Arthritis: Types and Symptoms

Arthritis: Types and Symptoms
Types of arthritis
There are around 200 types of arthritis - or musculoskeletal conditions - which are split into seven main groups:26
1.Inflammatory arthritis
2.Degenerative or mechanical arthritis
3.Soft tissue musculoskeletal pain
4.Back pain
5.Connective tissue disease
6.Infectious arthritis
7.Metabolic arthritis.
Inflammatory arthritis
Inflammation is a normal part of the body's healing process. The inflammation tends to occur as a defense against viruses and bacteria or as a response to injuries such as burns. However, with inflammatory arthritis, inflammation occurs in people for no apparent reason.26

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inflamed female joints
Inflammatory arthritis can affect several joints, damaging the surface of the joints and the underlying bone.

The inflammation in inflammatory arthritis does not help to repair the body. Instead, it causes the tissues in and around the affected joints to become damaged, causing pain, stiffness and swelling.
The word "arthritis" means "joint inflammation," but inflammation may also affect the tendons and ligaments surrounding the joint - known as enthesitis.
Inflammatory arthritis can affect several joints, and the inflammation can damage the surface of the joints and also the underlying bone.
Examples of inflammatory arthritis include:
◾RA
◾Reactive arthritis
◾Ankylosing spondylitis
◾Arthritis associated with colitis or psoriasis.
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Degenerative or mechanical arthritis
Degenerative or mechanical arthritis refers to a group of conditions where damage to the cartilage that covers the ends of the bones is the primary issue. The main job of the smooth, slippery cartilage is to help the joint glide and move smoothly. This type of arthritis causes the cartilage to become thinner and rougher.26
The bone underneath the cartilage attempts to repair the damage caused, but, as a result, sometimes overgrows, altering the shape of the joint. This condition is commonly called osteoarthritis.
Osteoarthritis can also result from previous damage to the joint such as a fracture or previous inflammation in the joint.
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Soft tissue musculoskeletal pain
Soft tissue musculoskeletal pain is felt in tissues other than the joints and bones. The pain often affects a part of the body following injury or overuse, such as tennis elbow, and originates from the muscles or soft tissues supporting the joints.
Sometimes if the pain is more widespread and associated with other symptoms, it could be diagnosed as fibromyalgia.
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Back pain
Back pain can arise from the muscles, discs, ligaments, bones or joints. Back pain may even be caused by problems with organs inside the body - known as "referred pain."26
There can be a specific causes for back pain including conditions such as osteoarthritis, which is often called spondylosis when it occurs in the spine. A "slipped" disc is another cause of back pain, as is osteoporosis (thinning of the bones. In most cases it is not possible for a doctor to identify the exact cause of pain - this is often described as "non-specific" pain.
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Connective tissue disease (CTD)
Connective tissues are tissues that support, bind together or separate other body tissues and organs. They include tendons, ligaments and cartilage.26
Joint pain is a symptom of CTD, but inflammation may occur in other tissues including the skin, muscles, lungs and kidneys. This results in a range of symptoms besides painful joints and a number of different specialists to be seen in addition to a doctor.
Examples of CTD include:
◾SLE
◾Scleroderma (systemic sclerosis)
◾Dermatomyositis.
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Infectious arthritis
A bacterium, virus or fungus entering the joint can sometimes cause inflammation. Organisms that can infect joints include:27
◾Salmonella and shigella (food poisoning or contamination)
◾Chlamydia and gonorrhea (sexually transmitted diseases)
◾Hepatitis C (a blood-to-blood infection, often through shared needles or transfusions).
In most of these cases, the joint infection can be cleared with antibiotics. However, the arthritis can sometimes become chronic.
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Metabolic arthritis
Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in human cells and several foods.27
Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine. Some people have elevated levels of uric acid because they either naturally produce more than is needed or their body cannot clear the uric acid quickly enough.
Uric acid builds up and accumulates in some people and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout attack.
