Editing Arthritis

{{Short description|Type of joint disorder}}
{{Distinguish|Arteritis}}
{{For|the journal|Arthritis (journal){{!}}''Arthritis'' (journal)}}
{{cs1 config|name-list-style=vanc}}
{{Use dmy dates|date=February 2024}}
{{Infobox medical condition
| name            = Arthritis
| pronounce       = {{IPAc-en|ɑːr|ˈ|θ|r|aɪ|t|ɪ|s}}<ref>{{cite web|title=arthritis noun - Definition, pictures, pronunciation and usage notes Oxford Advanced Learner's Dictionary|url=https://www.oxfordlearnersdictionaries.com/definition/english/arthritis|website=www.oxfordlearnersdictionaries.com|access-date=14 December 2017}}</ref>
| image           = Rheumatoid Arthritis.JPG
| caption         = A hand affected by [[rheumatoid arthritis]], an [[autoimmune]] form of arthritis
| alt             = photograph of elderly hand depicting advanced rheumatoid arthritis
| field           = [[Rheumatology]]
| symptoms        = [[Joint pain]], stiffness, redness, [[joint effusion|swelling]], decreased [[range of motion]]<ref name=niams/><ref name=cdc-ar/>
| complications   = [[Amplified musculoskeletal pain syndrome]]<ref name=ChildrensHealth>{{cite web |url=https://www.childrens.com/specialties-services/conditions/amplified-musculoskeletal-pain-syndrome-amps |title=Amplified Musculoskeletal Pain Syndrome (AMPS) |publisher=Children's Health}}</ref>
| onset           =
| duration        =
| types           = > 100, most common ([[osteoarthritis]], [[rheumatoid arthritis]])<ref name=cdc-ar/><ref name=niams-liv/>
| causes          =
| risks           = Family history, age, sex trait, previous joint injury, obesity.<ref name="mayo">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772|title=Arthritis|publisher=[[Mayo Clinic]]|date=29 August 2023 |access-date=30 January 2025}}</ref> 
| diagnosis       =
| differential    =
| prevention      =
| treatment       = Resting, applying ice or heat, weight loss, exercise, [[joint replacement]]<ref name=niams-liv/>
| medication      = [[Ibuprofen]], [[paracetamol]] (acetaminophen)<ref name="mayo-pain">{{cite web|publisher=Mayo Clinic|date=20 September 2023|access-date=30 January 2025|url=https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20046440|title=Arthritis pain: Do's and don'ts}}</ref>
| frequency       =
| deaths          =
}}

<!-- Definition and symptoms -->
'''Arthritis''' is a general medical term used to describe a disorder that affects [[joint]]s.<ref name="niams">{{cite web|date=September 2023|title=Arthritis and Rheumatic Diseases|url=https://www.niams.nih.gov/health-topics/arthritis-and-rheumatic-diseases|access-date=30 January 2025 |publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health}}</ref> [[Symptoms]] generally include [[joint pain]] and stiffness.<ref name=niams/> Other symptoms may include redness, warmth, [[Joint effusion|swelling]], and decreased [[range of motion]] of the affected joints.<ref name=niams/><ref name=cdc-ar>{{cite web|title=Arthritis|url=https://www.cdc.gov/arthritis/basics/index.html |publisher=US Centers for Disease Control and Prevention|date=22 March 2024|access-date=30 January 2025}}</ref> In certain types of arthritis, other organs such as the skin are also affected.<ref name=niams-liv>{{cite web |title=Living With Arthritis: Health Information Basics for You and Your Family|url=https://www.niams.nih.gov/community-outreach-initiative/understanding-joint-health/living-with-arthritis|publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health|date=May 2023|access-date=30 January 2025 }}</ref> Onset can be gradual or sudden.<ref name=cdc-ar/>

<!-- Cause and diagnosis -->
There are several types of arthritis.<ref name=niams/><ref>{{cite book | vauthors = Clegg HB, Jackson L |title=Eating well to fight arthritis: 200 easy recipes and practical tips to help reduce inflammation and ease symptoms |year=2013 |publisher=Favorite Recipes Press |isbn=978-0-9815640-5-0 |oclc=854909375}}</ref><ref name=Ath2013>{{cite book| vauthors = Athanasiou KA, Darling EM, Hu JC, DuRaine GD, Reddi AH |title=Articular Cartilage|date=2013 |publisher=CRC Press|isbn=9781439853252|url=https://books.google.com/books?id=Bn_RBQAAQBAJ&pg=PA105 |page=105}}</ref>  The most common forms are [[osteoarthritis]] (most commonly seen in weightbearing joints) and [[rheumatoid arthritis]].<ref name=niams/> Osteoarthritis usually occurs as an individual ages and often affects the hips, knees, shoulders, and fingers.<ref name=niams-liv/> Rheumatoid arthritis is an [[autoimmune disorder]] that often affects the hands and feet.<ref name=niams-liv/> Other types of arthritis include [[gout]], [[lupus]], and [[septic arthritis]].<ref name=cdc-ar/><ref name=niams-liv/> These are inflammatory based types of [[rheumatic disease]].<ref name=niams/>

<!-- Treatment -->
Early treatment for arthritis commonly includes resting the affected joint and conservative measures such as heating or icing.<ref name=niams-liv/> Weight [[Weight loss|loss]] and exercise may also be useful to reduce the force across a weightbearing joint.<ref name=niams-liv/> Medication intervention for symptoms depends on the form of arthritis.<ref name=niams-liv/> These may include anti-inflammatory medications such as [[ibuprofen]] and [[paracetamol]] (acetaminophen). With severe cases of arthritis, [[joint replacement]] surgery may be necessary.<ref name=niams-liv/>

<!-- Epidemiology and history -->
Osteoarthritis is the most common form of arthritis affecting more than 3.8% of people, while rheumatoid arthritis is the second most common affecting about 0.24% of people.<ref>{{cite journal | vauthors = March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F, Buchbinder R, Vos T, Woolf AD | display-authors = 6 | title = Burden of disability due to musculoskeletal (MSK) disorders | journal = Best Practice & Research. Clinical Rheumatology | volume = 28 | issue = 3 | pages = 353–366 | date = June 2014 | pmid = 25481420 | doi = 10.1016/j.berh.2014.08.002 }}</ref> In Australia about 15% of people are affected by arthritis,<ref name=ABS2015>{{cite web|website=ABS |url=http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/F6CE5715FE4AC1B1CA257AA30014C725?opendocument|access-date=14 January 2017 |title=National Health Survey|date=8 December 2015|archive-url=https://web.archive.org/web/20170116162239/http://www.abs.gov.au/AUSSTATS/abs%40.nsf/allprimarymainfeatures/F6CE5715FE4AC1B1CA257AA30014C725?opendocument|archive-date=16 January 2017 |url-status=live}}</ref> while in the United States more than 20% have a type of arthritis.<ref name=cdc-ar/> Overall arthritis becomes more common with age.<ref name=niams/> Arthritis is a common reason people are unable to carry out their work and can result in decreased ability to complete activities of daily living.<ref name=niams/><ref name=cdc-ar/> The term arthritis is derived from ''[[wikt:arthr-|arthr-]]'' (meaning 'joint') and ''[[wikt:-itis#English|-itis]]'' (meaning 'inflammation').<ref>{{cite book| veditors = Waite M |title=Paperback Oxford English Dictionary|date=2012|publisher=Oxford University Press |place=Oxford |isbn=9780199640942 |page=35|url=https://books.google.com/books?id=mYicAQAAQBAJ&pg=PA35 |url-status=live|archive-url=https://web.archive.org/web/20161220150636/https://books.google.com/books?id=mYicAQAAQBAJ&pg=PA35|archive-date=20 December 2016}}</ref><ref>{{cite book|vauthors=Leonard C|title=Quick & Easy Medical Terminology - E-Book|date=2015|publisher=Elsevier Health Sciences|isbn=9780323370646 |page=160|url=https://books.google.com/books?id=_h2KCwAAQBAJ&pg=PA160}}</ref>

