Inflammatory types of arthritis are characterized by their tendency to cause inflammation in joints and tendons. In inflammatory arthritis, the synovial membrane becomes swollen and inflamed, causing pain and stiffness. Chemicals released in the inflamed tissue increase blood flow to the joint, causing it to look red and feel warm to the touch. To reduce pain, patients with arthritis may favor affected joints, holding them in a fixed position. This causes the muscles surrounding the joints to stiffen and weaken and the tendons, which attach muscles to bone or to other muscles, to tighten. As a result, joints may contract or change shape and patients may eventually lose mobility. Inflammatory arthritis may be caused by autoimmune diseases in which the body’s immune system attacks its own healthy tissue. It can also be caused by crystal deposits in the joints or by infection.
Osteoarthritis
Osteoarthritis, a degenerative disease characterized by inflammation of the joints between bones, usually as a result of wear and tear over the years. Osteoarthritis is the most common of the various kinds of arthritis. It affects joints of the neck, back (joints of the spine), knees, hips, fingers, thumbs, and big toes. Osteoarthritis occurs most often after age 45, and, according to the Arthritis Foundation, affects an estimated 20.7 million Americans.
In a healthy joint, cartilage (smooth, elastic tissue that cushions the joint and allows for ease of movement) protects the ends of the bones. In osteoarthritis, years of joint use may eventually cause the cartilage to deteriorate, changing its surface from smooth to rough. Occasionally, a direct injury to a joint can cause osteoarthritis.
As the cartilage deteriorates, the ends of the bones begin to rub together, causing joint swelling. Eventually, bone may grow along the sides of the joint in the form of lumps, or spurs. These joint changes cause the typical symptoms of osteoarthritis: pain when the joint is used that may remain even after movement has stopped, swelling, a gradual loss of joint flexibility, and weather-induced joint discomfort.
Doctors diagnose osteoarthritis by observing symptoms, by physical examination, and with X rays. The condition may be treated with an exercise program to strengthen muscles and lessen stiffening. Doctors also advise weight loss in overweight patients to ease the pressure on joints, and good posture to strengthen spine muscles. To ease pain and inflammation, doctors most frequently prescribe aspirin or other nonsteroidal anti-inflammatory drugs (NSAID). When inflammation is severe, corticosteroids may be injected into the joint to reduce inflammation. This treatment is most often performed on weight-bearing joints such as ankles or knees. Doctors also advise patients to use hot or cold compresses or topical preparations to relieve inflammation and pain. Sometimes a patient needs a mechanical aid, such as a walker or cane, to help with mobility.
Once damaged, a joint cannot be fully repaired, but when deterioration is extensive, doctors may perform joint replacement surgery (replacement arthroplasty), in which a plastic or stainless steel joint is installed. Doctors most often perform this surgery on hip joints, but it also is used for knee and finger joints.
In a healthy joint, cartilage (smooth, elastic tissue that cushions the joint and allows for ease of movement) protects the ends of the bones. In osteoarthritis, years of joint use may eventually cause the cartilage to deteriorate, changing its surface from smooth to rough. Occasionally, a direct injury to a joint can cause osteoarthritis.
As the cartilage deteriorates, the ends of the bones begin to rub together, causing joint swelling. Eventually, bone may grow along the sides of the joint in the form of lumps, or spurs. These joint changes cause the typical symptoms of osteoarthritis: pain when the joint is used that may remain even after movement has stopped, swelling, a gradual loss of joint flexibility, and weather-induced joint discomfort.
Doctors diagnose osteoarthritis by observing symptoms, by physical examination, and with X rays. The condition may be treated with an exercise program to strengthen muscles and lessen stiffening. Doctors also advise weight loss in overweight patients to ease the pressure on joints, and good posture to strengthen spine muscles. To ease pain and inflammation, doctors most frequently prescribe aspirin or other nonsteroidal anti-inflammatory drugs (NSAID). When inflammation is severe, corticosteroids may be injected into the joint to reduce inflammation. This treatment is most often performed on weight-bearing joints such as ankles or knees. Doctors also advise patients to use hot or cold compresses or topical preparations to relieve inflammation and pain. Sometimes a patient needs a mechanical aid, such as a walker or cane, to help with mobility.
Once damaged, a joint cannot be fully repaired, but when deterioration is extensive, doctors may perform joint replacement surgery (replacement arthroplasty), in which a plastic or stainless steel joint is installed. Doctors most often perform this surgery on hip joints, but it also is used for knee and finger joints.
Arthritis
Arthritis, any of more than 100 different diseases causing pain, stiffness, and in most cases, swelling in the joints.
Joints, found where two bones in the body meet, cushion the bones and prevent them from rubbing against each other during movement. Joints are composed of cartilage—smooth, elastic tissue—surrounded by a casing called the joint capsule. The joint capsule is lined with a synovial membrane that secretes synovial fluid, a liquid that fills the joint cavity and further reduces friction between the bones. Although all arthritic conditions involve joint pain, the severity, duration, and effects of this pain vary considerably from one condition to another.
Joints, found where two bones in the body meet, cushion the bones and prevent them from rubbing against each other during movement. Joints are composed of cartilage—smooth, elastic tissue—surrounded by a casing called the joint capsule. The joint capsule is lined with a synovial membrane that secretes synovial fluid, a liquid that fills the joint cavity and further reduces friction between the bones. Although all arthritic conditions involve joint pain, the severity, duration, and effects of this pain vary considerably from one condition to another.
Prostaglandins
Prostaglandins, in biochemistry and medicine, family of hormonelike chemicals occurring naturally in all mammals (see Biochemistry; Hormone). Prostaglandins, fatty-acid derivatives, are found in almost all tissues in the human body. More than a dozen biologically important forms of prostaglandins occur, affecting many essential physiological functions.
