How often have you, like many others, woken up in the morning with stiff joints and aches all over? Sometimes this follows an unusually strenuous day. At other times, no obvious precipitating cause can be found. If the symptoms do not disappear after three or four days, or several episodes occur in a month, or if morning stiffness persists for more than 30 minutes, or the skin over a joint is red and warm, you may have arthritis.
Any joint discomfort that prevents you from comfortably performing your daily activities for three or more days should be taken seriously and evaluated. On the other hand, if the pain is mild, infrequent and disappears after a few days, it may simply be due to temporary overuse.
Arthritis is a generic term encompassing more than 100 related conditions that affect the joints, surrounding tissues and connective tissues. Some types require prompt treatment, while others develop slowly and can be evaluated without urgency. If you have an inflammatory arthritis that can permanently damage the joints, early treatment can preserve joint function and prevent other serious health problems.
As people age, wear and tear can damage the cushioning cartilage that reduces friction between the ends of bones. Osteoarthritis may then develop, often asymmetrically in weight-bearing joints such as the lower back, hips, knees and ankles. It is characterised by morning stiffness or after the joint has been rested, gradually increasing pain during movement with crackling or grating sounds. The risk increases with age, obesity, repetitive joint movements, and previous injuries, fractures or surgery.
In some families, members may have high levels of uric acid in the blood. Needle-shaped urate crystals can then accumulate in the joints, causing gout. Attacks produce sudden, severe pain, redness and swelling. Although the big toe is typically affected, gout can involve the ankles, knees, elbows, wrists or fingers. Repeated, untreated attacks can eventually cause permanent joint damage.
Viral infections can also cause joint pain. Mosquito-borne infections such as chikungunya and dengue, and infections such as parvovirus B19, Covid-19, and hepatitis B and C may produce fever, rashes and pain in several joints. These symptoms are often temporary, although joint pain following chikungunya may persist for months or even years.
Arthritis is characterised by morning stiffness or after the joint has been rested, gradually increasing pain during movement with crackling or grating sounds.
Arthritis is characterised by morning stiffness or after the joint has been rested, gradually increasing pain during movement with crackling or grating sounds.
Rheumatoid arthritis mainly affects middle-aged women but can occur in either gender and at any age. It is an autoimmune disease in which the immune system attacks the lining of the joints, commonly affecting the small joints of the hands and feet symmetrically. Without treatment, it can cause persistent pain and deformity. It may also affect the eyes, lungs, heart, blood vessels and nerves.
Arthritis may be part of other autoimmune diseases, including systemic lupus erythematosus and psoriatic arthritis. Ageing athletes, especially those who play contact sports, and people with physically demanding occupations may also be more likely to develop joint damage.
Joint pain and stiffness may occur in older people without an obvious cause. Arthritis is more common in people who are overweight, physically inactive, exposed to cigarette smoke or chew tobacco, or have a family history of the condition.
Diagnosing the cause of joint pain requires a detailed history, physical examination, blood tests and appropriate imaging. In osteoarthritis, x-rays may show narrowing of the joint space, bone spurs called osteophytes and changes in the underlying bone. Rheumatoid arthritis may produce symmetrical joint-space narrowing and erosions, although early x-rays can appear normal. Ultrasound or MRI can detect inflammation and early damage.
Blood tests may include the erythrocyte sedimentation rate (ESR) and C-reactive protein to assess inflammation. Uric acid levels may support a diagnosis of gout, but examining fluid drawn from the joint for urate crystals provides stronger confirmation. Rheumatoid factor and anti-CCP antibodies can support the diagnosis of rheumatoid arthritis. Antibody tests, antigen tests or ELISA or PCR may be required when an infection is suspected.
Specific treatment can begin once a diagnosis is reached. Medication can lower uric acid and prevent gout attacks. Treatment for rheumatoid arthritis has advanced considerably. In addition to analgesics and anti- inflammatory medicines, disease- modifying antirheumatic drugs such as methotrexate, leflunomide, hydroxychloroquine and sulfasalazine can slow disease progression. Biologics and Janus kinase inhibitors are also available. These treatments require supervision by a specialist.
Osteoarthritis can be managed with medication, weight control, exercise and physiotherapy. If pain is no longer controlled and daily functioning becomes difficult, surgical options may be considered. These include osteotomy, joint fusion and partial or total joint replacement. Injections may provide temporary relief for selected patients but cannot rebuild worn-out cartilage.
Painful joints require an accurate diagnosis and specific treatment. Arthritis is not a condition in which one treatment suits everyone.
To reduce the risk and impact of arthritis:
- Maintain an ideal body weight.
- Do not smoke or chew tobacco.
- Exercise aerobically for about 40 minutes on most days. If weight-bearing exercise is painful, swim or use a stationary cycle.
- Include strength training so that stronger muscles can support and stabilise affected joints.
- Seek physiotherapy for pain relief, flexibility, balance and muscle- strengthening exercises.
The writer is a paediatrician and author of Staying Healthy in Modern India