== Classification ==
There are several diseases where joint pain is the most prominent symptom. Generally when a person has "arthritis" it means that they have one of the following diseases:
* [[Hemarthrosis]]
* [[Osteoarthritis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/osteoarthritis/| title= Osteoarthritis|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Rheumatoid arthritis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/rheumatoid-arthritis/| title= Rheumatoid Arthritis
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Gout]] and [[Calcium pyrophosphate deposition disease|pseudo-gout]]<ref>{{cite web |url= https://www.lecturio.com/concepts/gout/| title= Gout|website=The Lecturio Medical Concept Library | date= 9 September 2020|access-date= 22 August 2021}}</ref>
* [[Septic arthritis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/septic-arthritis/| title= Septic Arthritis
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Ankylosing spondylitis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/ankylosing-spondylitis/| title= Ankylosing Spondylitis
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Juvenile idiopathic arthritis]]<ref>{{cite journal | vauthors = Prakken B, Albani S, Martini A | title = Juvenile idiopathic arthritis | journal = Lancet | volume = 377 | issue = 9783 | pages = 2138–2149 | date = June 2011 | pmid = 21684384 | doi = 10.1016/S0140-6736(11)60244-4 | s2cid = 202802455 }}</ref>
* [[Adult-onset Still's disease|Still's disease]]<ref>{{cite journal | vauthors = Akkara Veetil BM, Yee AH, Warrington KJ, Aksamit AJ, Mason TG | title = Aseptic meningitis in adult onset Still's disease | journal = Rheumatology International | volume = 32 | issue = 12 | pages = 4031–4034 | date = December 2012 | pmid = 20495923 | doi = 10.1007/s00296-010-1529-8 | s2cid = 19431424 }}</ref>
* [[Psoriatic arthritis]]<ref>{{cite web| vauthors = Garrick N |date=14 April 2017|title=Psoriatic Arthritis|url=https://www.niams.nih.gov/health-topics/psoriatic-arthritis|access-date=24 November 2021|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases|language=en}}</ref>

Joint pain can also be a symptom of other diseases. In this case, the person may not have arthritis and instead have one of the following diseases: 
* [[Psoriasis]]<ref>{{cite web|title=Questions and Answers About Psoriasis|url=https://www.niams.nih.gov/health_info/psoriasis/|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=22 April 2017|url-status=live|archive-url=https://web.archive.org/web/20170422134800/https://www.niams.nih.gov/health_info/psoriasis/|archive-date=22 April 2017|date=12 April 2017}}</ref>
* [[Reactive arthritis]]<ref>{{cite web|title=Reactive Arthritis|author=American College of Rheumatology|access-date=24 January 2017|url=http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Reactive-Arthritis}}</ref>
* [[Ehlers–Danlos syndrome]]<ref>{{cite web |url= https://www.lecturio.com/concepts/ehlers-danlos-syndrome/| title= Ehlers-Danlos Syndrome
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Iron overload]]<ref>{{cite book | vauthors = McDowell LA, Kudaravalli P, Sticco KL | chapter = Iron Overload |date=2021 | chapter-url= http://www.ncbi.nlm.nih.gov/books/NBK526131/ | title = StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30252387|access-date=24 November 2021}}</ref>
* [[Hepatitis]]<ref>{{cite web | title=Hepatitis | website=MedlinePlus | date=20 May 2020 | url=https://medlineplus.gov/hepatitis.html | access-date=19 July 2020 | quote=Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Hepatitis is an inflammation of the liver.}}</ref><ref>{{cite web|title=Hepatitis|url=https://www.niaid.nih.gov/diseases-conditions/hepatitis|website=NIAID|access-date=2 November 2016|url-status=live|archive-url=https://web.archive.org/web/20161104002228/https://www.niaid.nih.gov/diseases-conditions/hepatitis|archive-date=4 November 2016}}</ref>
* [[Lyme disease]]<ref>{{cite web |url= https://www.lecturio.com/concepts/lyme-disease/| title= Lyme Disease
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Sjögren's disease]]<ref>{{cite web|title=What Is Sjögren's Syndrome? Fast Facts| url= http://www.niams.nih.gov/health_info/sjogrens_syndrome/sjogrens_syndrome_ff.asp|website=NIAMS|access-date=15 July 2016| date= November 2014| url-status= live |archive-url= https://web.archive.org/web/20160704210602/http://www.niams.nih.gov/Health_Info/Sjogrens_Syndrome/sjogrens_syndrome_ff.asp|archive-date=4 July 2016}}</ref>
* [[Hashimoto's thyroiditis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/hashimotos-thyroiditis/| title= Hashimoto's Thyroiditis
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Celiac disease]]<ref name=GuandaliniAssiri2014>{{cite journal | vauthors = Guandalini S, Assiri A | title = Celiac disease: a review | journal = JAMA Pediatrics | volume = 168 | issue = 3 | pages = 272–278 | date = March 2014 | pmid = 24395055 | doi = 10.1001/jamapediatrics.2013.3858 }}</ref>
* [[Non-celiac gluten sensitivity]]<ref name="FasanoSapone2015">{{cite journal | vauthors = Fasano A, Sapone A, Zevallos V, Schuppan D | title = Nonceliac gluten sensitivity | journal = Gastroenterology | volume = 148 | issue = 6 | pages = 1195–1204 | date = May 2015 | pmid = 25583468 | doi = 10.1053/j.gastro.2014.12.049 | doi-access = free }}</ref><ref name=VoltaCaio2015>{{cite journal | vauthors = Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE | title = Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders | journal = Best Practice & Research. Clinical Gastroenterology | volume = 29 | issue = 3 | pages = 477–491 | date = June 2015 | pmid = 26060112 | doi = 10.1016/j.bpg.2015.04.006 }}</ref><ref name="CatassiBai2013">{{cite journal | vauthors = Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A | display-authors = 6 | title = Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders | journal = Nutrients | volume = 5 | issue = 10 | pages = 3839–3853 | date = September 2013 | pmid = 24077239 | pmc = 3820047 | doi = 10.3390/nu5103839 | type = Review | doi-access = free }}</ref>
* [[Inflammatory bowel disease]] (including [[Crohn's disease]] and [[ulcerative colitis]])<ref>{{cite web |url= https://www.lecturio.com/concepts/crohns-disease/| title= Crohn's Disease
|website=The Lecturio Medical Concept Library | date= 28 August 2020
|access-date= 22 August 2021}}</ref><ref>{{cite web |url= https://www.lecturio.com/concepts/ulcerative-colitis/| title= Ulcerative Colitis
|website=The Lecturio Medical Concept Library | date= 26 August 2020
|access-date= 22 August 2021}}</ref>
* [[Henoch–Schönlein purpura]]<ref>{{cite web |url= https://www.lecturio.com/concepts/henoch-schonlein-purpura/| title= Henoch-Schönlein Purpura
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Hyperimmunoglobulinemia D with recurrent fever]]
* [[Sarcoidosis]]<ref>{{cite web |url= https://www.lecturio.com/concepts/sarcoidosis/| title= Sarcoidosis|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[Whipple's disease]]<ref>{{cite web |url= https://www.lecturio.com/concepts/whipples-disease/| title= Whipple's Disease
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>
* [[TNF receptor associated periodic syndrome]]<ref>{{cite journal | vauthors = Rezaei N | title = TNF-receptor-associated periodic syndrome (TRAPS): an autosomal dominant multisystem disorder | journal = Clinical Rheumatology | volume = 25 | issue = 6 | pages = 773–777 | date = November 2006 | pmid = 16447098 | doi = 10.1007/s10067-005-0198-6 | s2cid = 41808394 }}subscription needed</ref>
* [[Granulomatosis with polyangiitis]] (and many other [[vasculitis]] syndromes)
* [[Familial Mediterranean fever]]<ref>{{cite book | vauthors = James W, Berger T, Elston D | date = 2005 | title = Andrews' Diseases of the Skin: Clinical Dermatology | edition = 10th | publisher = Saunders | isbn = 0-7216-2921-0 }}</ref>
* [[Systemic lupus erythematosus]]<ref>{{cite web |url= https://www.lecturio.com/concepts/systemic-lupus-erythematosus/| title= Systemic Lupus Erythematosus
|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}</ref>

{{anchor|undifferentiated}}
An ''undifferentiated arthritis'' is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite [[rheumatic disease]].<ref>{{cite journal | vauthors = Wollenhaupt J, Zeidler H | title = Undifferentiated arthritis and reactive arthritis | journal = Current Opinion in Rheumatology | volume = 10 | issue = 4 | pages = 306–313 | date = July 1998 | pmid = 9725091 | doi = 10.1097/00002281-199807000-00005 }}</ref>

