Diagnosis and Treatment Options for Arthritis


The treatment of arthritis varies depending on which particular form of arthritis is present, its location, severity, persistence, and any underlying background medical conditions of the patient.

March 27, 2018

The treatment of arthritis varies depending on which particular form of arthritis is present, its location, severity, persistence, and any underlying background medical conditions of the patient.

Diagnosis of Arthritis:

Based on the signs and symptoms Arthritis can be diagnosed by a rheumatologist. There are several types of Arthritis. Therefore the type of Arthritis need to be diagnose for proper treatment. To make a proper diagnosis, the rheumatologist will ask questions about personal and family medical history, perform a physical exam and order diagnostic tests as no single test can confirm the specific type of Arthritis.
Certain blood, urine, joint fluid, and x-ray tests might be done. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and any blood test and x-ray findings.
Evaluation of the over 100 forms of arthritis including rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still's disease, dermatomyositis, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others can be done by a rheumatologists.
Other medical specialists might be consulted when specific organs are affected by disease beside from the joints associated with the arthritis. Accurate diagnosis in an early stage can help to prevent irreversible damage and disability. Exercise and rest, medications, physical therapy, are recommended for mild symptoms.

Treatment Options for Arthritis:

The treatment of arthritis varies depending on which particular form of arthritis is present, its location, severity, persistence, and any underlying background medical conditions of the patient.
Treatment programs include home remedies, nonprescription and prescription medications, joint injections, and surgical operations. Weight reduction and avoiding activities that exert excessive stress on the joint can also be a part of treatment programs in some cases. The goal of treatment of arthritis is to reduce joint pain and inflammation while preventing damage and improving and maintaining joint function.

Treatment for Mild Symptoms:

Treatment may not be necessary for arthritis patient with mild or no symptoms. However, pain and anti inflammatory medications can be taken when symptoms are troubling and persist.
Rest, heat/cold applications, and topical pain creams can be helpful in initial stage. Over-the-counter food supplements glucosamine and chondroitin may be helpful for people with osteoarthritis.These supplements are available in pharmacies and health-food stores without a prescription. But patients taking blood-thinners should be careful taking chondroitin as it can increase the blood-thinning effect and cause excessive bleeding.
Increasing the dietary fish intake or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis as fish oils have been shown to have some anti-inflammation properties.
Weight reduction is recommended for patients who are overweight and have early signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees. This is because obesity is one of the risk factor for osteoarthritis of the knee.
Dipping hands in hot wax (paraffin) dips in the morning can sometimes help relief of pain symptoms. Warm water soaks and wearing nighttime cotton gloves to keep the hands warm during sleep can also help ease symptoms of hand. Gentle range of motion exercises is recommended to perform regularly which can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.
Over the counter Pain relief medications, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis. Since acetaminophen has less gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), acetaminophen is generally the preferred initial drug given to patients with osteoarthritis, especially in elderly patients.
Pain-relieving creams that are applied to the skin over the joints can provide relief of daytime minor arthritis pain. These include capsaicin, diclofenac cream, salicin, methyl salicylate, and menthol.
Local ice application can sometimes be helpful for additional relief of mild symptoms, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home. Gout Arthritis can be impacted by dietary changes.

Medical Treatments for Arthritis:

Medical attention is not required for every arthritis patient. Some patients with osteoarthritis have minimal or no pain and may not need treatment. However, for patients with persisting joint symptoms, a proper diagnosis and an optimal long-term treatment plan should be done at the earliest. Depending on the joints involved and the severity of symptoms, the treatment plan will be decided for each affected person.

Medications:

Mild pain relievers such as aspirin and acetaminophen is the first line treatment for many patients with arthritis. Acetaminophen given in adequate doses is considered as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis.
Since acetaminophen has less gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), acetaminophen is generally the preferred initial drug given to patients with osteoarthritis, especially in elderly patients.
Pain-relieving creams can be applied to the skin over the joints which can provide relief of minor arthritis pain. These include capsaicin, salicin, methyl salicylate, and menthol. Pain as well as inflammation in the joints can be reduced by Nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs include aspirin, ibuprofen,nabumetone, meloxicam, diclofenac, celecoxib, piroxicam and naproxen.
To decrease the risk of side effects of these medications, NSAIDs should be used temporarily and then discontinue them for periods of time without recurrent symptoms.
As in osteoarthritis, the symptoms vary in intensity and can be intermittent, this is more often possible in case of people with osteoarthritis. The most common side effects of NSAIDs involve gastrointestinal problem, such as stomach upset, cramping diarrhea, ulcers, and even bleeding. The risk of these and other side effects increases in the elderly. Cox-2 inhibitors is a new NSAIDs that is found to be less toxicity to the stomach and bowels.
Cortisone is used in many forms to treat arthritis. It can be taken orally in the form of prednisone or methylprednisolone, given intravenously, and injected directly into the inflamed joints to rapidly decrease inflammation and pain while restoring function. These can be used only for the patient with severe symptoms, as repetitive cortisone injections can be harmful to the tissue and bones.
If surgery is not being considered as an option for persisting pain of severe osteoarthritis of the knee, a series of injections of hyaluronic acid can be injected into the joint which can be helpful sometimes. This is the option when it that does not respond to weight reduction, exercise, or medications.These injections can temporarily restore the thickness of the joint fluid and allow better joint lubrication.
Medications such as methotrexate and sulfasalazine are used to suppress the immune system in case of rheumatoid arthritis or ankylosing spondylitis. Biological response modifiers can target specific areas of immune activation. Sometimes combinations of medications are used depending on the conditions. All of these medications require regular dosing and monitoring.

