the knee joint to help relief the pain.

Early signs of arthritis include pain, feel of grinding sensation, crepitus, and stiffness, especially at the extremes of range of motion. Patient may have recurrent episodes of acute pain which may remit to complete normalcy. Overtime these episodes start occurring more frequently and in worsening severity. Use of stairs getting in and out of chair or bed are especially difficult during an acute episode. Pain and swelling are also worsened with prolonged activity like walking or standing.

Patients with bad knees are advised to strengthen their muscles of thigh especially the quadriceps and the hamstrings but avoid high impact exercises as there is risk it poses to the knee. The good exercises include walking, biking, ellipticals, rowing, swimming, and various forms of stretching and strengthening exercises like yoga and pilates.

Water in the knee is formed as a reaction to the inflammation inside the knee. It can be resolved by reducing the inflammation using anti-inflammatory medications or disease modifying medications, especially in the case of inflammatory or autoimmune arthritis. The water can also be removed by putting a needle into the knee joint under sterile conditions and aspirating it.

Usually cortisone shot is given at the same time, which may help in decreasing the inflammation and preventing the recurrence of formation of more fluid inside the knee joint. Compression of the knee by use of sleeves can also be helpful in reducing the fluid in the knee as well as preventing the reformation of the extra joint fluid. Ice and elevation also help in decreasing the swelling in and around the knee.

An arthritis in the knee can be prevented by keeping fit, weight control, avoiding smoking, and keeping yourself active. Regular exercises of the body, in the form of stretching and strengthening have been found to prevent as well as delay worsening of arthritis in the knee joint.

Arthritis causing damage to the articular cartilage, is irreversible process because the body cannot regenerate the original cartilage. The cartilage that is formed in the repair process is not of the same quality as the native cartilage. But taking steps for prevention or treatment of the arthritis help to decrease the speed of breakdown of the cartilage.

Injury to the cartilage or the meniscus can ocassionally present with burning sensation around the knee. It can occasionally be a symptom of nerve pain, and not from the arthritis. The patient may be having spine problem or systemic diseases like diabetes, which may cause nerve pain.

Though acute onset knee pain should be treated with cold or ice, and longstanding pain usually treated with heat, it is more of patient’s preference as to what makes them feel better and should be used accordingly.

Kneeling causes an extreme of range of motion of the knee and causes increased joint pressures, especially on the knee cap. Excessive kneeling can be damaging to the cartilage as well as irritating to the knee joint and cause damage and causing pain and swelling of the knee joint.

Sitting in cross-legged position for long period may cause stretching of ligaments and muscles, especially on the outer side and compression on the inner side of the knee along with twisting forces which may be detrimental to the knee joint.

Exercises of the muscles around the knee and the hip joint, especially strengthening and stretching exercises of quadriceps and hamstrings help in relieving of knee symptoms like pain and swelling as well as increases circulation.

Quadriceps which is the largest muscle found in the body is found in the front of the thigh. It is made of four parts, Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius.

Arthritis usually caused by aging or degeneration of the joint cartilage is initially treated with anti-inflammatory medications along with physical therapy to help strengthen the muscles as well as maintain the mobility of the joint. Other supplements for arthritis like over the counter glucosamine and chondroitin sulfate can also be tried at the same time.

If the patient is not better with over-the-counter anti-inflammatory medications, then the physician may use cortisone injection to give pain relief as well as decrease the swelling. There are certain minimal invasive surgical procedures that can be done in cases the arthritis to treat and prevent complications of arthritis. If the arthritis is advanced and is bone-on-bone, then joint replacement may be the only treatment for arthritis.

Exercise is good for everyone, especially those with arthritis, because it keeps muscles strong as well as maintain the mobility of the joint. It also helps controlling the weight as well as controlling systemic diseases like diabetes and hypertension, which are all contributory to the comorbidity of arthritis.

If the exercise causes unbearable pain, then that specific exercise should not be done, but if the exercise is followed by a soreness, that may be due to the use and strengthening of the muscle. The soreness can be relieved with use of ice and elevation and occasional anti-inflammatory medications. This soreness usually goes off on regular exercises as the muscles get acclimatized to the strengthening process.

Being overweight means increased stresses to the bones and the joints and therefore accelerated degeneration of the cartilage. At the same time, being overweight also induces the risk of having systemic diseases like diabetes, which have detrimental effects on arthritis also. Loss of weight, maybe even 10 to 20 pounds, can have significant effect in decreasing the pain from hip/knee arthritis.

Hip arthritis usually presents with pain in the hip along with stiffness and restriction of range of motion, especially deep flexions, like doing squatting or doing child’s pose in yoga. Patients usually have stiffness in the morning. Some patients in advanced cases may start to limp or waddle.

Bursitis of the hip usually involves the greater trochanteric bursa or the trochanteric bursa in which the pain is on the outer side of the hip. Patient is not able to lie on that side of the hip and there’s pain with movement. The patient can also feel pain on pressing on the outer side of the hip.

Hip bursitis pain is located on the outer side of the hip. This is in comparison to the pain of hip arthritis, which is present along the front mostly on the front or on the back of the hip.

Pain for hip arthritis is usually present along the front of the hip or uncommonly along the back of the hip. It can rarely be present on the outer aspect of the hip.

Walking is a good exercise for patients with arthritis of the hip as it helps maintain the range of motion as well as maintain the muscles of the hip and the knee. It also helps control weight as well as control systemic disease like diabetes and hypertension, which can be contributory to the pathology of arthritis of the hip.

The physicians usually do a physical examination with a special test to find out if the patient has hip arthritis or bursitis. Then they also do x-rays of the hip to rule out hip arthritis. In rare cases, an MRI may be needed to confirm the diagnosis of hip arthritis or bursitis.

If the patient has hip pain, initially they should try over-the-counter medications like Tylenol, Aleve and Advil. If the patient is not improved with the over-the-counter medications, then they should see a physician for a proper diagnosis and management of hip pain. They may need to use prescription medications as well as cortisone injection or oral cortisone for pain relief.

Arthritis of hip can be an uncommon cause of low back pain, especially on the same side of the back. Vice versa, low back arthritis can also be a cause of hip pain, and therefore a proper examination along with radiological findings of the patient is helpful to reveal the exact cause of the pain.

The nerve supply to the hip and knee are similar in some aspect, and therefore patients with hip arthritis can occasionally have pain referred to the knee joint and vice versa.

Ice is usually used for acute onset pain, especially associated with injury. In most of the other cases, heat is a good modality for pain relief. Occasionally, patients may have preference towards heat or ice, and they should use the modality which helps them best.