== Signs and symptoms ==
{| class="wikitable" align="right"
|-
! Extra-articular features of joint disease<ref>{{cite book | veditors = Swash M, Glynn M |title=Hutchison's Clinical Methods: An Integrated Approach to Clinical Practice |date=2007 |publisher=Saunders Elsevier |location=Edinburgh |isbn=978-0702027994 |edition=22nd}}</ref>
|-
| [[Cutaneous]] [[Nodule (medicine)|nodules]]
|-
| Cutaneous [[vasculitis]] [[lesion]]s
|-
| [[Lymphadenopathy]]
|-
| [[Oedema]]
|-
| [[Human eye|Ocular]] [[inflammation]]
|-
| [[Urethritis]]
|-
| [[Tenosynovitis]] ([[tendon]] sheath [[effusion]]s)
|-
| [[Bursitis]] (swollen [[bursa (anatomy)|bursa]])
|-
| [[Diarrhea]]
|-
| Orogenital [[ulcer (dermatology)|ulceration]]
|}
Pain in varying severity is a common symptom in most types of arthritis.<ref>{{cite book | vauthors = Eustice C |title=Arthritis: types of arthritis |date=2012 |publisher=Adams Media |isbn=978-1-4405-4446-0 |oclc=808835849}}</ref><ref>{{cite book | vauthors = Galloway JB, Scott DL |chapter=Management of common types of arthritis in older adults |date=December 2017 |title=Oxford Textbook of Geriatric Medicine |pages=577–584 |publisher=Oxford University Press |doi=10.1093/med/9780198701590.003.0075 |isbn=978-0-19-870159-0 }}</ref> Other symptoms include [[swelling (medical)|swelling]], [[joint stiffness]], redness, and aching around the joint(s).<ref name=niams/> Arthritic disorders like [[lupus]] and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms including:<ref name=cdc-ar/>
* Inability to use the [[hand]] or [[walking|walk]]
* Stiffness in one or more joints
* Rash or itch
* [[Malaise]] and fatigue
* [[Weight loss]]
* Poor sleep
* [[myalgia|Muscle aches]] and pains
* [[Tenderness (medicine)|Tenderness]]
* Difficulty moving the joint

== Causes ==
Several factors contribute to the development of arthritis, differing on the type of arthritis.<ref name=niams/><ref name=mayo/>

Osteoarthritis occurs from damage to joint cartilage from prior injury or long-term wear-and-tear, resulting in bone-to-bone contact and grinding.<ref name=mayo/> The resulting arthritis can occur over years, or be worsened by further injury or infection.<ref name=mayo/> If joint cartilage is severely damaged, inflammation and swelling may add to the extent and pain of osteoarthritis.<ref name=mayo/>

In rheumatoid arthritis, the [[immune system]] itself, which normally serves to protect against  infection and diseases, attacks the lining of the [[joint capsule]], causing inflammation and swelling.<ref name=mayo/><ref name=niams-ra/>

[[Gout]] is a form of arthritis caused by excessive [[uric acid]] production, resulting in urate crystals depositing in joints, particularly in extremities, such as toes.<ref name="niams-gout">{{cite web|url=https://www.niams.nih.gov/health-topics/gout|title=Gout|date=December 2023|access-date=30 January 2025|publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health}}</ref><ref name="mayo-gout">{{cite web |title=Gout |url=https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897 |publisher=Mayo Clinic |access-date=30 January 2025 |date=16 November 2022}}</ref> Urate levels in the blood may increase from consuming [[purine]]-rich foods or from body factors affecting urate clearance from the blood, a topic remaining under study.<ref name=niams-gout/>

Arthritis types may also include [[ankylosing spondylitis]], [[juvenile idiopathic arthritis]], [[psoriatic arthritis]], and [[reactive arthritis]], among others.<ref name=niams/><ref name=mayo/>

== Risk factors ==
There are common risk factors that increase a person's chance of developing arthritis later in adulthood. Some of these are modifiable while others are not.<ref name=niams/><ref name=cdc-ar/>

Some common risk factors that can increase the chances of developing osteoarthritis include obesity, prior injury to the joint, type of joint, and muscle strength.<ref>{{Cite journal |last1=Vina |first1=Ernest R. |last2=Kwoh |first2=C. Kent |date=March 2018 |title=Epidemiology of Osteoarthritis: Literature Update |journal=Current Opinion in Rheumatology |volume=30 |issue=2 |pages=160–167 |doi=10.1097/BOR.0000000000000479 |issn=1040-8711 |pmc=5832048 |pmid=29227353}}</ref><ref>{{Cite journal |last1=Christensen |first1=Robin |last2=Bartels |first2=Else Marie |last3=Astrup |first3=Arne |last4=Bliddal |first4=Henning |date=April 2007 |title=Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis |journal=Annals of the Rheumatic Diseases |volume=66 |issue=4 |pages=433–439 |doi=10.1136/ard.2006.065904 |issn=0003-4967 |pmc=1856062 |pmid=17204567}}</ref>

The risk factors with the strongest association for developing inflammatory arthritis (such as rheumatoid arthritis and lupus arthritis) are the female sex, a family history, age, obesity, joint damage from a previous injury, and exposure to tobacco smoke.<ref name=mayo/><ref>{{Citation |last1=Chauhan |first1=Krati |title=Rheumatoid Arthritis |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK441999/ |access-date=2025-01-24 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28723028 |last2=Jandu |first2=Jagmohan S. |last3=Brent |first3=Lawrence H. |last4=Al-Dhahir |first4=Mohammed A.}}</ref><ref>{{cite journal |vauthors=Deane KD, Demoruelle MK, Kelmenson LB, Kuhn KA, Norris JM, Holers VM |date=February 2017 |title=Genetic and environmental risk factors for rheumatoid arthritis |journal=Best Practice & Research. Clinical Rheumatology |volume=31 |issue=1 |pages=3–18 |doi=10.1016/j.berh.2017.08.003 |pmc=5726551 |pmid=29221595}}</ref>

Smoking has been linked to an increased susceptibility of developing arthritis, particularly rheumatoid arthritis.<ref>{{cite web |title=Smoking and Rheumatoid Arthritis |url=https://www.nras.org.uk/smoking-and-rheumatoid-arthritis |website=NRAS |publisher=National Rheumatoid Arthritis Society |access-date=20 November 2020}}</ref>

== Diagnosis ==
{{Synovial fluid analysis}}
[[File:Osteoarthritis in the left hand index finger.jpg|thumb|right|Osteoarthritis in the left hand index finger of a 63-year-old woman]]

Diagnosis is made by clinical examination from an appropriate health professional, and may be supported by tests such as radiologic imaging and blood tests, depending on the type of suspected arthritis.<ref>{{cite web|title = How is arthritis diagnosed? {{!}} Arthritis Research UK|url = http://www.arthritisresearchuk.org/arthritis-information/conditions/arthritis/diagnosis.aspx|website = www.arthritisresearchuk.org|access-date = 9 June 2015|url-status = live|archive-url = https://web.archive.org/web/20150402061641/http://www.arthritisresearchuk.org/arthritis-information/conditions/arthritis/diagnosis.aspx|archive-date = 2 April 2015}}</ref> Pain patterns may vary depending on the type of arthritis and the location. [[Rheumatoid arthritis]] is generally worse in the morning and associated with stiffness lasting over 30 minutes.<ref name=":5">{{cite web|url=https://www.niams.nih.gov/health-topics/rheumatoid-arthritis|title=Rheumatoid Arthritis| vauthors = Garrick N |date=20 April 2017|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=6 May 2019}}</ref> On the other hand, with osteoarthritis, the pain tends to initially be related to activity and then becomes more constant over time.<ref>{{Cite journal |last1=Yu |first1=Huan |last2=Huang |first2=Tianwen |last3=Lu |first3=William Weijia |last4=Tong |first4=Liping |last5=Chen |first5=Di |date=2022-04-22 |title=Osteoarthritis Pain |journal=International Journal of Molecular Sciences |volume=23 |issue=9 |pages=4642 |doi=10.3390/ijms23094642 |doi-access=free |issn=1422-0067 |pmc=9105801 |pmid=35563035}}</ref>

Important features to look out for include the following:

* Rate of onset of symptoms
* Pattern of joint involvement
* Symmetry of symptoms
* Early morning stiffness
* Associated tenderness around the joint
* Locking of joint with inactivity
* Aggravating and relieving factors, and/or
* Presence of systemic symptoms