Surgery:

Surgery can be considered as an option for people with permanent damage that limits daily function, mobility and independence. Surgical procedures can be performed to relieve pain, improve function, and correct deformity. Occasionally, joint tissue is surgically removed for the purpose of biopsy and diagnosis. Orthopedic surgeons are doctors who is specialized in joint surgery.
Arthroscopy is a cutting instrument with viewing tube is generally used for this surgery. A bone-removal procedure called osteotomy can help realign some of the deformity in selected patients, usually those with knee disease. Removal of inflamed joint lining tissue is called synovectomy. Joint replacement surgery can relieve pain and restore function in joints which are badly damaged by RA. Damaged parts of a joint can be replaced with artificial joint (arthroplasty) such as metal and plastic parts in surgery. The small joints of the hand can be replaced with plastic material where as large joints, such as the hips or knees, are replaced with metals. Most common replacement are done for hip and knee. However, ankles, shoulders, wrists, elbows, and other joints may also be considered for replacement. Total hip and total knee replacements are now very common. These can relief pain and improved joint function.

Medical Follow-up After Initial Arthritis Treatment:

For the safest use of medications, communication with the treating doctor is essential both before and especially after the diagnosis of arthritis. By doing this the doctor can be aware of the patient's symptoms as well as their tolerance to and acceptance of various treatment options. On the other hand the patient can be assured that they have an understanding of the diagnosis and how the condition does and might affect them.
For monitoring your improvement in condition, regular follow-up with the health care professional is essential. People with rheumatoid arthritis, can develop certain symptoms that are really warning signs of some unexpected serious problem.
These rheumatoid warning signs are reasons to call the doctor so that they can be interpreted if medical emergency is required. The doctor can decide if any action should be taken immediately or in the near future by looking in to the overall condition of the patient.
Rheumatoid warning signs can be due to side effects of medications or a worsening or complications of the rheumatoid disease, or a new disease associated with it that is complicating the condition of patients with rheumatoid arthritis. Patients with rheumatoid arthritis should be aware of these rheumatoid warning signs so that they can contact their health care professional to take required action before the disease get worsen.
Below listed are some warning signs that require contacting the doctor:

Lack of improvement of joint symptoms:

If a patient with rheumatoid arthritis has started on a treatment program on consultation of his/her doctor and is not showing improvement but is worsening, it should be brought to the attention of the doctor. It might sometimes takes time for the medications, physical therapy, etc., to control the inflammation after starting a new treatment program. These course of time will be decided by the doctor whether things are on place.

Fever:

A mildly elevated temperature is common in a person with rheumatoid arthritis. But temperature above 100.4 degrees F or 38 degrees C is not expected and can represent an infection. People with rheumatoid arthritis are at increased risk for infection because of their disease. Often the cause of infection is due to suppression of the immune system of the body that is responsible for defending against infectious microbes by medications used for rheumatoid arthritis.
These medications can further increase the risk of a more serious infection when a bacterium or virus strikes. As soon as a fever occurs in people with rheumatoid arthritis it should be informed to the doctor so that infections are treated at the earliest time possible which can minimize the chances for many serious complications of infections.

Numbness or tingling:

Swelling of joint can pinch the nerves of sensation that pass next to it. If the swelling irritates the nerve, either because of the inflammation or pressure, sensations of pain, numbness, and/or tingling is sent to the brain by the nerve which is called nerve entrapment. Nerve entrapment most frequently occurs at the wrist and elbow. It should be treated early for best results. Neuropathy is rare form of nerve disease in patients with rheumatoid arthritis that causes numbness and/or tingling. It is damage of the nerves that can result from inflammation of blood vessels called vasculitis in people with rheumatoid arthritis.
Vasculitis it is a very dangerous disease and can be fatal which is very rare. Therefore, it is important to inform the doctor if numbness and/or tingling occurs.

Rash:

Rashes can occur for many reasons in anybody. However, in people with rheumatoid arthritis, the medications such as gold, methotrexate, leflunomide, and hydroxychloroquine can cause rashes as a result of side effects. Vasculitis can cause rash that most commonly appears in the finger tips, toes, or legs.

Eye redness:

Because of dryness of the eyes in Sjogren's syndrome, redness of the eyes is more common in people with rheumatoid arthritis which is an indication of infection of the eyes. Redness can also result from blood vessel inflammation or vasculitis, especially when pain is present.

Vision loss of red/green color distinction:

The commonly used rheumatoid arthritis drug hydroxychloroquine can cause injury to the retina which is a rare complication. The earliest sign of retinal changes from hydroxychloroquine is a decreased ability to distinguish between red and green colors as the vision area of the retina that normally detects these colors is first affected by the drug. If this happens you should stop taking hydroxychloroquine and contact your doctor immediately.