OCTOBER 2014
ARTHRITIS AND RHEUMATIC
DISEASES
Arthritis literally means joint inflammation. Although
joint inflammation is a symptom or sign rather than a
specific diagnosis, the term arthritis is often used to
refer to any disorder that affects the joints. These
disorders fall within the broader category of rheumatic
diseases. These are diseases characterized by
inflammation (signs include redness or heat, swelling,
and symptoms such as pain) and loss of function of
one or more connecting or supporting structures of the
body. They especially affect joints, tendons, ligaments,
bones, and muscles. Common signs and symptoms
are pain, swelling, and stiffness. Some rheumatic
diseases also can involve internal organs.
There are more than 100 rheumatic diseases that
collectively affect more than 46 million Americans.
This overview provides brief descriptions of some of
the more common forms of arthritis and rheumatic
diseases as well information about their causes,
diagnosis, and treatments.
EXAMPLES OF RHEUMATIC DISEASES
The most common type of arthritis, osteoarthritis,
damages both the cartilage, which is the tissue that
cushions the ends of bones within the joint and the
underlying bone. Osteoarthritis can cause joint pain
and stiffness. Disability results most often when the
disease affects the spine and the weight-bearing joints
(the knees and hips). Rheumatoid arthritis, which is
National Institute of
Arthritis and Musculoskeletal
and Skin Diseases (NIAMS)
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less common, is an inflammatory disease of the
immune system that attacks the lining of the joint,
called the synovium, resulting in pain and swelling
and loss of function in the joints. The most commonly
affected joints are those in the hands and feet. For
examples of other rheumatic diseases, see the box on
page 2.
CAUSES OF RHEUMATIC DISEASES
There are likely many genes and combinations of
genes that predispose people to rheumatic diseases.
Some have been identified. In rheumatoid arthritis,
juvenile arthritis, and lupus, for example, patients may
have a variation in a gene that codes for an enzyme
called protein tyrosine phosphatase nonreceptor 22
(PTPN22). In osteoarthritis, inherited cartilage
weakness may play a role.
In people who are genetically susceptible, factors in
the environment may trigger the disease. For
example, scientists have found a connection between
Epstein-Barr virus and lupus. Excessive stress on a
joint from repeated injury may lead to osteoarthritis.
Hormone or other malefemale differences may also
play a role. For example, lupus, rheumatoid arthritis,
scleroderma, and fibromyalgia are more common
among women.
The mission of the National Institute of
Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), a part of the
U.S. Department of Health and Human
Services National Institutes of Health (NIH),
is to support research into the causes,
treatment, and prevention of arthritis and
musculoskeletal and skin diseases; the
training of basic and clinical scientists to
carry out this research; and the
dissemination of information on research
progress in these diseases. For more
information about the NIAMS, call the
information clearinghouse toll free at
301-495-4484 or 87722 NIAMS or visit
the NIAMS website at www.niams.nih.gov.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES (NIAMS)
with eye problems, skin rashes, and mouth sores.
Psoriatic arthritis, which is a form of arthritis that
occurs in some patients with the skin disorder
psoriasis, is also considered a spondlyoarthropathy.
Psoriatic arthritis often affects the joints at the ends
of the fingers and toes and is accompanied by
changes in the fingernails and toenails. Back pain
may occur if the spine is involved.
OTHER RHEUMATIC DISEASES
Bursitis. A condition involving inflammation of the
bursae (small, fluid-filled sacs that help reduce
friction between bones and other moving structures
in the joints) that produces pain and tenderness and
may limit the movement of nearby joints.
Fibromyalgia. A chronic disorder characterized by
the presence of tender pointspoints on the body
that are painful upon the application of pressure
and widespread muscle pain. Many people also
experience fatigue and sleep disturbances.
Gout. A type of arthritis resulting from deposits of
needle-like crystals of uric acid in the joints, usually
beginning in the big toe. The crystals cause episodic
inflammation, swelling, and pain in the affected
joint(s).
Infectious arthritis. A general term used to
describe forms of arthritis that are caused by
infectious agents such as bacteria or viruses.
Parvovirus arthritis and gonococcal arthritis are
examples of infectious arthritis, as is the arthritis that
occurs with Lyme disease, a bacterial infection
following the bite of certain infected ticks.
Juvenile idiopathic arthritis. The most common
form of arthritis in childhood, causes pain, stiffness,
swelling, and loss of function of the joints. It may be
associated with rashes or fevers and may affect
various parts of the body.
Polymyalgia rheumatica. A condition involving
tendons, muscles, ligaments, and tissues around the
joint that causes pain, aching, and morning stiffness
in the shoulders, hips, neck, and lower back. It is
sometimes the first sign of giant cell arteritis, a
disease of the arteries characterized by headaches,
inflammation, weakness, weight loss, and fever.
Polymyositis. A rheumatic disease that causes
inflammation and weakness in the muscles. The
disease may affect the whole body and cause
disability.
