What is arthritis?
Arthritis, or "joint inflammation," is a general term for a group of more than 100 diseases. Arthritis is inflammation (swelling) in and around the body’s joints. (A joint is a point at which two or more bones come together, such as the hip or the knee.)
Inflammation is one of the body's natural responses to disease or injury. Inflammation can cause pain, stiffness, and swelling, as well as loss of movement in some patients. Some types of arthritis include osteoarthritis, rheumatoid arthritis, psoriatic arthritis and gout.
Arthritis limits everyday activities such as walking, dressing and bathing. In the United States, one in five adults (52.5 million) reports having arthritis that has been diagnosed by a doctor.
Arthritis is the leading cause of disability among Americans aged 15 and older. However, arthritis affects people in all age groups, including almost 300,000 children.
Other statistics about arthritis:
- More than 27 million people in the United States have osteoarthritis.
- An estimated 1.3 million have rheumatoid arthritis.
- More than half of those with arthritis are under 65 years of age.
- Nearly 60% of Americans with arthritis are women.
Symptoms and Causes
What causes arthritis?
The causes of most types of arthritis are not known. Scientists are studying how three major factors may play a role in certain types of arthritis:
- Genetic (inherited) factors (“runs in the family”).
- What happened during a person’s lifetime.
- The person’s current lifestyle.
Although the exact causes of arthritis might not be known, there are several risk factors. A risk factor is a something that increases a person's chance of developing a disease or condition. Risk factors for arthritis include:
- Age — The risk of developing arthritis, especially osteoarthritis, increases with age.
- Gender — In general, arthritis occurs more often in women than in men.
- Weight — Being overweight puts extra stress on the joints that support a person’s weight. This increases wear and tear, and the risk of arthritis.
- Work factors — Jobs in which the worker has to keep doing the same movements over and over, or does a great deal of heavy lifting, can cause stress in the joints and/or an injury, which can lead to arthritis.
The pain of arthritis might be caused by different things, including inflammation of the synovial membrane (tissue that lines the joints), tendons, or ligaments; muscle strain and fatigue. A combination of these factors can have an effect on how strong the pain is.
The pain of arthritis can be very different for each person. Things that contribute to the pain include the amount of damage and swelling within the joint.
What are the symptoms of arthritis?
Different types of arthritis have different symptoms, which can be mild in some people and very strong in others. Osteoarthritis usually does not cause any symptoms outside the joint.
Diagnosis and Tests
How is arthritis diagnosed?
To diagnose arthritis, a doctor will take a medical history and ask questions about the patient’s pain. The doctor will do a physical examination to find the causes of pain and how this pain is affecting the patient’s ability to function.
The patient might have X-rays or other imaging procedures such as a CT scan (computerized tomography) or MRI (magnetic resonance imaging) to see how much joint damage there is. The patient may also see several different specialists.
What blood tests are done to diagnose arthritis?
Patients with arthritis will probably have blood tests when they first see the doctor and as part of their follow-up care. This is because blood is the most easily and safely sampled body tissue, and it contains traces of material from every other part of the body. The most common blood tests used to help diagnose and manage arthritis include the following:
Complete blood count: The complete blood count (CBC) is a series of blood tests that provides information about the different parts of blood, including red blood cells, white blood cells and platelets. Automated machines rapidly count the cell types. The CBC test results can help diagnose diseases and also tell how serious the disease is. Under normal conditions, the white blood cell count is between 4,000 and 11,000. A high white blood cell count could mean there is inflammation (swelling), which can be caused by rheumatoid arthritis (RA). However, infections, stress and exercise will temporarily raise the white blood cell count, too. A CBC also measures hemoglobin, a component of red cells that contains iron and carries oxygen. The hematocrit is the percent of total blood volume that is made up of red cells. Normal hematocrit values are 39% to 51% for males, and 36% to 46% for females. A lower hematocrit can be caused by a number of factors or conditions, including RA.
Erythrocyte sedimentation rate: The erythrocyte sedimentation rate (ESR) is a test in which a blood sample is placed in a tube to see how far the red blood cells settle in one hour. Inflammation in the body produces proteins in the blood, which make the red cells clump together and causes them to fall faster than the healthy blood cells. Since inflammation can be caused by conditions other than arthritis, the ESR test alone does not diagnose arthritis.
Rheumatoid factor: Rheumatoid factor (RF) is an antibody found in many patients with RA. It is one of several methods used to diagnose RA (80% of RA patients have RF in their blood, though other inflammatory or infectious diseases may also be the cause).
Antinuclear antibody: Patients with certain rheumatic diseases, such as lupus, make antibodies that are directed at the nucleus of the body's cells. These antibodies, known as antinuclear antibodies (ANAs), are discovered by viewing the patient's blood serum (clear liquid separated from the blood) under a microscope. More than 95% of patients with lupus have a positive ANA test. However, patients with other diseases also can have positive ANA test results, and even perfectly healthy people can have positive ANA test results, so other tests must be completed before a diagnosis can be made.
