Common Types Of Arthritis
Commonly associated with older age, arthritis affects more than 50 million Americans, including more than 300,000 children each year. There are over 100 different forms of arthritis. Depending on the type, it can be extremely painful and affect everyday activities or go relatively unnoticed and be easily managed for years.
Simply put, arthritis is the inflammation of one or more joints. Most individuals experience common symptoms like joint pain, swelling, stiffness and/or decreased range of motion.
Here are 5 of the most common types of arthritis:
Gout Vs Rheumatoid Arthritis What Is The Difference
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Gout and rheumatoid arthritis are common bone and joint diseases mostly found in Thai population and worldwide. Since both types of orthopedic problems affect the joints and causing pain and inflammation, gout and rheumatoid arthritis can be generally confused with each another. Knowing the differences of these diseases helps to get accurate diagnosis and receive appropriate treatments in time.
Am I At Risk Of Having Gout
Youre more likely to have a gout attack if you:
- are male
- have a family history of gout
- have elevated levels of uric acid in the blood
- drink too much alcohol
- eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are overweight or obese
- use diuretics
- have type 2 diabetes, high blood pressure or high cholesterol these conditions can mean that your kidneys are less able to flush out the urates
- have kidney disease
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Spotlight On Gout: A Serious Yet Understated Form Of Arthritis
Meredith Hemler
Gout is not a disease that gets a lot of attention. Consequently, gout is widely misunderstood and often understated by the general public and even by those who suffer from the disease. In fact, just 10 percent of people with gout receive needed, ongoing treatment. This needs to be changed, considering the devastating consequences of untreated gout and elevated serum uric acid levels.
Caused by an accumulation of uric acid crystals in the joints and other tissues, gout is an extremely painful and chronic form of arthritis. Affecting more than 8.3 million Americans and growing, gout is the most common type of inflammatory arthritis even three to four times more common than Rheumatoid Arthritis, yet it gets just a fraction of the attention. Despite its growing prevalence, 70 percent of Americans dont know that gout is a form of arthritis three-quarters dont know what parts of the body it affects and half are unaware of gouts potentially crippling consequences.
Many people may recognize the classic signs of a gout attack sudden pain, warmth and swelling in one or more joints. Gout often begins in the big toe, but can also affect other areas including the feet, ankle, wrists, hands and elbows. The pain during a gout flare is so excruciating that many visit the emergency room for care. On a typical pain scale, most people with gout will rank their pain as a nine or a 10 with even the slightest touch causing agony.
About N. Lawrence Edwards, MD
What Is It Exactly
These attacks occur when urate crystals accumulate in the joints.
Normally, uric acid dissolves in the blood and passes through the kidneys into the urine.
The human body produces uric acid when it breaks down purines.
Purines are naturally found in your body, as well as in food such as organ meats, anchovies, asparagus, mushrooms and herring.
Sometimes, however, the body has either too much or too little uric acid.
With too much uric acid in the body, it starts to form sharp urate crystals which stab the joints or surrounding soft tissue, causing intense pain and inflammation.
Hyperuricemia is an abnormally high level of uric acid in the blood.
Surprisingly, hyperuricemia is commonly found in many people who never develop gout!
Your chances of developing gout are higher if youre overweight and the disease is more prevalent among men, but women become more susceptible after menopause.
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What Can I Do During A Gout Attack
You should see your doctor when you have your first attack of gout. Your doctor will recommend certain medicines to reduce pain and inflammation caused by gout, including:
Always talk to your doctor or pharmacist before you start taking any medicines. You may also need to protect the affected joint. For example, if your big toe is affected you may need to limit the amount of walking you do and create a bed cradle to keep your sheets off your foot when youre in bed.
Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
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Can Gout Be Prevented
The good news is that gout can be prevented. The goal of treatment is to lower uric acid levels to a level that prevents gout attacks. Your uric acid level can be checked with a blood test. For most people with gout, the target uric acid level you are aiming to achieve with treatment is:
Less than 0.36 millimoles per litre :
For some people with more severe gout, the target uric acid level will be less than 0.30 millimoles per litre . Talk to your doctor about treatments that can help you reach your target uric acid level, including:
Medicines: There are medicines that can lower uric acid levels in your blood. These medicines need to be taken every day, whether you are having an attack or not.
Alcohol: Cut down the amount of alcohol you drink and avoid drinking a lot of alcohol at one time . Talk to your doctor or visit www.alcohol.gov.au for Australian Government guidelines on recommended alcohol intake.
Weight loss: If you are overweight, lose weight gradually. Make sure you have a healthy diet as crash or starvation diets can actually increase uric acid levels. See a dietitian for advice.
Purine-rich foods: There are many misconceptions about diet and gout. For example it is commonly thought that foods such as citrus foods cause gout. There is no evidence that this is true. However several studies have shown that people with gout are more likely to eat certain foods.
The Queen ‘will Not Spend Christmas Alone’ Says Expert
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A painful flare-up of gout is enough to ruin your Christmas. With so many delicious foods on offer, do you know which ones to avoid if you often develop gout attacks? An expert weighs in on how to manage gout and avoid an excruciating flare-up this Christmas.
