{"id":344,"date":"2021-04-19T16:46:57","date_gmt":"2021-04-19T16:46:57","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&#038;p=344"},"modified":"2021-04-19T16:48:56","modified_gmt":"2021-04-19T16:48:56","slug":"arthritis","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/arthritis\/","title":{"raw":"Arthritis","rendered":"Arthritis"},"content":{"raw":"<h2><span id=\"Classification\" class=\"mw-headline\">Classification<\/span><\/h2>\r\nThere 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:\r\n<ul>\r\n \t<li><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a><\/li>\r\n \t<li><a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a><\/li>\r\n \t<li><a title=\"Gout\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gout\">Gout<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Calcium pyrophosphate deposition disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_pyrophosphate_deposition_disease\">pseudo-gout<\/a><\/li>\r\n \t<li><a title=\"Septic arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Septic_arthritis\">Septic arthritis<\/a><\/li>\r\n \t<li><a title=\"Ankylosing spondylitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosing_spondylitis\">Ankylosing spondylitis<\/a><\/li>\r\n \t<li><a title=\"Juvenile idiopathic arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Juvenile_idiopathic_arthritis\">Juvenile idiopathic arthritis<\/a><\/li>\r\n \t<li><a title=\"Adult-onset Still's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adult-onset_Still%27s_disease\">Still's disease<\/a><\/li>\r\n<\/ul>\r\nJoint 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:\r\n<ul>\r\n \t<li><a title=\"Psoriasis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriasis\">Psoriasis<\/a>\u00a0(<a title=\"Psoriatic arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriatic_arthritis\">Psoriatic arthritis<\/a>)<\/li>\r\n \t<li><a title=\"Reactive arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Reactive_arthritis\">Reactive arthritis<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Ehlers\u2013Danlos syndrome\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ehlers%E2%80%93Danlos_syndrome\">Ehlers\u2013Danlos syndrome<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Haemochromatosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Haemochromatosis\">Haemochromatosis<\/a><\/li>\r\n \t<li><a title=\"Hepatitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis\">Hepatitis<\/a><\/li>\r\n \t<li><a title=\"Lyme disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lyme_disease\">Lyme disease<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Sj\u00f6gren's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sj%C3%B6gren%27s_disease\">Sj\u00f6gren's disease<\/a><\/li>\r\n \t<li><a title=\"Hashimoto's thyroiditis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hashimoto%27s_thyroiditis\">Hashimoto's thyroiditis<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Celiac disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Celiac_disease\">Celiac disease<\/a><sup id=\"cite_ref-GuandaliniAssiri2014_15-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-GuandaliniAssiri2014-15\">[15]<\/a><\/sup><\/li>\r\n \t<li><a title=\"Non-celiac gluten sensitivity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Non-celiac_gluten_sensitivity\">Non-celiac gluten sensitivity<\/a><sup id=\"cite_ref-FasanoSapone2015_16-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-FasanoSapone2015-16\">[16]<\/a><\/sup><sup id=\"cite_ref-VoltaCaio2015_17-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-VoltaCaio2015-17\">[17]<\/a><\/sup><sup id=\"cite_ref-CatassiBai2013_18-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-CatassiBai2013-18\">[18]<\/a><\/sup><\/li>\r\n \t<li><a title=\"Inflammatory bowel disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammatory_bowel_disease\">Inflammatory bowel disease<\/a>\u00a0(including\u00a0<a title=\"Crohn's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Crohn%27s_disease\">Crohn's disease<\/a>\u00a0and\u00a0<a title=\"Ulcerative colitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ulcerative_colitis\">ulcerative colitis<\/a>)<\/li>\r\n \t<li><a title=\"Henoch\u2013Sch\u00f6nlein purpura\" href=\"https:\/\/en.wikipedia.org\/wiki\/Henoch%E2%80%93Sch%C3%B6nlein_purpura\">Henoch\u2013Sch\u00f6nlein purpura<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Hyperimmunoglobulinemia D with recurrent fever\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperimmunoglobulinemia_D_with_recurrent_fever\">Hyperimmunoglobulinemia D with recurrent fever<\/a><\/li>\r\n \t<li><a title=\"Sarcoidosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sarcoidosis\">Sarcoidosis<\/a><\/li>\r\n \t<li><a title=\"Whipple's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Whipple%27s_disease\">Whipple's disease<\/a><\/li>\r\n \t<li><a title=\"TNF receptor associated periodic syndrome\" href=\"https:\/\/en.wikipedia.org\/wiki\/TNF_receptor_associated_periodic_syndrome\">TNF receptor associated periodic syndrome<\/a><\/li>\r\n \t<li><a title=\"Granulomatosis with polyangiitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Granulomatosis_with_polyangiitis\">Granulomatosis with polyangiitis<\/a>\u00a0(and many other\u00a0<a title=\"Vasculitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vasculitis\">vasculitis<\/a>\u00a0syndromes)<\/li>\r\n \t<li><a title=\"Familial Mediterranean fever\" href=\"https:\/\/en.wikipedia.org\/wiki\/Familial_Mediterranean_fever\">Familial Mediterranean fever<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Systemic lupus erythematosus\" href=\"https:\/\/en.wikipedia.org\/wiki\/Systemic_lupus_erythematosus\">Systemic lupus erythematosus<\/a><\/li>\r\n<\/ul>\r\n<span id=\"undifferentiated\" class=\"anchor\"><\/span>An\u00a0<i>undifferentiated arthritis<\/i>\u00a0is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite\u00a0<a class=\"mw-redirect\" title=\"Rheumatic disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatic_disease\">rheumatic disease<\/a>.<sup id=\"cite_ref-19\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-19\">[19]<\/a><\/sup>\r\n<h2><span id=\"Signs_and_symptoms\" class=\"mw-headline\">Signs and symptoms<\/span><\/h2>\r\n<table class=\"wikitable\" style=\"height: 244px\" width=\"415\" align=\"right\">\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 429.5px\">Extra-articular features of joint disease<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-20\">[20]<\/a><\/sup><\/th>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a class=\"mw-redirect\" title=\"Cutaneous\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cutaneous\">Cutaneous<\/a>\u00a0<a title=\"Nodule (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nodule_(medicine)\">nodules<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\">Cutaneous\u00a0<a title=\"Vasculitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vasculitis\">vasculitis<\/a>\u00a0<a title=\"Lesion\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lesion\">lesions<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a title=\"Lymphadenopathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphadenopathy\">Lymphadenopathy<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a class=\"mw-redirect\" title=\"Oedema\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oedema\">Oedema<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a title=\"Human eye\" href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\">Ocular<\/a>\u00a0<a title=\"Inflammation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\">inflammation<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a title=\"Urethritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Urethritis\">Urethritis<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a title=\"Tenosynovitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tenosynovitis\">Tenosynovitis<\/a>\u00a0(<a title=\"Tendon\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\">tendon<\/a>\u00a0sheath\u00a0<a title=\"Effusion\" href=\"https:\/\/en.wikipedia.org\/wiki\/Effusion\">effusions<\/a>)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a title=\"Bursitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bursitis\">Bursitis<\/a>\u00a0(swollen\u00a0<a class=\"mw-redirect\" title=\"Bursa (anatomy)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bursa_(anatomy)\">bursa<\/a>)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\"><a title=\"Diarrhea\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diarrhea\">Diarrhea<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 429.5px\">Orogenital\u00a0<a title=\"Ulcer (dermatology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ulcer_(dermatology)\">ulceration<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nPain, which can vary in severity, is a common symptom in virtually all types of arthritis. Other symptoms include\u00a0<a class=\"mw-redirect\" title=\"Swelling (medical)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Swelling_(medical)\">swelling<\/a>,\u00a0<a title=\"Joint stiffness\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_stiffness\">joint stiffness<\/a>, redness, and aching around the joint(s).<sup id=\"cite_ref-NIH2014_2-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup>\u00a0Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms.