Penn Orthopaedics

Arthritis Frequently Asked Questions

Arthritis affects over 50 million U.S. adults and is the nation's most common cause of disability. Learn more about arthritis and ways to manage it.

About Arthritis

What is arthritis?

Arthritis is the inflammation (or stress) of a joint — resulting from a disease, infection, genetic defect, injury, overuse or other unknown cause. There is no known cure, but proper early treatment can help prevent further joint damage.

What are the symptoms?

Arthritis-related joint symptoms include pain, stiffness, inflammation and damage to joint cartilage and surrounding structures. This type of damage can lead to weakness of the joint and can affect many basic daily tasks, such as walking, climbing stairs, using a computer keyboard and, even, brushing your teeth.

What are the most common types of arthritis?

Often referred to as a single disease, arthritis is an umbrella term for over 100 types of medical conditions. The most common types are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, also called degenerative joint disease, refers to the pain and swelling that can result from the progressive loss of cartilage in the joints. As the cartilage wears down, the bones in the joint will begin to rub on one another. Bony spurs can develop on the unprotected bones causing pain and inflammation.

Rheumatoid arthritis, generally affecting women between the ages of 30-50, is characterized by inflammation, swelling, and pain in the hands, wrists, elbows, shoulders, knees and feet. The discomfort usually develops and worsens over weeks or months and tends to be most severe upon awakening.

What are the risk factors for arthritis?

Though the exact cause of arthritis may not be known, there are risk factors that increase an individual's chances of developing the disease. Some risk factors include:

Age: The risk of developing arthritis, especially osteoarthritis, increases with age.

Weight: Added weight puts extra strain on joints and increases wear and tear.

Occupation: Jobs that require heavy lifting or repetitive movements cause stress on the joints.

Gender: Arthritis occurs more frequently in women.

How is arthritis diagnosed?

To diagnose arthritis, your doctor will consider your symptoms; perform a physical exam to check for swollen joints or loss of motion, and order blood tests and X-rays. X-rays and blood tests are also used to help determine the type of arthritis. Doctors can use X-rays to diagnose osteoarthritis, by looking for loss of cartilage, bone spurs, and in extreme cases, bone rubbing against bone.

MRI's or magnetic resonance imaging can also be helpful in certain cases, but are not always needed. If you've already been x-rayed and the results didn't immediately reveal anything, but you are experiencing some atypical pain, an MRI can greatly help in the diagnosis of the condition. If you have already been diagnosed with arthritis and are planning on getting it treated by surgery, an MRI is not needed.

Possible lab tests that often help in the diagnosis are:

  • Rheumatoid factor test
  • Anti-CCP antibody test
  • Complete blood count
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Joint ultrasound
  • Synovial fluid analysis
Why do my joints make popping or cracking sounds? Does that mean I have arthritis?

Popping and cracking sounds are not necessarily signs that you have, or will, develop arthritis. These noises are simply fluid dispersing and do not mean that your joints are rubbing together or wearing out.

Oftentimes joints can lock up — with a loud pop — because something gets caught in between the joint surfaces. Torn cartilage in the knee or a loose piece of bone or cartilage in the joint can do this. Once a joint is stuck in this way it may need to be wiggled around to unlock it. This may also cause a pop.

If the sounds are accompanied by pain, you should be examined by a physician.

Living with Arthritis

How can you prevent arthritis flare-ups?

The pain caused by arthritis can be extreme and frequently debilitating. There are many ways you can prevent arthritis pain flare-ups.

  • Follow your treatment plan. Adhering to the treatment plan your physicians have created is one of the most important ways to prevent joint pain. Not taking the medications and not completing other treatments prescribed by your physicians reduces the effectiveness of your treatment and makes you more prone for further joint inflammation, damage and pain.

  • Keep Moving. Staying active helps to retain range-of-motion in the affected joints while also strengthen the muscles that support it. When you stop moving, your joints stiffen and your muscles weaken, increasing the strain and stress on your joints.

  • Protect your Joints. Find ways to reduce stress on joints by minimizing the burden of activities.

