Type of Arthritis

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Reactive Arthritis
  • Gout
  • Pseudogout


<Osteoarthritis>

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time.

Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine.

Osteoarthritis often gradually worsens, and no cure exists. But staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor

If you have joint pain or stiffness that lasts for more than a few weeks, make an appointment with your doctor.

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

Factors that may increase your risk of osteoarthritis include:

  • Older age. The risk of osteoarthritis increases with age.
  • Sex. Women are more likely to develop osteoarthritis.
  • Obesity. Carrying extra body weight contributes to osteoarthritis in several ways. It puts added stress on weight-bearing joints, such as your hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints.
  • Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  • Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
  • Genetics. Some people inherit a tendency to develop osteoarthritis.
  • Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  • Other diseases. Having diabetes or other rheumatic diseases such as gout and rheumatoid arthritis can increase your risk of osteoarthritis.

Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become severe enough to make daily tasks difficult. Some people are no longer able to work. When joint pain is this severe, doctors may suggest joint replacement surgery.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a doctor who specializes in joint disorders (rheumatologist) or orthopedic surgery. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

You may want to write a list that includes:

  • Information about medical problems you've had
  • Information about the medical problems of your parents or siblings
  • All the prescription and over-the-counter medications and dietary supplements you take and the dosages

Imaging tests

Pictures of the affected joint can be obtained during imaging tests. Examples include:

  • X-rays. Cartilage doesn't show up on X-ray images, but cartilage loss is revealed by a narrowing of the space between the bones in your joint. An X-ray may also show bone spurs around a joint. Some people may have X-ray evidence of osteoarthritis before they experience any symptoms.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including cartilage.

Lab tests

Analyzing your blood or joint fluid can help pinpoint the diagnosis.

  • Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
  • Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from your joint can determine if there's inflammation and if your pain is caused by gout or an infection.

There's no known cure for osteoarthritis, but treatments can help reduce pain and maintain joint movement.

Medications

Osteoarthritis symptoms may be helped by certain medications, including:

  • Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Topical NSAIDS have fewer side effects and may relieve pain just as well.

Therapy

Exercising and achieving a healthy weight are the best and most important ways to treat osteoarthritis. Your doctor also may suggest:

  • Physical therapy. A physical therapist can work with you to create an individualized exercise program that will strengthen the muscles around your joint, increase your range of motion and reduce pain.
  • Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  • Braces or shoe inserts. Your doctor may recommend shoe inserts or other devices that can help reduce pain when you stand or walk. These devices can immobilize or support your joint to help take pressure off it.
  • A chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis and chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.

Surgical and other procedures

If conservative treatments don't help, you may want to consider procedures such as:

  • Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can worsen joint damage over time.
  • Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee. Hyaluronic acid is similar to a component normally found in your joint fluid.
  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal parts. The hip and knee joints are those most commonly replaced. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced. 

Lifestyle changes and home treatments also can help reduce osteoarthritis symptoms. You might want to try some of the following tips:
  • Exercise. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Try biking or swimming. If you feel new joint pain, stop. New pain that lasts for hours after you exercise probably means you've overdone it but doesn't mean you should stop exercising altogether.
  • Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
  • Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.
  • Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Carry the cane in the hand opposite the leg that hurts. Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Catalogs and medical supply stores also may be places to look for ideas.

People who aren't helped by medications for osteoarthritis pain sometimes turn to complementary and alternative medicine practices for relief. Common treatments that have shown some promise for osteoarthritis include:

  • Glucosamine and chondroitin. Studies have been mixed on these nutritional supplements. A few have found benefits for people with osteoarthritis, while most indicate that these supplements work no better than placebo. Don't use glucosamine if you're allergic to shellfish.
  • Avocado-soybean unsaponifiables. This nutritional supplement — a mixture of avocado and soybean oils — is widely used in Europe to treat knee and hip osteoarthritis. It acts as an anti-inflammatory, and some studies have shown it may slow down or even prevent joint damage.
  • Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to reduce stress in their lives, though small studies have found that tai chi and yoga may reduce osteoarthritis pain. When led by a knowledgeable instructor, these therapies are safe. Avoid moves that cause pain in your joints.

Lifestyle changes and certain treatments are key to managing pain and disability, but another major component to treatment is your own outlook on life. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. 





<Rheumatoid arthritis>

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body — such as the skin, eyes, lungs and blood vessels.

Although rheumatoid arthritis can occur at any age, it usually begins after age 40. The disorder is much more common in women.

Treatment focuses on controlling symptoms and preventing joint damage.

Signs and symptoms of rheumatoid arthritis may include:

  • Tender, warm, swollen joints
  • Morning stiffness that may last for hours
  • Firm bumps of tissue under the skin on your arms (rheumatoid nodules)
  • Fatigue, fever and weight loss

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

When to see a doctor

Make an appointment with your doctor if you have persistent discomfort and swelling in your joints.

Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints.
The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.
The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

Factors that may increase your risk of rheumatoid arthritis include:

  • Sex. Women are more likely to develop rheumatoid arthritis.
  • Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
  • Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.

Rheumatoid arthritis increases your risk of developing:

  • Osteoporosis. Rheumatoid arthritis can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
  • Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
  • Heart problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
  • Lung disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a doctor who specializes in joint disorders (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

Write a list that includes:

  • Information about medical problems you've had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take

Test to help diagnose rheumatoid arthritis include:

  • Blood tests. People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinate d peptide (anti-CCP) antibodies.
  • X-rays. Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time.