<sup id=\"cite_ref-21\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-21\">[21]<\/a><\/sup>\u00a0Symptoms may include:<sup id=\"cite_ref-NIH2014_2-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup>\r\n<ul>\r\n \t<li>Inability to use the\u00a0<a title=\"Hand\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hand\">hand<\/a>\u00a0or\u00a0<a title=\"Walking\" href=\"https:\/\/en.wikipedia.org\/wiki\/Walking\">walk<\/a><\/li>\r\n \t<li>Stiffness in one or more joints<\/li>\r\n \t<li>Rash or itch<\/li>\r\n \t<li><a title=\"Malaise\" href=\"https:\/\/en.wikipedia.org\/wiki\/Malaise\">Malaise<\/a>\u00a0and fatigue<\/li>\r\n \t<li><a title=\"Weight loss\" href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_loss\">Weight loss<\/a><\/li>\r\n \t<li>Poor sleep<\/li>\r\n \t<li><a title=\"Myalgia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Myalgia\">Muscle aches<\/a>\u00a0and pains<\/li>\r\n \t<li><a title=\"Tenderness (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tenderness_(medicine)\">Tenderness<\/a><\/li>\r\n \t<li>Difficulty moving the joint<\/li>\r\n<\/ul>\r\nIt 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:\r\n<div class=\"thumb tright\">\r\n<div class=\"thumbinner\">\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"220\"]<a class=\"image\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gout_Signs_and_Symptoms.jpg\"><img class=\"thumbimage\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Gout_Signs_and_Symptoms.jpg\/220px-Gout_Signs_and_Symptoms.jpg\" alt=\"\" width=\"220\" height=\"124\" \/><\/a> Illustration of gout affected foot. Muscle\u00a0weakness Loss of\u00a0flexibility Decreased\u00a0aerobic fitness These changes, in addition to the primary symptoms, can have a huge impact on quality of life.[\/caption]\r\n\r\n<\/div>\r\n<\/div>\r\n<h3><span id=\"Disability\" class=\"mw-headline\">Disability<\/span><\/h3>\r\nArthritis is the most common cause of\u00a0<a title=\"Disability\" href=\"https:\/\/en.wikipedia.org\/wiki\/Disability\">disability<\/a>\u00a0in the United States. More than 20 million individuals with arthritis have severe limitations in function on a daily basis.<sup id=\"cite_ref-22\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-22\">[22]<\/a><\/sup>\u00a0<a title=\"Absenteeism\" href=\"https:\/\/en.wikipedia.org\/wiki\/Absenteeism\">Absenteeism<\/a>\u00a0and frequent visits to the\u00a0<a title=\"Physician\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\">physician<\/a>\u00a0are common in individuals who have arthritis. Arthritis can make it very difficult for individuals to be physically active and some become home bound.\r\n\r\nIt 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\u00a0<a title=\"Health care\" href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\">health care<\/a>\u00a0centers.<sup id=\"cite_ref-23\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-23\">[23]<\/a><\/sup>\r\n\r\nDecreased 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\u00a0<a title=\"Cholesterol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cholesterol\">cholesterol<\/a>\u00a0or vulnerability to\u00a0<a class=\"mw-redirect\" title=\"Heart disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_disease\">heart disease<\/a>.<sup id=\"cite_ref-24\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-24\">[24]<\/a><\/sup>\u00a0People with arthritis are also at increased risk of\u00a0<a title=\"Major depressive disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\">depression<\/a>, which may be a response to numerous factors, including fear of worsening symptoms.<sup id=\"cite_ref-25\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-25\">[25]<\/a><\/sup>\r\n<h2><span id=\"Risk_factors\" class=\"mw-headline\">Risk factors<\/span><\/h2>\r\nThere 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.\u00a0<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-26\">[26]<\/a><\/sup>\u00a0Smoking has been linked to an increased susceptibility of developing arthritis, particularly rheumatoid arthritis.<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-27\">[27]<\/a><\/sup>\r\n<h2><span id=\"Diagnosis\" class=\"mw-headline\">Diagnosis<\/span><\/h2>\r\nDiagnosis 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.<sup id=\"cite_ref-28\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-28\">[28]<\/a><\/sup>\u00a0All arthritides potentially feature\u00a0<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a>. Pain patterns may differ depending on the arthritides and the location.\u00a0<a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a>\u00a0is generally worse in the morning and associated with stiffness lasting over 30 minutes.<sup id=\"cite_ref-29\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-29\">[29]<\/a><\/sup>\u00a0However, in the early stages, patients may have no symptoms after a warm shower.\u00a0<a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a>, 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.\r\n\r\nElements 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.\r\n\r\n<a title=\"Blood test\" href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\">Blood tests<\/a>\u00a0and\u00a0<a title=\"X-ray\" href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\">X-rays<\/a>\u00a0of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include:\u00a0<a title=\"Rheumatoid factor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_factor\">rheumatoid factor<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Antinuclear factor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antinuclear_factor\">antinuclear factor<\/a>\u00a0(ANF),\u00a0<a title=\"Extractable nuclear antigen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Extractable_nuclear_antigen\">extractable nuclear antigen<\/a>, and specific antibodies.\r\n<h3><span id=\"Osteoarthritis\" class=\"mw-headline\">Osteoarthritis<\/span><\/h3>\r\n<a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a>\u00a0is the most common form of arthritis.<sup id=\"cite_ref-Van2010_30-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Van2010-30\">[30]<\/a><\/sup>\u00a0It 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 included the hands,\u00a0<a title=\"Wrist osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wrist_osteoarthritis\">wrists<\/a>, 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).<sup id=\"cite_ref-31\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-31\">[31]<\/a><\/sup>\u00a0Osteoarthritis 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\u00a0<a class=\"mw-redirect\" title=\"Chondrocytes\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chondrocytes\">chondrocytes<\/a>\u00a0to maintain the structural integrity of cartilage.<sup id=\"cite_ref-32\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-32\">[32]<\/a><\/sup>\u00a0More 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.<sup id=\"cite_ref-33\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-33\">[33]<\/a><\/sup>\r\n<h3><span id=\"Rheumatoid_arthritis\" class=\"mw-headline\">Rheumatoid arthritis<\/span><\/h3>\r\n<div class=\"thumb tright\">\r\n<div class=\"thumbinner\">[caption id=\"\" align=\"alignleft\" width=\"220\"]<a class=\"image\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_right_fourth_PIP_joint_with_bone_erosions_by_rheumatoid_arthritis.jpg\"><img class=\"thumbimage\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6c\/X-ray_of_right_fourth_PIP_joint_with_bone_erosions_by_rheumatoid_arthritis.jpg\/220px-X-ray_of_right_fourth_PIP_joint_with_bone_erosions_by_rheumatoid_arthritis.jpg\" alt=\"\" width=\"220\" height=\"264\" \/><\/a> Bone erosions\u00a0by\u00a0rheumatoid arthritis.[34][\/caption]\r\n<div class=\"thumbcaption\">\r\n<div class=\"magnify\"><a style=\"font-size: 1rem;text-align: initial\" title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a><span style=\"font-size: 1rem;text-align: initial\">\u00a0(RA) is a disorder in which the body's own immune system starts to attack body\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Tissue (biology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\">tissues<\/a><span style=\"font-size: 1rem;text-align: initial\">.<\/span><sup id=\"cite_ref-35\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-35\">[35]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0The 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\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Cartilage\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\">cartilage<\/a><span style=\"font-size: 1rem;text-align: initial\">\u00a0which 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\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Deformity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Deformity\">deformity<\/a><span style=\"font-size: 1rem;text-align: initial\">\u00a0in a few years if not treated. RA occurs mostly in people aged 20 and above. In children, the disorder can present with a skin\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Rash\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rash\">rash<\/a><span style=\"font-size: 1rem;text-align: initial\">,\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Fever\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fever\">fever<\/a><span style=\"font-size: 1rem;text-align: initial\">,\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a><span style=\"font-size: 1rem;text-align: initial\">, disability, and limitations in daily activities.<\/span><sup id=\"cite_ref-36\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-36\">[36]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0With earlier diagnosis and aggressive treatment, many individuals can lead a better quality of life than if going undiagnosed for long after RA's onset.<\/span><sup id=\"cite_ref-37\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-37\">[37]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0The 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.