Gout can either come and go in episodes or become chronic if uric acid levels are not reduced.
Some of the more common types of arthritis are discussed below.
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Rheumatoid arthritis
There are an estimated 1.5 million adults in the US with RA.4 The prevalence of RA is believed to range from 0.5-1.0% in the general population.
RA causes premature mortality, disability and compromises quality of life.12 The onset of RA can occur at any age and is associated with fatigue and prolonged stiffness after rest.
Individuals with RA have a more severe functional status than those with osteoarthritis.
RA is an autoimmune condition whereby the inflammatory process primarily affects the lining of the joints (synovial membrane/synovium), but it can also affect other organs.
The inflamed synovium leads to cartilage and bone erosion and at times, joint deformity. Pain, swelling and redness are common joint manifestations in people with RA.
The cause of RA is not fully understood. However, RA is suggested to be the consequence of a faulty immune response that results from an interaction between genetic factors and environmental exposures.
RA accounts for around 22% of all deaths due to AORC. Approximately 40% of all deaths in people with RA are owing to cardiovascular conditions, including ischemic heart disease and stroke.
In 2009, there were 15,600 hospitalizations with RA listed as the principal diagnosis with total hospital charges of $545 million.
For more information on rheumatoid arthritis, see our article: All about rheumatoid arthritis.
comparison of osteoarthritis and rheumatoid arthritis
Rheumatoid arthritis and osteoarthritis are different types of arthritis. They share some similar characteristics, but each has different symptoms.
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Osteoarthritis
There are an estimated 27 million adults that have osteoarthritis in the US. Osteoarthritis affects 13.9% of adults aged 25 years and older, and 33.6% (12.4 million) of those are 65+. Disease onset is gradual and often begins after the age of 40.
Osteoarthritis is a degenerative joint disease of the entire joint involving the cartilage, joint lining and ligaments and underlying bone. The breakdown of these tissues eventually leads to pain and joint stiffness.11
The joints most commonly affected by osteoarthritis are the joints that get heavy use, such as hips and knees, hands, spine and also often the base of the thumb and the big toe joint.
Nearly 1 in 2 people may develop symptomatic knee osteoarthritis by the age of 85.4 Knee osteoarthritis is one of the five leading causes of disability among non-institutionalized adults. Weight loss of 11 pounds has been said to reduce the risk of developing knee osteoarthritis among women by 50%. Also, 1 in 4 people may develop hip arthritis in their lifetime.
Taking part in moderate physical activity 3 times or more per week can reduce the risk of arthritis-related disability by 47% in older adults with knee osteoarthritis.4
The specific causes of osteoarthritis have not yet been identified but are suggested to be a result of mechanical and molecular events occurring in the affected joint.
On average, there are 0.2-0.3 deaths per 100,000 population due to osteoarthritis in the US, around 814,900 hospitalizations and 500 deaths.
Costs due to hospital expenditures are estimated at $28.5 billion for knee replacements and $13.7 billion for hip replacements annually. The average direct costs of osteoarthritis per patient is around $2,600 per year.
For more information on osteoarthritis, see our article: What is osteoarthritis? What causes osteoarthritis?
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Childhood arthritis
There are an estimated 294,000 children (or 1 in 250 children) under the age of 18 in the US that have been diagnosed with AORC.
"Childhood arthritis" is an umbrella term that covers a number of types of arthritis.
There are at least three clinical classification schemes of childhood arthritis including:
◾Juvenile rheumatoid arthritis (JRA)
◾Juvenile chronic arthritis (JCA)
◾Juvenile idiopathic arthritis (JIA).
All classifications define childhood arthritis as occurring in people younger than 16 years.
The most common form of childhood arthritis is JRA. JRA involves at least 6 weeks of incessant arthritis in children younger than 16 years with no other type of noticeable childhood arthritis.
Many of the numerous conditions that are counted as AORC in adults can also occur in children, although much more rarely.