Scleroderma (also known as systemic sclerosis). A
condition in which an excessive production of
collagen (a fiber-like protein) leads to thickening of
and damage to the skin, blood vessels, joints, and
sometimes internal organs such as the lungs and
kidneys.
Spondyloarthropathies. A group of rheumatic
diseases that principally affects the spine. One
common formankylosing spondylitisalso may
affect the hips, shoulders, and knees. Another
spondyloarthropathy, reactive arthritis, develops
after an infection involving the lower urinary tract,
bowel, or other organ and is commonly associated
Systemic lupus erythematosus (also known as
lupus or SLE). An autoimmune disease in which
the immune system attacks the bodys own healthy
cells and tissues. This can result in inflammation of
and damage to the joints, skin, kidneys, heart, lungs,
blood vessels, and brain.
Tendinitis. Inflammation of tendons (tough cords of
tissue that connect muscle to bone) that is caused
by overuse, injury, or a rheumatic condition and may
restrict movement of nearby joints.
WHO IS AFFECTED?
Rheumatic diseases affect an estimated 46 million
people in the United States of all races and ages,
including an estimated 294,000 children. Some
rheumatic diseases are more common among certain
populations. For example, as noted above, rheumatoid
arthritis, scleroderma, fibromyalgia, and lupus
predominantly affect women. The spondyloarthropathies and gout are more common in men. However,
after menopause, the incidence of gout in women
begins to rise. Lupus is more common in and tends to
be more severe in African Americans and Hispanics
than Caucasians.
SIGNS AND SYMPTOMS
Different types of arthritis and rheumatic diseases
have different signs and symptoms. In general, people
who have arthritis feel pain and stiffness in one or
more joints. Pain and stiffness may be accompanied
by tenderness, warmth, redness in a joint, and/or
difficulty using or moving a joint normally.
DIAGNOSIS
The diagnosis of a rheumatic disease may be made
by a general practitioner or a rheumatologist, a doctor
who specializes in diagnosing and treating arthritis
and other rheumatic diseases.
2
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES (NIAMS)
Based on the findings of the history and physical
exam, the doctor may order laboratory tests and x
rays or other imaging tests to help confirm a
diagnosis. Samples of blood, urine, or synovial fluid
(lubricating fluid found in the joint) may be needed for
the lab tests. Many of these same tests may be useful
later for monitoring the disease or the effectiveness
of treatments.
The doctor may need to see the patient more than
once and possibly a number of times to make an
accurate diagnosis.
patient. The medications used to treat most rheumatic
diseases do not provide a cure, but rather limit the
symptoms of the disease. In some cases, especially
when a person has rheumatoid arthritis or another
type of inflammatory arthritis, the medication may slow
the course of the disease and prevent further damage
to joints or other parts of the body.
Following are some of the types of medications
commonly used in the treatment of rheumatic
diseases.
Oral analgesics. Medications that are designed
purely for pain relief. These include over-thecounter analgesics such as acetaminophen and
stronger narcotic medications such as oxycodone
or hydrocodone, which are usually reserved for
severe pain or pain following surgery or a fracture.
Topical analgesics. Creams or ointments that are
rubbed into the skin over sore muscles or joints
and relieve pain through one or more active
ingredients.
Nonsteroidal anti-inflammatory drugs
(NSAIDs).2 A large class of medications useful
against both pain and inflammation. Two NSAIDs,
ibuprofen and naproxen sodium, are available over
the counter. More than two dozen others, including
a subclass of NSAIDs called COX-2 inhibitors, are
available only with a prescription.
Disease-modifying antirheumatic drugs
(DMARDs). A family of medicines that is used to
slow or stop the immune system from attacking the
joints and causing damage in inflammatory arthritis
like rheumatoid arthritis and ankylosing spondylitis.
Biologic response modifiers. A relatively new
family of genetically engineered drugs that block
TREATMENT
Treatments for arthritis and rheumatic diseases vary
depending on the specific disease or condition;
however, treatment generally includes the following:
Exercise. Physical activity can reduce joint pain and
stiffness and increase flexibility, muscle strength, and
endurance. Exercise also can result in weight loss,
which in turn reduces stress on painful joints. The best
exercises for people with arthritis are those that place
the least stress on the joints, such as walking,
stretching, using weight machines, stationary cycling,
exercising in water, and swimming. A doctor or
physical therapist can recommend a safe, wellrounded exercise program. People with arthritis should
speak with their doctor before beginning any new
exercise program.
Diet. Although there is not a specific diet that helps
arthritis, a well-balanced diet, along with exercise,
helps people manage their body weight and stay
healthy. Diet is especially important for people who
have gout. People with gout should avoid alcohol and
foods that are high in purines, such as organ meats
(liver, kidney), sardines, anchovies, and gravy.
Medications. A variety of medications are used to
treat rheumatic diseases.1 The type of medication
depends on the specific disease and the individual
1
All medicines can have side effects. Some medicines and side
effects are mentioned in this publication. Some side effects may
be more severe than others. You should review the package insert
that comes with your medicine and ask your health care provider
or pharmacist if you have any questions about the possible side
effects.
