Arthritis is a term generally used to describe inflammation within a joint, whilst rheumatism is a more general term used to describe aches and pains in or around the joint area. The three most common and well known types of arthritis are osteoarthritis, rheumatoid arthritis and gout. However, there are many rarer and less known types of the disease; we will explore some of these in this article.

Ankylosing Spondylitis (AS); this is an inflammatory type of arthritis affecting the joints of the spine. After an inflammation attack, the body produces calcium which is laid down over the point where the ligaments attach to the vertebrae in the spine, causing a loss of flexibility. Eventually ankylosis can result, which is a fusing of the bones in the spine. Symptoms include sciatica type pain in the buttocks or thighs and stiffness.

Reactive Arthritis (also known as Reiter’s Syndrome or Reiter’s Arthritis); this is an autoimmune type of arthritis that develops following an infection in another part of the body. It commonly develops in the knees and the back, and responds well to treatment.

Symptoms include increased frequency of urination or pain on urinating, pain and swelling in affected joints, conjunctivitis type symptoms and small hard nodules which develop on the soles of the feet or the palms of the hand. Some people also experience recurrent mouth ulcers.

Psoriatic arthritis; this is an inflammatory type of arthritis which often develops in people with the skin condition psoriasis. There are five forms of psoriatic arthritis, some of which can be severe if not diagnosed and treated. Symptoms include swelling, throbbing, redness and stiffness in the affected joints, particularly first thing in the morning or after a period of rest, a reduced range of movement in the affected joints and swelling to the fingers or toes.

Pseudo gout; this is another inflammatory type of arthritis, and, like gout, is caused by the formation of crystals in the joints. However, unlike gout where crystals are formed by uric acid, they are formed from a type of salt known as calcium pyrophosphate dihydrate (CPPD). This build up of crystals causes swelling and pain in the knees, ankles, wrists and other joints. Symptoms include joint pain and swelling and a build up of fluid in the joint.

The symptoms of pseudo gout can mimic the symptoms of gout and rheumatoid arthritis, making it difficult to diagnose at times.

Juvenile rheumatoid arthritis (JIA); this is an inflammatory type of arthritis which affects children under the age of sixteen. There are three main types of JIA; Oligoarticular (or pauciarticular) JIA, which is the most common form and which affects only a few of the joints, Polyarticular JIA, which affects more of the joints including the digits, and Systemic JIA (Stills disease), the rarer form of the condition, which is a more general illness of which joint pain is one symptom. Symptoms of JIA include stiff, swollen, reddened and painful joints which may feel hot to the touch. This can be accompanied by other symptoms such as a fever or rash.

Fibromyaligia; this is a connective tissue/ autoimmune type of arthritis and is found in the muscles and soft tissues overlying the joints. The cause of fibromyalgia is not yet fully known, but it is thought to be due to a defective neurotransmitter function in the brain. Fibromyalgia can affect the whole body, and symptoms range from exhaustion, chronic fatigue, muscular pain and spasm, muscle twitching and a disturbed sleep pattern. Although there is no cure for fibromyalgia, there are treatments available that can relieve some of the symptoms.

Polymyalgia Rheumatica (PMR); this is an inflammatory type of arthritis which most commonly affects people over the age of 65. It causes inflammation of the larger muscles in the body such as the muscles around the shoulders, neck, upper arms and hips. Although the cause of PMR is still unknown, it generally responds well to treatment. Symptoms include stiffness, aching or pain in the large muscles around the neck, shoulders and upper arms, which is often worse in the mornings or after sitting for long periods. Inflammation and swelling can also occur in the soft tissues around the joints.

If you suspect you may have one of these arthritis types, you should visit your doctor so that an accurate diagnosis can be made and appropriate treatment prescribed.

What Is Psoriatic Arthritis?

Psoriatic arthritis generally only develops in psoriasis sufferers, although this does not mean that psoriasis sufferers will automatically develop the condition, nor does it mean that those with the most severe psoriasis symptoms will develop more severe forms of psoriatic arthritis. The condition occurs in around five to ten percent of people with psoriasis. In addition, around fifteen percent of people develop psoriatic arthritis before experiencing the symptoms of psoriasis.

Different Types of Psoriatic Arthritis and Their Symptoms
There are five different types of psoriatic arthritis, and each type has its own symptoms and treatment.