Physical examination may include observing the affected joints, evaluating gait, and examining the skin for findings that could be related to rheumatological disease or pulmonary inflammation. Physical examination may confirm the diagnosis or may indicate systemic disease. Chest radiographs are often used to follow progression or help assess severity.<ref name="davis">{{cite journal |last1=Davis |first1=J. Lucian |last2=Murray |first2=John F. |date=2016 |title=History and Physical Examination |journal=Murray and Nadel's Textbook of Respiratory Medicine |pages=263–277.e2 |doi=10.1016/B978-1-4557-3383-5.00016-6 |pmc=7152492|isbn=978-1-4557-3383-5 }}</ref>

Screening blood tests for suspected arthritis include: [[rheumatoid factor]], [[antinuclear factor]] (ANF), [[extractable nuclear antigen]], and specific antibodies.<ref name=davis/>

Rheumatoid arthritis patients often have elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) levels, which indicates the presence of an inflammatory process in the body.<ref name=":5" /> Anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) are two more common blood tests when assessing for rheumatoid arthritis.<ref name=":5" />

Imaging tests like X-rays are commonly utilized to diagnose and monitor arthritis.<ref name=":2" /> Other imaging tests for rheumatoid arthritis that may be considered include computed tomography (CT) scanning, positron emission tomography (PET) scanning, bone scanning, and dual-energy X-ray absorptiometry (DEXA).<ref name=":2">{{cite web |title=Rheumatoid arthritis - Diagnosis |url=https://www.nhs.uk/conditions/rheumatoid-arthritis/diagnosis/ |website=nhs.uk |language=en |date=23 October 2017}}</ref>

=== Osteoarthritis ===
{{Main|Osteoarthritis}}
[[File:Varus Knee Osteoarthritis Xray.jpg|thumb|Bilateral medial joint space narrowing with osteophytes in varus knees with osteoarthritis]]

[[Osteoarthritis]] (OA) is the most common form of arthritis.<ref name=Van2010>{{cite journal | vauthors = VanItallie TB | title = Gout: epitome of painful arthritis | journal = Metabolism | volume = 59 | issue = Suppl 1 | pages = S32–S36 | date = October 2010 | pmid = 20837191 | doi = 10.1016/j.metabol.2010.07.009 }}</ref> It affects humans and other animals, notably dogs, but also occurs in cats and horses. It can affect both the larger (i.e. knee, hip, shoulder, etc.) and the smaller joints (i.e. fingers, toes, foot, etc.) of the body. The disease is caused by daily wear and tear of the joint. This process can progress more rapidly as a result of injury to the joint. Osteoarthritis is caused by the break down of the smooth surface between two bones, known as cartilage, which can eventually lead to the two opposing bones coming in direct contact and eroding one another. OA symptoms typically begin with minor pain during physical activity, but can eventually progress to be present at rest. The pain can be debilitating and prevent one from doing activities that they would normally do as part of their daily routine. OA typically affects the weight-bearing joints, such as the back, knee and hip due to the mechanical nature of this disease process. Unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. The strongest predictor of osteoarthritis is increased age, likely due to the declining ability of [[chondrocytes]] to maintain the structural integrity of cartilage.<ref>{{cite journal | vauthors = Pereira D, Ramos E, Branco J | title = Osteoarthritis | journal = Acta Médica Portuguesa | volume = 28 | issue = 1 | pages = 99–106 | date = January 2015 | pmid = 25817486 | doi = 10.20344/amp.5477 | doi-access = free }}</ref> More than 30 percent of women have some degree of osteoarthritis by age 65. One of the primary tools for diagnosing OA are X-rays of the joint. Findings on X-ray that are consistent with OA include those with joint space narrowing (due to cartilage breakdown), bone spurs, sclerosis, and bone cysts.<ref>{{Cite journal |last1=Fan |first1=Zijuan |last2=Yan |first2=Lei |last3=Liu |first3=Haifeng |last4=Li |first4=Xiaoke |last5=Fan |first5=Kenan |last6=Liu |first6=Qiang |last7=Li |first7=Jiao Jiao |last8=Wang |first8=Bin |date=2023-03-29 |title=The prevalence of hip osteoarthritis: a systematic review and meta-analysis |journal=Arthritis Research & Therapy |language=en |volume=25 |issue=1 |page=51 |doi=10.1186/s13075-023-03033-7 |doi-access=free |issn=1478-6362 |pmc=10053484 |pmid=36991481}}</ref>

=== Rheumatoid arthritis ===
{{Main|Rheumatoid arthritis}}
[[File:X-ray of right fourth PIP joint with bone erosions by rheumatoid arthritis.jpg|thumb|[[Bone erosion]]s by [[rheumatoid arthritis]]<ref>{{cite journal | vauthors = Ideguchi H, Ohno S, Hattori H, Senuma A, Ishigatsubo Y | title = Bone erosions in rheumatoid arthritis can be repaired through reduction in disease activity with conventional disease-modifying antirheumatic drugs | journal = Arthritis Research & Therapy | volume = 8 | issue = 3 | pages = R76 | year = 2006 | pmid = 16646983 | pmc = 1526642 | doi = 10.1186/ar1943 | doi-access = free }}</ref>]]

[[Rheumatoid arthritis]] (RA) is a disorder in which the body's own immune system starts to attack body [[tissue (biology)|tissues]] specifically the cartilage at the end of bones known as articular cartilage.<ref name="niams-ra">{{cite web|url=https://www.niams.nih.gov/health-topics/rheumatoid-arthritis |title=Rheumatoid arthritis|date=November 2022|access-date=30 January 2025|publisher=National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health}}</ref> The attack is not only directed at the joint but to many other parts of the body. RA often affects joints in the fingers, wrists, knees and elbows, is symmetrical (appears on both sides of the body), and can lead to severe progressive [[deformity]] in a matter of years if not adequately treated. RA usually onsets earlier in life than OA and commonly effects people aged 20 and above. In children, the disorder can present with a skin [[rash]], [[fever]], [[pain]], disability, and limitations in daily activities.<ref name=niams-ra/> With earlier diagnosis and appropriate aggressive treatment, many individuals can obtain control of their symptoms leading to a better quality of life compared to those without treatment.<ref name=niams-ra/><ref>{{cite report |url=https://effectivehealthcare.ahrq.gov/topics/rheumatoid-arthritis-medicine-update/final-report-update-2018 |title=Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update |last1=Donahue |first1=Katrina E. |last2=Gartlehner |first2=Gerald |date=2018 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer211 |last3=Schulman |first3=Elizabeth R. |last4=Jonas |first4=Beth |last5=Coker-Schwimmer |first5=Emmanuel |last6=Patel |first6=Sheila V. |last7=Weber |first7=Rachel Palmieri |last8=Lohr |first8=Kathleen N. |last9=Bann |first9=Carla|doi-access=free }}</ref>

One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the [[synovium]] (lining of the joint capsule), caused in part by the production of pro-inflammatory [[cytokine]]s and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts.<ref name="Chabaud_2000">{{cite journal | vauthors = Chabaud M, Garnero P, Dayer JM, Guerne PA, Fossiez F, Miossec P | title = Contribution of interleukin 17 to synovium matrix destruction in rheumatoid arthritis | journal = Cytokine | volume = 12 | issue = 7 | pages = 1092–1099 | date = July 2000 | pmid = 10880256 | doi = 10.1006/cyto.2000.0681 }}</ref> Osteoclast activity can be directly induced by osteoblasts through the RANK/RANKL mechanism.<ref name="pmid21464945">{{cite journal | vauthors = Won HY, Lee JA, Park ZS, Song JS, Kim HY, Jang SM, Yoo SE, Rhee Y, Hwang ES, Bae MA | display-authors = 6 | title = Prominent bone loss mediated by RANKL and IL-17 produced by CD4+ T cells in TallyHo/JngJ mice | journal = PLOS ONE | volume = 6 | issue = 3 | pages = e18168 | date = March 2011 | pmid = 21464945 | pmc = 3064589 | doi = 10.1371/journal.pone.0018168 | bibcode = 2011PLoSO...618168W | doi-access = free }}</ref>
[[File:Lupusfoto.jpg|thumb|160x160px|This is a malar ("butterfly") skin rash that is commonly seen in patients with Lupus.]]

