Arthritis Comes in Variety of Types, Severity

Posted on Fri, July 18, 2007

By Dr. Stephen J. Daniels

"OH, MY GOSH, Dr. Daniels," exclaimed Thelma, as she burst into tears.

I had just casually told her that her knee X-rays had shown "moderate joint degeneration," which meant she had arthritis.

Thelma's outburst seemed genuine, which surprised me, since most of my patients over 50 have some arthritis. I thought telling her this would confirm her expectations, and reassure her that she didn't have something more serious, like cancer.

"A girl in my school had arthritis, and she was deformed, and could barely walk," said Thelma. "I'd sure hate to be unable to walk. How would I care for my grandchildren, and for my mother?"

Thelma's concern about the diagnosis of arthritis highlights how many forms arthritis can take. And how easily misunderstood some medical terms can be.

Patients have asked me if their abdominal pain could be "arthritis in their stomach," or if their chest pain could be "arthritis in their heart?"

Technically, arthritis means inflammation in the joint(s). "Arthr," referring to a joint, and "itis," meaning inflammation. So, one can have inflammation in the stomach, called "gastritis," or in the heart, called "myocarditis," but it's only called "arthritis" if a joint is inflamed.

Inflammation (-itis) appears as redness, swelling, pain and warmth of a part of the body, whether a joint (arthritis), a tendon (tendonitis), the throat (pharyngitis), the brain (encephalitis), or any other inflamed part of the body.

Inflammation is the body's initial attempt to heal a cellular injury or eliminate a foreign substance.

Inflammation is the body's normal response to infections caused by bacteria or viruses or other germs.

Sometimes the body perceives its own tissues or proteins as foreign substances, such as in rheumatoid arthritis. Or, inflammation may be in response to the common wear and tear of joint tissues, which is called osteoarthritis.

This was Thelma's diagnosis.

She thought all arthritis was the same. Her childhood friend probably had juvenile rheumatoid arthritis, a rapidly progressive and often crippling illness, whereas Thelma had osteoarthritis, which usually progresses slowly and, thanks to new medicines and surgeries, is rarely crippling in developed countries.

Inflammation as a response to a bacterial or viral infection can help the body fight the infection. That's why doctors ask patients to gargle with warm water for a sore throat, or put a hot moist towel on a skin infection.

The heat increases the inflammation by attracting blood, which brings both infection-fighting blood cells and perhaps the antibiotics in the blood, to help fight the infection.

By contrast, doctors suggest that patients put ice on a sprained ankle or other similar injury, to reduce the inflammation. In this situation, the inflammation will cause more swelling and pain, but doesn't seem to help heal the ankle sprain.

Doctors often suggest that patients with osteoarthritis, especially of the hands, apply heat to the affected joints to help relieve morning stiffness. Such heat, as when a heating pad helps relieve a sore or stiff back, may help initially, but could lead to more discomfort if applied long enough to increase inflammation of the joints.

Inflammation has a wide variety of causes and treatments. Some, like osteoarthritis, are so common they can be considered a natural part of aging.

Daniels practices family medicine at the Concord and Pittsburg health centers, part of Contra Costa Health Services.