Symmetric arthritis; this affects the same joints in pairs, on each side of the body; for example both knee joints will be affected. The symptoms resemble a milder form of rheumatoid arthritis, although it can occur in more severe forms and cause deformity to the joints. Symmetrical arthritis is the second most common form of psoriatic arthritis and tends to cause more severe psoriasis symptoms.

Asymmetric arthritis; this tends to affect only a few joints, generally less than five, and joints are affected individually rather than in pairs. Although any joint can be affected, it is most common on the fingers and toes, and can cause a swelling in fingers known as ‘sausage digits’. Asymmetrical arthritis is one of the most common forms of psoriatic arthritis, and is milder and less progressive than other types.

Digital Interphalangeal Predominant (DIP) arthritis; this affects the last joint in the toes and fingers, and can be mistaken for osteoarthritis.

Arthritis mutilans; this is a rare form of psoriatic arthritis, affecting fewer than 5% of sufferers, but can be severe. It can destroy cartilage and bone tissue, and can cause deformity to the hands, feet or spine. It generally occurs in flare ups and subsequent remissions, which are reflected in the symptoms of psoriasis.

Spondylitis; this is an inflammation of the spinal joints and discs, and can be very severe, resulting in spinal deformities if not treated. It can also affect the joints and ligaments in the arms and legs. The predominant symptoms include stiffness in the back and neck joints, tenderness and inflammation.

People with psoriatic arthritis may develop more than one of these types and can show symptoms of several at any one time, which can make diagnosis of one single type more difficult. There are also other types of arthritis that sufferers of psoriasis are at risk of developing; these are gout, which causes sudden inflammation in the toes, feet or hands, rheumatoid arthritis, osteoarthritis and Reiter’s Syndrome, which causes arthritis as well as inflammation of the urethra and eyes.

Other Psoriatic Arthritis Symptoms
In addition to the above symptoms, there are several more which can indicate the presence of the condition;

• Swelling, throbbing, redness and stiffness in the affected joints, particularly first thing in the morning or after a period of rest

• Reduced range of movement in the affected joints of digits

• Swelling to the fingers or toes, as the joints and connective tissues become inflamed

• General tiredness

• Changes in finger and toe nails; nails may become thicker or become ‘pitted’ in appearance

These symptoms can be mild or more severe and can flare up and die down in a similar manner to the symptoms of psoriasis, and the two conditions can even mirror each other at times. Psoriatic arthritis occurs more frequently in the finger and toe joints, particularly the end joints, but can affect any joint in the body.

Although there is no cure for psoriatic arthritis, there are many treatments available to relieve the symptoms and avoid further damage to the joints. For more information on possible treatments, see this post.

Now for the science behind this scenario. The place where two bones meet is called the joint- the bone ends are covered with cartilage, also known as gristle.

This cartilage is sturdy, elastic, spongy and compressible, and keeps the bones from rubbing against each other at the joint. The cells of this cartilage, called chondrocytes, are thought to be the longest living cells of the body. Surrounding the bones and cartilage is strong, fibrous capsule lined with synovium, a thin membrane that lubricates the joint area with fluid. The end result is less friction or smoother rubbing together of the bones. This fluid also feeds the cartilage cells, keeping them healthy, and is “pumped” into them during joint movement. Thus lack of movement (activity / exercise) can be unhealthy.

Other parts of the body involved with this arthritic scenario include muscles, tendons, ligaments, bursea and mental activity. Muscles, attached to bones with tendons and ligaments, move bones by contracting. They also cushion movement, absorbing impact or shock. Throughout the muscle and tendon areas are bursae or sacs filled with fluid. These also help cushion movement. And all the coordination of these parts during movement, are controlled by the brain. The brain communicates via nerves throughout the body, in particular the muscles, to prepare joints for activity.

The exact science of what actually causes arthritis is still being researched. For most of the 100-plus forms of arthritis, the causes are unknown. Injury, overuse of joints and mechanical issues with joints (such as skeletal abnormalities, worn out joint muscles etc) can lead to arthritis. Issues relating to bacteria and germs are also thought to have some link to arthritis. Heredity, stress, drugs, food allergies and viruses have also been linked to some forms of arthritis, as have diet, poor circulation and lack of movement.

Arthritic joints can be affected with inflammation when bacteria or a virus (or other undesirable element) enters the joint area or when an injury occurs. When foreign matter enters this area, or the area sustains injury, white blood cells, antibodies and other natural “fighting” mechanisms automatically kick in internally to help. These fighters cause swelling, redness and heat as the body fluid moves around. The symptoms of this inflammation, one of the uncomfortable issues associated with arthritis, are redness, swelling and tender joints.

