Arthritis Facts and Falsehoods
Arthritis, a condition characterized by joint inflammation and pain, impacts about 58.5 million adults in the United States, according to the Centers for Disease Control and Prevention (CDC). Most are older adults and women, but the disease transcends demographics.
There are 100-plus types of arthritis, divided into two categories: osteoarthritis and inflammatory arthritis. The first, colloquially known as "wear and tear" arthritis, usually occurs gradually as a result of trauma or overuse over time. Inflammatory arthritis, on the other hand, is often caused by autoimmunity.
The degree to which arthritis impacts a person's overall health and well-being—including sex and relationships—depends on their particular condition, its severity, their overall health and the resources available to them.
Arthritis affects multiple aspects of their life, from sexual function to the ability to perform daily tasks, due to the associated fatigue, pain and lack of mobility, among other factors. Arthritis is a leading cause of disability, and research indicates approximately half of the people with the condition experience some level of sexual dysfunction. Many also struggle with infertility or have disease-related difficulties during pregnancy and birth.
Each subset of arthritis has distinct symptoms and everyone's experience is different. These variations can make the disease difficult to identify without medical training. When combined with certain misconceptions, uncertainty can lead some people to delay seeking a diagnosis. However, early intervention is crucial to preventing permanent, sometimes critical, complications.
Understanding the various forms arthritis can present and the treatment options available can empower you to take control of your health before the disease takes over your life.
The only defining symptom shared by all types of arthritis is joint pain, whether transient, intermittent or progressive, according to Michael D. Lockshin, M.D., director emeritus of the Barbara Volcker Center for Women and Rheumatic Diseases at the Hospital for Special Surgery in New York City, and professor of medicine and obstetrics-gynecology at Weill Cornell Medicine.
Dmitriy Dvoskin, M.D., a physician at Pain Management NYC in New York City, said just as arthritis can occur in myriad forms, the type of pain people experience can run the gamut from mild to severe. He noted that people describe the pain of degenerative arthritis as dull, aching, annoying and impairing their activities of daily living. As the disease progresses, pain becomes more intense and may be sharp during flare-ups.
"For example, at the beginning of knee osteoarthritis, patients show improvement with NSAIDs [nonsteroidal anti-inflammatory drugs] and physical therapy, but as the disease progresses and the joint degenerates further, you may have bone-on-bone rubbing resulting in sharp pain with every movement," he added.
Other common symptoms include redness, stiffness, swelling, warmth and tenderness in the affected joint, according to Cleveland Clinic. The joint may also become visibly disfigured and lose mobility and functionality.
Brett Smith, D.O., a rheumatologist at East Tennessee Children's Hospital in Knoxville, said a small subset of people with osteoarthritis lose their range of motion and see changes in the bone structure before pain arises. They may not realize they have arthritis because it's not painful. In the early stages of the disease, people with rheumatoid arthritis may be similarly unaware they have it because symptoms can come and go.
Some types of arthritis, including rheumatoid arthritis, can cause additional symptoms such as fatigue, sleep difficulties, depression and mood changes, numbness or tingling in the hands or feet, low-grade fever, coughing, and dry eyes and mouth, according to Lockshin and the arthritis website CreakyJoints.org.
For many people, arthritis symptoms are worse at certain times of the day. Pain is usually worse at night for people with osteoarthritis and gout, and stiffness is typically worse in the morning for people with both inflammatory and noninflammatory arthritis. Smith explained the latter is because of a phenomenon known as "gelling," the same reason symptoms tend to be more severe in the cold.
"The fluid in the joint—the synovial fluid—can be very thin when people are active, moving around and in warm climates," he explained. "But if people get cold or they've been inactive, that fluid gets a lot thicker, similar to maple syrup or honey, and it doesn't move as easily. Like starting the car when it's cold outside, it takes a little time to warm that engine up before it's ready to work functionally. It just takes a couple of minutes, usually. That happens mostly in the morning because they've been stationary all night sleeping."
Diagnosis and testing
Diagnosing arthritis is a multistep process that includes taking a patient's health history, a physical examination, and tests such as X-rays, MRIs (magnetic resonance imaging), PET (positron emission tomography) scans and blood tests. Doctors consider the patient's symptoms, how long they've persisted and what joints are affected. They inquire about when the symptoms appeared and what tends to exacerbate them.
In addition to indicating the type of arthritis, these assessments can help a doctor determine the severity of the disease.
"Almost all named types of arthritis have associated severity scales, which give graded points to symptoms, physical findings and laboratory tests, usually 0 for negative or normal, 5 for severely abnormal," Lockshin said. "It may be confusing. Because the abnormalities may not occur simultaneously, and because in many cases abnormalities wax and wane, severity may require several months of observations to assess."
When to seek help and who to see
See a doctor if you experience joint pain, swelling or stiffness that doesn't dissipate within a few days or notice changes in the joint's appearance. All forms of arthritis can progress and most are easier to treat in the early stages, according to both Lockshin and Smith. In many cases, early intervention can slow disease progression and prevent or postpone severe pain, permanent damage, disability and other complications.
You may need to see multiple doctors for a proper diagnosis and treatment, including a general practitioner and rheumatologist or orthopedist. Physical or occupational therapists and pain management specialists may be involved as well. If the first person you see doesn't take your concerns seriously, Lockshin advised seeking a second opinion.
What happens if it goes undiagnosed?
Over time, inflammation breaks down the cartilage between joints. When there is no cartilage left, the bones can rub together, causing permanent damage, disfigurement, severe pain and loss of function. Connecting bones and tissues, including tendons and ligaments, may become weaker.
With inflammatory arthritis, the damage can be widespread, affecting various body parts, including the circulatory, respiratory and immune systems, and causing severe conditions such as high blood pressure in the lungs and pulmonary fibrosis. Some forms of the disease can cause rashes and dryness of the skin, mouth, eyes and vagina.
While the timeline varies based on the specific type of arthritis and other factors, Smith said some degree of permanent, irreversible damage tends to occur within 12 to 24 months.
"Our goal is to prevent that or minimize that," he explained, noting there's a "window of opportunity" in the disease's initial phase where it's possible to curtail several risks, including joint damage, with appropriate treatment.
Myths and misconceptions
Dvoskin said one of the more pervasive fallacies is that arthritis affects only older people. Another, Lockshin noted, is that arthritis is "just old age" and cannot be improved. The condition can affect people of all ages and many forms are treatable.
Lockshin said there are conflicting misconceptions that arthritis is either never too serious or always severe and disabling. However, most patients' illnesses can be managed successfully with early intervention. At the same time, untreated arthritis can be debilitating, and certain forms of the disease, including rheumatoid arthritis, scleroderma, vasculitis and lupus, can be life-threatening.
Other misconceptions relate to pain. Dvoskin noted that some people assume arthritis pain is an inevitability they must accept, but many people find lifestyle changes, medications and other treatments can alleviate discomfort.
Smith said some people perceive their condition as a "toughness competition or pain perception issue," which could inhibit them from seeking help.
"There is a degree of pain tolerance that's important," Smith explained. "But there is a risk of a lot of bad things happening to people, like permanent joint damage, loss of function, decreased quality of life—all sorts of things if we're not diagnosed early and appropriately. I think people need to think it's not about being tough. It's about being accurately diagnosed and managed appropriately."