<\/span><sup id=\"cite_ref-38\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-38\">[38]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0<\/span><sup id=\"cite_ref-39\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-39\">[39]<\/a><\/sup><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nBone erosion is a central feature of rheumatoid arthritis. Bone continuously undergoes remodeling by actions of bone resorbing\u00a0<a title=\"Osteoclast\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoclast\">osteoclasts<\/a>\u00a0and bone forming\u00a0<a title=\"Osteoblast\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast\">osteoblasts<\/a>. One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the\u00a0<a class=\"mw-redirect\" title=\"Synovium\" href=\"https:\/\/en.wikipedia.org\/wiki\/Synovium\">synovium<\/a>, caused in part by the production of pro-inflammatory\u00a0<a title=\"Cytokine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cytokine\">cytokines<\/a>\u00a0and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts.<sup id=\"cite_ref-Chabaud_2000_40-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Chabaud_2000-40\">[40]<\/a><\/sup>\u00a0Osteoclast activity can be directly induced by osteoblasts through the RANK\/RANKL mechanism.<sup id=\"cite_ref-pmid21464945_41-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-pmid21464945-41\">[41]<\/a><\/sup>\r\n<h3><span id=\"Lupus\" class=\"mw-headline\">Lupus<\/span><\/h3>\r\n<a title=\"Lupus erythematosus\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lupus_erythematosus\">Lupus<\/a>\u00a0is a common\u00a0<a title=\"Collagen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\">collagen<\/a>\u00a0<a class=\"mw-redirect\" title=\"Vascular\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular\">vascular<\/a>\u00a0disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme\u00a0<a title=\"Photosensitivity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitivity\">photosensitivity<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Baldness\" href=\"https:\/\/en.wikipedia.org\/wiki\/Baldness\">hair loss<\/a>,\u00a0<a title=\"Kidney\" href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\">kidney<\/a>\u00a0problems, lung fibrosis and constant joint pain.<sup id=\"cite_ref-42\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-42\">[42]<\/a><\/sup>\r\n<h3><span id=\"Gout\" class=\"mw-headline\">Gout<\/span><\/h3>\r\n<div class=\"hatnote navigation-not-searchable\" role=\"note\"><\/div>\r\n<a title=\"Gout\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gout\">Gout<\/a>\u00a0is caused by deposition of\u00a0<a title=\"Uric acid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Uric_acid\">uric acid<\/a>\u00a0crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as\u00a0<a class=\"mw-redirect\" title=\"Calcium pyrophosphate deposition disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_pyrophosphate_deposition_disease\">pseudogout<\/a>. 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.<sup id=\"cite_ref-Becker_43-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Becker-43\">[43]<\/a><\/sup>\u00a0When 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.<sup id=\"cite_ref-Ali_44-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Ali-44\">[44]<\/a><\/sup>\r\n<h3><span id=\"Comparison_of_types\" class=\"mw-headline\">Comparison of types<\/span><\/h3>\r\n<table class=\"wikitable\"><caption>Comparison of some major forms of arthritis<sup id=\"cite_ref-agabegi2nd6-7unless_45-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-agabegi2nd6-7unless-45\">[45]<\/a><\/sup><\/caption>\r\n<tbody>\r\n<tr>\r\n<th><\/th>\r\n<th><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a><\/th>\r\n<th><a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a><\/th>\r\n<th><a class=\"mw-redirect\" title=\"Gouty arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gouty_arthritis\">Gouty arthritis<\/a><\/th>\r\n<\/tr>\r\n<tr>\r\n<th>Speed of onset<\/th>\r\n<td>Months<\/td>\r\n<td>Weeks-months<sup id=\"cite_ref-Chan1994_46-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Chan1994-46\">[46]<\/a><\/sup><\/td>\r\n<td>Hours for an attack<sup id=\"cite_ref-Harwood-Nuss2009_47-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Harwood-Nuss2009-47\">[47]<\/a><\/sup><\/td>\r\n<\/tr>\r\n<tr>\r\n<th>Main locations<\/th>\r\n<td>Weight-bearing joints (such as\u00a0<a title=\"Knee\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\">knees<\/a>,\u00a0<a title=\"Hip\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip#Articulation\">hips<\/a>,\u00a0<a title=\"Vertebral column\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebral_column\">vertebral column<\/a>) and hands<\/td>\r\n<td>Hands (<a class=\"mw-redirect\" title=\"Proximal interphalangeal joint\" href=\"https:\/\/en.wikipedia.org\/wiki\/Proximal_interphalangeal_joint\">proximal interphalangeal<\/a>\u00a0and\u00a0<a title=\"Metacarpophalangeal joint\" href=\"https:\/\/en.wikipedia.org\/wiki\/Metacarpophalangeal_joint\">metacarpophalangeal joint<\/a>)\u00a0<a title=\"Wrist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wrist\">wrists<\/a>,\u00a0<a title=\"Ankle\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\">ankles<\/a>,\u00a0<a title=\"Knee\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\">knees<\/a>\u00a0and\u00a0<a title=\"Hip\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\">hips<\/a><\/td>\r\n<td><a class=\"mw-redirect\" title=\"Great toe\" href=\"https:\/\/en.wikipedia.org\/wiki\/Great_toe\">Great toe<\/a>,\u00a0<a title=\"Ankle\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\">ankles<\/a>,\u00a0<a title=\"Knee\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\">knees<\/a>\u00a0and\u00a0<a title=\"Elbow\" href=\"https:\/\/en.wikipedia.org\/wiki\/Elbow\">elbows<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<th>Inflammation<\/th>\r\n<td>May occur, though often mild compared to inflammation in rheumatoid arthritis<\/td>\r\n<td>Yes<\/td>\r\n<td>Yes<\/td>\r\n<\/tr>\r\n<tr>\r\n<th><a class=\"mw-redirect\" title=\"Radiologic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Radiologic\">Radiologic<\/a>\u00a0changes<\/th>\r\n<td>\r\n<ul>\r\n \t<li>Narrowed joint space<\/li>\r\n \t<li><a title=\"Osteophyte\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteophyte\">Osteophytes<\/a><\/li>\r\n \t<li>Local\u00a0<a title=\"Osteosclerosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosclerosis\">osteosclerosis<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Subchondral cyst\" href=\"https:\/\/en.wikipedia.org\/wiki\/Subchondral_cyst\">Subchondral cysts<\/a><\/li>\r\n<\/ul>\r\n<\/td>\r\n<td>\r\n<ul>\r\n \t<li>Narrowed joint space<\/li>\r\n \t<li>Bone erosions<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td>\r\n<ul>\r\n \t<li>\"Punched out\" bone erosions<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th>Laboratory findings<\/th>\r\n<td>None<\/td>\r\n<td><a title=\"Anemia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anemia\">Anemia<\/a>, elevated\u00a0<a title=\"Erythrocyte sedimentation rate\" href=\"https:\/\/en.wikipedia.org\/wiki\/Erythrocyte_sedimentation_rate\">ESR<\/a>\u00a0and\u00a0<a title=\"C-reactive protein\" href=\"https:\/\/en.wikipedia.org\/wiki\/C-reactive_protein\">C-reactive protein<\/a>\u00a0(CRP),\u00a0<a title=\"Rheumatoid factor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_factor\">rheumatoid factor<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Anti-citrullinated protein antibody\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anti-citrullinated_protein_antibody\">anti-citrullinated protein antibody<\/a><\/td>\r\n<td><a title=\"Crystal\" href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal\">Crystal<\/a>\u00a0in joints<\/td>\r\n<\/tr>\r\n<tr>\r\n<th>Other features<\/th>\r\n<td>\r\n<ul>\r\n \t<li>No systemic signs<\/li>\r\n \t<li><a title=\"Bouchard's nodes\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bouchard%27s_nodes\">Bouchard's<\/a>\u00a0and\u00a0<a title=\"Heberden's node\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heberden%27s_node\">Heberden's nodes<\/a><\/li>\r\n<\/ul>\r\n<\/td>\r\n<td>\r\n<ul>\r\n \t<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#Signs_and_symptoms\">Extra-articular features<\/a>\u00a0are common<\/li>\r\n \t<li><a title=\"Ulnar deviation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ulnar_deviation\">Ulnar deviation<\/a>,\u00a0<a title=\"Swan neck deformity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Swan_neck_deformity\">swan neck-<\/a>\u00a0and\u00a0<a title=\"Boutonniere deformity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Boutonniere_deformity\">Boutonniere deformity<\/a>\u00a0of the hand<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td>\r\n<ul>\r\n \t<li><a title=\"Tophus\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tophus\">Tophi<\/a><\/li>\r\n \t<li><a class=\"mw-redirect\" title=\"Nephrolithiasis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrolithiasis\">Nephrolithiasis<\/a><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><span id=\"Other\" class=\"mw-headline\">Other<\/span><\/h3>\r\n<a class=\"mw-redirect\" title=\"Infectious arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Infectious_arthritis\">Infectious arthritis<\/a>\u00a0is 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.<sup id=\"cite_ref-48\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-48\">[48]<\/a><\/sup>\r\n\r\n<a title=\"Psoriasis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriasis\">Psoriasis<\/a>\u00a0can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of\u00a0<a title=\"Remission (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Remission_(medicine)\">remission<\/a>\u00a0but there is no cure for the disorder. A small percentage develop a severe 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.