Children diagnosed with AORC account for approximately 827,000 doctor visits each year, including an average of 83,000 emergency department room visits.
JRA appears to have substantial economic impacts with national direct costs estimated to be $285 million.
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Septic arthritis
There are an estimated 20,000 cases of septic arthritis in the US per year.36 The incidence of septic arthritis is around 2-10 cases per 100,000 in the general population and as high as 30-70 cases per 100,000 in patients with RA.37
Septic arthritis is joint inflammation due to a bacterial or fungal infection. If the septic arthritis is due to the bacteria that cause gonorrhea, it is described as gonococcal arthritis.23 The incidence of arthritis due to gonococcal infection is 2.8 cases per 100,000 person-years.
Joints that are commonly affected with septic arthritis are the knee and hip. Septic arthritis develops either when bacteria or other tiny disease-causing organisms (microorganisms) spread through the blood to a joint or when the joint is directly infected with a microorganism from injury or surgery.
Bacteria such as staphylococcus or streptococcus cause most cases of acute septic arthritis and organisms such as Mycobacterium tuberculosis and Candida albicans cause chronic septic arthritis - which is the less common of the two.
Septic arthritis may occur at any age. In children, it arises most often in those younger than 3 years. The hip is often the site of infection in infants.
Septic arthritis is uncommon from age 3 to adolescence. Children with septic arthritis are more likely than adults to be infected with Group B streptococcus or Haemophilus influenza if they have not been vaccinated.
The following conditions increase your risk for septic arthritis:
◾Artificial joint implants
◾Bacterial infection somewhere else in your body
◾Presence of bacteria in your blood
◾Chronic illness or disease (such as diabetes, RA and sickle cell disease)
◾Intravenous (IV) or injection drug use
◾Medications that suppress your immune system
◾Recent joint injury
◾Recent joint arthroscopy or other surgery.
Septic arthritis is a rheumatologic emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality.38 Septic arthritis in RA is associated with a higher mortality rate of 25-30% due to delays in diagnosis and initiation of treatment.37
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Fibromyalgia
Fibromyalgia affects an estimated 5.0 million adults in the US.4 The prevalence of fibromyalgia is around 2%, with prevalence significantly higher among women (3.4%) than men (0.5%). Children can also have the disorder.
Fibromyalgia often co-occurs up to 25-65% with other rheumatic conditions such as RA, SLE and ankylosing spondylitis.
Individuals are usually diagnosed with fibromyalgia during middle age and prevalence increases with age.
Fibromyalgia is a disorder of unknown cause characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often, psychological distress.8
People that suffer from fibromyalgia have abnormal pain perception processing and react strongly to things that other people would not find painful.
Causes and risk factors of fibromyalgia are unknown. However there are some factors that have been loosely associated with disease onset such as:
◾Stressful or traumatic events, including car accidents and post-traumatic stress disorder (PTSD)
◾Repetitive injuries
◾Illness - viral infections
◾Certain diseases - SLE, RA, chronic fatigue syndrome
◾Genetic predisposition
◾Obesity.
Direct medical costs for fibromyalgia range between $3400-$3600 per person, per year. Total direct and indirect costs per person are $5,945.
Mortality among adults with fibromyalgia is similar to that of the general population. However, death rates from suicide and injuries are higher among fibromyalgia patients.8
For more information on fibromyalgia, see our article: What is fibromyalgia? What causes fibromyalgia?
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Psoriatic arthritis
Estimates of the prevalence of psoriatic arthritis in the US population vary between 0.3-1%, with a reported prevalence of 7-42% in patients with psoriasis.39
Psoriatic arthritis is a joint problem that often occurs with a skin condition called psoriasis.18
While most people with psoriatic arthritis develop psoriasis first and are later diagnosed with psoriatic arthritis, joint problems can occasionally occur previous to the emergence of psoriasis skin lesions.