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Points To Remember About Gout
- Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
- With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
- The most common symptom of gout is pain in the affected joint, such as the big toe.
- Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.
The Role Of Imaging Tests
Both RA and gout can cause joint erosion, so rheumatologists will order X-rays to look for this. X-rays can also detect the beginnings of tophi, but Dr. Portnoff says theyre not an essential part of the diagnostic process for gout because a patients clinical history, physical exam, and uric acid testing will identify gout.
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How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
Medications For Acute Gout
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How Is Gout Diagnosed
Gout is diagnosed using a number of tests including:
- medical history
- physical examination
- blood test to measure urate levels although this cannot confirm gout
- removing a sample of fluid from the joint if you have gout, uric acid crystals can be seen under a microscope. This is the most definitive test
- ultrasound scan can identify early crystal formation in the fluid between your joints.
Early diagnosis and treatment is very important. The main goal for everyday management of gout is to reduce the level of uric acid in your blood so it cant form crystals in the tissues or joints and cause joint damage.
What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
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How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
Do Ra And Gout Have The Same Cause
Rheumatoid arthritis and gout both are types of arthritis, but the underlying causes are completely different. RA is an autoimmune condition. It happens when your bodyâs immune system attacks the tissue that lines your joints. This attack causes painful swelling, inflammation, and joint deformity. Since RA is an immune system disease , it can affect other parts of the body, too, including the skin, eyes, and heart.
Gout affects people with too much uric acid in their blood. Your body creates this type of acid when it breaks down certain foods, including meat. Your kidneys normally get rid of it when you pee. But when thereâs too much of it in your system, the uric acid can form crystals. These needle shaped crystals build up in joints and surrounding tissue where they can cause pain and inflammation.
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Common Symptoms Of Rheumatoid Arthritis
Symmetrical symptoms: In RA, joint pain usually affects both sides of the body. Symptoms typically begin in the small joints in the hands and feet as the disease progresses, pain can develop in the wrists, knees, ankles, elbows, hips, and shoulders.
Morning stiffness: The pain of RA is typically at its worst in the morning, which causes a period of stiffness that can last an hour or longer. Motion helps ease RA symptoms, so people generally feel better later in the day as they accumulate more activity.
How Will Gout Affect Me
Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.
Without medication attacks tend to happen more often and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- kidney stones
- an increased risk of some cancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction in men.
If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.
Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:
- treating the acute attack
- treatments to prevent future attacks.
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Do Doctors Treat Ra And Gout The Same Way
Neither RA nor gout is curable. But there are treatments to help manage your symptoms. Some are the same for either condition:
- Pain treatments. Over-the-counter pain relievers like ibuprofen and naproxen can help with either condition. A medication called colchicine can also ease gout pain.
- Inflammation treatments. Corticosteroids like prednisone can help with inflammation and the pain it causes.
When it comes to treating the underlying disease, doctors focus their efforts on treating the cause. RA treatment may include drugs that suppress the immune system.
Gout treatment usually includes medications that prevent the buildup of uric acid crystals.
What you eat can also affect the levels of uric acid in your blood. If you have gout, take these steps to prevent an attack of gout:
How Is Gout Arthritis Diagnosed
Uric acid levels can be measured by a simple thumb-prick blood test. Its good to have your blood tested at least once a year and try to keep your uric acid level below 0.36 millimoles per litre to prevent gout attacks.
Gout arthritis can also be diagnosed by testing a sample of fluid around the joint for urate crystals. X-rays will show damage to the joints in advanced stages of the disease, but are not useful for diagnosis as they are often normal in the early stages.
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Pathogenesis Of Acute Gouty Arthritis
Deposition of UA crystals in the joint cavity is the triggering cause of gout. These crystals initiate the inflammatory process by being engulfed by synovial phagocytic cells leading to release of lysosomal enzymes and production of inflammatory chemokines. Another mechanism is that UA crystals change the stability of cell membrane of phagocytic cells by direct crosslinkage with membrane lipids and glycoproteins. This involves the triggering of G protein, phospholipase A2, C and D, tyrosine kinase and other kinases such as mitogen-activated kinases and c-Jun N-terminal kinase. This interaction leads to increased IL-8 in phagocytes resulting in activation of neutrophils , .
The pathogenesis of gouty arthritis involves initial activation of monocytes and mast cells followed by neutrophils. Before the first attack of gout and in the inter-critical period, macrophages engulf UA crystals. Well-differentiated macrophages have the capability to contain these crystals without inducing an inflammatory response. While less-differentiated monocytes produce abundant amounts of TNF, IL-1, IL-6 and IL-8 along with endothelial activation following phagocytosis of urate crystals. Also, mast cells are key players in inducing the acute gouty attack by producing histamine and IL-1. This results in increasing vascular permeability and vasodilatation. Interestingly, it is thought that may even end the inflammatory phase by engulfing the crystals and the inflammatory debris , .