The word Arthritis has come to mean any joint ache or deformity. Medically, however, arthritis means a red, hot, swollen, and painful joint or else a joint with specific x-ray signs of bone deformity and damage. 

Arthralgia, on the other hand, means a painful joint with no physical signs of arthritis. Nevertheless, for the sake of this discussion, the word Arthritis will be used as a general term that encompasses all types.

Osteoarthritis, the commonest form, is the arthritis of age. It can attack any joint but prefers the distal joints of hands and feet, the hips, and the knees. The joints are not usually red or hot; instead, they present with combinations of swelling, deformity, and pain. Deformed hand and foot joints may not be painful and may function well although they look knotted.  Painful knees and hips may not look deformed or swollen but can make walking or taking the stairs most burdensome. 

The disease attacks the joint cartilages more than the bones.  Morning stiffness, which gets better with activity, is typical. Tylenol, aspirin-like anti-inflammatory medications such as ibuprofen and naproxen, and joint injections are common treatments. 

Joint replacements are the last resort and are only done when the patient can no longer tolerate the progressive suffering and dysfunction. The blood tests that measure inflammation and arthritis are usually normal. 

X-rays may look worse than symptoms indicate or symptoms may be worse than the x-rays indicate. The diagnosis and treatment decisions are based on the clinical picture more than on any test. The disease worsens with age and, unlike other arthritis, no treatment has been shown to halt its progression or induce remission.

Autoimmune Arthritis, the most malignant type, encompasses Rheumatoid Arthritis, Lupus Arthritis, Psoriasis Arthritis, Reactive Viral and Intestinal Arthritis, and so many others. These types cause rapid joint destruction and require specialized treatments that aim to induce remission and halt disease progression. Here, unlike osteoarthritis, the involved joints are red, hot, swollen, and painful. The cause is faulty immunity, which incites the body’s immune defenses to attack the body’s joints as if they were enemies.

Gout is caused by Uric Acid crystals, which precipitate into a joint, causing it to become red, hot, swollen, and very painful. The uric acid crystals usually choose one single joint, commonly that of the great toe, and make a surprise attack without due cause. The patient awakens from sleep startled by an inflamed joint that cannot tolerate even the weight of the bed sheets.  Fortunately, the gout attack can be aborted with anti-inflammatory medications such as Cortisone and Indomethacin, with anti-Uric Acid medications such as Colchicine, and with cortisone joint injections. If the attacks become too frequent, however, medications that lower the Uric Acid level in the blood can be given to prevent or reduce the attack frequency.  A common cause of gout is overindulgence in rich foods, which is epidemic now among industrialized nations. King Henry VIII, Benjamin Franklin, and so many other famous historical figures have suffered its ravages, earning it the nickname, The Royal Disease.

Traumatic Arthritis begins with an accidental joint injury and progresses slowly with age in spite of appropriate medical attention. Treatment is the same as Osteoarthritis and surgical repair or joint replacement may become necessary when the suffering or dysfunction become intolerable.  Frequently, such victims can tell the weather by the way their joints feel.

Infectious Arthritis is usually a surgical complication but may also occur after penetrating joint injuries. Skin or hospital bacteria invade the violated joints, causing fever and local inflammation.  Prolonged courses of appropriate antibiotics cure the infections in most situations. However, when foreign bodies such as knee or hip prostheses are in place, a cure may not be possible without removing the artificial joints.

Arthroscopic Joint Repair is done by inserting a scope into the joint cavity.  Although this procedure is less invasive than open surgery it’s widespread use has come under fire lately because of poor, long-term results.  Nevertheless, it still has its particular indications and can be very effective in selected patients who have damaged joint cartilage.    

Cortisone Joint Injections are most effective, safe, and give a good assessment of joint prognosis.  When such injections give prolonged relief, i.e. one or more months, they may be safely repeated when needed.  However, when they help for only a few days, they tell us that the joint is beyond salvage and that it may be ready for surgery or replacement.  The old notion—that only one or two joint injections per year are safe and that more frequent injections may cause irreparable joint damage—is now considered ultra conservative.  In fact, studies have shown that more frequent joint injections can still be safe and effective.