Psoriatic arthritis occurs when the immune system attacks healthy cells and tissue. The abnormal immune response causes inflammation in the joints and an overproduction of skin cells.31
Several factors can increase the risk of psoriatic arthritis, including:32
◾Psoriasis: having psoriasis is the greatest risk factor for developing psoriatic arthritis
◾Family history: many people with psoriatic arthritis have a parent or a sibling with the disease. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis
◾Age: although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30-50.
The severity of psoriatic arthritis is reflected not only in the accrual of joint damage but also in increased mortality. Patients with psoriatic arthritis are at an increased risk for death with a standardized mortality ratio of 1.62. The causes of death are similar to those in the general population, with cardiovascular causes being the most common.40
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Gout
There are around 8.3 million individuals that suffer from gout annually in the US; 6.1 million of which are men and 2.2 million women.10 The incidence of gout among black men is almost twice that among white men.
Gout is a rheumatic disease that occurs due to deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. This process occurs because of an overproduction or under excretion of uric acid from the body.
Acute gout will typically manifest itself as a severely red, hot and swollen joint with agonizing pain. Gout may remit for long periods, followed by flares for days to weeks, or can become chronic. Recurrent attacks of acute gout can lead to a degenerative form of chronic arthritis called gouty arthritis.
man with severe gout
Gout causes agonizing pain in the joint, with the area becoming red, hot and swollen.

Contributory risk factors for gout include:
◾Being overweight or obese
◾Hypertension
◾Alcohol
◾Diuretic use
◾A diet rich in meat and seafood
◾Common medicines
◾Poor kidney function.
Weight loss lowers the risk for gout.
On average, the annual incremental cost of care for a gout patient is estimated at greater than $3,000 compared with a non-gouty individual.41
Although a systematic review of 22 studies found that gout is associated with poor health-related quality of life, gout as the underlying cause of death is very rare.
For more information on gout, see our article: What is gout? What causes gout?
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Sjögren's syndrome
Sjögren's syndrome affects 1-2 million people in the US. The reported prevalence is between 0.05-4.8% of the population.42
Sjögren's syndrome often accompanies other autoimmune disorders, such as RA and SLE. The glands that produce tears and saliva are destroyed, which causes dry mouth and dry eyes. Other areas also become dry that usually need moisture such as the nose, throat and skin.
The condition can affect other parts of the body, including the joints, lungs, kidneys, blood vessels, digestive organs and nerves.21
The onset of Sjögren's syndrome occurs in adults aged 40 and over and nine out of 10 sufferers are women.20
No increased all-cause mortality has been detected in patients with primary Sjögren's syndrome compared with the general population.43
According to a study in Clinical and Experimental Rheumatology, around 40-50% of patients with primary Sjögren's syndrome develop extraglandular disease, which may be manifested either by epithelial lymphocytic invasion of lung, liver, or kidney or by skin vasculitis, peripheral neuropathy, glomerulonephritis and low C4 levels - conditions which represent an immune-complex mediated disease.44
Patients belonging to the latter category, inferring a high risk for development of non-Hodgkin's lymphoma, have a worse prognosis with higher mortality rates.
For more information on Sjögren's syndrome, see our article: What is Sjogren's syndrome? What causes Sjogren's syndrome?
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Scleroderma
The prevalence of scleroderma in adults in the US is 240 per 1 million. There are an estimated 300,000 adults with all forms of scleroderma in the US.46
Scleroderma refers to a group of diseases that affect connective tissue in the body.45 Scleroderma involves the buildup of scar-like tissue in the skin. It also damages the cells that line the walls of the small arteries.22
The cause of scleroderma is currently unknown. However, the buildup of a substance called collagen in the skin and organs is responsible for the symptoms of the condition.
Scleroderma often affects people between the ages of 30-50, with women developing the disease more than men.
Cases of widespread scleroderma that occur with other autoimmune diseases such as SLE and polymyositis are called mixed connective diseases.