What exercises help relieve arthritis symptoms?

Exercise can increase joint mobility, improve muscle strength and flexibility, and help to maintain a healthy weight. A good plan should include three types of exercises — range-of-motion, strengthening and endurance.

Range-of-motion exercises: These exercises (also known as stretching or flexibility exercises) help to relieve stiffness and increase joint mobility. The goal is to get your joints moving in their normal range of movement. Examples include raising your arms over your head or rolling your shoulders back and forth. It is recommended that these exercises be done daily or at least every other day.

  • Yoga
  • Pilates
  • T'ai chi

Strengthening exercises: Strong muscles help support and protect joints. A workout program that includes weight or resistance training can help to maintain current muscle strength or increase it. These type of exercises should be done every other day, but allow an extra day in between if joints become painful or swollen.

  • Wrist curls
  • Overhead arm raises
  • Seated rows

Aerobic or endurance exercises: These types of activities can improve your cardiovascular health, give you more energy and help to maintain or reduce weight. Having control of your weight reduces the pressure on affected joints. Try to include 20-30 minutes of aerobic exercise three times a week.

  • Walking
  • Bike-riding
  • Swimming
Does the weather have an impact on joint pain severity?

Several atmospheric variables, including temperature, humidity, and barometric pressure have been studied to determine their correlation with joint pain, but these studies have been inconclusive.

It is important to remember that bones, muscles and tendons that make up joints (knee, hip, shoulder, etc.) are all living tissue and contain water. As a result, external changes around the body can affect the water content of the tissues and potentially cause swelling or tightness in the area, leading to temporary pain and discomfort.

  • Maintain comfortable living environment: During colder months, keep warm by wearing extra layers and heating your house. In the warmer months, remove unnecessary layers and use air conditioning.
  • Keep active: To avoid stiff, achy joints, take walks or find other ways to stay active, regardless of the weather.
  • Realize the pain is temporary: Pain caused by atmospheric pressure change is short-lived and the body will begin to adjust bringing it back to equilibrium.
How does weight affect arthritis?

Your hips and knees are weight bearing joints and must support most, if not all, of your body weight. Because of that, it is extremely important to maintain a healthy weight to help prevent and manage arthritis.

Using your knee joint as the example, it is estimated that over four times one's body weight is applied to the knee. The additional strain on the joints could increase or accelerate cartilage damage causing osteoarthritis, inflammation and joint pain. According to the Centers for Disease Control and Prevention (CDC), two out of every three overweight individuals are likely to develop osteoarthritis in their lifetime.

Keeping your weight within the healthy range (using BMI as a guide) is an excellent way to keep the strain on your joints and your risk of osteoarthritis at a minimum. Just as increasing your weight increases strain on your joints, losing weight reduces that strain and lowers your risk factors for developing osteoarthritis while reducing inflammation and joint pain for those who already suffer from arthritis.

How much weight should I lose to reduce arthritis pain?

For an overweight individual (based on body mass index or BMI), every extra pound equates to over 3 times that weight being applied to the joints. So, losing any amount of weight is helpful in reducing strain on your joints.

Though there is no "perfect" amount to lose, aiming to lose 10 pounds (depending on your starting BMI) is a good goal. By doing so, you would remove an estimated 45 pounds of weight from your joints. Or, about three average size bowling balls!

Structuring weight loss in 10 pound increments can also help to keep you motivated. If 10 pounds seems daunting, use five pound increments. You still have the benefit of setting small goals on the path to your ultimate goal weight, and losing five pounds still removes an estimated 22.5 pounds off your joints, about the size of an average car tire.

What foods or vitamins help prevent arthritis?