=== Lupus ===
{{Main|Lupus erythematosus}}

[[Lupus erythematosus|Lupus]] is an autoimmune [[collagen]] [[Blood vessel|vascular]] disorder that can be present with severe arthritis. In fact, about 90% of patients with Lupus have musculoskeletal involvement.<ref name=":6">{{Cite journal |last1=Ceccarelli |first1=Fulvia |last2=Govoni |first2=Marcello |last3=Piga |first3=Matteo |last4=Cassone |first4=Giulia |last5=Cantatore |first5=Francesco Paolo |last6=Olivieri |first6=Giulio |last7=Cauli |first7=Alberto |last8=Favalli |first8=Ennio Giulio |last9=Atzeni |first9=Fabiola |last10=Gremese |first10=Elisa |last11=Iannone |first11=Florenzo |last12=Caporali |first12=Roberto |last13=Sebastiani |first13=Marco |last14=Ferraccioli |first14=Gian Franco |last15=Lapadula |first15=Giovanni |date=2022-10-12 |title=Arthritis in Systemic Lupus Erythematosus: From 2022 International GISEA/OEG Symposium |journal=Journal of Clinical Medicine |language=en |volume=11 |issue=20 |pages=6016 |doi=10.3390/jcm11206016 |doi-access=free |issn=2077-0383 |pmc=9604412 |pmid=36294337}}</ref> Symptoms in these patients can often mimic those of rheumatoid arthritis with similar stiffness and pain patterns. Joints in the fingers, wrist, and knee tend to be the most affected.<ref name=":6" /> Other features commonly seen in patients with Lupus include a skin rash (pictured on the right), extreme [[photosensitivity]], [[baldness|hair loss]], [[kidney]] problems, and shortness of breath secondary to scarring that occurs in the lungs.<ref>{{EMedicine|article|331715|Rheumatoid Arthritis: Differential Diagnoses & Workup|diagnosis}}</ref>

=== Gout ===
{{Main|Gout}}
[[File:Gout Signs and Symptoms.jpg|thumb|Gout most commonly affects the big toe, leading to swelling, redness, and warmth around that area.]]

In the early stages of gout, usually only one joint is affected; however over time, many joints can become affected. Gout most commonly occurs in joints located in the big toe, knee, and/or fingers.<ref name=mayo-gout/> During a gout flare, the affected joints often become swollen with associated warmth and redness. The resulting pain can be significant and potentially debilitating.<ref name="Becker">{{cite book |title=Arthritis and Allied Conditions: A textbook of Rheumatology edition 15 |vauthors=Becker MA |publisher=Lippincott Williams & Wilkins |year=2005 |pages=2303–2339}}</ref> When one of these flares occurs, management involves the use of anti-inflammatories, such as NSAIDs, colchicine, or glucocorticoids.<ref name=":8">{{Cite journal |last1=Afinogenova |first1=Yuliya |last2=Danve |first2=Abhijeet |last3=Neogi |first3=Tuhina |date=2022-03-01 |title=Update on Gout Management: what's old and what's new |journal=Current Opinion in Rheumatology |volume=34 |issue=2 |pages=118–124 |doi=10.1097/BOR.0000000000000861 |issn=1040-8711 |pmc=8799507 |pmid=34907116}}</ref> In between gout flares, it is recommended that patients take medications that decrease the production of uric acid (i.e. allopurinol, febuxostat) or increase the elimination of uric acid from the body (i.e. probenecid).<ref name=":8" /><ref name="Ali">{{cite journal |vauthors=Ali S, Lally EV |date=November 2009 |title=Treatment failure gout |journal=Medicine and Health, Rhode Island |volume=92 |issue=11 |pages=369–371 |citeseerx=10.1.1.608.3812 |pmid=19999896}}</ref>

Gout has been associated with excessive intake of alcohol and food, such as red meat.<ref name=mayo-gout/> Thus, it is also recommended that patients with gout adhere to a diet rich in fiber, vegetables, and whole grains, while limiting the intake of alcohol and fatty foods.<ref name=mayo-gout/>

There is also an uncommon form of gout that is known as [[Calcium pyrophosphate deposition disease|pseudogout]], which is caused by the formation of calcium pyrophosphate crystals in the joint.<ref name=":9">{{Cite journal |last1=Stack |first1=John |last2=McCarthy |first2=Geraldine |date=2021-12-01 |title=Calcium pyrophosphate deposition (CPPD) disease – Treatment options |journal=Best Practice & Research Clinical Rheumatology |series=Crystal Induced Arthritis |volume=35 |issue=4 |pages=101720 |doi=10.1016/j.berh.2021.101720 |pmid=34756508 |issn=1521-6942|doi-access=free }}</ref> Unlike gout, no targeted treatments are currently available.<ref name=":9" /> At this time, management is aimed at decreasing inflammation in order to reduce the intensity and frequency of flares.<ref name=":9" />

=== Comparison of types ===
{|class="wikitable"
|+ Comparison of some major forms of arthritis<ref name=agabegi2nd6-7unless>Unless otherwise specified in table box, the reference is: {{cite book | vauthors = Agabegi ED, Agabegi SS |chapter=Table 6–7 |title=Step-Up to Medicine |url=https://archive.org/details/stepuptomedicine0000agab |url-access=registration |series=Step-Up Series |publisher=Lippincott Williams & Wilkins |location=Hagerstwon MD |year=2008 |page=[https://archive.org/details/stepuptomedicine0000agab/page/253 253] |isbn=978-0-7817-7153-5 }}</ref>
|-
!  !! [[Osteoarthritis]] !! [[Rheumatoid arthritis]] !! [[Gouty arthritis]]
|-
! Speed of onset
| Months-Years || Weeks-months<ref name=Chan1994>[[Diagnosis lag time]] of median 4 weeks, and median [[diagnosis lag time]] of 18 weeks, taken from: {{cite journal | vauthors = Chan KW, Felson DT, Yood RA, Walker AM | title = The lag time between onset of symptoms and diagnosis of rheumatoid arthritis | journal = Arthritis and Rheumatism | volume = 37 | issue = 6 | pages = 814–820 | date = June 1994 | pmid = 8003053 | doi = 10.1002/art.1780370606 }}</ref> || Hours for an attack<ref name=Harwood-Nuss2009>{{cite book | vauthors = Schaider J, Wolfson AB, Hendey GW, Ling L, Rosen CL |title=Harwood-Nuss' Clinical Practice of Emergency Medicine (Clinical Practice of Emergency Medicine (Harwood-Nuss)) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2009 |pages=740 (upper right of page) |isbn=978-0-7817-8943-1 |url=https://books.google.com/books?id=Idb0Z658lFQC&pg=PT773 |url-status = live|archive-url=https://web.archive.org/web/20150321185321/http://books.google.com/books?id=Idb0Z658lFQC&pg=PT773 |archive-date=21 March 2015 }}</ref>
|-
! Main locations
| Weight-bearing joints (such as [[knee]]s, [[Hip#Articulation|hips]], [[vertebral column]]) and hands
| Hands ([[Proximal interphalangeal joint|proximal interphalangeal]] and [[metacarpophalangeal joint]]) [[wrist]]s, [[ankle]]s, [[knee]]s and [[hip]]s
| [[Great toe]], [[ankle]]s, [[knee]]s and [[elbow]]s
|-
! Inflammation
| May occur, though often mild compared to inflammation in rheumatoid arthritis || Yes || Yes
|-
! [[Radiologic]] changes
|
* Narrowed joint space
* [[Osteophyte]]s
* Local [[osteosclerosis]]
* [[Subchondral cyst]]s
|
* Narrowed joint space
* Bone erosions
|
* "Punched out" bone erosions
|-
! Laboratory findings
| None || [[Anemia]], elevated [[erythrocyte sedimentation rate|ESR]] and [[C-reactive protein]] (CRP), [[rheumatoid factor]], [[anti-citrullinated protein antibody]]
| [[Crystal]] in joints
|-
!Other features
|
* No systemic signs
* [[Bouchard's nodes|Bouchard's]] and [[Heberden's node]]s
|
* [[#Signs and symptoms|Extra-articular features]] are common
* [[Ulnar deviation]], [[swan neck deformity|swan neck-]] and [[Boutonniere deformity]] of the hand
|
* [[Tophus|Tophi]]
* [[Nephrolithiasis]]
|}