There is no cure for rheumatoid arthritis. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage.

Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.

Medications

Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs if your disease progresses.

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription.
  • Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
  • Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Tofacitinib (Xeljanz), a new, synthetic DMARD, is also available in the U.S.

Therapy

Your doctor may send you to a therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.

Rheumatoid arthritis surgery may involve one or more of the following procedures:

  • Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
  • Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
  • Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.

You can take steps to care for your body if you have rheumatoid arthritis. These self-care measures, when used along with your rheumatoid arthritis medications, can help you manage your signs and symptoms:

  • Exercise regularly. Gentle exercise can help strengthen the muscles around your joints, and it can help fight fatigue you might feel. Check with your doctor before you start exercising. If you're just getting started, begin by taking a walk. Try swimming or gentle water aerobics. Avoid exercising tender, injured or severely inflamed joints.
  • Apply heat or cold. Heat can help ease your pain and relax tense, painful muscles. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms.
  • Relax. Find ways to cope with pain by reducing stress in your life. Techniques such as guided imagery, distraction and muscle relaxation can all be used to control pain.

Some common complementary and alternative treatments that have shown promise for rheumatoid arthritis include:

  • Plant oils. The seeds of evening primrose, borage and black currant contain a type of fatty acid that may help with rheumatoid arthritis pain and morning stiffness. Side effects may include nausea, diarrhea and gas. Some plant oils can cause liver damage or interfere with medications.
  • Fish oil. Some preliminary studies have found that fish oil supplements may reduce rheumatoid arthritis pain and stiffness. 
  • Tai chi. This movement therapy involves gentle exercises and stretches combined with deep breathing. Many people use tai chi to relieve stress in their lives. Small studies have found that tai chi may reduce rheumatoid arthritis pain. When led by a knowledgeable instructor, tai chi is safe. But don't do any moves that cause pain.

Research on other supplements, such as ginger, green tea and turmeric, are still in the early stages, but preliminary studies show they may be beneficial in treating rheumatoid arthritis.

The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease.

  • Take control. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease.
  • Know your limits. Rest when you're tired. Rheumatoid arthritis can make you prone to fatigue and muscle weakness. A rest or short nap that doesn't interfere with nighttime sleep may help.
  • Connect with others. Keep your family aware of how you're feeling. They may be worried about you but might not feel comfortable asking about your pain. Find a family member or friend you can talk to when you're feeling especially overwhelmed. Also connect with other people who have rheumatoid arthritis — whether through a support group in your community or online.
  • Take time for yourself. It's easy to get busy and not take time for yourself. Find time for what you like, whether it's time to write in a journal, go for a walk or listen to music. Use this time to relieve stress and reflect on your feelings.





<Psoriatic arthritis>

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with white scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling.

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.

Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.

However, psoriatic arthritis is more likely to also cause:

  • Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
  • Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
  • Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).


When to see a doctor

If you have psoriasis, be sure to tell your doctor if you develop joint pain. 

Psoriatic arthritis can come on suddenly or develop slowly, but in either case it can severely damage your joints if left untreated.

Psoriatic arthritis occurs when your body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis. Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Several factors can increase your risk of psoriatic arthritis, including:

  • Psoriasis. Having psoriasis is the single greatest risk factor for developing psoriatic arthritis. People who have psoriasis lesions on their nails are especially likely to develop psoriatic arthritis.
  • Your family history. Many people with psoriatic arthritis have a parent or a sibling with the disease.
  • Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • What types of symptoms are you having? When did they begin?
  • Do you or any of your close family members have psoriasis?
  • Has anyone in your immediate family ever had psoriatic arthritis?
  • What medications and supplements do you take?

No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout.

Imaging tests

  • X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
  • Magnetic resonance imaging (MRI). MRI utilizes radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.

Laboratory tests

  • Rheumatoid factor (RF). RF is an antibody that's often present in the blood of people with rheumatoid arthritis, but it's not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.
  • Joint fluid test. Using a long needle, your doctor can remove a small sample of fluid from one of your affected joints — often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability.

Medications

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. 
  • Steroids. This type of medication reduces inflammation quickly.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine). 
  • Immunosuppressants. These medications act to tame your immune system, which is out of control in psoriatic arthritis. Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune). These medications can increase your susceptibility to infection.
  • TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia). 

Surgical and other procedures

  • Joint replacement surgery. Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic.
  • Protect your joints. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel. For example, you can avoid straining your finger joints by using gadgets such as jar openers to twist the lids from jars, by lifting heavy pans or other objects with both hands, and by pushing doors open with your whole body instead of just your fingers.
  • Maintain a healthy weight. Maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility. The best way to increase nutrients while limiting calories is to eat more plant-based foods — fruits, vegetables and whole grains.
  • Exercise regularly. Exercise can help keep your joints flexible and your muscles strong. Types of exercises that are less stressful on joints include biking, swimming and walking.
  • Use cold and hot packs. Because cold has a numbing effect, it can dull the sensation of pain. You can apply cold several times a day for 20 or 30 minutes at a time. Heat can help relax tense muscles and relieve pain.
  • Pace yourself. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue. The key isn't to stop being active entirely, but to rest before you become too tired. Divide exercise or work activities into short segments. Find time to relax several times throughout the day.

Psoriatic arthritis can be particularly discouraging because the emotional pain that psoriasis can cause is compounded by joint pain and, in some cases, disability.