A healthy diet assists in maintaining a healthy body weight, lessening the force and stress that is put on major joints such as the hip and knee. One way to prevent arthritis and arthritis pain, especially rheumatoid arthritis is to eat foods that help curb an excessive inflammatory response from the body including:

  • Fatty Fish: Salmon, mackerel and tuna have high levels of Omega-3 fatty acids and Vitamin D, which have been found to help reduce inflammation. For non-fish eaters, consider fish oil supplements as an alternative.
  • Dark Leafy Greens: Spinach, kale, broccoli and collard greens are great sources for Vitamin E, which may help protect the body against pro-inflammatory molecules.
  • Nuts: Almonds and walnuts contain high amounts of fiber, calcium, Vitamin E and Omega-3 fats.
  • Olive Oil: The main compound in olive oil has been shown to have similar effect on pain and inflammation as NSAID painkillers.
  • Berries: All fruits are high in antioxidants, which can help fight inflammation. Additionally, blueberries, raspberries, strawberries and blackberries contain anthocyanins, which have shown to have anti-inflammatory properties.

Managing Joint Pain & Arthritis

How should I stand?

Your entire body helps you stand correctly. If you put too much weight on one foot, lean forward too much or position your feet outward or inward while standing, you could be causing pain in various parts of your body. To avoid joint pain:

  • Maintain good posture
  • Keep your knees slightly bent (unlock knees)
  • Tighten your stomach and buttocks muscles for extra core support
  • Stand with your feet shoulder-width apart with one foot in front of the other to improve your base of balance
How should I sit?

Because many Americans spend much of their day sitting (in the car, at the office or on the couch), it is important to be sure that you are not sitting in a way that could cause an arthritis pain flare-up. So when you are sitting, remember to:

  • Keep your spine stable
    • Maintain good posture
    • Keep your hips, knees, and ankles at a 90° angle
  • Keep your spine supported
    • If the chair you are sitting in doesn’t provide lower back support, use a rolled-up towel or a pillow for support
  • Relax your shoulders with your elbows at a 90° angle
  • Choose a seat/chair that enables you to adhere to the three rules above
How should I sleep?

Getting the recommended eight hours of sleep every night can, on its own, reduces pain by giving your joints time to rest. Despite this inherent benefit, sleeping in certain positions can actually cause pain. Some helpful tips to avoid joint pain:

  • If you sleep on your back:
    • Avoid using pillows under your knees
    • Keep your head and neck supported with a small roll or cervical pillow
  • If you sleep on your side:
    • Support your arms and legs with a pillow to keep your spine straight.
What are the best ways to do household chores?

It is easy to become overwhelmed by work around the house and with the fatigue and joint pain caused by arthritis; these activities are made even more difficult. To make them easier on both your joints and your peace-of-mind:

  • Maintain good posture
  • Plan ahead. Preparing ahead of time and setting reachable goals, will help you pace yourself and conserve energy, making it less likely you will over-exert yourself. This should help reduce strain on your joints.
  • Take breaks. Give your joints time to rest and recover when performing activities that put your body in awkward positions.
  • Use tools and gadgets. Minimize the amount of effort needed to complete the task. Everything from making sure your knives are sharp so they cut more easily, to using a "grabber" to pick things off the floor or from a high place without needing to bend or stretch your body helps reduce joint strain, retain energy, and fight fatigue caused by arthritis.
  • Lift with your legs. Never bend over to lift something that is low or on the ground. Instead, bend at your knees (keeping your back straight) and straighten your knees to lift it up.
  • Lift/Carry things close to your body. It is much more difficult and stressful on your joints to lift or carry something when it is further away from your center of balance.
What is the best way to go up and down stairs?
  • Let your stronger leg carry your weight.
  • When going up a flight of stairs, lead with your strong leg.
  • When going down the stairs, lead with your weaker leg because the leg you leave behind on the previous step will be actually holding most of your weight.
  • Be sure to always brace yourself on a hand rail when on the stairs.
What is the best way to get in and out of the car?
  • When entering and exiting a vehicle let your stronger leg carry your weight.
  • When entering a car, lead with your weaker leg because the leg you leave outside the car will be holding most of your weight.
  • When getting out of the car, lead with your strong leg.
  • Be sure to always brace yourself on the car door frame when getting in and out of the car. Do NOT brace yourself on the door because it can swing and cause you to lose your balance.

Arthritis Treatment

What are treatment options for arthritis?