Management and Treatment
How is arthritis treated?
Treatment of arthritis will depend on the type of arthritis, how strong the pain is and the patient’s overall health. The goal is to treat all aspects of arthritis pain, increase joint mobility (movement) and strength, and help patients learn to manage pain.
Treatment options include medicine, exercise, heat/cold, use of joint protection and surgery. Treatment plans might include more than one of these treatments. As part of a comprehensive plan for arthritis treatment, your doctor might also prescribe occupational and physical therapy, which can provide additional help in your recovery.
How can occupational therapists help you treat your arthritis?
Occupational therapists can teach you how to reduce strain on your joints during daily activities. They can show you how to modify your home and workplace environments to reduce motions that might aggravate arthritis. Occupational therapists can also provide splints for your hands or wrists, and recommend assistive devices to help you drive, bathe, dress, keep house, and do other tasks.
How can physical therapists help you treat your arthritis?
Physical therapists can teach you:
- Exercises designed to preserve the mobility, strength, and use of your joints
- Proper body mechanics to move from one position to another
- Proper mechanics during the performance of your daily activities
- Correct posture to protect the integrity of the joints
- How to use walking aids such as crutches, a walker, or cane when needed
For patients with mild to moderate knee or ankle arthritis, your therapist may recommend a functional knee or ankle brace that will support your joint, allowing more freedom with daily activities such as walking, hiking, and golfing.
What are the goals of arthritis treatment using physical therapy?
Your physical therapist will tailor a program to your specific needs, whether your arthritic problems are widespread or confined to one joint or body area.
The goals of treatment are to:
- Prevent loss of use of the joints
- Restore abilities that may have been lost
- Help you adapt to new activity levels
- Maintain your fitness
- Maintain your ability to take part in the activities you choose with minimal help from others
Therapy should be started early in order to reduce painful symptoms of inflammation, prevent deformity and permanent joint stiffness, and maintain strength in the surrounding muscles. When pain and swelling are better controlled, treatment plans may include exercises to increase range of motion, and to improve muscle strength and endurance.
What are some therapeutic methods of using occupational therapy or physical therapy to treat arthritis?
- Exercise. This is an important part of arthritis treatment that is most effective when done properly every day. Your therapist will prescribe a program for you that will vary as your needs change.
- Thermal modalities. Applying ice packs or heating pads can help relieve pain locally. Heat can help relax muscle spasms or taking a warm bath or shower before exercising might help you exercise more easily.
- Therapy for joint surgery patients. Preoperative programs of education and exercise, started before surgery in the outpatient therapy department, are continued at home. They might be changed in the hospital after surgery to fit new needs in the rehabilitation period. These exercises might be added to your usual exercise regimen, and you might find your ability to exercise has improved after surgery.
- Joint protection techniques. You can reduce the stress on joints affected by arthritis while participating in daily activities.
- Some ways to do this:
- A therapist can show you ways to do everyday tasks without worsening pain or producing joint damage. Joint protection techniques can help you:
- Use proper body mechanics to get in and out of a car, chair or tub, as well as for lifting objects.
- Assistive devices. Many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist will suggest devices that will be helpful for tasks you might have found difficult at home or work. A few examples of helpful devices include a bath stool in the shower or tub; grab bars around the toilet or tub; and long-handled shoehorns and sock grippers. Your therapist can direct you to catalogs that offer a wide variety of assistive devices you can order.
- Functional bracing: In some cases of mild to moderate knee and ankle arthritis, bracing can provide improved stability, unloading of the painful joint, and increased comfort for activities such as walking, stairs, and recreational activities such as golfing and hiking.
What are some benefits of occupational and physical therapy programs for arthritis?
Physical therapy programs may provide:
- Exercises aimed at restoring normal joint mobility or flexibility
- Exercises aimed at restoring normal strength
- Education on whether you are safe to walk with or without an assistive device
- Postural education and activity modifications to relieve discomfort and improve performance
- Assessment for functional bracing of the affected joint
What can I do to make living with my arthritis easier?
Getting dressed, brushing your teeth, eating a meal — you do these things every day. But people with arthritis often struggle with these everyday activities.
Often, simple tweaks make these tasks easier to manage, and there is a world of adaptive products designed for people with arthritis. Start with the following tips for an easier daily routine.
In the kitchen
Open up: If you have arthritis in your hands, opening a jar presents a challenge. For mild cases, a rubber jar-opening grip helps by adding traction. If that doesn’t do the trick, consider buying a specialized opener for jars, cans and other containers.
Get a grip: If you love to cook, pots and pans with soft grips and longer handles may ease the process. Likewise, if you have trouble handling silverware, adaptive utensils with thicker handles make it easier to enjoy your home-cooked meals.
