arthritis arthritis arthritis is a term often used to mean any disorder that affects joints. symptoms generally include joint pain and stiffness. other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. in some types of arthritis, other organs are also affected. onset can be gradual or sudden. not to be confused with arteritis. arthritisa hand affected by rheumatoid arthritis, an autoimmune form of arthritispronunciation/ɑːrˈθraɪtɪs/ specialtyrheumatologysymptomsjoint pain, stiffness, redness, swelling, decreased range of motiontypes> 100, most common (osteoarthritis, rheumatoid arthritis)risk factorsfamily history, age, sex trait, previous joint injury, obesity.treatmentresting, applying ice or heat, weight loss, exercise, joint replacementmedicationibuprofen, paracetamol (acetaminophen) there are over 100 types of arthritis. the most common forms are osteoarthritis (degenerative joint disease) and rheumatoid arthritis. osteoarthritis usually occurs with age and affects the fingers, knees, and hips. rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet. other types include gout, lupus, fibromyalgia, and septic arthritis. they are all types of rheumatic disease. treatment may include resting the joint and alternating between applying ice and heat. weight loss and exercise may also be useful. recommended medications may depend on the form of arthritis. these may include pain medications such as ibuprofen and paracetamol (acetaminophen). in some circumstances, a joint replacement may be useful. osteoarthritis affects more than 3.8% of people, while rheumatoid arthritis affects about 0.24% of people. gout affects about 1–2% of the western population at some point in their lives. in australia about 15% of people are affected by arthritis, while in the united states more than 20% have a type of arthritis. overall the disease becomes more common with age. arthritis is a common reason that people miss work and can result in a decreased quality of life. the term is derived from arthr- (meaning 'joint') and -itis (meaning 'inflammation'). classification there are several diseases where joint pain is primary, and is considered the main feature. generally when a person has "arthritis" it means that they have one of these diseases, which include: osteoarthritis rheumatoid arthritis gout and pseudo-gout septic arthritis ankylosing spondylitis juvenile idiopathic arthritis still's disease psoriatic arthritis joint pain can also be a symptom of other diseases. in this case, the arthritis is considered to be secondary to the main disease; these include: psoriasis reactive arthritis ehlers–danlos syndrome iron overload hepatitis lyme disease sjögren's disease hashimoto's thyroiditis celiac disease non-celiac gluten sensitivity inflammatory bowel disease (including crohn's disease and ulcerative colitis) henoch–schönlein purpura hyperimmunoglobulinemia d with recurrent fever sarcoidosis whipple's disease tnf receptor associated periodic syndrome granulomatosis with polyangiitis (and many other vasculitis syndromes) familial mediterranean fever systemic lupus erythematosus an undifferentiated arthritis is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite rheumatic disease. signs and symptoms extra-articular features of joint disease cutaneous nodules cutaneous vasculitis lesions lymphadenopathy oedema ocular inflammation urethritis tenosynovitis (tendon sheath effusions) bursitis (swollen bursa) diarrhea orogenital ulceration pain, which can vary in severity, is a common symptom in virtually all types of arthritis. other symptoms include swelling, joint stiffness, redness, and aching around the joint(s). arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. symptoms may include: inability to use the hand or walk stiffness in one or more joints rash or itch malaise and fatigue weight loss poor sleep muscle aches and pains tenderness difficulty moving the joint it is common in advanced arthritis for significant secondary changes to occur. for example, arthritic symptoms might make it difficult for a person to move around and/or exercise, which can lead to secondary effects, such as: illustration of gout affected foot. muscle weakness loss of flexibility decreased aerobic fitness these changes, in addition to the primary symptoms, can have a huge impact on quality of life. disability arthritis is the most common cause of disability in the united states. more than 20 million individuals with arthritis have severe limitations in function on a daily basis. absenteeism and frequent visits to the physician are common in individuals who have arthritis. arthritis can make it difficult for individuals to be physically active and some become home bound. it is estimated that the total cost of arthritis cases is close to $100 billion of which almost 50% is from lost earnings. each year, arthritis results in nearly 1 million hospitalizations and close to 45 million outpatient visits to health care centers. decreased mobility, in combination with the above symptoms, can make it difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol or vulnerability to heart disease. people with arthritis are also at increased risk of depression, which may be a response to numerous factors, including fear of worsening symptoms. risk factors there are common risk factors that increase a person's chance of developing arthritis later in adulthood. some of these are modifiable while others are not. smoking has been linked to an increased susceptibility of developing arthritis, particularly rheumatoid arthritis. diagnosis diagnosis is made by clinical examination from an appropriate health professional, and may be supported by other tests such as radiology and blood tests, depending on the type of suspected arthritis. all arthritides potentially feature pain. pain patterns may differ depending on the arthritides and the location. rheumatoid arthritis is generally worse in the morning and associated with stiffness lasting over 30 minutes. however, in the early stages, patients may have no symptoms after a warm shower. osteoarthritis, on the other hand, tends to be associated with morning stiffness which eases relatively quickly with movement and exercise. in the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb. osteoarthritis in the left hand index finger of a 63-year-old woman. elements of the history of the disorder guide diagnosis. important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. physical examination may confirm the