Warning: NSAIDs can cause stomach irritation or, less often,
they can affect kidney function. The longer a person uses NSAIDs,
the more likely he or she is to have side effects, ranging from mild
to serious. Many other drugs cannot be taken when a patient is
being treated with NSAIDs because NSAIDs alter the way the
body uses or eliminates these other drugs. Check with your health
care provider or pharmacist before you take NSAIDs. Also,
NSAIDs sometimes are associated with serious gastrointestinal
problems, including ulcers, bleeding, and perforation of the
stomach or intestine. People age 65 and older, as well as those
with any history of ulcers or gastrointestinal bleeding, should use
NSAIDs with caution.
3
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES (NIAMS)
specific molecular pathways of the immune system
that are involved in the inflammatory process.
The incorrect use of a splint or brace can cause joint
damage, stiffness, and pain.
Janus kinase inhibitors. A new class of
medications that work by blocking Janusassociated kinase, or JAK, pathways that are
involved in the bodys immune response.
Corticosteroids. Strong inflammation-fighting
drugs that are similar to the cortisone made by our
bodies. Corticosteroids can be given by mouth, in
creams applied to the skin, intravenously, or by
injection directly into the affected joint(s).
Assistive devices. A person with arthritis can use
many kinds of devices to ease the pain. For example,
using a cane when walking can reduce some of the
weight placed on a knee or hip affected by arthritis. A
shoe insert (orthotic) can ease the pain of walking
caused by arthritis of the foot or knee. Other devices
can help with activities such as opening jars, closing
zippers, and holding pencils.
Although all of these drugs have the potential to help
arthritis and rheumatic diseases, all have the potential
for dangerous side effects. When prescribing
medications, doctors and patients must weigh the
potential risks against the expected benefits.
Heat and cold therapies. Heat and cold can both be
used to reduce the pain and inflammation of arthritis.
Heat therapy increases blood flow, tolerance for pain,
and flexibility. Cold therapy numbs the nerves around
the joint to reduce pain and may relieve inflammation
and muscle spasms. Heat therapy can involve placing
warm towels or hot packs on the inflamed joint or
taking a warm bath or shower. Cold therapy can
involve cold packs, ice massage, soaking in cold
water, or over-the-counter sprays and ointments that
cool the skin and joints.
Relaxation therapy. Relaxation therapy helps reduce
pain by teaching people various ways to release
muscle tension throughout the body. In one method of
relaxation therapy, known as progressive relaxation,
the patient tightens a muscle group and then slowly
releases the tension. Doctors and physical therapists
can teach patients a variety of relaxation techniques.
Splints and braces. Splints and braces are used to
support weakened joints or allow them to rest. Some
prevent the joint from moving; others allow some
movement. A splint or brace should be used only
when recommended by a doctor or therapist, who will
ensure a proper fit and provide instructions for its use.
Surgery. Surgery may be required to repair damage
to a joint after an injury or to restore function or relieve
pain in a joint damaged by arthritis. Many types of
surgery are performed for arthritis. They range from
outpatient procedures performed arthroscopically
(through small incisions over the joints) to the surgical
removal and replacement of a damaged joint with an
artificial joint, known as total joint replacement.
PROGRESS AND PROMISE
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS), part of the National
Institutes of Health (NIH), leads the Federal medical
research effort in arthritis and rheumatic diseases. The
NIAMS sponsors research and research training on
the NIH campus in Bethesda, Maryland, and at
universities and medical centers throughout the United
States. Both clinical studies (involving patients) and
basic (laboratory) research result in a better
understanding of what causes these conditions and
how best to treat and prevent them.
The National Institutes of Health (NIH)The Nations
Medical Research Agencyincludes 27 Institutes and
Centers and is a component of the U.S. Department of
Health and Human Services. It is the primary Federal
agency for conducting and supporting basic, clinical,
and translational medical research, and it investigates
the causes, treatments, and cures for both common
and rare diseases. For more information about NIH
and its programs, visit www.nih.gov.
NIH Publication No. 144999
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES (NIAMS)
FOR YOUR INFORMATION
This publication contains information
about medications used to treat the
health condition discussed here. When
this publication was printed, we included
the most up-to-date (accurate)
information available. Occasionally, new
information on medication is released.
For updates and for any questions
about any medications you are taking,
please contact the U.S. Food and Drug
Administration (FDA) toll free at
888INFOFDA (8884636332) or
visit its website at www.fda.gov. For
additional information on specific
medications, visit Drugs@FDA at
www.accessdata.fda.gov/scripts/
cder/drugsatfda. Drugs@FDA is a
searchable catalog of FDA-approved
drug products.
For updates and questions about
statistics, please contact the Centers
for Disease Control and Preventions
(CDC) National Center for Health
Statistics toll free at 8002324636
or visit its website at www.cdc.gov/nchs.