=== Other ===
[[Infectious arthritis]] is another severe form of arthritis that is sometimes referred to as septic arthritis. It typically occurs when a patient is ill or has an infection. Common symptoms include the sudden onset of chills, fever, and joint pain. The condition is caused by bacteria that spread through the blood stream from elsewhere in the body. This bacteria can travel to specific joints and start to erode cartilage. Infectious arthritis must be rapidly diagnosed and treated promptly in order to prevent irreversible joint damage.<ref>{{cite web | url = http://www.arthritis.org/ | title = Severe Arthritis Disease Facts | archive-url = https://web.archive.org/web/20070423120449/http://www.arthritis.org/ | work = Arthritis.org | archive-date=23 April 2007 | access-date = 5 February 2010 }}</ref> Only about 1% of cases of infectious arthritis are a result of [[virus]]es.<ref name="pmid27037381">{{cite journal | vauthors = Marks M, Marks JL | title = Viral arthritis | journal = Clinical Medicine | volume = 16 | issue=2 | pages = 129–134 | date=2016 | doi = 10.7861/clinmedicine.16-2-129 | pmc=4868140 | pmid = 27037381}}</ref> Within recent years, the virus [[SARS-CoV-2]], which causes [[Covid-19]], has been added to this list.<ref name="pmid35655110">{{cite journal | vauthors = Slouma M, Abbes M, Louzir B | title = Reactive arthritis occurring after COVID-19 infection: a narrative review | journal = [[Infection (journal)|Infection]] | volume = 51 | issue=1 | pages = 37–45 | date=2023 | doi = 10.1007/s15010-022-01858-z | pmc=9162104 | pmid = 35655110}}</ref> SARS-CoV-2 tends to cause [[reactive arthritis]] rather than local septic arthritis.<ref name="pmid35655110" />

[[Psoriasis]] can develop into psoriatic arthritis.<ref name=":3" /> With psoriatic arthritis, most individuals first develop skin symptoms (such as scaly patches and itchiness) and then begin to experience joint related symptoms. They typically experience continuous joint pain, stiffness and swelling like other forms of arthritis. This disease can go into [[remission (medicine)|remission]], but there is currently no known cure for the disorder.<ref name=":3" /> Treatment current revolves around decreasing autoimmune attacks with immune suppressive medications.<ref name=":3" /> A small percentage of patients with psoriatic arthritis can develop a severely painful and destructive form of arthritis which destroys the small joints in the hands and sometimes lead to permanent disability and loss of hand function.<ref name=":3">{{cite web | url = http://www.mayoclinic.com/health/psoriatic-arthritis/DS00476/DSECTION=symptoms | title = Psoriatic Arthritis | work = Mayo Clinic | archive-url = https://web.archive.org/web/20100209073725/http://www.mayoclinic.com/health/psoriatic-arthritis/DS00476/DSECTION%3Dsymptoms | archive-date=9 February 2010 | access-date = 5 February 2010 }}</ref>

== Treatment ==
There is no known cure for arthritis and rheumatic diseases. Treatment options vary depending on the type of arthritis and include [[physical therapy]], exercise and diet, [[Brace (orthopaedic)|orthopedic bracing]], and oral and topical medications.<ref name=niams/><ref>{{cite web|title=Knee braces for osteoarthritis - Mayo Clinic|url=https://www.mayoclinic.org/tests-procedures/knee-braces/about/pac-20384791|access-date=31 March 2021|website=www.mayoclinic.org}}</ref> [[Joint replacement surgery]] may be required to repair damage, restore function, or relieve pain.<ref name=niams/>

=== Physical therapy ===
In general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.<ref>{{cite journal | vauthors = Ettinger WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, Craven T | display-authors = 6 | title = A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST) | journal = JAMA | volume = 277 | issue = 1 | pages = 25–31 | date = January 1997 | pmid = 8980206 | doi = 10.1001/jama.1997.03540250033028 }}</ref>

Individuals with arthritis can benefit from both physical and [[occupational therapy]]. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay the need for surgical intervention in advanced cases.<ref>{{cite journal | vauthors = Fransen M, Crosbie J, Edmonds J | title = Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial | journal = The Journal of Rheumatology | volume = 28 | issue = 1 | pages = 156–164 | date = January 2001 | pmid = 11196518 | url = http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=11196518 }}</ref> Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities. Assistive technology is a tool used to aid a person's disability by reducing their physical barriers by improving the use of their damaged body part, typically after an amputation. Assistive technology devices can be customized to the patient or bought commercially.<ref>{{cite web|url=https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/assistive-technology.aspx|title=The Role of Occupational Therapy in Providing Assistive Technology Devices and Services|date=2018|website=www.aota.org|access-date=8 April 2018}}</ref>

=== Medications ===
There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.<ref>{{cite web|url= http://www.arthritistoday.org/treatments/drug-guide/index.php|title=Arthritis Drugs|work=arthritistoday.org|access-date=5 July 2010| archive-url= https://web.archive.org/web/20100722013235/http://www.arthritistoday.org/treatments/drug-guide/index.php| archive-date= 22 July 2010 <!--DASHBot-->|url-status = live}}</ref>

Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for [[osteoarthritis]] is [[acetaminophen]] (paracetamol) while for [[inflammatory arthritis]] it involves [[non-steroidal anti-inflammatory drug]]s (NSAIDs) like [[ibuprofen]]. [[Opioid]]s and NSAIDs may be less well tolerated.<ref>{{cite journal | vauthors = Reid MC, Shengelia R, Parker SJ | title = Pharmacologic management of osteoarthritis-related pain in older adults | journal = The American Journal of Nursing | volume = 112 | issue = 3 Suppl 1 | pages = S38–S43 | date = March 2012 | pmid = 22373746 | pmc = 3733545 | doi = 10.1097/01.NAJ.0000412650.02926.e3 }}</ref> However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular [[corticosteroid]] injections may also be considered.<ref>{{Cite journal |last1=McAlindon |first1=Timothy E. |last2=LaValley |first2=Michael P. |last3=Harvey |first3=William F. |last4=Price |first4=Lori Lyn |last5=Driban |first5=Jeffrey B. |last6=Zhang |first6=Ming |last7=Ward |first7=Robert J. |date=2017-05-16 |title=Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial |journal=JAMA |language=en |volume=317 |issue=19 |pages=1967–1975 |doi=10.1001/jama.2017.5283 |issn=0098-7484 |pmc=5815012 |pmid=28510679}}</ref><ref>{{cite journal | vauthors = Taruc-Uy RL, Lynch SA | title = Diagnosis and treatment of osteoarthritis | journal = Primary Care | volume = 40 | issue = 4 | pages = 821–36, vii | date = December 2013 | pmid = 24209720 | doi = 10.1016/j.pop.2013.08.003 | s2cid = 43061687 }}</ref>

The drugs to treat [[rheumatoid arthritis]] (RA) range from [[corticosteroid]]s to [[monoclonal antibodies]] given [[Intravenous therapy|intravenously]]. Due to the [[autoimmune]] nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called [[disease-modifying antirheumatic drug]]s (DMARDs). csDMARDs, TNF biologics and tsDMARDs are specific kinds of DMARDs that are recommended for treatment.<ref>{{cite journal | vauthors = Donahue KE, Schulman ER, Gartlehner G, Jonas BL, Coker-Schwimmer E, Patel SV, Weber RP, Bann CM, Viswanathan M | display-authors = 6 | title = Comparative Effectiveness of Combining MTX with Biologic Drug Therapy Versus Either MTX or Biologics Alone for Early Rheumatoid Arthritis in Adults: a Systematic Review and Network Meta-analysis | journal = Journal of General Internal Medicine | volume = 34 | issue = 10 | pages = 2232–2245 | date = October 2019 | pmid = 31388915 | pmc = 6816735 | doi = 10.1007/s11606-019-05230-0 }}</ref> Treatment with DMARDs is designed to slow down the progression of RA by initiating an [[adaptive immune system|adaptive immune response]], in part by CD4+ T helper (Th) cells, specifically Th17 cells.<ref name="pmid23383714">{{cite journal | vauthors = Kurebayashi Y, Nagai S, Ikejiri A, Koyasu S | title = Recent advances in understanding the molecular mechanisms of the development and function of Th17 cells | journal = Genes to Cells | volume = 18 | issue = 4 | pages = 247–265 | date = April 2013 | pmid = 23383714 | pmc = 3657121 | doi = 10.1111/gtc.12039 }}</ref> Th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17).<ref name="Chabaud_2000" />