<sup id=\"cite_ref-49\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-49\">[49]<\/a><\/sup>\r\n<h2><span id=\"Treatment\" class=\"mw-headline\">Treatment<\/span><\/h2>\r\nThere is no known cure for arthritis and rheumatic diseases. Treatment options vary depending on the type of arthritis and include\u00a0<a title=\"Physical therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\">physical therapy<\/a>, exercise and diet,\u00a0<a class=\"mw-redirect\" title=\"Brace (orthopaedic)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Brace_(orthopaedic)\">orthopedic bracing<\/a>, and oral and topical medications.<sup id=\"cite_ref-NIH2014_2-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup><sup id=\"cite_ref-50\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-50\">[50]<\/a><\/sup>\u00a0<a class=\"mw-redirect\" title=\"Joint replacement surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_surgery\">Joint replacement surgery<\/a>\u00a0may be required to repair damage, restore function, or relieve pain.<sup id=\"cite_ref-NIH2014_2-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup>\r\n<h3><span id=\"Physical_therapy\" class=\"mw-headline\">Physical therapy<\/span><\/h3>\r\nIn 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.<sup id=\"cite_ref-51\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-51\">[51]<\/a><\/sup>\r\n\r\nIndividuals with arthritis can benefit from both physical and\u00a0<a title=\"Occupational therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_therapy\">occupational therapy<\/a>. 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 need for surgical intervention in advanced cases.<sup id=\"cite_ref-52\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-52\">[52]<\/a><\/sup>\u00a0Exercise 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.<sup id=\"cite_ref-53\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-53\">[53]<\/a><\/sup>\r\n<h3><span id=\"Medications\" class=\"mw-headline\">Medications<\/span><\/h3>\r\nThere 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.<sup id=\"cite_ref-54\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-54\">[54]<\/a><\/sup>\r\n\r\nDepending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for\u00a0<a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">osteoarthritis<\/a>\u00a0is\u00a0<a class=\"mw-redirect\" title=\"Acetaminophen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acetaminophen\">acetaminophen<\/a>\u00a0(paracetamol) while for\u00a0<a title=\"Inflammatory arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammatory_arthritis\">inflammatory arthritis<\/a>\u00a0it involves\u00a0<a class=\"mw-redirect\" title=\"Non-steroidal anti-inflammatory drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Non-steroidal_anti-inflammatory_drug\">non-steroidal anti-inflammatory drugs<\/a>\u00a0(NSAIDs) like\u00a0<a title=\"Ibuprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ibuprofen\">ibuprofen<\/a>.\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">Opioids<\/a>\u00a0and NSAIDs may be less well tolerated.<sup id=\"cite_ref-55\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-55\">[55]<\/a><\/sup>\u00a0However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular corticosteroid injections may also be considered.<sup id=\"cite_ref-56\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-56\">[56]<\/a><\/sup>\r\n\r\nThe drugs to treat\u00a0<a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">rheumatoid arthritis<\/a>\u00a0(RA) range from\u00a0<a title=\"Corticosteroid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Corticosteroid\">corticosteroids<\/a>\u00a0to\u00a0<a class=\"mw-redirect\" title=\"Monoclonal antibodies\" href=\"https:\/\/en.wikipedia.org\/wiki\/Monoclonal_antibodies\">monoclonal antibodies<\/a>\u00a0given\u00a0<a title=\"Intravenous therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\">intravenously<\/a>. Due to the\u00a0<a class=\"mw-redirect\" title=\"Autoimmune\" href=\"https:\/\/en.wikipedia.org\/wiki\/Autoimmune\">autoimmune<\/a>\u00a0nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called\u00a0<a title=\"Disease-modifying antirheumatic drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Disease-modifying_antirheumatic_drug\">disease-modifying antirheumatic drugs<\/a>\u00a0(DMARDs). Treatment with DMARDs is designed to slow down the progression of RA by initiating an\u00a0<a title=\"Adaptive immune system\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adaptive_immune_system\">adaptive immune response<\/a>, in part by CD4+ T helper (Th) cells, specifically Th17 cells.<sup id=\"cite_ref-pmid23383714_57-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-pmid23383714-57\">[57]<\/a><\/sup>\u00a0Th17 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).<sup id=\"cite_ref-Chabaud_2000_40-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Chabaud_2000-40\">[40]<\/a><\/sup>\r\n<h3><span id=\"Surgery\" class=\"mw-headline\">Surgery<\/span><\/h3>\r\nA number of\u00a0<a class=\"mw-redirect\" title=\"Rheumasurgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumasurgery\">rheumasurgical<\/a>\u00a0interventions have been incorporated in the treatment of arthritis since the 1950s.\u00a0<a class=\"mw-redirect\" title=\"Arthroscopic surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopic_surgery\">Arthroscopic surgery<\/a>\u00a0for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.<sup id=\"cite_ref-pmid18784099_58-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-pmid18784099-58\">[58]<\/a><\/sup>\r\n<h3><span id=\"Adaptive_aids\" class=\"mw-headline\">Adaptive aids<\/span><\/h3>\r\nPeople with hand arthritis can have trouble with simple\u00a0<a title=\"Activities of daily living\" href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\">activities of daily living<\/a>\u00a0tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. There are\u00a0<a class=\"new\" title=\"Adaptive aids (page does not exist)\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Adaptive_aids&amp;action=edit&amp;redlink=1\">adaptive aids<\/a>\u00a0or (<a title=\"Assistive technology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_technology\">assistive devices<\/a>\u00a0(ADs)) available to help with these tasks,<sup id=\"cite_ref-59\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-59\">[59]<\/a><\/sup>\u00a0but they are generally more costly than conventional products with the same function. It is now possible to\u00a0<a class=\"mw-redirect\" title=\"3-D print\" href=\"https:\/\/en.wikipedia.org\/wiki\/3-D_print\">3-D print<\/a>\u00a0adaptive aids, which have been released as\u00a0<a class=\"mw-redirect\" title=\"Open source hardware\" href=\"https:\/\/en.wikipedia.org\/wiki\/Open_source_hardware\">open source hardware<\/a>\u00a0to reduce patient costs.<sup id=\"cite_ref-60\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-60\">[60]<\/a><\/sup><sup id=\"cite_ref-61\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-61\">[61]<\/a><\/sup>\u00a0Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.<sup id=\"cite_ref-62\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-62\">[62]<\/a><\/sup>\r\n<h3><span id=\"Alternative_medicine\" class=\"mw-headline\">Alternative medicine<\/span><\/h3>\r\nFurther research is required to determine if\u00a0<a title=\"Transcutaneous electrical nerve stimulation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\">transcutaneous electrical nerve stimulation<\/a>\u00a0(TENS) for knee osteoarthritis is effective for controlling pain.<sup id=\"cite_ref-63\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-63\">[63]<\/a><\/sup>\r\n\r\n<a class=\"mw-redirect\" title=\"Low level laser therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Low_level_laser_therapy\">Low level laser therapy<\/a>\u00a0may be considered for relief of pain and stiffness associated with arthritis.<sup id=\"cite_ref-64\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-64\">[64]<\/a><\/sup>\u00a0Evidence of benefit is tentative.<sup id=\"cite_ref-65\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-65\">[65]<\/a><\/sup>\r\n\r\n<a title=\"Pulsed electromagnetic field therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsed_electromagnetic_field_therapy\">Pulsed electromagnetic field therapy<\/a>\u00a0(PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis.<sup id=\"cite_ref-66\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-66\">[66]<\/a><\/sup>\u00a0The 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.