Arthritis, also known as joint inflammation, is defined as an inflammation of one or more joints and involves the breakdown of cartilage, resulting in pain, swelling, and limited movement.

Cartilage is responsible for protecting the joints and serves as a shock absorber when pressure is placed on the joint during walking or running. It allows for the smooth movement of our limbs. Without cartilage, the bones can rub together and cause pain, swelling (inflammation), and stiffness. Doctors usually prescribe arthritis pain relief and anti-inflammatory drugs to help alleviate the pain.

Arthritis, or joint inflammation, can be due to the following causes:
• Broken Bones;
• Infections that are usually caused by bacteria or viruses;
• An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign)
• General “wear and tear” on joints.

Generally, as soon as the injury heals, the inflammation disappears. The infection is treated and the disease is cured. However, there are some injuries and diseases wherein the inflammation stubbornly remains, continuously causing pain that may lead to deformity. This condition is known as chronic arthritis.

People suffering from arthritis experience the following symptoms:
• Joint pain
• Joint swelling
• Stiffness, especially in the morning
• Warmth around a joint
• Redness of the skin around a joint
• Reduced ability to move the joint

Arthritis is a condition that can occur in men and women of all ages. Other types of arthritis include:

• Rheumatoid arthritis (in adults)
• Osteoarthritis (middle age and above )
• Juvenile rheumatoid arthritis (in children)
• Systemic lupus erythematosus (SLE)
• Gout
• Scleroderma
• Psoriatic arthritis
• Ankylosing spondylitis
• Reiter’s syndrome (reactive arthritis)
• Adult Still’s disease
• Viral arthritis
• Gonococcal arthritis
• Other bacterial infections (non-gonococcal bacterial arthritis)
• Tertiary Lyme disease (the late stage)
• Tuberculous arthritis
• Fungal infections such as blastomycosis

Osteoarthritis, being the most common type, is a chronic disease which causes the cartilage between the bone joints to deteriorate and may cause painful sensation and/or stiffness. New pieces of bones, called bone spurs, may grow around the joints as a result of osteoarthritis. Until now, there is no known reason yet as to the cause of osteoarthritis but it is generally associated with aging. However, factors such as metabolism and genes can play a role in its development.

There are many factors to consider before your doctor can prescribe arthritis pain relief treatment plan such as the particular cause of arthritis, affected joints, severity of arthritis, and how the condition affects your daily activities. Age and occupation will also be taken into consideration.

Eliminating the underlying cause of the arthritis is one of the goals for treating arthritis. However, not all causes are curable, such as those that cause osteoarthritis and rheumatoid arthritis. Relieving pain and discomfort as well as prevention from further damage will then become the focus.

Lifestyle changes and exercise can greatly help in improving the condition of those suffering from arthritis. Medications such as arthritis pain relief and anti-inflammatory drugs can be taken in addition to exercise and lifestyle changes.

The Definition of Rheumatoid Arthritis
Rheumatoid arthritis, known as Still’s disease in children, is a condition that causes inflammation of joints and associated pain, swelling and stiffness. Rheumatoid arthritis causes the body’s own immune system to attack joint tissue, breaking down collagen, cartilage, and sometimes bone or other organs. This chronic disease affects people differently and fluctuates over time, often marked by symptoms that improve only to re-emerge later. In some cases rheumatoid arthritis is mild and lasts only a few months (this kind of rheumatoid arthritis is called type 1), while in others the disease becomes progressively complicated by disability and other health problems, lasting many years (this is called type 2 rheumatoid arthritis).

Rheumatoid arthritis most often affects the wrist and finger joints closest to the hand, but can also affect joints in the feet and throughout the body. Anyone can be affected by rheumatoid arthritis, but women are more likely to develop symptoms. These most often begin between the ages of 20 and 30. The causes of rheumatoid arthritis are not yet understood, but many effective strategies have been developed to manage the symptoms.

Rheumatoid Arthritis Symptoms and Signs
The main symptom of rheumatoid arthritis is joint stiffness in the morning, often in the hands or feet. Stiffness that persists for an hour or more, or swelling and pain that lasts for more than six weeks, may be indicative of rheumatoid arthritis. Joint discomfort is typically symmetrical, i.e. both hands will hurt or feel stiff, not just one. Early rheumatoid arthritis symptoms also may include fever, excessive tiredness, or pea-sized lumps called “nodules” that can be felt under the skin.

