The word arthritis literally means joint inflammation, but it's used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases might affect not just the joints, but also other parts of the body, including supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs. Two of the most common forms of arthritis cause many of us a great deal of pain: osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthrosis.

Osteoarthritis is a joint disease that mostly affects the cartilage - the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint can lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, causing still more pain and damage.

People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs.

Rheumatoid Arthritis

Rheumatoid arthritis, the second most common form of arthritis, affects other parts of the body besides the joints. It begins at a younger age than osteoarthritis, causes swelling and redness in joints, and may make people feel sick, tired, and sometimes feverish. Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that make it different from other kinds of arthritis, for example, rheumatoid arthritis generally occurs in a symmetrical pattern. This means that if one knee or hand is involved, the other one is also.

For some people, rheumatoid arthritis lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have severe disease that is active most of the time, lasts for many years, and leads to serious joint damage and disability.

Coping with Arthritis Pain

Chronic pain is a major health problem in the United States and is one of the most weakening effects of arthritis. More than 40 million Americans are affected by some form of arthritis, and many have chronic pain that limits daily activity. Osteoarthritis affects more than 20 million Americans, while rheumatoid arthritis, the most disabling form of the disease, affects about 2.1 million.

The long-term goal of pain management is to help patients cope with a chronic, often disabling disease. People with arthritis may be caught in a cycle of pain, depression, and stress. To break out of this cycle, you need to be an active participant with the doctor and other health care professionals in managing your pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques such as deep breathing and meditation, and family counseling therapy. In addition, you can promote your health with measures including:

* Eating a healthy diet.
* Getting 8 to 10 hours of sleep at night.
* Keeping a daily diary of pain and mood changes to share with your physician.
* Choosing a caring physician.
* Joining a support group.
* Staying informed about new research on managing arthritis pain.

Arthritis Treatment and Self-Care

There is no single treatment that applies to everyone with arthritis, but health care providers who work with arthritic patients will typically develop individual management plans designed to minimize pain and improve joint function. A number of treatments can provide pain relief. These include:

Medications

Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen (e.g., Tylenol) may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Motrin or Advil). In addition there are many prescription medications that can be used for the various types of arthritis pain.

Heat and Cold

The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain. If you have poor circulation, do not use cold packs.

Joint Protection

Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.

Transcutaneous Electrical Nerve Stimulation (TENS)

A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception.

Massage

In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive, so the therapist must be familiar with the problems of the disease.

Weight Reduction

Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.

Exercise

Swimming, walking, low-impact aerobic exercise, and range-of-motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit.

Surgery

In select patients with arthritis, surgery might be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.

Alternative Therapies

Many people seek other ways of treating their disease, such as special diets or supplements. Although these methods may not be harmful in and of themselves, no research to date shows that they help. Some people have tried acupuncture, in which thin needles are inserted at specific points in the body. Others have tried glucosamine and chondroitin sulfate, two natural substances found in and around cartilage cells, for osteoarthritis of the knee.

Some alternative or complementary approaches may help you to cope with or reduce some of the stress of living with a chronic illness. It is important to inform your doctor if you are using alternative therapies. If the doctor feels the approach has value and will not harm you, it can be incorporated into your treatment plan. However, it is important not to neglect your regular health care or treatment of serious symptoms.

Research

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health, is sponsoring research that will increase understanding of the specific ways to diagnose, treat, and possibly prevent arthritis pain. At centers around the US, researchers are studying arthritis as it relates to human joints, injuries, pain, medications and surgery.

Osteoarthritis and rheumatoid arthritis are chronic diseases that may last a lifetime. Learning how to manage your pain over the long term is an important factor in controlling the disease and maintaining a good quality of life.