The course of scleroderma varies with each individual, and, as a result, mortality figures vary vastly. Broadly, 10-year survival is 60-70%. Deaths from kidney disease have decreased over recent years, and most mortality is caused by severe cardiac or pulmonary complications.47
For more information on scleroderma, see our article: What is scleroderma? What causes scleroderma?
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Systemic lupus erythematosus (SLE)
Estimates of lupus prevalence range as high as 1.5 million, with annual estimates finding a prevalence of 161,000 with definite SLE and 322,000 with definite or probable SLE.
SLE is an autoimmune disease whereby the immune system produces antibodies to cells within the body leading to widespread inflammation and tissue damage.13 The disease is characterized by periods of illness and remissions.
Although the peak occurrence of SLE is between the ages of 15-40 and more common in women, SLE can occur from infancy to old age in both females and males.
SLE can affect the joints, skin, brain, lungs, kidneys and blood vessels. People with SLE may experience fatigue, pain or swelling in joints, skin rashes and fevers.
The causes of SLE are not confirmed, but they could be linked with factors such as genetics, environment and hormones.
A study released in 2008 found that the average annual direct health care cost of patients with lupus was $12,643.48
Between the years of 1979-1998, the annual number of deaths with lupus as the underlying cause increased from 879 to 1,406.
For more information on systemic lupus erythematosus, see our article: Lupus: What is lupus?
Signs and symptoms of arthritis
As with the cause of arthritis, the pattern and location of symptoms of arthritis can also vary depending on the type.
areas of painful joints
Warning signs of arthritis include pain, swelling, stiffness and difficulty moving a joint.

Arthritis symptoms can develop gradually or suddenly, and as arthritis is most often a chronic disease, symptoms may come and go, or persist over time.
There are four key warning signs of arthritis that should prompt a discussion with a health care provider:28
1.Pain. Pain from arthritis can be constant, or it may come and go. Pain might be isolated to one place or felt in many parts of the body
2.Swelling. Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch
3.Stiffness. Stiffness is a typical arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time
4.Difficulty moving a joint. Moving a joint or getting up from a chair should not be hard or painful.
Rheumatoid arthritis
RA usually affects the joints on both sides of the body equally. The joints of the wrists, fingers, knees, feet and ankles are the most commonly affected.15
Joint symptoms may include:
◾Morning stiffness, lasting more than 1 hour, is common
◾Joint pain is often felt on the same joints on both sides of the body
◾Over time, joints may lose their range of motion and may become deformed.
Other symptoms of RA include:
◾Chest pain when taking a breath (pleurisy)
◾Dry eyes and mouth (Sjögren's syndrome)
◾Eye burning, itching and discharge
◾Nodules under the skin (usually a sign of more severe disease)
◾Numbness, tingling or burning in the hands and feet
◾Sleep difficulties.
Osteoarthritis
People with osteoarthritis may experience the following symptoms:16
◾Pain and stiffness in the joints
◾Pain that becomes worse after exercise or pressure on the joint
◾Rubbing, grating or crackling sound when a joint is moved
◾Morning stiffness
◾Pain that causes sleep disturbances.
Even though X-rays show the changes of osteoarthritis visible, some people may not experience symptoms.
Childhood arthritis
Symptoms of childhood arthritis include:17
◾Swollen, red, or warm joint
◾Limping or problems using a limb
◾Sudden high fever
◾Rash (on trunk and extremities) that comes and goes with fever
◾Stiffness, pain and limited movement in a joint
◾Body-wide symptoms such as pale skin, swollen lymph gland and a "sick" appearance.
JRA can also cause eye problems called uveitis, iridocyclitis, or iritis. There may be no symptoms, but when eye symptoms do occur they can include:
◾Red eyes
◾Eye pain made worse by looking at light (photophobia)
◾Vision changes.
