To Your Health: Understanding arthritis may help with treatment for pain

By Alfred Casale - To Your Health

Mary and I were joined by 8 others on our recent trip to Ireland.

After days of fairly vigorous fly-fishing and/or touring, it seemed that at least part of each night’s dinner conversation included some ache or pain, involving some joint for members of our troop.

If you’ve been living with the severe pain and stiffness of arthritis, you’re certainly not alone. Arthritis affects 54 million people in the United States and is considered the leading cause of adult disability nationwide.

But with over 100 individual forms, not all arthritis diagnoses are created equal.

Different types of arthritis are marked by combinations of inflammation and deteriorating joints and can require anything from simple lifestyle changes to specialized treatment from your care team.

Here’s what you need to know about arthritis, and how you can ease the ache:


Doctor-diagnosed arthritis is more common in women than men. And almost two-thirds of diagnosed patients are of working age, between 18 and 64 years.

If you’ve been experiencing joint pain, you should see your doctor for an evaluation. Your doctor will ask questions about the severity and frequency of your pain and mobility issues, as well as any family history of arthritis, before starting the comprehensive physical assessment.

During the evaluation, your doctor will count the affected joints, check for symmetry (pain in both wrists or both elbows), feel for swelling or fluid in the joints, and test for tenderness or inflammation. Your exam will also likely include a temperature and reflex check to eliminate any other health concerns.

If all signs point to an arthritis diagnosis, your doctor may request an X-ray, ultrasound or MRI to check for joint deterioration, cartilage loss or muscle injury. Blood tests are often in order as well.

If high levels of inflammation are present, your doctor may prescribe an anti-rheumatic or corticosteroid drug that will help reduce permanent damage while a final diagnosis is confirmed.

Arthritis types and how to treat them

The most common types of arthritis include osteoarthritis, rheumatoid arthritis, psoriatic arthritis, fibromyalgia and gout. Though they have individual characteristics, all lead to problems with mobility and pain.

• Osteoarthritis is a degenerative disease that usually impacts the hips, knees, neck, lower back or hands because of overuse or excessive weight. Treatment typically includes anti-inflammatory or disease-modifying anti-rheumatic drugs, physical therapy and, in severe cases, joint replacement surgery.

• Rheumatoid arthritis (RA) is an autoimmune disorder that affects the joints in the hands, wrists, elbows, shoulders, knees, feet and ankles. Autoimmune diseases occur when the body’s own systems work against it, and in this case, its own enzymes cause a breakdown in joint lining and increased inflammation. In addition to joint pain, people with RA also experience fever, fatigue, anemia and other internal side effects. Your doctor may prescribe an anti-inflammatory medication as well as biologic drugs that target specific enzymes without compromising all the other immune responses.

• You might be familiar with psoriasis, a disease where red and white patches develop on the skin. Similarly to RA, psoriasis occurs when the body’s immune system attacks the skin cells. But psoriasis can also develop into psoriatic arthritis, which causes pain, inflammation and stiffness. Moderate cases of psoriatic arthritis can be treated with ibuprofen, while more severe cases require prescription medication.

• Fibromyalgia is a condition where patients experience widespread pain, fatigue, insomnia, memory loss and cognitive problems, tension headaches and depression. Doctors aren’t sure what causes fibromyalgia, but research suggests the brain of a fibromyalgia patient amplifies pain signals, often triggered by a trauma or infection. Fibromyalgia can be treated with antidepressants, anti-seizure medications or muscle relaxants.

• Gout causes sudden severe pain, swelling and tenderness, often at the base of the big toe or in other small bones of your feet. This inflammation happens as a result of uric acid crystals building up in the joints. You are at risk for gout if you are obese, have a family history of it, eat a diet rich in meat and fruit sugar or take medications that cause an increase in uric acid. To treat gout, your doctor may recommend ibuprofen or corticosteroids for inflammation, and medications like colchicine that block uric acid production.

Joint aches and pains are certainly common. But if they become excessive, limit your lifestyle, involve many separate joints or have the characteristics mentioned above, see your doctor. Referral to a rheumatologist or orthopedic surgeon may be appropriate.

By Alfred Casale

To Your Health

Dr. Alfred Casale, a cardiothoracic surgeon, is Associate Chief Medical Officer for Geisinger Health and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]

Dr. Alfred Casale, a cardiothoracic surgeon, is Associate Chief Medical Officer for Geisinger Health and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]