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{{Infobox Disease |
  Name           = Arthritis |
  Image          = Arthrite rhumatoide.jpg|
  Caption        = Hands affected by [[rheumatoid arthritis]], an autoimmune form of arthritis |
  Width          = 325 |
  DiseasesDB     = 15237 |
  ICD10          = {{ICD10|M|00||m|00}}-{{ICD10|M|25||m|20}} |
  ICD9           = {{ICD9|710}}-{{ICD9|719}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = 001243 |
  eMedicineSubj  = search |
  eMedicineTopic = arthritis |
  MeshID         = D001168 |
}}
'''Arthritis''' (from Greek ''arthro-'', joint + ''-itis'', inflammation; plural: arthritides) is a group of conditions involving damage to the [[joint]]s of the body.

There are over 100 different forms of arthritis<ref>Healthline [http://www.healthline.com/adamcontent/arthritis]</ref><ref>[http://www.webmd.com/osteoarthritis/guide/arthritis-basics Web MD]</ref>. The most common form, [[osteoarthritis]] (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are [[rheumatoid arthritis]], [[psoriatic arthritis]], and related [[autoimmune disorder|autoimmune diseases]] in which the body attacks itself. [[Septic arthritis]] is caused by joint [[infection]].

The major complaint by individuals who have arthritis is [[pain]]. Pain is often a constant and daily feature of the disease. The pain may be localized to the [[human back|back]], [[neck]], [[hip]], [[knee]] or [[foot|feet]].
The pain from arthritis occurs due to [[inflammation]] that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscles [[strain (injury)|strains]] caused by forceful movements against stiff, painful joints and [[fatigue (medical)|fatigue]]. The most important factor in treatment is to understand the disorder and find ways to overcome the obstacles which prevent [[physical exercise]].

==Classification==
Primary forms of arthritis:
* [[Osteoarthritis]]
* [[Rheumatoid arthritis]]
* [[Septic arthritis]]
* [[Gout]] and [[Calcium pyrophosphate deposition disease|pseudo-gout]]
* [[Juvenile idiopathic arthritis]]
* [[Still's disease]]
* [[Ankylosing spondylitis]]

Secondary to other diseases:
* [[Ehlers-Danlos Syndrome]]
* [[Sarcoidosis]]
* [[Henoch-Schönlein purpura]]
* [[Psoriatic arthritis]]
* [[Reactive arthritis]]
* [[Haemochromatosis]]
* [[Hepatitis]]
* [[Wegener's granulomatosis]] (and many other [[vasculitis]] syndromes)
* [[Lyme disease]]
* [[Familial Mediterranean fever]]
* [[Hyperimmunoglobulinemia D with recurrent fever]]
* [[TNF receptor associated periodic syndrome]]
* [[Inflammatory bowel disease]] (Including [[Crohn's Disease]] and [[Ulcerative Colitis]])

Diseases that can mimic arthritis include:
* [[nail clubbing|Hypertrophic osteoarthropathy]] (nail clubbing)
* [[Multiple myeloma]]
* [[Osteoporosis]]
* [[Fifth disease]] ([[parvovirus]] infection)

===Rheumatoid Arthritis===
Rheumatoid arthritis is a disorder where, for some unknown reason, the body's own immune system starts to attack body [[tissue (biology)|tissues]]. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and [[cartilage]] which eventually results in erosion of two opposing bones. Rheumatoid arthritis affects joints in the fingers, wrists, knees and elbows. The disease is [[Symmetry|symmetrical]] and can lead to severe [[deformity]] in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. No one knows why rheumatoid arthritis occurs and all treatments are focused on easing the symptoms. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from [[corticosteroid]]s to [[monoclonal antibodies]] given [[Intravenous therapy|intravenously]]. The latest drugs like [[infliximab|Remicade]] can significantly improve quality of life in the short term. In rare cases, surgery may be required to replace joints but there is no cure for the illness.<ref>[http://www.aihw.gov.au/cdarf/diseases_pages/index.cfm Chronic Diseases] Australian Institute Of Health And Welfare. Retrieved on 2010-01-24</ref> 

Rheumatic fever has now seen resurgence in America primarily because of mass immigration of people from developing countries{{Citation needed|date=July 2010}}. The disorder can present with a migratory nature of arthritis with many other features like  [[heart problems]], [[skin rash]], [[gait abnormality]] and skin [[nodule (medicine)|nodules]].

