Arthritis

Ask a Nurse
by Geraldine Bednash Ph.D., RN, FAAN, American Association of Colleges of Nursing (AACN)

(Page 2 of 5)

More than 100 different conditions can be called arthritis, and they all have two things in common — they affect the joints and cause pain. The two most prevalent forms of arthritis are osteoarthritis and rheumatoid arthritis. Osteo-arthritis, the most common form, involves the breakdown of cartilage and other tissues in a joint and is often called wear-and-tear arthritis. It generally affects older adults. The areas most commonly affected are the hips, knees, feet, and spine. Rheumatoid arthritis involves joint inflammation, but it can also affect other parts of the body, including connective tissues and the tissues that surround organs. It often starts at a young age, and its cause is unknown.

Symptoms: The primary symptom of osteoarthritis is pain, which usually begins as an ache or stiffness after unusual exercise or periods of inactivity. Symptoms of rheumatoid arthritis include fatigue, weight loss, fever, and general malaise, in addition to joint stiffness and pain. The symptoms of both kinds of arthritis may come (in what's called a flare-up) and go (in a remission). If left untreated, the affected joints may become deformed.

Diagnosis: Physical examination, X rays, and analysis of joint fluid may help in the diagnosis of both osteoarthritis and rheumatoid arthritis. The diagnosis of rheumatoid arthritis usually also involves a series of blood tests, including a test for rheumatic factor (a protein that signals the presence of inflammation). In difficult cases, techniques such as magnetic resonance imaging (MRI) may be used.

Treatment: There is no cure for arthritis; treatment focuses on relieving symptoms. A hallmark of treatment for both osteoarthritis and rheumatoid arthritis is pain relievers, notably acetaminophen, aspirin, and other non-steroidal anti-inflammatory drugs (NSAIDs). Two recently approved drugs used in the treatment of arthritis are Cox-2 inhibitors and biological modifiers. Ask your practitioner if these might be helpful. The NSAIDs, which are available both by prescription and over the counter, help relieve pain and inflammation. They should be taken with food, says Janyce Cagan Agruss of Chicago. Steroids such as prednisone and cortisone may also be prescribed to reduce the inflammation and relieve the pain of rheumatoid arthritis. Other drugs, known as remittive agents, are thought to slow the progression of rheumatoid arthritis. The drugs most commonly prescribed are gold salts, Plaquenil (a malaria drug), penicillamine, and methotrexate.

Surgery is used as a last resort to treat both types of arthritis. For osteoarthritis, surgery may be used to replace an entire joint or to remove floating bits of cartilage and bone around the joint and resurface or reline the ends of bones so they can move freely against each other. For rheumatoid arthritis, a surgical procedure called synovectomy is used to replace the lining of the joint. Joints may also be altered or replaced depending on the progression of the disease.

Self-care: You can do several things on your own to alleviate arthritis pain.

• Maintain the proper weight. Being overweight puts stress and pressure on joints, which can increase inflammation and pain.

• Exercise. This not only helps reduce weight but is also effective in relieving symptoms of both osteoarthritis and rheumatoid arthritis. Exercise helps you get moving and stay moving; easy weight-bearing exercise helps build muscles and strengthen joints, says Amy Berndt of Reno, Nevada. Easy stretching is also helpful, she says. Water aerobics and swimming are recommended as well: they reduce pressure on the knees and hips, says Paula Siciliano of Salt Lake City.

• Stay away from high-impact exercises such as running. Protect your knees and elbows against injuries when playing sports by wearing protective gear such as knee pads and elbow pads. Braces can provide stability and decrease joint stress, notes Paula Siciliano of Salt Lake City. Lygia Holcomb of Orlando, Florida, advises using a cold pack on joints after exercise to prevent swelling.

• Practice good posture. Standing and sitting up straight can help reduce pressure on the joints, especially those of the spine.

• Learn to perform your job without stressing your joints. Ergonomic office equipment and work tools can help reduce stress on your joints, especially if your job requires repetitive movements.

• Try applying heat or cold. Applying heat to joints increases blood flow and loosens joints; cold treatments can help relieve pain. Yvonne Sehy of Salt Lake City suggests alternating heat and cold for relief. "But don't use an electric heating pad for heat. Instead use a pack that you heat in the microwave, or anything that cools down naturally. For cold, use gel packs that you freeze." Don't put ice directly on your body, warns Lygia Holcomb.