<sup id=\"cite_ref-67\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-67\">[67]<\/a><\/sup>","rendered":"<h2><span id=\"Classification\" class=\"mw-headline\">Classification<\/span><\/h2>\n<p>There are several diseases where joint pain is primary, and is considered the main feature. Generally when a person has &#8220;arthritis&#8221; it means that they have one of these diseases, which include:<\/p>\n<ul>\n<li><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a><\/li>\n<li><a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a><\/li>\n<li><a title=\"Gout\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gout\">Gout<\/a>\u00a0and\u00a0<a class=\"mw-redirect\" title=\"Calcium pyrophosphate deposition disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_pyrophosphate_deposition_disease\">pseudo-gout<\/a><\/li>\n<li><a title=\"Septic arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Septic_arthritis\">Septic arthritis<\/a><\/li>\n<li><a title=\"Ankylosing spondylitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosing_spondylitis\">Ankylosing spondylitis<\/a><\/li>\n<li><a title=\"Juvenile idiopathic arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Juvenile_idiopathic_arthritis\">Juvenile idiopathic arthritis<\/a><\/li>\n<li><a title=\"Adult-onset Still's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adult-onset_Still%27s_disease\">Still&#8217;s disease<\/a><\/li>\n<\/ul>\n<p>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:<\/p>\n<ul>\n<li><a title=\"Psoriasis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriasis\">Psoriasis<\/a>\u00a0(<a title=\"Psoriatic arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriatic_arthritis\">Psoriatic arthritis<\/a>)<\/li>\n<li><a title=\"Reactive arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Reactive_arthritis\">Reactive arthritis<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Ehlers\u2013Danlos syndrome\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ehlers%E2%80%93Danlos_syndrome\">Ehlers\u2013Danlos syndrome<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Haemochromatosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Haemochromatosis\">Haemochromatosis<\/a><\/li>\n<li><a title=\"Hepatitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis\">Hepatitis<\/a><\/li>\n<li><a title=\"Lyme disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lyme_disease\">Lyme disease<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Sj\u00f6gren's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sj%C3%B6gren%27s_disease\">Sj\u00f6gren&#8217;s disease<\/a><\/li>\n<li><a title=\"Hashimoto's thyroiditis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hashimoto%27s_thyroiditis\">Hashimoto&#8217;s thyroiditis<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Celiac disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Celiac_disease\">Celiac disease<\/a><sup id=\"cite_ref-GuandaliniAssiri2014_15-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-GuandaliniAssiri2014-15\">[15]<\/a><\/sup><\/li>\n<li><a title=\"Non-celiac gluten sensitivity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Non-celiac_gluten_sensitivity\">Non-celiac gluten sensitivity<\/a><sup id=\"cite_ref-FasanoSapone2015_16-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-FasanoSapone2015-16\">[16]<\/a><\/sup><sup id=\"cite_ref-VoltaCaio2015_17-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-VoltaCaio2015-17\">[17]<\/a><\/sup><sup id=\"cite_ref-CatassiBai2013_18-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-CatassiBai2013-18\">[18]<\/a><\/sup><\/li>\n<li><a title=\"Inflammatory bowel disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammatory_bowel_disease\">Inflammatory bowel disease<\/a>\u00a0(including\u00a0<a title=\"Crohn's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Crohn%27s_disease\">Crohn&#8217;s disease<\/a>\u00a0and\u00a0<a title=\"Ulcerative colitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ulcerative_colitis\">ulcerative colitis<\/a>)<\/li>\n<li><a title=\"Henoch\u2013Sch\u00f6nlein purpura\" href=\"https:\/\/en.wikipedia.org\/wiki\/Henoch%E2%80%93Sch%C3%B6nlein_purpura\">Henoch\u2013Sch\u00f6nlein purpura<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Hyperimmunoglobulinemia D with recurrent fever\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperimmunoglobulinemia_D_with_recurrent_fever\">Hyperimmunoglobulinemia D with recurrent fever<\/a><\/li>\n<li><a title=\"Sarcoidosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sarcoidosis\">Sarcoidosis<\/a><\/li>\n<li><a title=\"Whipple's disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Whipple%27s_disease\">Whipple&#8217;s disease<\/a><\/li>\n<li><a title=\"TNF receptor associated periodic syndrome\" href=\"https:\/\/en.wikipedia.org\/wiki\/TNF_receptor_associated_periodic_syndrome\">TNF receptor associated periodic syndrome<\/a><\/li>\n<li><a title=\"Granulomatosis with polyangiitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Granulomatosis_with_polyangiitis\">Granulomatosis with polyangiitis<\/a>\u00a0(and many other\u00a0<a title=\"Vasculitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vasculitis\">vasculitis<\/a>\u00a0syndromes)<\/li>\n<li><a title=\"Familial Mediterranean fever\" href=\"https:\/\/en.wikipedia.org\/wiki\/Familial_Mediterranean_fever\">Familial Mediterranean fever<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Systemic lupus erythematosus\" href=\"https:\/\/en.wikipedia.org\/wiki\/Systemic_lupus_erythematosus\">Systemic lupus erythematosus<\/a><\/li>\n<\/ul>\n<p><span id=\"undifferentiated\" class=\"anchor\"><\/span>An\u00a0<i>undifferentiated arthritis<\/i>\u00a0is an arthritis that does not fit into well-known clinical disease categories, possibly being an early stage of a definite\u00a0<a class=\"mw-redirect\" title=\"Rheumatic disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatic_disease\">rheumatic disease<\/a>.<sup id=\"cite_ref-19\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-19\">[19]<\/a><\/sup><\/p>\n<h2><span id=\"Signs_and_symptoms\" class=\"mw-headline\">Signs and symptoms<\/span><\/h2>\n<table class=\"wikitable\" style=\"height: 244px; width: 415px; text-align: right;\">\n<tbody>\n<tr>\n<th style=\"width: 429.5px\">Extra-articular features of joint disease<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-20\">[20]<\/a><\/sup><\/th>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a class=\"mw-redirect\" title=\"Cutaneous\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cutaneous\">Cutaneous<\/a>\u00a0<a title=\"Nodule (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nodule_(medicine)\">nodules<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\">Cutaneous\u00a0<a title=\"Vasculitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vasculitis\">vasculitis<\/a>\u00a0<a title=\"Lesion\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lesion\">lesions<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a title=\"Lymphadenopathy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphadenopathy\">Lymphadenopathy<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a class=\"mw-redirect\" title=\"Oedema\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oedema\">Oedema<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a title=\"Human eye\" href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\">Ocular<\/a>\u00a0<a title=\"Inflammation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\">inflammation<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a title=\"Urethritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Urethritis\">Urethritis<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a title=\"Tenosynovitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tenosynovitis\">Tenosynovitis<\/a>\u00a0(<a title=\"Tendon\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\">tendon<\/a>\u00a0sheath\u00a0<a title=\"Effusion\" href=\"https:\/\/en.wikipedia.org\/wiki\/Effusion\">effusions<\/a>)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a title=\"Bursitis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bursitis\">Bursitis<\/a>\u00a0(swollen\u00a0<a class=\"mw-redirect\" title=\"Bursa (anatomy)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bursa_(anatomy)\">bursa<\/a>)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\"><a title=\"Diarrhea\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diarrhea\">Diarrhea<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 429.5px\">Orogenital\u00a0<a title=\"Ulcer (dermatology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ulcer_(dermatology)\">ulceration<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Pain, which can vary in severity, is a common symptom in virtually all types of arthritis. Other symptoms include\u00a0<a class=\"mw-redirect\" title=\"Swelling (medical)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Swelling_(medical)\">swelling<\/a>,\u00a0<a title=\"Joint stiffness\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_stiffness\">joint stiffness<\/a>, redness, and aching around the joint(s).<sup id=\"cite_ref-NIH2014_2-5\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup>\u00a0Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms.<sup id=\"cite_ref-21\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-21\">[21]<\/a><\/sup>\u00a0Symptoms may include:<sup id=\"cite_ref-NIH2014_2-6\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup><\/p>\n<ul>\n<li>Inability to use the\u00a0<a title=\"Hand\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hand\">hand<\/a>\u00a0or\u00a0<a title=\"Walking\" href=\"https:\/\/en.wikipedia.org\/wiki\/Walking\">walk<\/a><\/li>\n<li>Stiffness in one or more joints<\/li>\n<li>Rash or itch<\/li>\n<li><a title=\"Malaise\" href=\"https:\/\/en.wikipedia.org\/wiki\/Malaise\">Malaise<\/a>\u00a0and fatigue<\/li>\n<li><a title=\"Weight loss\" href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_loss\">Weight loss<\/a><\/li>\n<li>Poor sleep<\/li>\n<li><a title=\"Myalgia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Myalgia\">Muscle aches<\/a>\u00a0and pains<\/li>\n<li><a title=\"Tenderness (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tenderness_(medicine)\">Tenderness<\/a><\/li>\n<li>Difficulty moving the joint<\/li>\n<\/ul>\n<p>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:<\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\">\n<div style=\"width: 230px\" class=\"wp-caption alignright\"><a class=\"image\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gout_Signs_and_Symptoms.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Gout_Signs_and_Symptoms.jpg\/220px-Gout_Signs_and_Symptoms.jpg\" alt=\"\" width=\"220\" height=\"124\" \/><\/a><\/p>\n<p class=\"wp-caption-text\">Illustration of gout affected foot. Muscle\u00a0weakness Loss of\u00a0flexibility Decreased\u00a0aerobic fitness These changes, in addition to the primary symptoms, can have a huge impact on quality of life.