The first uses of prostaglandins were in obstetrics. By constricting blood vessels in the uterus, some prostaglandins stimulate contractions, making them useful in delivery or therapeutic abortion. In the late 1970s this same action was shown to cause the pain and cramping, called dysmenorrhea, that many women experience during the menstrual period. Administration of drugs that inhibit prostaglandin synthesis, such as ibuprofen and naproxen, relieves dysmenorrhea in most cases. The effects of prostaglandins on blood vessels are also thought to cause some migraine headaches.
The two prostaglandins discovered in the 1970s, thromboxane and prostacyclin, were found to affect the clotting ability of blood: one of them (thromboxane) promoting and the other (prostacyclin) inhibiting the clumping of platelets (thrombocytes), the small corpuscles in the blood that aid in wound healing. Because aggregation of platelets is thought to contribute to stroke and heart attacks, prostaglandin-synthesis inhibitors such as aspirin are now being tested for the ability to prevent these events. Prostaglandins also promote inflammation; thus drugs that block prostaglandin synthesis are effective against arthritis and similar diseases.
Prostaglandins block production of gastric acid, and work is progressing on the development of drugs that may prove useful for treatment of peptic ulcer and other conditions caused by gastric hyperactivity.
The first uses of prostaglandins were in obstetrics. By constricting blood vessels in the uterus, some prostaglandins stimulate contractions, making them useful in delivery or therapeutic abortion. In the late 1970s this same action was shown to cause the pain and cramping, called dysmenorrhea, that many women experience during the menstrual period. Administration of drugs that inhibit prostaglandin synthesis, such as ibuprofen and naproxen, relieves dysmenorrhea in most cases. The effects of prostaglandins on blood vessels are also thought to cause some migraine headaches.
The two prostaglandins discovered in the 1970s, thromboxane and prostacyclin, were found to affect the clotting ability of blood: one of them (thromboxane) promoting and the other (prostacyclin) inhibiting the clumping of platelets (thrombocytes), the small corpuscles in the blood that aid in wound healing. Because aggregation of platelets is thought to contribute to stroke and heart attacks, prostaglandin-synthesis inhibitors such as aspirin are now being tested for the ability to prevent these events. Prostaglandins also promote inflammation; thus drugs that block prostaglandin synthesis are effective against arthritis and similar diseases.
Prostaglandins block production of gastric acid, and work is progressing on the development of drugs that may prove useful for treatment of peptic ulcer and other conditions caused by gastric hyperactivity.
Ibuprofen
Ibuprofen, drug used to reduce inflammation, fever, and the sensation of pain. In prescription form, ibuprofen is usually taken to relieve the more severe symptoms associated with arthritis. The nonprescription form available over the counter is taken for low-intensity pain, inflammation, or fever.
Ibuprofen works by inhibiting the action of prostaglandins (chemicals that cause inflammation and contribute to the brain’s perception of pain). Ibuprofen reduces fever by blocking prostaglandin synthesis in the hypothalamus, a structure in the brain that regulates body temperature. Ibuprofen also acts as an anticoagulant, suppressing the formation of blood clots.
In adults, the dosage of ibuprofen commonly prescribed for arthritis is 1200 to 3200 mg per day, usually divided into 3 or 4 doses. For mild to moderate pain in nonprescription uses, the dosage is generally 400 mg taken every 4 to 6 hours as necessary. Because ibuprofen can cause stomach upset, pills should be swallowed with a full glass of water, and may be taken with food. Ibuprofen is not recommended for use by pregnant women.
Prolonged use of ibuprofen can result in ulcers and internal bleeding because it blocks the production of the stomach lining’s protective mucous barrier.
Ibuprofen prevents the body from excreting salt and water properly, and it should be used with caution by people who suffer from kidney disease, liver disease, or high blood pressure. The anticoagulant effect of ibuprofen can also result in excessive bleeding when taken prior to tooth extraction or minor surgery. When taken in excessive amounts, ibuprofen can produce a potentially fatal overdose syndrome, which usually involves vomiting, diarrhea, rapid breathing, or rapid heartbeat. Alcoholic beverages should be avoided while taking this medication.
Brand Names: Advil, Motrin, Nuprin
Ibuprofen works by inhibiting the action of prostaglandins (chemicals that cause inflammation and contribute to the brain’s perception of pain). Ibuprofen reduces fever by blocking prostaglandin synthesis in the hypothalamus, a structure in the brain that regulates body temperature. Ibuprofen also acts as an anticoagulant, suppressing the formation of blood clots.
In adults, the dosage of ibuprofen commonly prescribed for arthritis is 1200 to 3200 mg per day, usually divided into 3 or 4 doses. For mild to moderate pain in nonprescription uses, the dosage is generally 400 mg taken every 4 to 6 hours as necessary. Because ibuprofen can cause stomach upset, pills should be swallowed with a full glass of water, and may be taken with food. Ibuprofen is not recommended for use by pregnant women.
Prolonged use of ibuprofen can result in ulcers and internal bleeding because it blocks the production of the stomach lining’s protective mucous barrier.
Ibuprofen prevents the body from excreting salt and water properly, and it should be used with caution by people who suffer from kidney disease, liver disease, or high blood pressure. The anticoagulant effect of ibuprofen can also result in excessive bleeding when taken prior to tooth extraction or minor surgery. When taken in excessive amounts, ibuprofen can produce a potentially fatal overdose syndrome, which usually involves vomiting, diarrhea, rapid breathing, or rapid heartbeat. Alcoholic beverages should be avoided while taking this medication.
Brand Names: Advil, Motrin, Nuprin
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