===Osteoarthritis===
Unlike rheumatoid arthritis, osteoarthritis can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially one acquired from daily wear and tear of the joint. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night. The pain can be debilitating and prevent one from doing any type of activity. Osteoarthritis typically affects the weight bearing joints like the back, spine and [[pelvis]]. Unlike rheumatoid arthritis, osteoarthritis is a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65.

'''Risk factors for osteoarthritis:'''
* Prior joint trauma
* [[Obesity]]
* Repetitive joint use
* [[Sedentary lifestyle]]

Osteoarthritis, like rheumatoid arthritis, cannot be cured but one can prevent the condition from worsening. Weight loss is the key to improving symptoms and preventing progression. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.<ref>[http://arthritis-research.com/content/6/6/279 Chronic arthritis pain] Arthritis research & therapy. Retrieved on 2010-01-24</ref>

===Lupus===
This is a common [[collagen]] [[vascular]] disorder that can be present with severe arthritis. Other features of [[lupus erythematosus|lupus]] include a skin rash, extreme [[photosensitivity]], [[baldness|hair loss]], [[kidney]] problems, emotional [[lability]], lung fibrosis and constant joint pain.<ref>[http://emedicine.medscape.com/article/331715-diagnosis Rheumatoid Arthritis: Differential Diagnoses & Workup] Emedicine Portal. Retrieved on 2010-02-05</ref>

===Gout===
[[Gout]] is caused by deposition of [[uric acid]] crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate. This gout is known as [[Calcium pyrophosphate deposition disease|pseudogout]].  In the early stages, the gouty arthritis usually occur in one joint, but with time, it can occur in many joints and be quite crippling. The joints in gout can often become swollen and lose function.<ref>[http://severearthritis.net/ Severe Arthritis Disease Facts] Retrieved on 2010-02-05</ref>

===Other===
[[Infectious arthritis]] is another severe form of arthritis. It presents with sudden onset of chills, fever and joint pain. The condition is caused by bacteria elsewhere in the body. Infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible and permanent joint damage.<ref>[http://www.arthritis.org/ Severe Arthritis Disease Facts] Retrieved on 2010-02-05</ref>

[[Psoriasis]] is another type of arthritis. With psoriasis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of [[remission (medicine)|remission]] but there is no cure for the disorder. A small percentage develop a severe painful and destructive form of arthritis which destroys the small joint in the hands and can lead to permanent disability and loss of hand function <ref>[http://www.mayoclinic.com/health/psoriatic-arthritis/DS00476/DSECTION=symptoms Psoriatic Arthritis] Mayo Clinic. Retrieved on 2010-02-05</ref>

==Signs and symptoms==
Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, [[swelling (medical)|swelling]], [[joint stiffness]] and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms.<ref>[http://www.cdc.gov/chronicdisease/resources/publications/AAG/arthritis.htm Arthritis: The Nation’s Most Common Cause of Disability] Centers for disease prevention and health promotion. Retrieved on 2010-01-24</ref>

* Inability to use the [[hand]] or [[walking|walk]]
* [[Malaise]] and a feeling of tiredness
* [[Fever]]
* [[Weight loss]]
* Poor [[sleep]]
* [[myalgia|Muscle aches]] and pains
* [[Tenderness (medicine)|Tenderness]]
* Difficulty moving the joint

It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:
* Muscle [[weakness]]
* Loss of [[flexibility (anatomy)|flexibility]]
* Decreased [[aerobic exercise|aerobic fitness]]
These changes can also impact on life and social roles, such as community involvement.

===Disability===
Arthritis is the most common cause of [[disability]] in the USA. More than 20 million individuals with arthritis have severe limitations in function on a daily basis. [[Absenteeism]] and frequent visits to the [[physician]] are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and soon become home bound.<ref>[http://www.chronicarthritis.net/ Chronic Arthritis treatment, symptoms and relief] Retrieved on 2010-01-24</ref>

It is estimated that the total cost of arthritis cases is close to $100 billion of which nearly 50% accounts from lost earnings. Each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to [[health care]] centers.<ref>[http://www.arthritis.ca/types%20of%20arthritis/default.asp?s=1&province=bc Types of Arthritis] The Arthritis Society. Retrieved on 2010-02-05</ref>

Arthritis makes it very difficult for the individual to remain physically active. Many individuals who have arthritis also suffer from obesity, high [[cholesterol]] or have [[heart disease]]. Individuals with arthritis also become [[depression (mood)|depressed]] and have fear of worsening symptoms.