The support of friends and family can make a tremendous difference when you're facing the physical and psychological challenges of psoriatic arthritis. Just having someone to talk to can give you strength. For some people, support groups can offer the same benefits — this may be especially important if you're worried about burdening your loved ones.

A counselor or therapist can help you devise coping strategies to reduce your stress levels. The chemicals your body releases when you're under stress can aggravate both psoriasis and psoriatic arthritis.





<Reactive arthritis>

Reactive arthritis is joint pain and swelling triggered by an infection in another part of your body — most often your intestines, genitals or urinary tract.

Your knees and the joints of your ankles and feet are the usual targets of reactive arthritis. Inflammation also may affect your eyes, skin and urethra when you have reactive arthritis.

Although reactive arthritis is sometimes called Reiter's syndrome, Reiter's is actually a specific type of reactive arthritis. In Reiter's, inflammation typically affects the eyes and urethra, as well as your joints.

Reactive arthritis isn't common. For most people, signs and symptoms of reactive arthritis come and go, eventually disappearing within 12 months.

The signs and symptoms of reactive arthritis generally start one to three weeks after exposure to a triggering infection. They may include:

  • Pain and stiffness. The joint pain associated with reactive arthritis most commonly occurs in your knees, ankles and feet. You also might experience pain in your heels, low back or buttocks.
  • Eye inflammation. Many people who have reactive arthritis also develop eye inflammation (conjunctivitis).
  • Urinary problems. Increased frequency and discomfort during urination may occur, as can inflammation of the prostate gland or cervix.
  • Swollen toes or fingers. In some cases, your toes or fingers might become so swollen that they resemble sausages.

Certain factors increase your risk of reactive arthritis:

  • Your age. Reactive arthritis occurs most frequently in people 20 to 40 years old.
  • Your sex. Women and men are equally likely to develop reactive arthritis in reaction to foodborne infections. However, men are more likely than are women to develop reactive arthritis in response to sexually transmitted bacteria.
  • Hereditary factors. A specific genetic marker has been linked to reactive arthritis. But many people who have this marker never develop reactive arthritis.

Reactive arthritis develops in reaction to an infection in another part of your body, often in your intestines, genitals or urinary tract. You may not be aware of the triggering infection because it may cause only mild symptoms or none at all.

Numerous bacteria can cause reactive arthritis. The most common ones include:
  • Chlamydia
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter

Reactive arthritis isn't contagious. However, the bacteria that cause it can be transmitted sexually or in contaminated food. But only a few of the people who are exposed to these bacteria develop reactive arthritis.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a doctor who specializes in joint disorders (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you've had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take

Blood tests

Your doctor might recommend that a sample of your blood be tested for:

  • Evidence of past or present infections
  • Signs of inflammation
  • Antibodies associated with other types of arthritis

Joint fluid tests

Your doctor may use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for:

  • White blood cell count. If the joint fluid has an increased number of white blood cells, it may indicate inflammation or an infection.
  • Infections. If your joint fluid contains bacteria, you may have septic arthritis, which can result in severe joint damage.
  • Crystals. If uric acid crystals are found in your joint fluid, you may have gout. This very painful type of arthritis often affects the big toe.

Imaging tests

X-rays of your low back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis.

The goal of treatment is to manage your symptoms and treat any underlying infections that may still be present.

Medications

If your reactive arthritis was triggered by a bacterial infection, your doctor might prescribe an antibiotic. Which antibiotic you take depends on the bacteria that are present.

For your arthritis signs and symptoms, your doctor may recommend:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription NSAIDs can relieve the inflammation and pain of reactive arthritis.
  • Corticosteroids. Steroids can reduce inflammation and allow you to return to your normal activity level.
  • Rheumatoid arthritis drugs. Limited evidence suggests that medications such as sulfasalazine (Azulfidine), methotrexate (Trexall) or etanercept (Enbrel) can relieve pain and stiffness for some people with reactive arthritis.

Physical therapy

Exercise can help people with arthritis improve joint function. A physical therapist can provide you with specific exercises for your joints and muscles. Strengthening exercises are valuable for developing the muscles around your affected joints, which increase the joint's support. Performing range-of-motion exercises can increase your joints' flexibility and reduce stiffness.

Genetic factors appear to play a role in whether you're likely to develop reactive arthritis. Though you can't change your genetic makeup, you can reduce your exposure to the bacteria that may lead to reactive arthritis. Make sure your food is stored at proper temperatures and is cooked properly. These steps can help you avoid the many foodborne bacteria that can cause reactive arthritis, including salmonella, shigella, yersinia and campylobacter. Some sexually transmitted infections can trigger reactive arthritis. Using condoms may lower your risk.





<Gout>

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:

  • Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. Decreased joint mobility may occur as gout progresses

When to see a doctor

If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

  • Diet. Eating a diet that's high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
  • Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.
  • Medical conditions. Certain diseases and conditions make it more likely that you'll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
  • Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
  • Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.

People with gout can develop more-severe conditions, such as:

  • Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
  • Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi. Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
  • Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Make an appointment with your primary care doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

  • Write down your symptoms, including when they started and how often they occur.
  • Note important personal information, such as any recent changes or major stressors in your life.
  • Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking. Your doctor will also want to know if you have any family history of gout.

Tests to help diagnose gout may include:

  • Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
  • Blood test. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood.
  • X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.

Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.

Gout medications can be used to treat acute attacks and prevent future attacks as well as reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits.