Other possible rheumatoid arthritis symptoms include anemia, appetite loss and the accumulation of fluid in the ankles or behind the knee. In children, symptoms may include shaking chills and a pink rash which may follow the characteristic painful and swollen joints.

You may experience stiffness or pain in one or more of your joints. You will usually experience this pain in the neck, knees, fingers or hips, but your toes and elbows can also become affected. This stiffness or pain may be more apparent on waking or after sitting for long periods of time. As the joints naturally loosen with use, the pain may ease during the day, but may return in the evening.

The joints may become hot or swollen, and in the event of Osteoporosis bony growths may develop, usually on the knuckles.

As the condition progresses, every day activities such as opening bottles, turning taps or even walking can become affected. Activity can aggravate pain and swelling, and sleep can be disturbed. The pain and stiffness may limit the range of motion in the affected joint.

Some people experience other symptoms such as general tiredness or exhaustion, or unexplained fever. Most forms of arthritis tend to develop after the age of 40, although the condition can develop earlier.

As arthritis is a progressive condition, these symptoms are likely to worsen over time. If you do experience one or more of these symptoms consistently, visit your doctor for a possible diagnosis.

Hip arthritis can differ from other forms of arthritis in that it does not always follow a natural progression; sufferers report that the severity of symptoms can fluctuate month by month, and that these can be influenced by the weather and climatic conditions. This means that it can be difficult to determine the progression of hip arthritis.

Hip arthritis generally affects those over 50 years old. People who are overweight tend to be at greater risk of developing it, and excess weight can exacerbate the symptoms. Past injuries or trauma to the area, or fractures to bones around the hip joint, can be contributory factors in developing hip arthritis. There is also thought to be a genetic link.

Symptoms of hip arthritis are; pain and stiffness in the hip area, particularly on exertion, affected walking gait and a limited range of motion in the hip.

If you suspect that you may be suffering from hip arthritis, consult your doctor, who should carry out a physical examination and arrange for x-rays to be taken to determine the extent of the condition.

Treatment;
Anti-Inflammatory medication (NSAIDS) may be prescribed to reduce symptoms such as pain and inflammation. These can include prescription medications or non prescription medications such as aspirin and ibuprofen.

Corticosteroids (symptom-modifying anti-rheumatic drugs or SMARDS) may be prescribed. These can be taken orally, applied to the skin in cream or gel form or given by injection.

Lifestyle changes such as weight loss could be beneficial in reducing symptoms and pressure on the joints, and can help to prevent hip arthritis developing.

Walking aids may help mobility and reduce pressure on the joint, such as a stick or cane used in the opposite hand.

You may need to limit activities which cause pain, although certain activities may be beneficial, such as swimming, which supports the joints. There may be certain exercises you can carry out to strengthen the muscles surrounding the hip joint and improve flexibility- a physiotherapist may work with you to devise a suitable exercise program.

Surgery may be required in advanced cases of hip arthritis. The most common types of surgery preformed are;

•    Total hip replacement, involving the replacement of the ball and socket joint with a metal and plastic joint. This can be particularly useful for rheumatoid arthritis sufferers.

•    If the arthritis has only affected the lining of the joint rather than the cartilage, Synovectomy surgery may be offered (removal of part or all of the joint lining).

•    An operation to reduce bone marrow pressure and increase the flow of the blood, known as Core Decompression, may be suitable in some cases.

Whilst rheumatoid arthritis is an autoimmune condition, osteoarthritis is generally caused by wear and tear to the joints in the body over the years. The joints are protected by cartilage and other tissues, which are able to repair and heal themselves on a daily basis.

However, as we age, the cartilage becomes brittle and less able to repair itself. This can cause it to wear away, causing arthritis. This is why arthritis is common amongst the older population.

Injury; a major injury can result in arthritis, as damage to the joints can be irreparable. Illnesses to the joints, such as Septic Joint, can also result in arthritis developing.

It is thought that some forms of arthritis can be hereditary. Although not much research has been done in this area, genetics do appear to play a part in developing arthritis or the severity of symptoms, particularly rheumatoid arthritis.

Prolonged heavy use of joints, such as undertaking certain high impact sports or a particularly strenuous occupation, can put an individual at slightly greater risk of developing arthritis later in life. Having a poor posture or ‘stoop’ can also have an effect.

