Arthritis

What is arthritis?

Arthritis is a common pain condition marked by inflammation of the joints. The inflammation causes pain, swelling, and stiffness. Arthritis can occur at any joint of the body.

There are different types of arthritis. The two most common are osteoarthritis and rheumatoid arthritis.

Osteoarthritis might best be considered the result of general wear and tear. It can occur from traumatic injuries, overuse, and age. It results from a loss of cartilage. Cartilage provides cushioning for the bones in the joints. The loss of cartilage causes inflammation when the joint is used. In turn, the inflammation leads to pain, tenderness, swelling, and stiffness. While it can occur any joint, osteoarthritis most commonly occurs in the hips, knees, ankles and feet.

Rheumatoid arthritis is the result of the immune system mistaking healthy cartilage for being diseased, and consequently it attacks the cartilage of the joints. Over time, the immune system erodes the cartilage. The subsequent loss of cartilage causes inflammation when the joints are used. In turn, the inflammation causes pain, joint stiffness, and swelling. In advanced stages, the joints become deformed. Rheumatoid arthritis most commonly occurs in the hands and fingers.

Central sensitization can occur in both types of arthritis.1, 2 Central sensitization is a highly reactive state of the central nervous system, which amplifies pain. It also can cause sensitivity to touch and mild pressure, fatigue, poor sleep, anxiety, and depression. It can occur with any pain disorder, including arthritis. Central sensitization is a complication of the pain associated with arthritis. It is important to address in treatment. 

Is there a cure for arthritis?

Arthritis is a chronic condition. Typically, chronic health conditions are also conditions that have no cure and last indefinitely.

Therapies & Procedures for arthritis

Common treatments for osteoarthritis are anti-inflammatory medications, physical therapy, cortisone injections, arthroscopic and joint replacement surgeries, and chronic pain rehabilitation programs.

Common treatments for rheumatoid arthritis are anti-inflammatory medications, chemotherapies, physical therapy, and chronic pain rehabilitation programs.

Chronic pain rehabilitation programs focus on reducing the central sensitization associated with any type of chronic pain condition, including arthritis. It is an intensive, interdisciplinary approach that combines lifestyle changes, coping skills training, and medication management. The overall goal of these treatment approaches is to reduce central sensitization by down-regulating the nervous system. The arthritic changes to the joints remain the same. However, by reducing central sensitization, pain is reduced to tolerable levels. Additionally, with less central sensitization, patients also have less fatigue, sleep problems and emotional distress.  As a result, they are more able to cope with the pain that remains. They are also more able to engage in the activities of life. 

References

1. Arendt-Nielsen, L., Nie, H., Laursen M. B., Laursen, B. S., Madeleine P., Simonson O. H., & Graven-Nielsen, T. (2010). Sensitization in patients with painful knee osteoarthritis. Pain, 149, 573-581.

2. Meeus M., Vervisch, S., De Clerck, L. S., Moorkens, G., Hans, G., & Nijs, J. (2012). Central sensitization in patients with rheumatoid arthritis: A systematic literature review. Seminars in Arthritis & Rheumatism, 41, 556-567.

Date of publication: April 27, 2012

Date of last modification: February 19, 2015

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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