Medications 

Drugs used to treat acute attacks and prevent future attacks include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others), as well as more-powerful prescription NSAIDs. 
  • Colchicine. Your doctor may recommend colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain. The drug's effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
  • Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. 
  • Medications that block uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout.
  • Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.

Medications are the most proven, effective way to treat gout symptoms. However, making certain lifestyle changes also help, such as:

  • Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.
  • Limit intake of foods high in purines, such as red meat, organ meats and seafood.
  • Exercising regularly and losing weight. Keeping your body at a healthy weight reduces your risk of gout.

If gout treatments aren't working as well as you'd hoped, you may be interested in trying an alternative approach. Before trying such a treatment on your own, talk with your doctor — to weigh the benefits and risks and learn whether the treatment might interfere with your gout medication. Because there isn't a lot of research on alternative therapies for gout, however, in some cases the risks aren't known.

Certain foods have been studied for their potential to lower uric acid levels, including:

  • Coffee. Studies have found an association between coffee drinking — both regular and decaffeinated coffee — and lower uric acid levels, though no study has demonstrated how or why coffee may have such an effect. The available evidence isn't enough to encourage noncoffee drinkers to start, but it may give researchers clues to new ways of treating gout in the future.
  • Vitamin C. Supplements containing vitamin C may reduce the levels of uric acid in your blood. However, no studies have demonstrated that vitamin C affects the frequency or severity of gout attacks.
  • Cherries. Cherries have been associated with lower levels of uric acid in studies, as well as a reduced number of gout attacks. Eating more cherries and drinking cherry extract may be a way to supplement your gout treatment.

Other complementary and alternative medicine treatments may help you cope until your gout pain subsides or your medications take effect. For instance, relaxation techniques, such as deep-breathing exercises and meditation, may help take your mind off your pain.

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

  • Keep your fluid intake high. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
  • Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
  • Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
  • Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
  • Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.





<Pseudogout>

Pseudogout is a form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. The most commonly affected joint is the knee.

Also called calcium pyrophosphate deposition disease, the common term "pseudogout" was coined for the condition's similarity to gout. Both conditions are caused by crystal deposits within a joint, although the type of crystal differs for each condition.

It isn't clear why crystals form in your joints and cause pseudogout, but the risk increases with age. Treatments can help relieve pain and reduce inflammation.

Pseudogout most commonly affects the knees. Less often, wrists and ankles are involved. During a pseudogout attack, the affected joints are usually:

  • Swollen
  • Warm
  • Severely painful

When to see a doctor

Make an appointment with your doctor if you experience sudden, intense joint pain and swelling.

Pseudogout has been linked to the presence of calcium pyrophosphate dihydrate crystals within the affected joint. These crystals become more numerous as people age, appearing in nearly half the population older than 85. But most people who have these crystal deposits never develop pseudogout. 

Factors that can increase your risk of pseudogout include:

  • Older age. The risk of developing pseudogout increases with age.
  • Joint trauma. Trauma to a joint, such as a serious injury or surgery, increases your risk of pseudogout in that joint.
  • Genetic disorder. In some families, a predisposition for developing pseudogout is hereditary. These people tend to develop pseudogout at younger ages.
  • Mineral imbalances. The risk of pseudogout is higher for people who have excessive calcium or iron in their blood or too little magnesium.
  • Other medical conditions. Pseudogout has also been linked to an underactive thyroid gland or an overactive parathyroid gland.

The crystal deposits associated with pseudogout can also cause joint damage, which can mimic the signs and symptoms of osteoarthritis or rheumatoid arthritis.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • When did your symptoms begin?
  • Have these symptoms ever occurred before?
  • Does any activity or position make your joint feel better or worse?
  • Have you ever injured this joint?
  • Do you have any other medical conditions?
  • Has anyone in your family had joint problems?
  • What medicines or supplements do you take regularly?

Pseudogout signs and symptoms can mimic those of gout and other types of arthritis, so lab and imaging tests are usually necessary to confirm a diagnosis.

  • Lab tests. Blood tests can check for problems with your thyroid and parathyroid glands, as well as for a variety of mineral imbalances that have been linked to pseudogout. Your doctor may also use a needle to withdraw a sample of the fluid within your affected joint. This fluid can be tested for the presence of crystals.
  • Imaging tests. X-rays of your affected joint often can reveal evidence of joint damage, along with crystal deposits in the joint's cartilage.

There's no cure for pseudogout, but a combination of treatments can help relieve pain and improve the joint's function.

Medications

If over-the-counter pain relievers aren't enough, your doctor may suggest:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription strength NSAIDs include naproxen (Anaprox, Naprosyn, others). 
  • Colchicine (Colcrys). Low-dose pills of this gout drug are also effective for pseudogout. If you have frequent episodes of pseudogout, your doctor may recommend that you take colchicine daily as a preventive measure.
  • Corticosteroids. If you can't take NSAIDs or colchicine, your doctor may suggest taking corticosteroid pills, such as prednisone, to reduce inflammation and terminate the attack. 

Home treatments may be useful during pseudogout flare-ups. Examples include:

  • NSAIDs. Over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), often are helpful.
  • Rest the joint. Try not to use the affected joint for a couple of days.
  • Ice. Cold packs can help reduce the inflammation associated with flare-ups.
Picture

Type of Arthritis

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Reactive Arthritis
  • Gout
  • Pseudogout


<Osteoarthritis>

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time.

Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine.

Osteoarthritis often gradually worsens, and no cure exists. But staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor

If you have joint pain or stiffness that lasts for more than a few weeks, make an appointment with your doctor.