Although there is no way to reverse cartilage loss or arthritis, there are numerous options to help relieve symptoms. Treatment of arthritis can include medications, injections, occupational and physical therapy, surgery and changes to one's lifestyle (rest, exercise, healthy eating).

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs): Address pain and inflammation caused by arthritis.

Analgesics: Specifically for pain relief for those who are unable to take NSAIDs, due to allergies or other side effects. Does not treat joint inflammation.

Corticosteroids: Reduces systemic inflammation caused by arthritis.

Disease modifying anti-rheumatic drugs (DMARDs): Manipulates and slow the development of autoimmune disease for those suffering from autoimmune disease–related types of arthritis.

Biologic response modifiers: Treat specific issues of certain types of arthritis by blocking the inflammation process, while not affecting the entire immune system.

Injections

Corticosteroid injections: Targets inflammation in the joints. Relief can last between several days to multiple months. Injections have shown to have increased effectiveness and fewer side effects compared to corticosteroids taken by mouth.

Hyaluronic acid injections: Osteoarthritis can cause the fluid around the joints to become thin, causing pain. These injections help to supplement joint lubrication, thus reducing pain and discomfort.

Occupational & Physical Therapy

Therapeutics: Through a variety of techniques and best practices, physical therapists can teach you ways to relieve discomfort and acute pain from everyday activities.

Joint Muscle and Ligament Training: There are many weight-training and low-impact aerobic exercises designed to strengthen the muscles and ligaments that support your joints. This can lead to reduced strain on the joints, which helps to mitigate the pain brought on by arthritis.

Apparel/Support: Braces and footwear can be worn to provide additional joint support. When worn during daily activities, braces and footwear can provide additional support and reduce strain and impact on the joint.

Surgery

In general, surgery is a last resort when other pain-relief methods are unsuccessful. Surgical procedures include:

Arthroscopy: A minimally-invasive procedure in which a small camera is used to examine and treat damage of the interior of a joint.

Osteotomy: When damage is located in one area of a joint, this procedure can be used to reshape and reposition bones in an effort to relieve pressure.

Resurfacing: The joint surfaces are reshaped and fitted with an implant covering that fits within the natural joint. Only the diseased portion is removed and is capped with a smooth metal covering.

Joint replacement: Damaged cartilage and bone is removed and replaced with joint implants.

What kinds of doctors treat arthritis?

Principally, there are five types of doctors who treat arthritis:

Primary care physicians are the first line for arthritis care and will be the ones to provide referrals for arthritis specialists to best treat the condition.

Physiatrists specialize in physical medicine and rehabilitation. They will evaluate your condition and prescribe various physical therapy exercises for rehabilitation and joint strengthening.

Occupational Therapists will provide guidance and advice on ways to reduce joint strain during activities of daily living (ADLs) through the use of ADL management strategies and supporting/assisting devices.

Orthopaedic Surgeons are often the leaders of a patient's arthritis management team. In addition to guiding the overall course of treatment, they treat arthritis with injections and surgical options meant to repair or replace the affected joint.

Rheumatologists specialize in the treatment of Rheumatoid arthritis (one of the two most common forms of arthritis).

In addition to these five, others who can be part of the arthritis treatment team are:

  • Internists
  • Pediatricians
  • Podiatrists
  • Nurses
  • Pharmacists
  • Certified dietitians (nutritionists)
  • X-ray and laboratory technologists
Heat or Cold: Which is better to relieve arthritis pain?

Heat and ice treatments are both known to temporarily reduce pain, stiffness and swelling associated with arthritis. It is important to remember that the effectiveness of each varies by individual.

  • Heat is most often used to relieve pain or relax muscles before exercise. Never apply heat for more than 20 minutes at a time and always allow skin to return to normal temperature before re-applying heat.
  • Cold is used to treat inflammation and lessen pain in a sore joint by numbing the area around the joint. Do not apply ice or cold packs directly to the skin, rather wrap them in a towel or other barrier to protect skin. Be careful not to make joints overly cold since the numbness can increase risk of overusing the joint.

Have a question you would like answered? Email us at pennorthopaedics@uphs.upenn.edu.