diseases. treatment options vary depending on the type of arthritis and include physical therapy, exercise and diet, orthopedic bracing, and oral and topical medications. joint replacement surgery may be required to repair damage, restore function, or relieve pain. physical therapy in general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person. individuals with arthritis can benefit from both physical and occupational therapy. in arthritis the joints become stiff and the range of movement can be limited. physical therapy has been shown to significantly improve function, decrease pain, and delay the need for surgical intervention in advanced cases. exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. exercise often focuses on improving muscle strength, endurance and flexibility. in some cases, exercises may be designed to train balance. occupational therapy can provide assistance with activities. assistive technology is a tool used to aid a person's disability by reducing their physical barriers by improving the use of their damaged body part, typically after an amputation. assistive technology devices can be customized to the patient or bought commercially. medications there are several types of medications that are used for the treatment of arthritis. treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective. depending on the type of arthritis, the medications that are given may be different. for example, the first-line treatment for osteoarthritis is acetaminophen (paracetamol) while for inflammatory arthritis it involves non-steroidal anti-inflammatory drugs (nsaids) like ibuprofen. opioids and nsaids may be less well tolerated. however, topical nsaids may have better safety profiles than oral nsaids. for more severe cases of osteoarthritis, intra-articular corticosteroid injections may also be considered. the drugs to treat rheumatoid arthritis (ra) range from corticosteroids to monoclonal antibodies given intravenously. due to the autoimmune nature of ra, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called disease-modifying antirheumatic drugs (dmards). csdmards, tnf biologics and tsdmards are specific kinds of dmards that are recommended for treatment. treatment with dmards is designed to slow down the progression of ra by initiating an adaptive immune response, in part by cd4+ t helper (th) cells, specifically th17 cells. th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (il-17). surgery a number of rheumasurgical interventions have been incorporated in the treatment of arthritis since the 1950s. arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. adaptive aids people with hand arthritis can have trouble with simple activities of daily living tasks (adls), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. there are adaptive aids or assistive devices (ads) available to help with these tasks, but they are generally more costly than conventional products with the same function. it is now possible to 3-d print adaptive aids, which have been released as open source hardware to reduce patient costs. adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them. alternative medicine further research is required to determine if transcutaneous electrical nerve stimulation (tens) for knee osteoarthritis is effective for controlling pain. low level laser therapy may be considered for relief of pain and stiffness associated with arthritis. evidence of benefit is tentative. pulsed electromagnetic field therapy (pemft) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis. the fda has not approved pemft for the treatment of arthritis. in canada, pemf devices are legally licensed by health canada for the treatment of pain associated with arthritic conditions. epidemiology arthritis is predominantly a disease of the elderly, but children can also be affected by the disease. arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. in the united states a cdc survey based on data from 2013 to 2015 showed 54.4 million (22.7%) adults had self-reported doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitation (aaal). with an aging population, this number is expected to increase. adults with co-morbid conditions, such as heart disease, diabetes, and obesity, were seen to have a higher than average prevalence of doctor-diagnosed arthritis (49.3%, 47.1%, and 30.6% respectively). disability due to musculoskeletal disorders increased by 45% from 1990 to 2010. of these, osteoarthritis is the fastest increasing major health condition. among the many reports on the increased prevalence of musculoskeletal conditions, data from africa are lacking and underestimated. a systematic review assessed the prevalence of arthritis in africa and included twenty population-based and seven hospital-based studies. the majority of studies, twelve, were from south africa. nine studies were well-conducted, eleven studies were of moderate quality, and seven studies were conducted poorly. the results of the systematic review were as follows: rheumatoid arthritis: 0.1% in algeria (urban setting); 0.6% in democratic republic of congo (urban setting); 2.5% and 0.07% in urban and rural settings in south africa respectively; 0.3% in egypt (rural setting), 0.4% in lesotho (rural setting) osteoarthritis: 55.1% in south africa (urban setting); ranged from 29.5 to 82.7% in south africans aged 65 years and older knee osteoarthritis has the highest prevalence from all types of osteoarthritis, with 33.1% in rural south africa ankylosing spondylitis: 0.1% in south africa (rural setting) psoriatic arthritis: 4.4% in south africa (urban setting) gout: 0.7% in south africa (urban setting) juvenile idiopathic arthritis: 0.3% in egypt (urban setting) history evidence of osteoarthritis and potentially inflammatory arthritis has been discovered in dinosaurs. the first known traces of human arthritis date back as far as 4500 bc. in early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples. it was noted in skeletal remains of native americans found in tennessee and parts of what is now olathe, kansas. evidence of arthritis has been found throughout history, from ötzi, a mummy (c. 3000 bc) found along the border of modern italy and austria, to the egyptian mummies circa 2590 bc. in 1715, william musgrave published the second edition of his most important medical work, de arthritide symptomatica, which concerned arthritis and its effects. augustin jacob landré-beauvais, a 28-year-old resident physician at salpêtrière asylum in france was the first person to describe the symptoms of rheumatoid arthritis. though landré-beauvais' classification of rheumatoid arthritis as a relative of gout was inaccurate, his dissertation encouraged others to further study the disease. terminology the term is derived from arthr- (from ancient greek: ἄρθρον, romanized: árthron, lit. 'joint') and -itis (from -ῖτις, -îtis, lit. 'pertaining to'), the latter suffix having come to be associated with inflammation. the word arthritides is the plural form of arthritis, and denotes the collective group of arthritis-like conditions.