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

Factors that may increase your risk of osteoarthritis include:

  • Older age. The risk of osteoarthritis increases with age.
  • Sex. Women are more likely to develop osteoarthritis.
  • Obesity. Carrying extra body weight contributes to osteoarthritis in several ways. It puts added stress on weight-bearing joints, such as your hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints.
  • Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  • Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
  • Genetics. Some people inherit a tendency to develop osteoarthritis.
  • Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  • Other diseases. Having diabetes or other rheumatic diseases such as gout and rheumatoid arthritis can increase your risk of osteoarthritis.

Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become severe enough to make daily tasks difficult. Some people are no longer able to work. When joint pain is this severe, doctors may suggest joint replacement surgery.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a doctor who specializes in joint disorders (rheumatologist) or orthopedic surgery. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

You may want to write a list that includes:

  • Information about medical problems you've had
  • Information about the medical problems of your parents or siblings
  • All the prescription and over-the-counter medications and dietary supplements you take and the dosages

Imaging tests

Pictures of the affected joint can be obtained during imaging tests. Examples include:

  • X-rays. Cartilage doesn't show up on X-ray images, but cartilage loss is revealed by a narrowing of the space between the bones in your joint. An X-ray may also show bone spurs around a joint. Some people may have X-ray evidence of osteoarthritis before they experience any symptoms.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce detailed images of bone and soft tissues, including cartilage.

Lab tests

Analyzing your blood or joint fluid can help pinpoint the diagnosis.

  • Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
  • Joint fluid analysis. Your doctor may use a needle to draw fluid out of the affected joint. Examining and testing the fluid from your joint can determine if there's inflammation and if your pain is caused by gout or an infection.

There's no known cure for osteoarthritis, but treatments can help reduce pain and maintain joint movement.

Medications

Osteoarthritis symptoms may be helped by certain medications, including:

  • Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but it doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Stronger NSAIDs are available by prescription. NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Topical NSAIDS have fewer side effects and may relieve pain just as well.

Therapy

Exercising and achieving a healthy weight are the best and most important ways to treat osteoarthritis. Your doctor also may suggest:

  • Physical therapy. A physical therapist can work with you to create an individualized exercise program that will strengthen the muscles around your joint, increase your range of motion and reduce pain.
  • Occupational therapy. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  • Braces or shoe inserts. Your doctor may recommend shoe inserts or other devices that can help reduce pain when you stand or walk. These devices can immobilize or support your joint to help take pressure off it.
  • A chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis and chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.

Surgical and other procedures

If conservative treatments don't help, you may want to consider procedures such as:

  • Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can worsen joint damage over time.
  • Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee. Hyaluronic acid is similar to a component normally found in your joint fluid.
  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal parts. The hip and knee joints are those most commonly replaced. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced. 

Lifestyle changes and home treatments also can help reduce osteoarthritis symptoms. You might want to try some of the following tips:
  • Exercise. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Try biking or swimming. If you feel new joint pain, stop. New pain that lasts for hours after you exercise probably means you've overdone it but doesn't mean you should stop exercising altogether.
  • Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.
  • Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness, and cold can relieve muscle spasms and pain.
  • Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Carry the cane in the hand opposite the leg that hurts. Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Catalogs and medical supply stores also may be places to look for ideas.

People who aren't helped by medications for osteoarthritis pain sometimes turn to complementary and alternative medicine practices for relief. Common treatments that have shown some promise for osteoarthritis include:

  • Glucosamine and chondroitin. Studies have been mixed on these nutritional supplements. A few have found benefits for people with osteoarthritis, while most indicate that these supplements work no better than placebo. Don't use glucosamine if you're allergic to shellfish.
  • Avocado-soybean unsaponifiables. This nutritional supplement — a mixture of avocado and soybean oils — is widely used in Europe to treat knee and hip osteoarthritis. It acts as an anti-inflammatory, and some studies have shown it may slow down or even prevent joint damage.
  • Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to reduce stress in their lives, though small studies have found that tai chi and yoga may reduce osteoarthritis pain. When led by a knowledgeable instructor, these therapies are safe. Avoid moves that cause pain in your joints.

Lifestyle changes and certain treatments are key to managing pain and disability, but another major component to treatment is your own outlook on life. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. 





<Rheumatoid arthritis>

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body — such as the skin, eyes, lungs and blood vessels.

Although rheumatoid arthritis can occur at any age, it usually begins after age 40. The disorder is much more common in women.

Treatment focuses on controlling symptoms and preventing joint damage.

Signs and symptoms of rheumatoid arthritis may include:

  • Tender, warm, swollen joints
  • Morning stiffness that may last for hours
  • Firm bumps of tissue under the skin on your arms (rheumatoid nodules)
  • Fatigue, fever and weight loss

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

When to see a doctor

Make an appointment with your doctor if you have persistent discomfort and swelling in your joints.

Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints.
The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.
The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

Factors that may increase your risk of rheumatoid arthritis include:

  • Sex. Women are more likely to develop rheumatoid arthritis.
  • Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
  • Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.

Rheumatoid arthritis increases your risk of developing:

  • Osteoporosis. Rheumatoid arthritis can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
  • Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
  • Heart problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
  • Lung disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a doctor who specializes in joint disorders (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

Write a list that includes:

  • Information about medical problems you've had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take

Test to help diagnose rheumatoid arthritis include:

  • Blood tests. People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinate d peptide (anti-CCP) antibodies.
  • X-rays. Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time.