=== Surgery ===
A number of [[Rheumasurgery|surgical]] interventions have been incorporated in the treatment of arthritis since the 1950s. The primary surgical treatment option of arthritis is joint replacement surgery known as arthroplasty.<ref name=":4">{{Cite journal |last1=Park |first1=Jisu |last2=Chang |first2=Moon Jong |last3=Kim |first3=Tae Woo |last4=D'Lima |first4=Darryl D. |last5=Kim |first5=Hyunkwon |last6=Han |first6=Hyuk-Soo |date=2024-12-04 |title=Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis |journal=Knee Surgery & Related Research |language=en |volume=36 |issue=1 |page=43 |doi=10.1186/s43019-024-00241-6 |doi-access=free |issn=2234-2451 |pmc=11616191 |pmid=39633483}}</ref> Common joints that are replaced due to arthritis include the shoulder, hip, and knee.<ref name=":4" /> [[Arthroscopic surgery]] for osteoarthritis of the knee provides no additional benefit  to patients when compared to optimized physical and medical therapy.<ref name="pmid18784099">{{cite journal | vauthors = Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D'Ascanio LM, Pope JE, Fowler PJ | display-authors = 6 | title = A randomized trial of arthroscopic surgery for osteoarthritis of the knee | journal = The New England Journal of Medicine | volume = 359 | issue = 11 | pages = 1097–1107 | date = September 2008 | pmid = 18784099 | doi = 10.1056/NEJMoa0708333 | doi-access = free }}</ref> Joint replacement surgery can last anywhere from 15 to 30 years depending on the patient.<ref>{{Cite journal |last1=Evans |first1=Jonathan T |last2=Walker |first2=Robert W |last3=Evans |first3=Jonathan P |last4=Blom |first4=Ashley W |last5=Sayers |first5=Adrian |last6=Whitehouse |first6=Michael R |date=February 2019 |title=How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up |journal=The Lancet |language=en |volume=393 |issue=10172 |pages=655–663 |doi=10.1016/S0140-6736(18)32531-5 |pmc=6381229 |pmid=30782341}}</ref> Following joint replacement surgery, patients can expect to get back to several physical activities including those such as swimming, tennis, and golf.<ref>{{Cite journal |last1=Liu |first1=Joseph N. |last2=Steinhaus |first2=Michael E. |last3=Garcia |first3=Grant H. |last4=Chang |first4=Brenda |last5=Fields |first5=Kara |last6=Dines |first6=David M. |last7=Warren |first7=Russell F. |last8=Gulotta |first8=Lawrence V. |date=January 2018 |title=Return to sport after shoulder arthroplasty: a systematic review and meta-analysis |journal=Knee Surgery, Sports Traumatology, Arthroscopy |language=en |volume=26 |issue=1 |pages=100–112 |doi=10.1007/s00167-017-4547-1 |pmid=28409200 |issn=0942-2056}}</ref>

=== Adaptive aids ===
People with hand arthritis can have trouble with simple [[activities of daily living]] tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. There are [[adaptive equipment|adaptive aids]] or [[Assistive technology|assistive devices]] (ADs) available to help with these tasks,<ref>{{cite web |last=Bloomquist |first=Michele |title=Arthritis-Friendly Tools |website=Everyday Health |date=5 February 2013 |url=https://www.everydayhealth.com/arthritis-pictures/10-terrific-arthritis-gadgets.aspx |archive-url=https://web.archive.org/web/20200530173038/https://www.everydayhealth.com/arthritis-pictures/10-terrific-arthritis-gadgets.aspx |archive-date=2020-05-30 |access-date=8 March 2019}}</ref> but they are generally more costly than conventional products with the same function. It is now possible to [[3-D print]] adaptive aids, which have been released as [[open source hardware]] to reduce patient costs.<ref>{{cite web |date=15 December 2018 |url=https://orthofeed.com/2018/12/15/3-d-printing-offers-helping-hand-to-people-with-arthritis/ |title=3-D Printing Offers Helping Hand to People with Arthritis |website=OrthoFeed |access-date=8 March 2019 |archive-date=15 November 2020 |archive-url=https://web.archive.org/web/20201115053144/https://orthofeed.com/2018/12/15/3-d-printing-offers-helping-hand-to-people-with-arthritis/ |url-status=dead}}</ref><ref>{{cite journal |vauthors=Gallup N, Bow JK, Pearce JM |title=Economic Potential for Distributed Manufacturing of Adaptive Aids for Arthritis Patients in the U.S |journal=Geriatrics |volume=3 |issue=4 |pages=89 |date=December 2018 |pmid=31011124 |pmc=6371113 |doi=10.3390/geriatrics3040089 |doi-access=free}}</ref> Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.<ref>{{cite journal |vauthors=Yeung KT, Lin CH, Teng YL, Chen FF, Lou SZ, Chen CL |title=Use of and Self-Perceived Need for Assistive Devices in Individuals with Disabilities in Taiwan |journal=PLOS ONE |volume=11 |issue=3 |pages=e0152707 |date=29 March 2016 |pmid=27023276 |pmc=4811424 |doi=10.1371/journal.pone.0152707 |doi-access=free |bibcode=2016PLoSO..1152707Y}}</ref>

=== Alternative medicine ===
Further research is required to determine if [[transcutaneous electrical nerve stimulation]] (TENS) for knee osteoarthritis is effective for controlling pain.<ref>{{cite journal | vauthors = Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P | display-authors = 6 | title = Transcutaneous electrostimulation for osteoarthritis of the knee | journal = The Cochrane Database of Systematic Reviews | volume = 2009 | issue = 4 | pages = CD002823 | date = October 2009 | pmid = 19821296 | pmc = 7120411 | doi = 10.1002/14651858.CD002823.pub2 }}</ref>

[[Low level laser therapy]] may be considered for relief of pain and stiffness associated with arthritis.<ref>{{cite journal | vauthors = Brosseau L, Welch V, Wells G, Tugwell P, de Bie R, Gam A, Harman K, Shea B, Morin M | display-authors = 6 | title = Low level laser therapy for osteoarthritis and rheumatoid arthritis: a metaanalysis | journal = The Journal of Rheumatology | volume = 27 | issue = 8 | pages = 1961–1969 | date = August 2000 | pmid = 10955339 }}</ref> Evidence of benefit is tentative.<ref>{{cite journal | vauthors = Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K, Morin M, Shea B, Tugwell P | display-authors = 6 | title = Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2005 | issue = 4 | pages = CD002049 | date = October 2005 | pmid = 16235295 | pmc = 8406947 | doi = 10.1002/14651858.CD002049.pub2 }}</ref>

[[Pulsed electromagnetic field therapy]] (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis.<ref>{{cite journal | vauthors = Vavken P, Arrich F, Schuhfried O, Dorotka R | title = Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials | journal = Journal of Rehabilitation Medicine | volume = 41 | issue = 6 | pages = 406–411 | date = May 2009 | pmid = 19479151 | doi = 10.2340/16501977-0374 | doi-access = free }}</ref> The FDA has not approved PEMFT for the treatment of arthritis. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.<ref>{{cite web|url=https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/licences/medical-devices-active-licence-listing.html|title=Medical Devices Active Licence Listing (MDALL) | work = Health Canada|date=16 July 2002 |access-date=28 March 2020}}</ref>

== Epidemiology ==
Arthritis is predominantly a disease of the elderly, but children can also be affected by the disease.<ref>{{cite web|url=https://medlineplus.gov/ency/article/000451.htm|title=Juvenile idiopathic arthritis: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=6 May 2019}}</ref> Arthritis is more common in women than men at all ages and affects all races, [[ethnic group]]s and cultures. In the United States, a CDC survey based on data from 2013 to 2015 showed 54.4 million (22.7%) adults had self-reported doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number is expected to increase. Adults with co-morbid conditions, such as heart disease, diabetes, and obesity, were seen to have a higher than average prevalence of doctor-diagnosed arthritis (49.3%, 47.1%, and 30.6% respectively).<ref>{{cite journal | vauthors = Barbour KE, Helmick CG, Boring M, Brady TJ | title = Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 66 | issue = 9 | pages = 246–253 | date = March 2017 | pmid = 28278145 | pmc = 5687192 | doi = 10.15585/mmwr.mm6609e1 }}</ref>

Disability due to [[musculoskeletal disorder]]s increased by 45% from 1990 to 2010. Of these, osteoarthritis is the fastest increasing major health condition.<ref>{{cite journal | title = GBD 2010 country results: a global public good | journal = Lancet | volume = 381 | issue = 9871 | pages = 965–970 | date = March 2013 | pmid = 23668561 | doi = 10.1016/S0140-6736(13)60283-4 | s2cid = 11808683 | author1 = ((GBD 2010 Country Collaboration)) }}</ref> 