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Disability\" class=\"mw-headline\">Disability<\/span><\/h3>\n<p>Arthritis is the most common cause of\u00a0<a title=\"Disability\" href=\"https:\/\/en.wikipedia.org\/wiki\/Disability\">disability<\/a>\u00a0in the United States. More than 20 million individuals with arthritis have severe limitations in function on a daily basis.<sup id=\"cite_ref-22\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-22\">[22]<\/a><\/sup>\u00a0<a title=\"Absenteeism\" href=\"https:\/\/en.wikipedia.org\/wiki\/Absenteeism\">Absenteeism<\/a>\u00a0and frequent visits to the\u00a0<a title=\"Physician\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\">physician<\/a>\u00a0are common in individuals who have arthritis. Arthritis can make it very difficult for individuals to be physically active and some become home bound.<\/p>\n<p>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\u00a0<a title=\"Health care\" href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\">health care<\/a>\u00a0centers.<sup id=\"cite_ref-23\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-23\">[23]<\/a><\/sup><\/p>\n<p>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\u00a0<a title=\"Cholesterol\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cholesterol\">cholesterol<\/a>\u00a0or vulnerability to\u00a0<a class=\"mw-redirect\" title=\"Heart disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_disease\">heart disease<\/a>.<sup id=\"cite_ref-24\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-24\">[24]<\/a><\/sup>\u00a0People with arthritis are also at increased risk of\u00a0<a title=\"Major depressive disorder\" href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\">depression<\/a>, which may be a response to numerous factors, including fear of worsening symptoms.<sup id=\"cite_ref-25\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-25\">[25]<\/a><\/sup><\/p>\n<h2><span id=\"Risk_factors\" class=\"mw-headline\">Risk factors<\/span><\/h2>\n<p>There are common risk factors that increase a person&#8217;s chance of developing arthritis later in adulthood. Some of these are modifiable while others are not.\u00a0<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-26\">[26]<\/a><\/sup>\u00a0Smoking has been linked to an increased susceptibility of developing arthritis, particularly rheumatoid arthritis.<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-27\">[27]<\/a><\/sup><\/p>\n<h2><span id=\"Diagnosis\" class=\"mw-headline\">Diagnosis<\/span><\/h2>\n<p>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.<sup id=\"cite_ref-28\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-28\">[28]<\/a><\/sup>\u00a0All arthritides potentially feature\u00a0<a title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a>. Pain patterns may differ depending on the arthritides and the location.\u00a0<a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a>\u00a0is generally worse in the morning and associated with stiffness lasting over 30 minutes.<sup id=\"cite_ref-29\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-29\">[29]<\/a><\/sup>\u00a0However, in the early stages, patients may have no symptoms after a warm shower.\u00a0<a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a>, 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.<\/p>\n<p>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.<\/p>\n<p><a title=\"Blood test\" href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\">Blood tests<\/a>\u00a0and\u00a0<a title=\"X-ray\" href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\">X-rays<\/a>\u00a0of the affected joints often are performed to make the diagnosis. Screening blood tests are indicated if certain arthritides are suspected. These might include:\u00a0<a title=\"Rheumatoid factor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_factor\">rheumatoid factor<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Antinuclear factor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Antinuclear_factor\">antinuclear factor<\/a>\u00a0(ANF),\u00a0<a title=\"Extractable nuclear antigen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Extractable_nuclear_antigen\">extractable nuclear antigen<\/a>, and specific antibodies.<\/p>\n<h3><span id=\"Osteoarthritis\" class=\"mw-headline\">Osteoarthritis<\/span><\/h3>\n<p><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a>\u00a0is the most common form of arthritis.<sup id=\"cite_ref-Van2010_30-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Van2010-30\">[30]<\/a><\/sup>\u00a0It 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 included the hands,\u00a0<a title=\"Wrist osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wrist_osteoarthritis\">wrists<\/a>, 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).<sup id=\"cite_ref-31\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-31\">[31]<\/a><\/sup>\u00a0Osteoarthritis 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\u00a0<a class=\"mw-redirect\" title=\"Chondrocytes\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chondrocytes\">chondrocytes<\/a>\u00a0to maintain the structural integrity of cartilage.<sup id=\"cite_ref-32\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-32\">[32]<\/a><\/sup>\u00a0More 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.<sup id=\"cite_ref-33\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-33\">[33]<\/a><\/sup><\/p>\n<h3><span id=\"Rheumatoid_arthritis\" class=\"mw-headline\">Rheumatoid arthritis<\/span><\/h3>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\">\n<div style=\"width: 230px\" class=\"wp-caption alignleft\"><a class=\"image\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_right_fourth_PIP_joint_with_bone_erosions_by_rheumatoid_arthritis.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6c\/X-ray_of_right_fourth_PIP_joint_with_bone_erosions_by_rheumatoid_arthritis.jpg\/220px-X-ray_of_right_fourth_PIP_joint_with_bone_erosions_by_rheumatoid_arthritis.jpg\" alt=\"\" width=\"220\" height=\"264\" \/><\/a><\/p>\n<p class=\"wp-caption-text\">Bone erosions\u00a0by\u00a0rheumatoid arthritis.[34]<\/p>\n<\/div>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><a style=\"font-size: 1rem;text-align: initial\" title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a><span style=\"font-size: 1rem;text-align: initial\">\u00a0(RA) is a disorder in which the body&#8217;s own immune system starts to attack body\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Tissue (biology)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\">tissues<\/a><span style=\"font-size: 1rem;text-align: initial\">.<\/span><sup id=\"cite_ref-35\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-35\">[35]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0The 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\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Cartilage\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\">cartilage<\/a><span style=\"font-size: 1rem;text-align: initial\">\u00a0which 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\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Deformity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Deformity\">deformity<\/a><span style=\"font-size: 1rem;text-align: initial\">\u00a0in a few years if not treated. RA occurs mostly in people aged 20 and above. In children, the disorder can present with a skin\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Rash\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rash\">rash<\/a><span style=\"font-size: 1rem;text-align: initial\">,\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Fever\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fever\">fever<\/a><span style=\"font-size: 1rem;text-align: initial\">,\u00a0<\/span><a style=\"font-size: 1rem;text-align: initial\" title=\"Pain\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\">pain<\/a><span style=\"font-size: 1rem;text-align: initial\">, disability, and limitations in daily activities.<\/span><sup id=\"cite_ref-36\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-36\">[36]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0With earlier diagnosis and aggressive treatment, many individuals can lead a better quality of life than if going undiagnosed for long after RA&#8217;s onset.<\/span><sup id=\"cite_ref-37\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-37\">[37]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0The 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.<\/span><sup id=\"cite_ref-38\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-38\">[38]<\/a><\/sup><span style=\"font-size: 1rem;text-align: initial\">\u00a0<\/span><sup id=\"cite_ref-39\" class=\"reference\" style=\"text-align: initial\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-39\">[39]<\/a><\/sup><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>Bone erosion is a central feature of rheumatoid arthritis. Bone continuously undergoes remodeling by actions of bone resorbing\u00a0<a title=\"Osteoclast\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoclast\">osteoclasts<\/a>\u00a0and bone forming\u00a0<a title=\"Osteoblast\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast\">osteoblasts<\/a>. One of the main triggers of bone erosion in the joints in rheumatoid arthritis is inflammation of the\u00a0<a class=\"mw-redirect\" title=\"Synovium\" href=\"https:\/\/en.wikipedia.org\/wiki\/Synovium\">synovium<\/a>, caused in part by the production of pro-inflammatory\u00a0<a title=\"Cytokine\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cytokine\">cytokines<\/a>\u00a0and receptor activator of nuclear factor kappa B ligand (RANKL), a cell surface protein present in Th17 cells and osteoblasts.