There is no cure for rheumatoid arthritis. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage.

Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.

Medications

Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs if your disease progresses.

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription.
  • Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
  • Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Tofacitinib (Xeljanz), a new, synthetic DMARD, is also available in the U.S.

Therapy

Your doctor may send you to a therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.

Rheumatoid arthritis surgery may involve one or more of the following procedures:

  • Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
  • Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
  • Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.

You can take steps to care for your body if you have rheumatoid arthritis. These self-care measures, when used along with your rheumatoid arthritis medications, can help you manage your signs and symptoms:

  • Exercise regularly. Gentle exercise can help strengthen the muscles around your joints, and it can help fight fatigue you might feel. Check with your doctor before you start exercising. If you're just getting started, begin by taking a walk. Try swimming or gentle water aerobics. Avoid exercising tender, injured or severely inflamed joints.
  • Apply heat or cold. Heat can help ease your pain and relax tense, painful muscles. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms.
  • Relax. Find ways to cope with pain by reducing stress in your life. Techniques such as guided imagery, distraction and muscle relaxation can all be used to control pain.

Some common complementary and alternative treatments that have shown promise for rheumatoid arthritis include:

  • Plant oils. The seeds of evening primrose, borage and black currant contain a type of fatty acid that may help with rheumatoid arthritis pain and morning stiffness. Side effects may include nausea, diarrhea and gas. Some plant oils can cause liver damage or interfere with medications.
  • Fish oil. Some preliminary studies have found that fish oil supplements may reduce rheumatoid arthritis pain and stiffness. 
  • Tai chi. This movement therapy involves gentle exercises and stretches combined with deep breathing. Many people use tai chi to relieve stress in their lives. Small studies have found that tai chi may reduce rheumatoid arthritis pain. When led by a knowledgeable instructor, tai chi is safe. But don't do any moves that cause pain.

Research on other supplements, such as ginger, green tea and turmeric, are still in the early stages, but preliminary studies show they may be beneficial in treating rheumatoid arthritis.

The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease.

  • Take control. With your doctor, make a plan for managing your arthritis. This will help you feel in charge of your disease.
  • Know your limits. Rest when you're tired. Rheumatoid arthritis can make you prone to fatigue and muscle weakness. A rest or short nap that doesn't interfere with nighttime sleep may help.
  • Connect with others. Keep your family aware of how you're feeling. They may be worried about you but might not feel comfortable asking about your pain. Find a family member or friend you can talk to when you're feeling especially overwhelmed. Also connect with other people who have rheumatoid arthritis — whether through a support group in your community or online.
  • Take time for yourself. It's easy to get busy and not take time for yourself. Find time for what you like, whether it's time to write in a journal, go for a walk or listen to music. Use this time to relieve stress and reflect on your feelings.





<Psoriatic arthritis>

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with white scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling.

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.

Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.

However, psoriatic arthritis is more likely to also cause:

  • Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
  • Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
  • Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).


When to see a doctor

If you have psoriasis, be sure to tell your doctor if you develop joint pain. 

Psoriatic arthritis can come on suddenly or develop slowly, but in either case it can severely damage your joints if left untreated.

Psoriatic arthritis occurs when your body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis. Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Several factors can increase your risk of psoriatic arthritis, including:

  • Psoriasis. Having psoriasis is the single greatest risk factor for developing psoriatic arthritis. People who have psoriasis lesions on their nails are especially likely to develop psoriatic arthritis.
  • Your family history. Many people with psoriatic arthritis have a parent or a sibling with the disease.
  • Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • What types of symptoms are you having? When did they begin?
  • Do you or any of your close family members have psoriasis?
  • Has anyone in your immediate family ever had psoriatic arthritis?
  • What medications and supplements do you take?

No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout.

Imaging tests

  • X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
  • Magnetic resonance imaging (MRI). MRI utilizes radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.

Laboratory tests

  • Rheumatoid factor (RF). RF is an antibody that's often present in the blood of people with rheumatoid arthritis, but it's not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.
  • Joint fluid test. Using a long needle, your doctor can remove a small sample of fluid from one of your affected joints — often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability.

Medications

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. 
  • Steroids. This type of medication reduces inflammation quickly.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine). 
  • Immunosuppressants. These medications act to tame your immune system, which is out of control in psoriatic arthritis. Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune). These medications can increase your susceptibility to infection.
  • TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia). 

Surgical and other procedures

  • Joint replacement surgery. Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic.
  • Protect your joints. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel. For example, you can avoid straining your finger joints by using gadgets such as jar openers to twist the lids from jars, by lifting heavy pans or other objects with both hands, and by pushing doors open with your whole body instead of just your fingers.
  • Maintain a healthy weight. Maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility. The best way to increase nutrients while limiting calories is to eat more plant-based foods — fruits, vegetables and whole grains.
  • Exercise regularly. Exercise can help keep your joints flexible and your muscles strong. Types of exercises that are less stressful on joints include biking, swimming and walking.
  • Use cold and hot packs. Because cold has a numbing effect, it can dull the sensation of pain. You can apply cold several times a day for 20 or 30 minutes at a time. Heat can help relax tense muscles and relieve pain.
  • Pace yourself. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue. The key isn't to stop being active entirely, but to rest before you become too tired. Divide exercise or work activities into short segments. Find time to relax several times throughout the day.

Psoriatic arthritis can be particularly discouraging because the emotional pain that psoriasis can cause is compounded by joint pain and, in some cases, disability.