Among the many reports on the increased prevalence of musculoskeletal conditions, data from Africa are lacking and underestimated. A [[systematic review]] assessed the prevalence of arthritis in Africa and included twenty population-based and seven hospital-based studies.<ref name=":0">{{cite journal | vauthors = Usenbo A, Kramer V, Young T, Musekiwa A | title = Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis | journal = PLOS ONE | volume = 10 | issue = 8 | pages = e0133858 | date = 4 August 2015 | pmid = 26241756 | pmc = 4524637 | doi = 10.1371/journal.pone.0133858 | doi-access = free | bibcode = 2015PLoSO..1033858U }}</ref> The majority of studies, twelve, were from South Africa. Nine studies were well-conducted, eleven studies were of moderate quality, and seven studies were conducted poorly. The results of the systematic review were as follows:<ref name=":0" />
* [[Rheumatoid arthritis]]: 0.1% in Algeria (urban setting); 0.6% in Democratic Republic of Congo (urban setting); 2.5% and 0.07% in urban and rural settings in South Africa respectively; 0.3% in Egypt (rural setting), 0.4% in Lesotho (rural setting)
* [[Osteoarthritis]]: 55.1% in South Africa (urban setting); ranged from 29.5 to 82.7% in South Africans aged 65 years and older
** Knee osteoarthritis has the highest prevalence from all types of osteoarthritis, with 33.1% in rural South Africa
* [[Ankylosing spondylitis]]: 0.1% in South Africa (rural setting)
* [[Psoriatic arthritis]]: 4.4% in South Africa (urban setting)
* [[Gout]]: 0.7% in South Africa (urban setting)
* [[Juvenile idiopathic arthritis]]: 0.3% in Egypt (urban setting)

== History ==
Evidence of osteoarthritis and potentially inflammatory arthritis has been discovered in dinosaurs.<ref name="DeLisaGans2005">{{cite book| vauthors = DeLisa JA, Gans BM, Walsh NE |title=Physical Medicine and Rehabilitation: Principles and Practice|url=https://books.google.com/books?id=1sWk1GYCvKoC&pg=PA765|year=2005|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-4130-9|pages=765–|url-status = live|archive-url=https://web.archive.org/web/20170108193339/https://books.google.com/books?id=1sWk1GYCvKoC&pg=PA765|archive-date=8 January 2017}}</ref><ref>{{cite journal | vauthors = Blumberg BS, Sokoloff L | title = Coalescence of caudal vertebrae in the giant dinosaur Diplodocus | journal = Arthritis and Rheumatism | volume = 4 | issue = 6 | pages = 592–601 | date = December 1961 | pmid = 13870231 | doi = 10.1002/art.1780040605 | doi-access =  }}</ref> The first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples.<ref name="Bridges ">{{cite journal | vauthors=Bridges PS | title=Prehistoric Arthritis in the Americas | journal=Annual Review of Anthropology | year=1992| volume=21 |pages=67–91 | doi=10.1146/annurev.an.21.100192.000435}}</ref> It was noted in skeletal remains of [[Native Americans in the United States|Native Americans]] found in [[Tennessee]] and parts of what is now [[Olathe, Kansas]]. Evidence of arthritis has been found throughout history, from [[Ötzi the Iceman|Ötzi]], a [[mummy]] ({{circa|3000 BC}}) found along the border of modern [[Italy]] and [[Austria]], to the Egyptian mummies {{Circa|2590 BC}}.<ref>{{cite web | url = http://www.news-medical.net/health/Arthritis-History.aspx | title = Arthritis History | archive-url = https://web.archive.org/web/20100130200315/http://www.news-medical.net/health/Arthritis-History.aspx | archive-date=30 January 2010 | work = Medical News | date = 2 December 2009 }}</ref>

In 1715, [[William Musgrave]] published the second edition of his most important medical work, ''De arthritide symptomatica'', which concerned arthritis and its effects.<ref name=ODNB>{{cite book | vauthors = Cameron A | chapter = Musgrave, William (1655–1721) | title = Oxford Dictionary of National Biography | publisher = Oxford University Press | date = September 2004 }}</ref> Augustin Jacob Landré-Beauvais, a 28-year-old resident physician at Salpêtrière Asylum in France was the first person to describe the symptoms of rheumatoid arthritis. Though Landré-Beauvais' classification of rheumatoid arthritis as a relative of gout was inaccurate, his dissertation encouraged others to further study the disease.<ref>{{cite journal | vauthors = Entezami P, Fox DA, Clapham PJ, Chung KC | title = Historical perspective on the etiology of rheumatoid arthritis | journal = Hand Clinics | volume = 27 | issue = 1 | pages = 1–10 | date = February 2011 | pmid = 21176794 | pmc = 3119866 | doi = 10.1016/j.hcl.2010.09.006 }}</ref>

[[John Charnley]] completed the first hip replacement (total hip arthroplasty) in England to treat arthritis in the 1960s.

== Society and culture ==
Arthritis is the most common cause of [[disability]] in the United States. More than 20 million individuals with arthritis in the United States have severe limitations in function on a daily basis.<ref name=cdc-ar/> [[Absenteeism]] and frequent visits to the [[physician]] are common in individuals who have arthritis. Arthritis can make it difficult for individuals to be physically active and some become home bound.<ref name=":1">{{Cite web |last=Mutter |first=Justin |date=2023-11-21 |title=Ask the Expert {{!}} What medical conditions most commonly cause older adults to become homebound? |url=https://dailyprogress.com/opinion/column/ask-the-expert-what-medical-conditions-most-commonly-cause-older-adults-to-become-homebound/article_e09690f8-8700-11ee-b460-5fe470a56392.html |access-date=2024-04-20 |website=The Daily Progress |language=en}}</ref> It is estimated that the total cost of arthritis cases is close to $100 billion of which almost 50% is from lost earnings.

== Terminology ==
The term is derived from ''[[wikt:arthr-|arthr-]]'' (from {{langx|grc|[[wikt:ἄρθρον|ἄρθρον]]|árthron| joint}}) and ''[[wikt:-itis#English|-itis]]'' (from {{lang|grc|-ῖτις}}, {{transliteration|grc|-îtis}}, {{Literal translation|pertaining to|lk=no}}), the latter [[suffix]] having come to be associated with [[inflammation]].

The word ''[[wikt:arthritides|arthritides]]'' is the plural form of arthritis, and denotes the collective group of arthritis-like conditions.<ref>{{cite web|title=Definition of ARTHRITIDES|url=https://www.merriam-webster.com/dictionary/ARTHRITIDES|access-date=5 November 2020|website=www.merriam-webster.com|language=en}}</ref>

== See also ==
* [[Antiarthritics]]
* [[Arthritis Care]] (charity in the UK)
* [[Arthritis Foundation]] (US not-for-profit)
* [[Knee arthritis]]
* [[Osteoimmunology]]
* [[Weather pains]]

== References ==
{{Reflist}}

== External links ==
* [http://www.rheumatology.org American College of Rheumatology]&nbsp;– US professional society of rheumatologists
* [https://web.archive.org/web/20150116000259/http://niams.nih.gov/Health_Info/Arthritis/default.asp National Institute of Arthritis and Musculoskeletal and Skin Diseases]&nbsp;- US National Institute of Arthritis and Musculoskeletal and Skin Diseases
* [https://www.arthritis.org/health-wellness/healthy-living/nutrition/anti-inflammatory/the-ultimate-arthritis-diet The Ultimate Arthritis Diet] [[Arthritis Foundation]]

{{Medical resources
| DiseasesDB      = 15237
| ICD11           = {{ICD11|FA00}}–{{ICD11|FA38}}
| ICD10           = {{ICD10|M00-M03}}, {{ICD10|M05-M14}}, {{ICD10|M15-M19}}, {{ICD10|M20-M25}}
| ICD9            = {{ICD9|710}}-{{ICD9|719}}
| ICDO            =
| OMIM            =
| MedlinePlus     = 001243
| eMedicineSubj   = search
| eMedicineTopic  = arthritis
| MeshID          = D001168
| SNOMED CT       = 372091005
}}
{{Diseases of the musculoskeletal system and connective tissue}}
{{Authority control}}

[[Category:Arthritis| ]]
[[Category:Aging-associated diseases]]
[[Category:Inflammations]]
[[Category:Rheumatology]]
[[Category:Wikipedia neurology articles ready to translate]]
[[Category:Skeletal disorders]]
[[Category:Wikipedia medicine articles ready to translate]]