From the issue, Living With Inflammatory Arthritis
Inflammatory arthritis is a condition many people endure for a lifetime. Thanks to advances in treatment, however, innovative medications can delay and even halt the progression of the disease, and non-drug approaches have can help relieve symptoms so you can live a full and productive life.
Inflammatory arthritis describes a group of diseases caused by an overactive immune system. The most common symptoms are joint pain and stiffness. Affected joints may feel warm, swollen, and tender. But inflammatory arthritis can also affect other tissues in the body, including the lungs, heart, eyes, skin, and other organs. Left untreated, it can cause irreversible damage. Early treatment is the best way to relieve symptoms and limit the effects of inflammatory arthritis on the body.
While it’s not known what causes inflammatory arthritis in every patient, what is known is that the immune system does not know when to put on the brakes. Normally when we are exposed to bacteria, viruses, or fungi, the immune system produces white blood cells called lymphocytes as well as immune proteins to mount an attack against these invaders. Lymphocytes and immune proteins cause inflammation, which under typical circumstances is limited and resolves once the foreign substance is defeated.
But in someone with inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking your own tissues instead of the foreign substance and causes continued inflammation. For this reason, inflammatory arthritis is known as an "autoimmune disease" − auto meaning "self" and “immune” because the immune system loses its ability to distinguish self from foreign.
Although they share some common symptoms, inflammatory arthritis and osteoarthritis are very different diseases. Osteoarthritis is a common condition causing wear-and-tear of the cartilage of the joints due to age and/or prior injury. Here are some other differences:
|Body parts, tests and causes||Inflammatory arthritis||Osteoarthritis|
|Parts of body affected||A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skin||Symptoms are limited to the joints|
|Positive biomarker tests||Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on blood tests||Blood tests for biomarkers are negative|
|Causes||Autoimmune disease related to body-wide inflammation||Mechanical wear-and-tear on joints due to age or injury|
If you are experiencing symptoms that suggest inflammatory arthritis, your doctor will perform a number of tests, including a physical exam, blood tests, and imaging exams (such as X-rays, joint ultrasound, and/or MRI or CT scans). Sometimes the physician takes a sample of fluid from an affected joint for analysis − a procedure called joint aspiration.
Based on the results of these exams, your physician will determine if you have inflammatory arthritis and if so, which type:
Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis. It tends to involve more than one of the small joints of the hands and feet. In particular, the lining of the joint or tendons (the synovium) is inflamed, causing warmth, pain, and stiffness. In 30% to 60% of people with RA, blood tests confirm the presence of proteins called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies. It is very important to control inflammation in the synovium to stop joint destruction and to treat RA to minimize damage to the heart, lungs, and eyes.
Psoriatic arthritis is a type of arthritis called a "spondyloarthropathy" that is a combination of psoriasis (red, scaly patches on the skin, especially the knees, elbows, and scalp) as well as pain and swelling in the large and small joints and sometimes the spine. It can cause complete swelling of a finger or toe − a condition called "dactylitis."
Juvenile idiopathic arthritis (JIA) affects young people under age 16, causing inflammation in the joints and sometimes in the spine and ligaments (tissues that connect bone to bone) that lasts for more than six weeks. Swelling or mobility problems, including a limp if the legs are affected, may be the only signs of JIA. Some types of JIA cause eye inflammation that can occur without symptoms, so prompt diagnosis, treatment, and monitoring of JIA are vital to prevent permanent damage. Children and teens with JIA are best treated by a pediatric rheumatologist.
Ankylosing spondylitis (AS) affects primarily the spin and hip joints, breastbone, and large joints in the body. Over time, AS can result in noticeably reduced motion in the spine. Up to half of people with AS have a gene called HLA-B27, the presence of which can help confirm the diagnosis of this condition when it is found in combination with AS symptoms.
Gout and Pseudogout (calcium pyrophosphate dehydrate deposition disease or CPDD) are forms of arthritis caused by elevated levels of certain crystals in the body. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones. CPPD occurs when calcium salts form in the joints and are engulfed by white blood cells, provoking inflammation − most commonly in the wrists and knees.
Other autoimmune diseases can cause inflammatory arthritis as a symptom. Examples include Sjogrens syndrome and lupus.
If you have inflammatory arthritis, it is imperative that you see a rheumatologist on a regular basis to monitor your health and customize your treatment. Rheumatologists are medical doctors with special training in the care of people with joint diseases and autoimmune diseases. They are different from orthopedists, who are trained in surgery and who may also be involved in the care of people with inflammatory arthritis when medical treatments are not enough.
How do you know whether to start with a rheumatologist or orthopedist? If you have ongoing joint discomfort without chronic swelling or other symptoms, such as fatigue, you may be able to see an orthopedist first. But if your joint pain is accompanied by warmth, swelling, other signs of inflammation, fatigue or discomfort in other parts of your body, a visit to a rheumatologist may be in order. Your primary care physician can guide you.
Because inflammatory arthritis is an autoimmune disease that can affect multiple parts of your body, you may need to see other specialists, too, to keep your symptoms in check and maintain the best quality of life possible.
To prepare for your visit with a rheumatologist:
Your rheumatologist may choose from a variety of treatment options for inflammatory arthritis, depending on the type and severity of your disease, such as:
A diagnosis of inflammatory arthritis can initially feel overwhelming. It can take weeks or even months to come to terms with and understand what having this disease can mean in your life. By developing a close working relationship with your rheumatologist and other caregivers, however, there is much you can do to control inflammatory arthritis and maintain an independent and active lifestyle.
If you or someone you know is living with a chronic inflammatory condition, learn about the different patient support programs available at HSS.