The support of friends and family can make a tremendous difference when you're facing the physical and psychological challenges of psoriatic arthritis. Just having someone to talk to can give you strength. For some people, support groups can offer the same benefits — this may be especially important if you're worried about burdening your loved ones.

A counselor or therapist can help you devise coping strategies to reduce your stress levels. The chemicals your body releases when you're under stress can aggravate both psoriasis and psoriatic arthritis.





<Reactive arthritis>

Reactive arthritis is joint pain and swelling triggered by an infection in another part of your body — most often your intestines, genitals or urinary tract.

Your knees and the joints of your ankles and feet are the usual targets of reactive arthritis. Inflammation also may affect your eyes, skin and urethra when you have reactive arthritis.

Although reactive arthritis is sometimes called Reiter's syndrome, Reiter's is actually a specific type of reactive arthritis. In Reiter's, inflammation typically affects the eyes and urethra, as well as your joints.

Reactive arthritis isn't common. For most people, signs and symptoms of reactive arthritis come and go, eventually disappearing within 12 months.

The signs and symptoms of reactive arthritis generally start one to three weeks after exposure to a triggering infection. They may include:

  • Pain and stiffness. The joint pain associated with reactive arthritis most commonly occurs in your knees, ankles and feet. You also might experience pain in your heels, low back or buttocks.
  • Eye inflammation. Many people who have reactive arthritis also develop eye inflammation (conjunctivitis).
  • Urinary problems. Increased frequency and discomfort during urination may occur, as can inflammation of the prostate gland or cervix.
  • Swollen toes or fingers. In some cases, your toes or fingers might become so swollen that they resemble sausages.

Certain factors increase your risk of reactive arthritis:

  • Your age. Reactive arthritis occurs most frequently in people 20 to 40 years old.
  • Your sex. Women and men are equally likely to develop reactive arthritis in reaction to foodborne infections. However, men are more likely than are women to develop reactive arthritis in response to sexually transmitted bacteria.
  • Hereditary factors. A specific genetic marker has been linked to reactive arthritis. But many people who have this marker never develop reactive arthritis.

Reactive arthritis develops in reaction to an infection in another part of your body, often in your intestines, genitals or urinary tract. You may not be aware of the triggering infection because it may cause only mild symptoms or none at all.

Numerous bacteria can cause reactive arthritis. The most common ones include:
  • Chlamydia
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter

Reactive arthritis isn't contagious. However, the bacteria that cause it can be transmitted sexually or in contaminated food. But only a few of the people who are exposed to these bacteria develop reactive arthritis.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a doctor who specializes in joint disorders (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you've had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take

Blood tests

Your doctor might recommend that a sample of your blood be tested for:

  • Evidence of past or present infections
  • Signs of inflammation
  • Antibodies associated with other types of arthritis

Joint fluid tests

Your doctor may use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for:

  • White blood cell count. If the joint fluid has an increased number of white blood cells, it may indicate inflammation or an infection.
  • Infections. If your joint fluid contains bacteria, you may have septic arthritis, which can result in severe joint damage.
  • Crystals. If uric acid crystals are found in your joint fluid, you may have gout. This very painful type of arthritis often affects the big toe.

Imaging tests

X-rays of your low back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis.

The goal of treatment is to manage your symptoms and treat any underlying infections that may still be present.

Medications

If your reactive arthritis was triggered by a bacterial infection, your doctor might prescribe an antibiotic. Which antibiotic you take depends on the bacteria that are present.

For your arthritis signs and symptoms, your doctor may recommend:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription NSAIDs can relieve the inflammation and pain of reactive arthritis.
  • Corticosteroids. Steroids can reduce inflammation and allow you to return to your normal activity level.
  • Rheumatoid arthritis drugs. Limited evidence suggests that medications such as sulfasalazine (Azulfidine), methotrexate (Trexall) or etanercept (Enbrel) can relieve pain and stiffness for some people with reactive arthritis.

Physical therapy

Exercise can help people with arthritis improve joint function. A physical therapist can provide you with specific exercises for your joints and muscles. Strengthening exercises are valuable for developing the muscles around your affected joints, which increase the joint's support. Performing range-of-motion exercises can increase your joints' flexibility and reduce stiffness.

Genetic factors appear to play a role in whether you're likely to develop reactive arthritis. Though you can't change your genetic makeup, you can reduce your exposure to the bacteria that may lead to reactive arthritis. Make sure your food is stored at proper temperatures and is cooked properly. These steps can help you avoid the many foodborne bacteria that can cause reactive arthritis, including salmonella, shigella, yersinia and campylobacter. Some sexually transmitted infections can trigger reactive arthritis. Using condoms may lower your risk.





<Gout>

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:

  • Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. Decreased joint mobility may occur as gout progresses

When to see a doctor

If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

  • Diet. Eating a diet that's high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
  • Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.
  • Medical conditions. Certain diseases and conditions make it more likely that you'll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
  • Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
  • Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.

People with gout can develop more-severe conditions, such as:

  • Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
  • Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi. Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
  • Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Make an appointment with your primary care doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

  • Write down your symptoms, including when they started and how often they occur.
  • Note important personal information, such as any recent changes or major stressors in your life.
  • Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking. Your doctor will also want to know if you have any family history of gout.

Tests to help diagnose gout may include:

  • Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
  • Blood test. Your doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood.
  • X-ray imaging. Joint X-rays can be helpful to rule out other causes of joint inflammation.

Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences.