• Soak in a whirlpool or hot tub; it loosens tight joints while providing buoyancy to reduce some of the pressure on affected joints.

• Use an Ace bandage on an affected joint while you are awake, suggests Paula Siciliano of Salt Lake City.

• To relieve pain and redistribute the force on your joints, use orthotic supports such as wedge insoles in your shoes, Paula Siciliano advises.

• Try glucosamine and chondroitin, suggests Mary Ann Zakutney of Washington, D.C. Zakutney says these supplements help the cartilage absorb more water and relieve friction in the joints. Siciliano recommends up to 1,500 milligrams of glucosamine and 100 milligrams of chondroitin a day.

• Watch what you eat. Though there is no definitive evidence, some experts believe that certain foods are linked to arthritis symptoms. In some studies, milk and cheese have been found to cause symptoms. Other research shows that foods in the nightshade family (potatoes, bell peppers, tomatoes, eggplant, and chili peppers) trigger arthritis flare-ups. Some studies have indicated that fish oil helps alleviate some symptoms of rheumatoid arthritis. Pineapple may also help, says Kathy Niemeyer of Allendale, Michigan, noting that the fruit contains an anti-inflammatory substance. If the pineapple causes soreness in your mouth, dip it in honey before eating it, she says.

• Try acupuncture, which involves the insertion of small, thin needles under the skin and may help relieve arthritis symptoms temporarily in some individuals.

• Consider herbal therapy, too, which has met with some success. Herbs that may be helpful include arnica, meadowsweet, cayenne pepper, devil's claw, and feverfew. Arnica is typically used in cream form, says Kathy Niemeyer of Allendale, Michigan. The other herbs may be used in tea, tincture, or pill form. You may also find combinations of these herbs as teas, tinctures, or pills.

Over-the-counter treatment: NSAIDs help relieve pain and inflammation and are commonly used to treat arthritis. They work by blocking the production of prostaglandins (chemicals believed to be responsible for producing pain and inflammation) at the site of an injury. The most well known NSAID is aspirin, which is available in both generic and brand-name forms. Brand-name aspirins include Anacin, Ascriptin Regular/Maximum Strength, and Bayer Aspirin. Other NSAIDs available over the counter include Advil, Nuprin, Orudis, and Aleve.

Another over-the-counter product, acetaminophen, relieves pain but does not reduce inflammation.

Brand names:

Allerest Headache Strength
Allerest Sinus Pain Formula
Anacin Aspirin Free Maximum Strength
Anacin P.M. Aspirin Free
Bayer Select Maximum Strength Headache Pain Relief Formula
Bufferin AF
Excedrin Aspirin Free
Liquiprin, Infants'
Midol Menstrual Multisymptom Formula
Panadol, Children's
Panadol Maximum Strength
Percogesic Analgesic
St. Joseph Aspirin-Free Tablets for Children
Tempra
Tylenol, Children's
Tylenol Extra Strength
Tylenol Junior
Tylenol Regular Strength
Unisom with Pain Relief

In addition to analgesics, some people find relief through counterirritants, topical medications that induce sensations such as heat and cold to distract sufferers from muscle and joint pain. Counterirritants include capsaicin (the substance that makes hot peppers hot) and menthol. Products containing capsaicin include the following:

Arthricare Odor Free Pain Relieving Rub
Capzasin-P
Mentholatum Menthacin
Zostrix
Zostrix Hp

Products containing menthol include the following:

Arthritis Hot
Ben-Gay Arthritis Extra Strength Rub
Mentholatum Deep Heating Arthritis Formula Rub

Copyright © 2001 by American Association of Colleges of Nursing and People's Medical Society

About the Author

Geraldine Bednash Ph.D., RN, FAAN, Has been the executive director of the AACN since 1989. She serves as the vice president of nursing of Health Professions Education Council of the Association of Academic Health Centers and is a member of the editorial boards of several nursing publications.

The American Association of Colleges of Nursing (AACN) represents 550 schools of nursing at public and private universities and senior colleges nationwide.