Arthritis (from Greek arthro-, joint + -itis, inflammation) is a group of conditions that affect the health of the bone joints in the body. One in three adult Americans suffer from some form of arthritis and the disease affects about twice as many women as men.

Arthritic diseases include rheumatoid arthritis and psoriatic arthritis, which are autoimmune diseases; septic arthritis, caused by joint infection; and the more common osteoarthritis, or degenerative joint disease. Arthritis can be caused from strains and injuries caused by repetitive motion, sports, overexertion, and falls. Unlike the autoimmune diseases, osteoarthritis largely affects older people and results from the degeneration of joint cartilage. Other forms are discussed below.

Arthritic joints can be sensitive to weather changes. The increased sensitivity is thought to be caused by the affected joints developing extra nerve endings in an attempt to protect the joint from further damage.

Signs and symptoms

All arthritides feature pain, which is generally worse in the morning and on initiating movement, and resolves in the cause of time. In elderly people and children, the pain may not be the main feature, and the patient simply moves less (elderly) or refuse to use the affected limb (children).

When faced with joint pain, a doctor will generally ask about several other medical symptoms (such as fever, skin symptoms, breathlessness, Raynaud's phenomenon) that may narrow down the differential diagnosis to a few items, for which testing can be done.

Arthritis and fever together are pointers towards septic arthritis (see below). This is a medical emergency, and requires urgent referral to a rheumatologist.

Diagnosis

The various types of arthritis can be distinguished by the pace of onset, the age and sex of the patient, the amount of (and which) joints affected, additional symptoms (such as psoriasis, iridocyclitis, Raynaud's phenomenon, and rheumatoid nodules), and other clues.

Blood tests and X-rays of the affected joints are often performed to make the diagnosis. X-rays can show erosions or bone appositions.

Screening blood tests: full blood count, electrolytes, renal function, liver enzymes, calcium, phosphate, protein electrophoresis, C-reactive protein and the erythrocyte sedimentation rate (ESR). Specific tests are the rheumatoid factor, antinuclear factor (ANF), extractable nuclear antigen and specific antibodies whenever the ANF is found to be positive.

Types of arthritis

Primary forms of arthritis:

• Septic arthritis
• Rheumatoid arthritis
• Osteoarthritis
• Gout and pseudogout
• Juvenile arthritis
• Still's disease
• Ankylosing spondylitis

Secondary to other diseases:

• Systemic lupus erythematosus (SLE)
• Henoch-Schönlein purpura
• Psoriatic arthritis
• Reiter's syndrome
• Reactive arthritis
• Hemochromatosis
• Hepatitis
• Wegener's granulomatosis (and many other vasculitis syndromes)
• Familial Mediterranean fever (FMF), HIDS (hyperimmunoglobulinemia D and periodic fever syndrome) and TRAPS (TNF-alpha receptor associated periodic fever syndrome).

Diseases that can mimic arthritis:

• Pierre Marie-Bamberger syndrome (hypertrophic pulmonary osteoarthropathy, a paraneoplastic phenomenon of lung cancer)
• multiple myeloma
• osteoporosis
• others

Alternative medicine

According to a 2002 survey (http://nccam.nih.gov/news/2004/052704.htm), 4.9% of American adults who used complementary and alternative medicine in 2002 did so to treat arthritis, gout, lupus, or fibromyalgia ([1] (http://nccam.nih.gov/news/report.pdf) p9). There are numerous herbal remedies available for arthritis, including Harpagophytum procumbens.

External links

• Arthritis Foundation (http://www.arthritis.org) (non-profit organisation)
• Arthritis Rheumatism International (http://www.ar-i.org) (International Patient Advoacacy Group)
• American College of Rheumatologists (http://www.rheumatology.org) (US professional body) - also contains classification criteria of important forms of arthritis
• British Society for Rheumatology (http://www.rheumatology.org.uk) (UK professional body)
• Pain Relief Research Centre (http://www.pain-relief.org)