==Diagnosis==
Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. All arthritides potentially feature [[pain]]. Pain patterns may differ depending on the arthritides and the location. [[Rheumatoid arthritis]] is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. [[Osteoarthritis]], on the other hand, tends to be worse after exercise. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.

Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms.  Physical examination may confirm the diagnosis, or may indicate systemic disease.  Radiographs are often used to follow progression or help assess severity.

==Prevention==
While neither Rheumatoid arthritis nor osteoarthritis can be completely prevented, one can reduce the risks by becoming physically active, participating in physical therapy, losing weight and eating healthily. All individuals who have pain in the joints should seek early diagnosis because the earlier the treatment is started, the better is the [[prognosis]].

==Treatment==

Once the diagnosis of arthritis is made, treatments are available for a variety of symptoms. There is no cure for either rheumatoid or osteoarthritis.

Treatment options vary depending on the type of arthritis and include [[physical therapy]], lifestyle changes (including exercise and weight control), [[Brace (orthopaedic)|orthopedic bracing]], medications, and dietary supplements (symptomatic or targeted at the disease process causing the arthritis). [[Arthroplasty]] (joint replacement surgery) may be required in eroding forms of arthritis. Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage is slowed.<ref>[http://www.treatarthritis.net/ How to treat arthritis] Retrieved on 2010-02-01</ref>

In general, studies have shown that physical exercise of the affected joint can have noticeable improvement in terms of long-term pain relief.  Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.<ref>{{cite pmid|8980206}}</ref>

===Physical Therapy===
Individuals with arthritis can definitely benefit from both physical and [[occupational therapy]]. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases <ref>Fransen M, Crosbie J, and Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. The Journal of Rheumatology  January 1, 2001  vol. 28  no. 1  pp156-164</ref>. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focusses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can teach you how to reduce stress on your joint from daily living activities. Occupation therapy can also teach you how to modify your home and work environment so that you do reduce movements that may worsen your arthritis. There are also assist devices available that can help you drive, getting a bath, dressing and also in housekeeping labors.

As well as exercise, [[physical therapy]] may include education about modifying activities, and other self-management skills such as using ice or heat, and [[Medical ultrasonography|ultrasound]]. Physical therapists will routinely educate patients to manage their problems related to arthritis themselves. Other aspects of physical therapy means learning how to maintain good posture, conserving energy by allowing rest before and after activity.

Occupational therapy can help you do everyday activities without worsening pain or causing joint damage. The techniques can help you distribute pressures to minimize stress on any one joint. Ways to accomplish daily living tasks are made easier.<ref>[http://www.cdc.gov/arthritis/ Arthritis Disability Information] Centers for disease control and prevention portal. Retrieved on 2010-02-01</ref>

===Medications===
Physicians usually start with drugs which have the fewest side effects and shift to stronger [[Pharmaceutical drug|medications]] as the disease progresses.<ref>{{Cite web
 |url= http://www.arthritistoday.org/treatments/drug-guide/index.php
 |title=Arthritis Drugs | Arthritis Prescription Medication | Arthritis Today
 |work=arthritistoday.org
 |accessdate=July 5, 2010
}}</ref>

''Non-steroidal anti-inflammatory drugs'' (NSAIDs) are usually the drugs of first choice. These drugs help decrease inflammation and reduce pain. Over the counter medications like [[Ibuprofen]] or [[naproxen|Aleve]] do help but most people require stronger prescription [[analgesic|painkillers]] like [[celecoxib|Celebrex]] or [[tramadol]]. While these drugs are effective, they are also associated with a variety of side effects like [[abdominal pain]], bleeding, ulcers, liver and kidney damage. Non steroidal anti inflammatory drugs should not be used for prolonged periods without proper physician supervision.<ref>{{Cite web
 |url= http://www.medicinenet.com/arthritis/article.htm
 |title=Arthritis Medication, Prevention, Symptoms, Treatment and Causes by MedicineNet.com
 |work=medicinenet.com
 |accessdate=July 5, 2010
}}</ref>

''Corticosteroids'' are frequently prescribed for individuals with arthritis. These potent drugs can help reduce inflammation and slow down joint damage. However, corticosteroids have potent side effects which range from ulcer, skin bruising, weight gain, [[cataract]]s, bone thinning, [[diabetes mellitus|diabetes]] and [[hypertension]]. Corticosteroids are usually given for a short time to help reduce acute symptoms.