In the bathroom
Elevate your seat: For many — especially those with knee, hip and back issues — getting on and off the toilet is a daily challenge. Solutions range from elevated seats that add height to a toilet to powered toilet lifts if you need the extra help.
Go electric: Electric toothbrushes have fatter, easier-to-grip handles than traditional ones. They also do much of the brushing work for you, which is helpful if you have shoulder problems. Similarly, electric razors make shaving easier and may reduce the nicks and cuts you get from shaving with achy, unsteady hands.
Shower smart: If you have trouble getting in and out of the shower or fear falls, try installing rails or using an adjustable shower chair. Other, simpler changes can help, too. For example, liquid soap is easier to handle than bars. You can even add an automatic dispenser to your shower.
Try wiping alternatives: Nobody wants to talk about toilet hygiene, but it’s important. Patients often tell me arthritis prevents them from getting properly clean, which leads to irritation. One alternative: Buy rolled cotton, and break off pieces to use when wiping. Cotton feels more tactile than toilet paper, and you can moisten it for better cleaning. Just remember: Don’t flush it, or you will have plumbing work to do.
In the living room
Firm up your seat: That big, cushy recliner might look inviting, but it may do more harm than good. A chair that is too soft aggravates symptoms in your back, for example. And when you sink into a chair, it’s harder to get back up. Shop for a firm chair that’s high enough for you to get in and out easily. Powered chairs can give you a boost back up, if needed.
Add doorknob handles: If turning traditional, rounded doorknobs is a strain, consider getting adapters. These fit over doorknobs and include a lever mechanism that requires only a push rather than a turn.
In the dressing room
Slip into your shoes: For many of my patients, putting on shoes is the toughest part of getting dressed. Tiny, traditional shoehorns don’t cut it. But like gardening and cleaning tools, you can buy shoehorns with long handles (two to three feet). Using these long handles eliminates the need to bend and struggle.
Zip up: Because zippers and buttons on clothing are so small, they are difficult to maneuver if you’re dealing with swollen, inflamed joints. Consider buying a multi-use dressing tool, which helps pull zippers shut and even slip buttons into place.
How do I deal with the pain in my hands?
Because pain in your hands makes it harder to do everyday tasks and activities, you need practical ways to get through the day. Beyond medical treatment, you can take steps on your own — with the help of experts — to get a grip on your condition.
Take advantage of timing
Hand pain varies for different types of arthritis.
For example, people with osteoarthritis tend to have pain that gets worse as the day goes on. If this applies to you, try being more active in the morning. Get your gardening or yard work — and other activities that require heavy hand use — done early. Schedule your tee time or tennis game for the morning. You’ll feel and perform better as a result.
People with rheumatoid arthritis or other inflammatory conditions may feel the opposite. They tend to wake up stiff. As the day goes on, they loosen up. If that describes you, save your activities for the afternoon and evening, when you feel your best.
In either case, don’t overdo it. For people with arthritis, the “play through the pain” sports cliché offers a recipe for injuries.
Get expert advice on adapting
Never underestimate your power to adapt. But also don’t underestimate an occupational therapist’s (OTs) ability to help you adapt.
For example, an OT can offer exercises designed to strengthen your grip, keep your pain levels down and increase your range of motion. All three are critical.
An OT also can help you adjust how you interact with everyday objects in your home or office, plus sports gear. For example, some people with severe thumb issues change the way they grip ski poles to put less stress on their thumbs.
Your hobby might differ, but the goal of working with an OT remains the same: to help you be as active and independent as possible.
Embrace ice and heat
First, the ice. An ice massage can do wonders for pain caused by physical activity. Take a piece of ice and rub it in a circular motion over your painful joint. Just don’t do it for more than five minutes at a time so you don’t irritate your skin. You can use an ice pack with a cover, too.
As for heat, soaking in warm water offers relief. In fact, some people with rheumatoid arthritis enjoy the feeling of warm water so much they will even hand-wash dishes in the sink to get a good soak. Just remember that heat isn't always a good idea for an acute injury.
Seek specialized tools
With help from an OT or a doctor — or groups such as the Arthritis Foundation — you can find adaptive tools to ease your hand pain.
For example, look for kitchen utensils and gardening tools with special, thicker grips if you have trouble handling regular tools.
In the office, you can order special keyboards for computers that are easier on your hands, plus hands-free headsets for talking on the phone. You can even get special pen adapters that make putting ink on paper easier.
The same goes for physical activity. For golf, tennis or other hand-intensive sports, specialized grips can make a big difference. Gloves are recommended for all sorts of activities, too. They reduce friction, and the compression they provide can ease symptoms. A golf glove may help your tennis game, for example, even if it takes some getting used to. And even though gardeners love the feel of the earth, the protection and extra grip gloves provide are important.