Septic arthritis
Symptoms of septic arthritis occur rapidly. There is often fever, joint swelling in one joint and intense joint pain that becomes more severe with movement.23
Symptoms in newborns or infants include:
◾Cries when infected joint is moved
◾Fever
◾Inability to move the limb with the infected joint (pseudoparalysis)
◾Irritability.
Symptoms in children and adults include:
◾Pseudoparalysis
◾Intense joint pain
◾Joint swelling
◾Joint redness
◾Fever.
Chills sometimes occur but are an uncommon symptom.
Fibromyalgia
People with fibromyalgia may experience the following symptoms:8
symptoms of fibromyalgia
Fibromyalgia has many symptoms that tend to vary from person to person. The main symptom is widespread pain.
 ◾Widespread pain
◾Sleep disturbance
◾Fatigue
◾Psychological stress
◾Morning stiffness
◾Tingling or numbness in hands and feet
◾Headaches, including migraines
◾Irritable bowel syndrome
◾Cognitive problems with thinking and memory - sometimes called "fibro fog"
◾Painful menstrual periods and other pain syndromes.
Psoriatic arthritis
Symptoms of psoriatic arthritis may be mild and involve only a few joints such as the end of fingers or toes.18
In people with severe psoriatic arthritis, the disease may affect multiple joints, including the spine. Spinal symptoms are usually felt in the lower spine and sacrum and consist of stiffness, burning and pain.
People with psoriatic arthritis often have the skin and nail changes of psoriasis, and the skin gets worse at the same time as the arthritis.
Gout
Symptoms of gout include:19
◾Big toe, knee or ankle joints most often affected
◾Sudden pain, often during the night, described as throbbing, crushing or excruciating
◾Joint appearing warm and red, tender and swollen
◾Occasional fever.
Tophi are lumps below the skin around joints or apparent on fingertips and ears. Tophi can develop after a person has had gout for many years. These lumps may drain chalky material.
Sjögren's syndrome
Symptoms of Sjögren's syndrome include:
◾Dry eyes
◾Itching eyes
◾Feeling that something is in the eye
◾Dry mouth
◾Difficulty swallowing or eating
◾Loss of sense of taste
◾Problems speaking
◾Thick or stringy saliva
◾Mouth sores or pain
◾Hoarseness
◾Fatigue
◾Fever
◾Change in color of hands or feet
◾Joint pain or joint swelling
◾Swollen glands.
Scleroderma
Symptoms of scleroderma may include:
◾Fingers or toes that turn blue or white in response to cold temperatures (Raynaud's phenomenon)
◾Hair loss
◾Skin that becomes darker or lighter than normal
◾Stiffness and tightness of skin of fingers, hands, forearm and face
◾Small white lumps beneath the skin that sometimes ooze a white substance that looks like toothpaste
◾Sores (ulcers) on the fingertips or toes
◾Tight and mask-like skin on the face
◾Joint pain
◾Numbness and pain in the feet
◾Pain, stiffness and swelling of fingers and joints
◾Wrist pain
◾Dry cough
◾Shortness of breath
◾Wheezing
◾Bloating after meals
◾Constipation
◾Diarrhea
◾Difficulty swallowing
◾Esophageal reflux or heartburn
◾Problems controlling stools.
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Systemic lupus erythematosus
The most common signs of SLE are:49
◾Red rash or color change on the face, often in the shape of a butterfly across the nose and cheeks
◾Painful or swollen joints
◾Unexplained fever
◾Chest pain with deep breathing
◾Swollen glands
◾Extreme fatigue
◾Unusual hair loss
◾Pale or purple fingers or toes from cold or stress
◾Sensitivity to the sun
◾Low blood count
◾Depression, trouble thinking or memory problems.
Other signs are mouth sores, unexplained seizures (convulsions), "seeing things" (hallucinations), repeated miscarriages, and unexplained kidney problems.
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On the final page we look at how arthritis is diagnosed, the available treatments for arthritis and how it can be prevented.