<sup id=\"cite_ref-Chabaud_2000_40-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Chabaud_2000-40\">[40]<\/a><\/sup>\u00a0Osteoclast activity can be directly induced by osteoblasts through the RANK\/RANKL mechanism.<sup id=\"cite_ref-pmid21464945_41-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-pmid21464945-41\">[41]<\/a><\/sup><\/p>\n<h3><span id=\"Lupus\" class=\"mw-headline\">Lupus<\/span><\/h3>\n<p><a title=\"Lupus erythematosus\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lupus_erythematosus\">Lupus<\/a>\u00a0is a common\u00a0<a title=\"Collagen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\">collagen<\/a>\u00a0<a class=\"mw-redirect\" title=\"Vascular\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular\">vascular<\/a>\u00a0disorder that can be present with severe arthritis. Other features of lupus include a skin rash, extreme\u00a0<a title=\"Photosensitivity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitivity\">photosensitivity<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Baldness\" href=\"https:\/\/en.wikipedia.org\/wiki\/Baldness\">hair loss<\/a>,\u00a0<a title=\"Kidney\" href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\">kidney<\/a>\u00a0problems, lung fibrosis and constant joint pain.<sup id=\"cite_ref-42\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-42\">[42]<\/a><\/sup><\/p>\n<h3><span id=\"Gout\" class=\"mw-headline\">Gout<\/span><\/h3>\n<div class=\"hatnote navigation-not-searchable\" role=\"note\"><\/div>\n<p><a title=\"Gout\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gout\">Gout<\/a>\u00a0is caused by deposition of\u00a0<a title=\"Uric acid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Uric_acid\">uric acid<\/a>\u00a0crystals in the joint, causing inflammation. There is also an uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known as\u00a0<a class=\"mw-redirect\" title=\"Calcium pyrophosphate deposition disease\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_pyrophosphate_deposition_disease\">pseudogout<\/a>. 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.<sup id=\"cite_ref-Becker_43-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Becker-43\">[43]<\/a><\/sup>\u00a0When 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.<sup id=\"cite_ref-Ali_44-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Ali-44\">[44]<\/a><\/sup><\/p>\n<h3><span id=\"Comparison_of_types\" class=\"mw-headline\">Comparison of types<\/span><\/h3>\n<table class=\"wikitable\">\n<caption>Comparison of some major forms of arthritis<sup id=\"cite_ref-agabegi2nd6-7unless_45-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-agabegi2nd6-7unless-45\">[45]<\/a><\/sup><\/caption>\n<tbody>\n<tr>\n<th><\/th>\n<th><a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">Osteoarthritis<\/a><\/th>\n<th><a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">Rheumatoid arthritis<\/a><\/th>\n<th><a class=\"mw-redirect\" title=\"Gouty arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gouty_arthritis\">Gouty arthritis<\/a><\/th>\n<\/tr>\n<tr>\n<th>Speed of onset<\/th>\n<td>Months<\/td>\n<td>Weeks-months<sup id=\"cite_ref-Chan1994_46-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Chan1994-46\">[46]<\/a><\/sup><\/td>\n<td>Hours for an attack<sup id=\"cite_ref-Harwood-Nuss2009_47-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Harwood-Nuss2009-47\">[47]<\/a><\/sup><\/td>\n<\/tr>\n<tr>\n<th>Main locations<\/th>\n<td>Weight-bearing joints (such as\u00a0<a title=\"Knee\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\">knees<\/a>,\u00a0<a title=\"Hip\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip#Articulation\">hips<\/a>,\u00a0<a title=\"Vertebral column\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebral_column\">vertebral column<\/a>) and hands<\/td>\n<td>Hands (<a class=\"mw-redirect\" title=\"Proximal interphalangeal joint\" href=\"https:\/\/en.wikipedia.org\/wiki\/Proximal_interphalangeal_joint\">proximal interphalangeal<\/a>\u00a0and\u00a0<a title=\"Metacarpophalangeal joint\" href=\"https:\/\/en.wikipedia.org\/wiki\/Metacarpophalangeal_joint\">metacarpophalangeal joint<\/a>)\u00a0<a title=\"Wrist\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wrist\">wrists<\/a>,\u00a0<a title=\"Ankle\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\">ankles<\/a>,\u00a0<a title=\"Knee\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\">knees<\/a>\u00a0and\u00a0<a title=\"Hip\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\">hips<\/a><\/td>\n<td><a class=\"mw-redirect\" title=\"Great toe\" href=\"https:\/\/en.wikipedia.org\/wiki\/Great_toe\">Great toe<\/a>,\u00a0<a title=\"Ankle\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\">ankles<\/a>,\u00a0<a title=\"Knee\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\">knees<\/a>\u00a0and\u00a0<a title=\"Elbow\" href=\"https:\/\/en.wikipedia.org\/wiki\/Elbow\">elbows<\/a><\/td>\n<\/tr>\n<tr>\n<th>Inflammation<\/th>\n<td>May occur, though often mild compared to inflammation in rheumatoid arthritis<\/td>\n<td>Yes<\/td>\n<td>Yes<\/td>\n<\/tr>\n<tr>\n<th><a class=\"mw-redirect\" title=\"Radiologic\" href=\"https:\/\/en.wikipedia.org\/wiki\/Radiologic\">Radiologic<\/a>\u00a0changes<\/th>\n<td>\n<ul>\n<li>Narrowed joint space<\/li>\n<li><a title=\"Osteophyte\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteophyte\">Osteophytes<\/a><\/li>\n<li>Local\u00a0<a title=\"Osteosclerosis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosclerosis\">osteosclerosis<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Subchondral cyst\" href=\"https:\/\/en.wikipedia.org\/wiki\/Subchondral_cyst\">Subchondral cysts<\/a><\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li>Narrowed joint space<\/li>\n<li>Bone erosions<\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li>&#8220;Punched out&#8221; bone erosions<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th>Laboratory findings<\/th>\n<td>None<\/td>\n<td><a title=\"Anemia\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anemia\">Anemia<\/a>, elevated\u00a0<a title=\"Erythrocyte sedimentation rate\" href=\"https:\/\/en.wikipedia.org\/wiki\/Erythrocyte_sedimentation_rate\">ESR<\/a>\u00a0and\u00a0<a title=\"C-reactive protein\" href=\"https:\/\/en.wikipedia.org\/wiki\/C-reactive_protein\">C-reactive protein<\/a>\u00a0(CRP),\u00a0<a title=\"Rheumatoid factor\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_factor\">rheumatoid factor<\/a>,\u00a0<a class=\"mw-redirect\" title=\"Anti-citrullinated protein antibody\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anti-citrullinated_protein_antibody\">anti-citrullinated protein antibody<\/a><\/td>\n<td><a title=\"Crystal\" href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal\">Crystal<\/a>\u00a0in joints<\/td>\n<\/tr>\n<tr>\n<th>Other features<\/th>\n<td>\n<ul>\n<li>No systemic signs<\/li>\n<li><a title=\"Bouchard's nodes\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bouchard%27s_nodes\">Bouchard&#8217;s<\/a>\u00a0and\u00a0<a title=\"Heberden's node\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heberden%27s_node\">Heberden&#8217;s nodes<\/a><\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#Signs_and_symptoms\">Extra-articular features<\/a>\u00a0are common<\/li>\n<li><a title=\"Ulnar deviation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ulnar_deviation\">Ulnar deviation<\/a>,\u00a0<a title=\"Swan neck deformity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Swan_neck_deformity\">swan neck-<\/a>\u00a0and\u00a0<a title=\"Boutonniere deformity\" href=\"https:\/\/en.wikipedia.org\/wiki\/Boutonniere_deformity\">Boutonniere deformity<\/a>\u00a0of the hand<\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li><a title=\"Tophus\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tophus\">Tophi<\/a><\/li>\n<li><a class=\"mw-redirect\" title=\"Nephrolithiasis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrolithiasis\">Nephrolithiasis<\/a><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><span id=\"Other\" class=\"mw-headline\">Other<\/span><\/h3>\n<p><a class=\"mw-redirect\" title=\"Infectious arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Infectious_arthritis\">Infectious arthritis<\/a>\u00a0is 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.<sup id=\"cite_ref-48\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-48\">[48]<\/a><\/sup><\/p>\n<p><a title=\"Psoriasis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriasis\">Psoriasis<\/a>\u00a0can develop into psoriatic arthritis. With psoriatic arthritis, most individuals develop the skin problem first and then the arthritis. The typical features are of continuous joint pains, stiffness and swelling. The disease does recur with periods of\u00a0<a title=\"Remission (medicine)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Remission_(medicine)\">remission<\/a>\u00a0but there is no cure for the disorder. A small percentage develop a severe 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.<sup id=\"cite_ref-49\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-49\">[49]<\/a><\/sup><\/p>\n<h2><span id=\"Treatment\" class=\"mw-headline\">Treatment<\/span><\/h2>\n<p>There is no known cure for arthritis and rheumatic diseases. Treatment options vary depending on the type of arthritis and include\u00a0<a title=\"Physical therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\">physical therapy<\/a>, exercise and diet,\u00a0<a class=\"mw-redirect\" title=\"Brace (orthopaedic)\" href=\"https:\/\/en.wikipedia.org\/wiki\/Brace_(orthopaedic)\">orthopedic bracing<\/a>, and oral and topical medications.