Individual who are overweight are more likely to develop arthritis, as increased pressure is placed on load bearing joints, such as the knees and the hips. A poor diet can also increase risk, as certain foods such as foods containing caffeine can reduce the calcium levels in the body. Calcium is essential for maintaining a healthy bone structure.
Fried or processed foods can release free radicals into the body; although these occur in the body naturally, an excess of them can damage joint tissues. A poor diet can also reduce the amount of synovial fluid, which is naturally produced by the body to lubricate the joints. Dehydration can affect joint cartilage, particularly in the spine, fingers and knees; arthritis sufferers who increased their water intake have reported an improvement and reduction in the severity of symptoms.

Smoking can also reduce the body’s calcium levels and contribute to the risk of developing arthritis. It is also believed that certain allergies or pollutants can leave certain individuals at risk of developing the condition.

Understanding the cause of arthritis can give more of an idea of how best to treat the condition, or prevent arthritis from developing.

Symptoms; You may notice increased stiffness in the spine, which can be worse in the morning or after periods of inactivity. There will also be pain, which may be exacerbated by movement and which may come and go. There may be additional pain or numbness in the neck, shoulders, arms or legs, including the Sciatic nerve.

Movement of the spine may be limited and you may find bending difficult. In extreme cases, the spine may become deformed. Often, bony growths occur which can form ‘spurs’, which can cause increased pain or restriction of movement. You may also notice a ‘crunching’ or clicking sound or sensation on moving.

If the arthritis develops in the lower spinal region, it can affect the nerves to the legs and buttocks. Arthritis in the cervical area can similarly affect the arms and shoulders.

If you think you may have spinal arthritis, consult your doctor, who may refer you for an x-ray for diagnosis and the extent of the damage.

Treatment; As with other forms of arthritis, there is currently no known cure, but a range of treatments are available to relieve symptoms.

Medications which may be prescribed include anti-inflammatory drugs, steroids or painkillers.

Losing excess weight will help to reduce pressure on the spine and soft tissue. Diet can be important; eating calcium and nutrient rich foods can help maintain bone density and strength and slow the rate of deterioration. Exercise has also proven beneficial in improving flexibility and relieving pain. A health professional or physiotherapist should be able to put together a suitable exercise or diet program for you.

Heat or ice treatment applied regularly has also proved to relieve pain and discomfort in sufferers.

Arthritis of the spine can cause the invertebral discs within the spine to deteriorate, which may then require further treatment. The joints of the spine can be affected by formation of bony growths on the spine, which may be removed by surgery.

Having spinal arthritis need not restrict you. A lot of people experience only minimal symptoms, and pain can be managed with appropriate medication and support.

It is possible to identify Rheumatoid Arthritis (RA) in its early stages if you learn how to recognise the common symptoms of this condition. RA usually starts with one or more symptoms which can change over time with its progression.

RA often starts in middle age, but can also develop in younger people and even children. It causes inflammation of the joint linings (synovium), which results in excessive joint fluid being produced, causing stiffness, pain, characteristic swelling and loss of joint function. In worse cases, it can cause inflammation of the lining of the lungs, heart and surrounding blood vessels. RA can also cause the glands around the mouth and eyes to become inflamed, causing dryness- this is known as Sjogren’s syndrome.

RA can be notoriously difficult to diagnose as symptoms can differ from one person to the other, and can mimic other health conditions such as fibromyalgia. The full range of symptoms which may be experienced tend to develop over a period of time. The most common symptoms to be aware of are;

Joint pain which may come and go; joint stiffness, especially on waking or after a prolonged period of rest; swelling to the soft tissue areas of the joint and unusual feelings of warmth or redness in the joints. Sufferers may also experience feelings of fatigue. One symptom that appears to be typical of RA is joint symmetry pain- that is, if symptoms occur in one of the joints on one side of the body, the same symptoms may occur in the corresponding joint on the other side of the body.

Joints most likely to be affected are those in the hands, fingers and wrists, but RA can attack any joints in the body. As the condition advances, sufferers can develop hard, tender lumps under the skin, known as arthritic nodules. These can vary in size but are not usually painful, although they can occasionally become infected.

If you suspect you may have RA, see your doctor in the first instance. He may refer you for tests and x-rays to diagnose the condition and determine the extent of its progression. Although there is no cure for RA at present, there are a variety of different treatments available to alleviate the symptoms and inflammation, and slow the rate of joint damage. Although it is classed as a chronic condition, symptoms can vary in severity and can come and go, with many people experiencing periods of remission when they are relatively symptom free.

With the right treatment, there is no reason why RA sufferers cannot continue to follow a full and active lifestyle.