Arthritis

Arthritis is not one disease but a shared name for pain, swelling and stiffness in the joints. Dozens of separate conditions hide behind the word, from the slow wearing of cartilage that shows up around sixty to an autoimmune inflammation that starts at thirty and reshapes the hands within months. They are treated differently and they end differently, so the useful question is not «do I have arthritis» but which kind, and how fast it is moving.

Two very different mechanisms, one word

Osteoarthritis is the common form. The cartilage capping the ends of the bones thins and roughens, the gliding surface stops gliding, and bony spurs grow along the joint margins. Tendons take over work the cartilage used to do, and the joint changes shape. Knees, hips, hands and the spine suffer most; it usually belongs to the second half of life, but after an injury or years of loading the same joint it arrives far sooner.

Inflammatory arthritis works differently: the immune system treats the lining inside the joint as an enemy, the lining overgrows and dissolves cartilage and bone. That is rheumatoid arthritis, which begins between thirty and fifty, more often in women, and takes the small joints of hands and feet symmetrically. The same family includes psoriatic arthritis, ankylosing spondylitis, reactive arthritis after a gut or urinary infection, and the arthritis of Crohn's disease and ulcerative colitis.

Gout stands apart: crystals of uric acid settle in the joint and an attack unfolds overnight, most often at the base of the big toe. Fibromyalgia is counted among the arthritides by mistake — the pain there is muscular and the joints are not destroyed.

Wear or inflammation: what you can notice yourself

• Morning stiffness from wear clears in ten or fifteen minutes; inflammatory stiffness lasts an hour or longer.
• A worn joint hurts after walking and towards evening and eases with rest. An inflamed joint aches precisely at rest and at night, and loosens once you move.
• Inflammatory swelling is soft and warm, often in both hands at once; wear leaves hard bony thickenings with no heat in them.
• Inflammation usually adds heavy fatigue, a low fever and weight loss.
• Wear takes years to build; inflammation takes weeks.

If stiffness lasts an hour, small joints have swollen on both sides and fatigue has joined in, you need a rheumatologist within weeks, not months. The first months of inflammatory arthritis are the window in which treatment decides whether the joint still works ten years from now.

When the clock runs in hours

Call emergency services if a single joint has turned hot, red and so painful within a few hours that you cannot bear it being touched, with fever and shivering on top. That is septic arthritis: bacteria have reached the joint cavity and destroy cartilage in a matter of days. The risk is higher after an injury or an injection into the joint, with a replaced joint, with diabetes, with weakened immunity, or with a skin infection nearby. A gout attack looks exactly the same, and only a doctor can tell them apart by drawing fluid from the joint — which is why waiting until morning is a poor idea.

A second danger hides in people over fifty with pain and stiffness in the shoulders and hips, known as polymyalgia rheumatica. If headache in the temples, a tender scalp when combing, jaw pain while chewing, or blurred or darkened vision appear, help is needed at once. Those are signs of inflammation in the large arteries of the head, and sight is lost irreversibly, sometimes within a single day.

When more than joints are involved

• A red, painful eye with light sensitivity and blurring is inflammation of the inner layers of the eye, a frequent companion of spondyloarthritis. An eye specialist should see it the same day.
• Rheumatoid arthritis can bring dry eyes and mouth, nodules under the skin, anaemia and inflammation of the lung lining and lung tissue. Sustained inflammation also speeds up furring of the arteries, so blood pressure, cholesterol and stopping smoking matter here as much as the joints.
• Psoriatic arthritis gives itself away through changed nails, scaly patches and a finger swollen along its whole length.
• Bloody diarrhoea alongside joint pain is a reason to look for inflammatory bowel disease.

Arthritis in children

When pain and swelling in one or several joints last at least six weeks in a child under sixteen, this is juvenile idiopathic arthritis, and its cause is unknown. It may involve few joints or many; it may be systemic, opening with fever, a rash and enlarged glands before any swelling; and it may attach itself to tendon insertions, with back and heel pain in teenagers.

The trap is in the eyes. In the few-joint form, inflammation inside the eye advances without pain and without redness: the child complains of nothing while sight quietly slips away. Scheduled eye checks are the only way to catch this in time.

Watch for a morning limp, refusal to run about, a habit of holding an arm or leg half-bent, and one joint clearly bigger than its pair. Shielding a child from effort «just in case» does harm: lack of movement weakens the muscles.

What treatment can realistically do

Worn cartilage cannot yet be regrown, and anyone promising to cure arthritis for good deserves suspicion. But the gap between «no cure» and «nothing can be done» is enormous.

In osteoarthritis the essentials are movement and weight. Exercises for the muscles around the joint relieve pain more reliably than any ointment, and every kilogram lost takes several times as much load off the knees. Painkillers are kept to the least that lets you move: paracetamol and anti-inflammatory drugs in short courses, starting with the ones applied to the skin for knees and hands. When pain stops you sleeping and walking, replacing the joint returns people to ordinary life.

In inflammatory arthritis the aim is different — to damp the inflammation down to remission. Disease-modifying drugs that alter how the immune system works are prescribed, and if the response is weak, biological and targeted agents are added; steroids are used briefly, to break a flare. The regimen is chosen from blood tests and reviewed, so rheumatology visits continue even when you feel well. In gout, besides settling the attack, medicines that lower uric acid are given long term: dropping them at the first improvement brings the attacks back almost without fail.

About supplements «for the joints», plainly: convincing evidence of benefit is missing, and they do not replace treatment that actually halts the damage.

Everyday habits that protect joints

• Move regularly and without impact on the joint: swimming, cycling, walking.
• Do not hold one position for more than half an hour.
• Spread the load: push a heavy door with your shoulder rather than your hand, carry shopping in both hands or in a rucksack, choose tools with thick handles.
• Keep your weight within reason and do not smoke: tobacco worsens rheumatoid arthritis and blunts the response to treatment.
• Protect your sleep — pain and insomnia feed each other.
• Tell your employer about your condition and ask for the workstation to be adapted; if tasks at home are hard, an occupational therapist will find aids that help.

Online consultation

In an online consultation the doctor will go through how the pain started, how long morning stiffness lasts and which joints are involved, help you see whether this is wear or inflammation, and explain which blood tests and scans make sense. They will also say whether the situation calls for an urgent face-to-face examination and which specialist to start with.

This material is for information only and does not replace medical advice.