<sup id=\"cite_ref-NIH2014_2-7\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup><sup id=\"cite_ref-50\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-50\">[50]<\/a><\/sup>\u00a0<a class=\"mw-redirect\" title=\"Joint replacement surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_surgery\">Joint replacement surgery<\/a>\u00a0may be required to repair damage, restore function, or relieve pain.<sup id=\"cite_ref-NIH2014_2-8\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-NIH2014-2\">[2]<\/a><\/sup><\/p>\n<h3><span id=\"Physical_therapy\" class=\"mw-headline\">Physical therapy<\/span><\/h3>\n<p>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.<sup id=\"cite_ref-51\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-51\">[51]<\/a><\/sup><\/p>\n<p>Individuals with arthritis can benefit from both physical and\u00a0<a title=\"Occupational therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_therapy\">occupational therapy<\/a>. 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 need for surgical intervention in advanced cases.<sup id=\"cite_ref-52\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-52\">[52]<\/a><\/sup>\u00a0Exercise 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&#8217;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.<sup id=\"cite_ref-53\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-53\">[53]<\/a><\/sup><\/p>\n<h3><span id=\"Medications\" class=\"mw-headline\">Medications<\/span><\/h3>\n<p>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.<sup id=\"cite_ref-54\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-54\">[54]<\/a><\/sup><\/p>\n<p>Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for\u00a0<a title=\"Osteoarthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\">osteoarthritis<\/a>\u00a0is\u00a0<a class=\"mw-redirect\" title=\"Acetaminophen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Acetaminophen\">acetaminophen<\/a>\u00a0(paracetamol) while for\u00a0<a title=\"Inflammatory arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammatory_arthritis\">inflammatory arthritis<\/a>\u00a0it involves\u00a0<a class=\"mw-redirect\" title=\"Non-steroidal anti-inflammatory drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Non-steroidal_anti-inflammatory_drug\">non-steroidal anti-inflammatory drugs<\/a>\u00a0(NSAIDs) like\u00a0<a title=\"Ibuprofen\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ibuprofen\">ibuprofen<\/a>.\u00a0<a title=\"Opioid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\">Opioids<\/a>\u00a0and NSAIDs may be less well tolerated.<sup id=\"cite_ref-55\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-55\">[55]<\/a><\/sup>\u00a0However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular corticosteroid injections may also be considered.<sup id=\"cite_ref-56\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-56\">[56]<\/a><\/sup><\/p>\n<p>The drugs to treat\u00a0<a title=\"Rheumatoid arthritis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\">rheumatoid arthritis<\/a>\u00a0(RA) range from\u00a0<a title=\"Corticosteroid\" href=\"https:\/\/en.wikipedia.org\/wiki\/Corticosteroid\">corticosteroids<\/a>\u00a0to\u00a0<a class=\"mw-redirect\" title=\"Monoclonal antibodies\" href=\"https:\/\/en.wikipedia.org\/wiki\/Monoclonal_antibodies\">monoclonal antibodies<\/a>\u00a0given\u00a0<a title=\"Intravenous therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\">intravenously<\/a>. Due to the\u00a0<a class=\"mw-redirect\" title=\"Autoimmune\" href=\"https:\/\/en.wikipedia.org\/wiki\/Autoimmune\">autoimmune<\/a>\u00a0nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called\u00a0<a title=\"Disease-modifying antirheumatic drug\" href=\"https:\/\/en.wikipedia.org\/wiki\/Disease-modifying_antirheumatic_drug\">disease-modifying antirheumatic drugs<\/a>\u00a0(DMARDs). Treatment with DMARDs is designed to slow down the progression of RA by initiating an\u00a0<a title=\"Adaptive immune system\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adaptive_immune_system\">adaptive immune response<\/a>, in part by CD4+ T helper (Th) cells, specifically Th17 cells.<sup id=\"cite_ref-pmid23383714_57-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-pmid23383714-57\">[57]<\/a><\/sup>\u00a0Th17 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).<sup id=\"cite_ref-Chabaud_2000_40-1\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-Chabaud_2000-40\">[40]<\/a><\/sup><\/p>\n<h3><span id=\"Surgery\" class=\"mw-headline\">Surgery<\/span><\/h3>\n<p>A number of\u00a0<a class=\"mw-redirect\" title=\"Rheumasurgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumasurgery\">rheumasurgical<\/a>\u00a0interventions have been incorporated in the treatment of arthritis since the 1950s.\u00a0<a class=\"mw-redirect\" title=\"Arthroscopic surgery\" href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopic_surgery\">Arthroscopic surgery<\/a>\u00a0for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.<sup id=\"cite_ref-pmid18784099_58-0\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-pmid18784099-58\">[58]<\/a><\/sup><\/p>\n<h3><span id=\"Adaptive_aids\" class=\"mw-headline\">Adaptive aids<\/span><\/h3>\n<p>People with hand arthritis can have trouble with simple\u00a0<a title=\"Activities of daily living\" href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\">activities of daily living<\/a>\u00a0tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. There are\u00a0<a class=\"new\" title=\"Adaptive aids (page does not exist)\" href=\"https:\/\/en.wikipedia.org\/w\/index.php?title=Adaptive_aids&amp;action=edit&amp;redlink=1\">adaptive aids<\/a>\u00a0or (<a title=\"Assistive technology\" href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_technology\">assistive devices<\/a>\u00a0(ADs)) available to help with these tasks,<sup id=\"cite_ref-59\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-59\">[59]<\/a><\/sup>\u00a0but they are generally more costly than conventional products with the same function. It is now possible to\u00a0<a class=\"mw-redirect\" title=\"3-D print\" href=\"https:\/\/en.wikipedia.org\/wiki\/3-D_print\">3-D print<\/a>\u00a0adaptive aids, which have been released as\u00a0<a class=\"mw-redirect\" title=\"Open source hardware\" href=\"https:\/\/en.wikipedia.org\/wiki\/Open_source_hardware\">open source hardware<\/a>\u00a0to reduce patient costs.<sup id=\"cite_ref-60\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-60\">[60]<\/a><\/sup><sup id=\"cite_ref-61\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-61\">[61]<\/a><\/sup>\u00a0Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.<sup id=\"cite_ref-62\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-62\">[62]<\/a><\/sup><\/p>\n<h3><span id=\"Alternative_medicine\" class=\"mw-headline\">Alternative medicine<\/span><\/h3>\n<p>Further research is required to determine if\u00a0<a title=\"Transcutaneous electrical nerve stimulation\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\">transcutaneous electrical nerve stimulation<\/a>\u00a0(TENS) for knee osteoarthritis is effective for controlling pain.<sup id=\"cite_ref-63\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-63\">[63]<\/a><\/sup><\/p>\n<p><a class=\"mw-redirect\" title=\"Low level laser therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Low_level_laser_therapy\">Low level laser therapy<\/a>\u00a0may be considered for relief of pain and stiffness associated with arthritis.<sup id=\"cite_ref-64\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-64\">[64]<\/a><\/sup>\u00a0Evidence of benefit is tentative.<sup id=\"cite_ref-65\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-65\">[65]<\/a><\/sup><\/p>\n<p><a title=\"Pulsed electromagnetic field therapy\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsed_electromagnetic_field_therapy\">Pulsed electromagnetic field therapy<\/a>\u00a0(PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis.<sup id=\"cite_ref-66\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-66\">[66]<\/a><\/sup>\u00a0The 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.<sup id=\"cite_ref-67\" class=\"reference\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis#cite_note-67\">[67]<\/a><\/sup><\/p>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-344\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Arthritis. <strong>Provided by<\/strong>: Wikimedia Foundation, Inc.. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\">https:\/\/en.wikipedia.org\/wiki\/Arthritis<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":142337,"menu_order":2,"template":"","meta":{"_candela_citation":"[{\"type\":\"pd\",\"description\":\"Arthritis\",\"author\":\"\",\"organization\":\"Wikimedia Foundation, Inc.\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-344","chapter","type-chapter","status-publish","hentry"],"part":107,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/users\/142337"}],"version-history":[{"count":2,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/344\/revisions"}],"predecessor-version":[{"id":346,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/344\/revisions\/346"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/parts\/107"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/344\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/media?parent=344"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapter-type?post=344"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/contributor?post=344"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/license?post=344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}