Gout medications can be used to treat acute attacks and prevent future attacks as well as reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits.

Medications 

Drugs used to treat acute attacks and prevent future attacks include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others), as well as more-powerful prescription NSAIDs. 
  • Colchicine. Your doctor may recommend colchicine (Colcrys, Mitigare), a type of pain reliever that effectively reduces gout pain. The drug's effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
  • Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. 
  • Medications that block uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout.
  • Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.

Medications are the most proven, effective way to treat gout symptoms. However, making certain lifestyle changes also help, such as:

  • Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water.
  • Limit intake of foods high in purines, such as red meat, organ meats and seafood.
  • Exercising regularly and losing weight. Keeping your body at a healthy weight reduces your risk of gout.

If gout treatments aren't working as well as you'd hoped, you may be interested in trying an alternative approach. Before trying such a treatment on your own, talk with your doctor — to weigh the benefits and risks and learn whether the treatment might interfere with your gout medication. Because there isn't a lot of research on alternative therapies for gout, however, in some cases the risks aren't known.

Certain foods have been studied for their potential to lower uric acid levels, including:

  • Coffee. Studies have found an association between coffee drinking — both regular and decaffeinated coffee — and lower uric acid levels, though no study has demonstrated how or why coffee may have such an effect. The available evidence isn't enough to encourage noncoffee drinkers to start, but it may give researchers clues to new ways of treating gout in the future.
  • Vitamin C. Supplements containing vitamin C may reduce the levels of uric acid in your blood. However, no studies have demonstrated that vitamin C affects the frequency or severity of gout attacks.
  • Cherries. Cherries have been associated with lower levels of uric acid in studies, as well as a reduced number of gout attacks. Eating more cherries and drinking cherry extract may be a way to supplement your gout treatment.

Other complementary and alternative medicine treatments may help you cope until your gout pain subsides or your medications take effect. For instance, relaxation techniques, such as deep-breathing exercises and meditation, may help take your mind off your pain.

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

  • Keep your fluid intake high. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
  • Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
  • Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
  • Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
  • Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.





<Pseudogout>

Pseudogout is a form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. The most commonly affected joint is the knee.

Also called calcium pyrophosphate deposition disease, the common term "pseudogout" was coined for the condition's similarity to gout. Both conditions are caused by crystal deposits within a joint, although the type of crystal differs for each condition.

It isn't clear why crystals form in your joints and cause pseudogout, but the risk increases with age. Treatments can help relieve pain and reduce inflammation.

Pseudogout most commonly affects the knees. Less often, wrists and ankles are involved. During a pseudogout attack, the affected joints are usually:

  • Swollen
  • Warm
  • Severely painful

When to see a doctor

Make an appointment with your doctor if you experience sudden, intense joint pain and swelling.

Pseudogout has been linked to the presence of calcium pyrophosphate dihydrate crystals within the affected joint. These crystals become more numerous as people age, appearing in nearly half the population older than 85. But most people who have these crystal deposits never develop pseudogout. 

Factors that can increase your risk of pseudogout include:

  • Older age. The risk of developing pseudogout increases with age.
  • Joint trauma. Trauma to a joint, such as a serious injury or surgery, increases your risk of pseudogout in that joint.
  • Genetic disorder. In some families, a predisposition for developing pseudogout is hereditary. These people tend to develop pseudogout at younger ages.
  • Mineral imbalances. The risk of pseudogout is higher for people who have excessive calcium or iron in their blood or too little magnesium.
  • Other medical conditions. Pseudogout has also been linked to an underactive thyroid gland or an overactive parathyroid gland.

The crystal deposits associated with pseudogout can also cause joint damage, which can mimic the signs and symptoms of osteoarthritis or rheumatoid arthritis.

Make an appointment with your primary care doctor if you have symptoms and signs. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • When did your symptoms begin?
  • Have these symptoms ever occurred before?
  • Does any activity or position make your joint feel better or worse?
  • Have you ever injured this joint?
  • Do you have any other medical conditions?
  • Has anyone in your family had joint problems?
  • What medicines or supplements do you take regularly?

Pseudogout signs and symptoms can mimic those of gout and other types of arthritis, so lab and imaging tests are usually necessary to confirm a diagnosis.

  • Lab tests. Blood tests can check for problems with your thyroid and parathyroid glands, as well as for a variety of mineral imbalances that have been linked to pseudogout. Your doctor may also use a needle to withdraw a sample of the fluid within your affected joint. This fluid can be tested for the presence of crystals.
  • Imaging tests. X-rays of your affected joint often can reveal evidence of joint damage, along with crystal deposits in the joint's cartilage.

There's no cure for pseudogout, but a combination of treatments can help relieve pain and improve the joint's function.

Medications

If over-the-counter pain relievers aren't enough, your doctor may suggest:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription strength NSAIDs include naproxen (Anaprox, Naprosyn, others). 
  • Colchicine (Colcrys). Low-dose pills of this gout drug are also effective for pseudogout. If you have frequent episodes of pseudogout, your doctor may recommend that you take colchicine daily as a preventive measure.
  • Corticosteroids. If you can't take NSAIDs or colchicine, your doctor may suggest taking corticosteroid pills, such as prednisone, to reduce inflammation and terminate the attack. 

Home treatments may be useful during pseudogout flare-ups. Examples include:

  • NSAIDs. Over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), often are helpful.
  • Rest the joint. Try not to use the affected joint for a couple of days.
  • Ice. Cold packs can help reduce the inflammation associated with flare-ups.
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