Arthritis Pain

Different Types

Rheumatoid Arthritis (RA)

Rheumatoid arthritis is a disorder in which the patient's own immune system begins to attack the tissues. Although almost any part of the body can be affected, the disease does the most damage to the joints. Rheumatoid arthritis affects about one in 100 people. It usually appears between the ages of 25 and 50, and is two to three times more common in women than in men.

Symptoms

RA can begin suddenly or gradually. Affected joints (most commonly the hands, feet, wrists, elbows and ankles) become painful, stiff, swollen and ultimately disfigured. The same joints on both sides of the body are usually affected at the same time. Some people also experience fever, tiredness and weakness. Although treatment relieves symptoms in three out of four people, at least one out of 10 people eventually becomes disabled.

Treatment

• Rest, dietary changes, exercise, physical therapy
• Nonsteroidal anti-inflammatory drugs (NSAIDs), ASA, or COX-2 inhibitors
• Slow-acting drugs (gold compounds, penicillamine, hydroxychloroquine and sulfasalazine) to try to slow disease progression
• Corticosteroids (such as prednisone) during flare-ups to reduce inflammation
• Immunosuppressive drugs (methotrexate, azathioprine and cyclophosphamide) in more severe cases
• Surgery (e.g., hip or knee replacement)

For more information, see the National Institutes of Health publication http://www.nih.gov/niams/healthinfo/rahandout/.

Childhood Arthritis

Chronic childhood arthritis, also known as juvenile rheumatoid arthritis or juvenile chronic arthritis, is defined as continuous inflammation of one or more joints that lasts for at least six weeks and for which no other cause can be found. Childhood arthritis affects 1 in 1,000 Canadian children under the age of 16. Boys and girls are equally likely to develop it.

Symptoms

Some children experience similar symptoms to those experienced in adult rheumatoid arthritis, although only one joint may be involved. Others may develop fever, rash and enlarged lymph nodes.

Treatment

Like adult RA, childhood arthritis may be treated with NSAIDs, slow-acting drugs, exercise and corticosteroids injected directly into the joints.

For more information, see the Pediatric Rheumatology Page http://www.goldscout.com/.

Gout and Pseudogout

Gout produces sudden, recurring attacks of very painful arthritis, which are caused by deposits of crystals that accumulate in the joints. Pseudogout is very similar but involves a different type of crystal.

Men are more likely to develop gout than women are. People with kidney disease or who are taking certain drugs are also at a higher risk. Gout usually develops during middle age in men and after menopause in women, while pseudogout tends to affect older people of both sexes equally.

Symptoms

Gout causes attacks of sudden, severe pain in one or more joints. The pain becomes worse with time and may become excruciating. The affected joint swells and the skin over it becomes warm, tight, shiny, reddish-purple and extremely painful. The base of the big toe is most often affected, followed by the instep, ankle, knee, wrist and elbow. Gout may also cause fever, chills and a rapid heartbeat.

Pseudogout causes widely varying symptoms of joint pain and stiffness, which may be constant or occasional but are usually less severe than gout symptoms.

Treatment

• During an attack, nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and sometimes corticosteroids to reduce pain and inflammation
• To prevent an attack, weight loss and dietary changes or low-dose NSAIDS and/or colchicine
• Other drugs (probenecid, sulfinpyrazone and allopurinol) to reduce chance of gout crystals forming in the joints

For more information, see The Merck Manual Home Edition http://www.merck.com/pubs/mmanual_home/sec5/52.htm.

Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory disease that affects the spine and large joints, causing stiffness and pain. It is three times more common in men than in women, and usually develops between the ages of 20 and 40. It tends to run in families and affects between 150,000 and 300,000 Canadians.

Symptoms

Ankylosing spondylitis causes flare-ups of inflammation that alternate with periods of almost no symptoms. The most common symptoms are back pain, which is often worse at night, and early morning stiffness that is relieved by activity. Some people also develop loss of appetite, tiredness or eye inflammation.

Treatment

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
• Exercise program to strengthen the back muscles that support the spine
• In severe cases, corticosteroids injected into affected joints and occasional muscle relaxants
• Joint replacement surgery to relieve pain and restore function to the hips and knees

For more information, see the National Ankylosing Spondylitis Society home page http://nass.co.uk.

Lupus

Systemic lupus erythematosus (lupus) is a disease in which a patient's immune system attacks and inflames his or her joints, tendons and other tissues and organs. About 90 percent of the people with lupus are young women in their late teens to 30s, but children (mostly girls) and older men and women can also be affected. About 15,000 Canadians have lupus.

Symptoms

Different tissues and organs are affected in different people, and the severity of the disease varies greatly. Joint symptoms occur in about 90% of patients and range from occasional mild aches to severe arthritis in several joints. Other possible symptoms include fever, skin rash, hair loss, chest pain, kidney disease, swollen lymph nodes, headaches, personality changes, seizures and difficulty in thinking clearly.

Treatment

Treatment of lupus depends on which organs are affected and whether the disease is mild or severe. Mild lupus may require little or no treatment. Severe lupus is treated with:

• Corticosteroids (e.g., prednisone) to reduce inflammation
• Immunosuppressive drugs (e.g., azathioprine or cyclophosphamide) to suppress the immune system's attack on the body
• Drugs to treat the wide variety of other symptoms

For further information, see this National Institutes of Health publication http://www.nih.gov/niams/healthinfo/slehandout/