What works for you may not work for somebody else, so it may take a little experimentation to find relief. But don’t be afraid to ask an OT or doctor for help. Your hands are too important to your daily life.
How do I deal with arthritis affecting my sex life?
There are ways to overcome the hurdles arthritis places in your way. They take patience, a willingness to try new things and honesty with your partner. But sex is an important and healthy part of life. Usually, the benefits are worth extra effort.
Try a new position
Pain is a major symptom of arthritis. Unfortunately, it’s also one of the major barriers to sex.
Sometimes a small change in your routine — such as trying a new position — can make a big difference. A few examples:
- If arthritis in your hips makes being on the bottom too painful, switch to the top.
- If lower back pain is your main problem, try using pillows to support your back and ease discomfort.
- If knees are your pain points, try positions that take the stress off of them. This may mean being on the bottom, for example.
- If other positions put stress on your aching joints, try a “spooning” position where both you and your partner lie on your sides.
For people with arthritis, “mixing things up” is about more than variety. It’s practical. Finding the right positions for you will take time — and experimentation.
Pick the best time for sex
Pain is one factor. Fatigue is another. There are certain times of day when you may feel too drained for sex. And although most medications for arthritis don’t affect sexual function, drugs such as methotrexate (for rheumatoid arthritis) can add to your fatigue.
Planning can help. Do you feel most rested and energetic first thing in the morning or in the afternoon? Is your pain level at its lowest a few minutes after you take an anti-inflammatory? Make these your windows of opportunity. Bedtime is not the only time for sex, especially if that’s when you feel your worst.
“But sex is better when it’s spontaneous,” you may think. It’s a romantic notion, but it’s not always true. Couples often have to work to keep up a healthy sex life in the long term. Finding creative solutions for pain and fatigue is just part of that work.
Talk it through with your partner
If you don’t talk about sex, you can’t work at it.
Not all issues that come with arthritis are physical. You may have depression. You may feel less attractive than you used to. Don’t keep these issues to yourself.
If talking is too tough for you, consider bringing your partner to an appointment and letting your doctor start the conversation. In some cases, couples’ counseling can help you deal with the relationship concerns that come with chronic pain.
Being open and honest can lead to creative solutions. For example, if intercourse is simply too painful, using adult toys or trying other forms of intimacy such as massage offer alternatives. You’ll never know if you don’t start the conversation.
Deal with related concerns
Sometimes rheumatoid arthritis brings physical concerns beyond pain and fatigue. About 15% to 20% of rheumatoid arthritis patients also have Sjögren’s syndrome, which leads to dryness in several parts of the body, including the vagina.
For women with Sjögren’s syndrome, intercourse tends to cause pain. Personal lubricants can make a world of difference. Just be sure to check the label for the ingredient propylene glycol. This ingredient causes irritation for some people.
If fatigue is your biggest issue, lifestyle changes can help. Cut out highly refined foods, which may affect inflammation. Eat more fresh fruits and vegetables to boost your nutrient levels. Add low-impact exercise to your weekly routine. Don’t burn the candle at both ends, because rest is crucial.
These tips are good for anybody’s health. But for people with arthritis, they can help boost the energy you need for all of life’s activities — including sex.
Cleveland Clinic Podcasts
Listen to a podcast that discusses the many forms of arthritis.
Other helpful resources
- The National Psoriasis Foundation https://www.psoriasis.org/
- The Arthritis Foundation https://www.arthritis.org/
- Road Back Foundation https://www.roadback.org/
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) https://www.niams.nih.gov/
- American Academy of Orthopaedic Surgeons https://www.aaos.org/
- American College of Rheumatology https://www.rheumatology.org/
- International Scleroderma Network https://www.sclero.org/
- Scleroderma Research Foundation https://srfcure.org/
- Spondylitis Association of America https://www.spondylitis.org/
- Arthritis National Research Foundation https://curearthritis.org/
- Lupus Foundation of America https://www.lupus.org/
- American Autoimmune Related Diseases Association https://www.aarda.org/
- The Myositis Association https://www.myositis.org/
- Vasculitis Foundation https://www.vasculitisfoundation.org/
- American Lyme Disease Foundation https://www.aldf.com/
- Lyme Disease Association https://lymediseaseassociation.org/
- Sjogren's Syndrome Foundation https://www.sjogrens.org/
- National Fibromyalgia Association http://www.fmaware.org/
- Fibromyalgia Network http://fmnetnews.iraherman.com/
- Scleroderma Foundation https://www.scleroderma.org/site/
- The Arthritis Research Institute of America http://preventarthritis.org/
- National Organization for Rare Disorders https://rarediseases.org/
- American Chronic Pain Association (ACPA) https://www.theacpa.org/
- Scoliosis Research Society https://www.srs.org/
- Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) https://rsds.org/