diagnosis or may indicate systemic disease. radiographs are often used to follow progression or help assess severity. blood tests and x-rays of the affected joints often are performed to make the diagnosis. screening blood tests are indicated if certain arthritides are suspected. these might include: rheumatoid factor, antinuclear factor (anf), extractable nuclear antigen, and specific antibodies. osteoarthritis main article: osteoarthritis osteoarthritis is the most common form of arthritis. it affects humans and other animals, notably dogs, but also occurs in cats and horses. it can affect both the larger and the smaller joints of the body. in humans, this includes the hands, wrists, feet, back, hip, and knee. in dogs, this includes the elbow, hip, stifle (knee), shoulder, and back. the disease is essentially one acquired from daily wear and tear of the joint; however, osteoarthritis can also occur as a result of injury. osteoarthritis begins in the cartilage and eventually causes the two opposing bones to erode into each other. the condition starts with minor pain during physical activity, but soon the pain can be continuous and even occur while in a state of rest. the pain can be debilitating and prevent one from doing some activities. in dogs, this pain can significantly affect quality of life and may include difficulty going up and down stairs, struggling to get up after lying down, trouble walking on slick floors, being unable to hop in and out of vehicles, difficulty jumping on and off furniture, and behavioral changes (e.g., aggression, difficulty squatting to toilet). osteoarthritis typically affects the weight-bearing joints, such as the back, knee and hip. unlike rheumatoid arthritis, osteoarthritis is most commonly a disease of the elderly. the strongest predictor of osteoarthritis is increased age, likely due to the declining ability of chondrocytes to maintain the structural integrity of cartilage. more than 30 percent of women have some degree of osteoarthritis by age 65. other risk factors for osteoarthritis include prior joint trauma, obesity, and a sedentary lifestyle. rheumatoid arthritis main article: rheumatoid arthritis bone erosions by rheumatoid arthritis. rheumatoid arthritis (ra) is a disorder in which the body's own immune system starts to attack body tissues. the attack is not only directed at the joint but to many other parts of the body. in rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. ra often affects joints in the fingers, wrists, knees and elbows, is symmetrical (appears on both sides of the body), and can lead to severe deformity in a few years if not treated. ra occurs mostly in people aged 20 and above. in children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. with earlier diagnosis and aggressive treatment, many individuals can lead a better quality of life than if going undiagnosed for long after ra's onset. the risk factors with the strongest association for developing rheumatoid arthritis are the female sex, a family history of rheumatoid arthritis, age, obesity, previous joint damage from an injury, and exposure to tobacco smoke. bone erosion is a central feature of rheumatoid arthritis. bone continuously undergoes remodeling by actions of bone resorbing osteoclasts and bone forming osteoblasts. one of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the synovium, caused in part by the production of pro-inflammatory cytokines and receptor activator of nuclear factor kappa b ligand (rankl), a cell surface protein present in th17 cells and osteoblasts. osteoclast activity can be directly induced by osteoblasts through the rank/rankl mechanism. lupus main article: lupus erythematosus lupus is a common collagen vascular disorder that can be present with severe arthritis. other features of lupus include a skin rash, extreme photosensitivity, hair loss, kidney problems, lung fibrosis and constant joint pain. gout main article: gout gout is caused by deposition of uric acid crystals in the joints, causing inflammation. there is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as pseudogout. in the early stages, the gouty arthritis usually occurs in one joint, but with time, it can occur in many joints and be quite crippling. the joints in gout can often become swollen and lose function. gouty arthritis can become particularly painful and potentially debilitating when gout cannot successfully be treated. when uric acid levels and gout symptoms cannot be controlled with standard gout medicines that decrease the production of uric acid (e.g., allopurinol) or increase uric acid elimination from the body through the kidneys (e.g., probenecid), this can be referred to as refractory chronic gout. comparison of types comparison of some major forms of arthritis osteoarthritisrheumatoid arthritisgouty arthritis speed of onset monthsweeks-monthshours for an attack main locations weight-bearing joints (such as knees, hips, vertebral column) and hands hands (proximal interphalangeal and metacarpophalangeal joint) wrists, ankles, knees and hips great toe, ankles, knees and elbows inflammation may occur, though often mild compared to inflammation in rheumatoid arthritisyesyes radiologic changes narrowed joint space osteophytes local osteosclerosis subchondral cysts narrowed joint space bone erosions "punched out" bone erosions laboratory findings noneanemia, elevated esr and c-reactive protein (crp), rheumatoid factor, anti-citrullinated protein antibody crystal in joints other features no systemic signs bouchard's and heberden's nodes extra-articular features are common ulnar deviation, swan neck- and boutonniere deformity of the hand tophi nephrolithiasis other infectious arthritis is another severe form of arthritis. it presents with sudden onset of chills, fever and joint pain. the condition is caused by bacteria elsewhere in the body. infectious arthritis must be rapidly diagnosed and treated promptly to prevent irreversible joint damage. psoriasis can develop into psoriatic arthritis. with psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. the typical features are continuous joint pains, stiffness and swelling. the disease does recur with periods of remission but there is no cure for the disorder. a small percentage develop a severely painful and destructive form of arthritis which destroys the small joints in the hands and can lead to permanent disability and loss of hand function. treatment there is no known cure for arthritis and rheumatic