''[[Disease-modifying antirheumatic drug]]s'' (DMARDs) can help slow down progression of rheumatoid arthritis and joint damage. The most common DMARDs include [[methotrexate]] (Rheumatrex, Trexall), [[leflunomide]] (Arava), [[hydroxychloroquine]] (Plaquenil), [[sulfasalazine]] (Azulfidine) and [[minocycline]] (Dynacin, Minocin). All these drugs have side effects which include liver damage, [[bone marrow suppression]] and possibility of opportunistic infections.

''[[Immunosuppression|Immunosuppressants]]'' like cyclosporine and cyclophosphamide suppress potent cells of the body and help decrease the inflammation. These medications do help treat severe arthritis but also make one prone to infections.

''Tumor necrosis factor inhibitors'' have been shown to reduce inflammation, pain, morning stiffness and swelling of joints. Drugs like [[etanercept]] (Enbrel), [[infliximab]] (Remicade) and [[adalimumab]] (Humira) can significantly improve quality of life. The most common side effects from these drugs include pain at site of injection, heart failure and increased risk of infection.<ref>[http://www.arthritisinformation.biz/ Arthritis Overview] Arthritis Information Portal. Retrieved on 2010-02-01</ref>

==Epidemiology==
Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, [[ethnic group]]s and cultures. An estimated 46 million individuals in USA have arthritis and the numbers continue to increase each year. Close to one million individuals are admitted to hospitals each year because of their arthritis.<ref>[http://www.ncbi.nlm.nih.gov/pubmed/18605390 Chronic Arthritis in adolescence] National Center for Biotechnology Information. Retrieved on 2010-01-24</ref>

==History==
While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as [[4500 BC]]. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples.<ref name="Bridges ">{{cite journal | author=Bridges PS | title=Prehistoric Arthritis in the Americas | journal=Annual Review of Anthropology | year=1992| volume=21 |pages=67–91 |url=http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.an.21.100192.000435 | doi=10.1146/annurev.an.21.100192.000435}}</ref> It was noted in skeletal remains of [[Native Americans in the United States|Native Americans]] found in [[Tennessee]] and parts of what is now Olathe, [[Kansas]].  Evidence of arthritis has been found throughout history, from [[Ötzi the Iceman|Ötzi]], a [[mummy]] (circa 3000 BC) found along the border of modern [[Italy]] and [[Austria]], to the Egyptian mummies circa 2590 BC <ref>[http://www.news-medical.net/health/Arthritis-History.aspx Arthritis History] Medical News</ref>

In 1715 [[William Musgrave]] published the second edition of his most important medical work ''De arthritide symptomatica'' which concerned arthritis and its effects.<ref name=ODNB>Alick Cameron, "Musgrave, William (1655–1721)", Oxford Dictionary of National Biography, Oxford University Press, Sept 2004</ref>

{| class="wikitable"
|-
! Extra-articular features of joint disease<ref>Swash, M, Glynn, M.(eds). 2007. Hutchison's Clinical Methods. Edinburgh. Saunders Elsevier.</ref>
|-
| [[Cutaneous]] [[Nodule (medicine)|nodules]]
|-
| Cutaneous [[vasculitis]] [[lesions]]
|-
| [[Lymphadenopathy]]
|-
| [[Oedema]]
|-
| [[Ocular]] [[inflammation]]
|-
| [[Urethritis]]
|-
| [[Tenosynovitis]] ([[tendon]] sheath [[effusion]]s)
|-
| [[Bursitis]] (swollen [[bursa (anatomy)|bursa]])
|-
| [[Diarrhea]]
|-
| Orogenital [[ulceration]]
|}

[[Blood test]]s and [[X-ray]]s of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include: [[rheumatoid factor]], [[antinuclear factor]] (ANF), [[extractable nuclear antigen]], and specific antibodies.

==See also==
*[[Arthritis Care]] (charity in the UK)
*[[Osteoimmunology]]
*[[Arthritis Foundation]] (US not-for-profit)

==References==
{{Reflist}}

==External links==
* {{dmoz|/Health/Conditions_and_Diseases/Musculoskeletal_Disorders/Arthritis/|Arthritis}}
* [http://www.rheumatology.org American College of Rheumatology] - US professional society of rheumatologists
* [http://www.arthritis.org Arthritis Foundation] - US national not-for-profit organization for arthritis

{{Diseases of the musculoskeletal system and connective tissue}}
{{Inflammation}}

[[Category:Aging-associated diseases]]
[[Category:Arthritis| ]]
[[Category:Inflammations]]
[[Category:Rheumatology]]
[[Category:Skeletal disorders]]

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