Arthritis is often thought of as a single disease. In fact, it is an umbrella term for more than 100 medical conditions that affect the joints and surrounding connective tissues (muscles, tendons and ligaments).

People with arthritis experience pain and stiffness in the joints. Severity varies, but in many cases it can seriously impact simple daily tasks such as walking, driving or carrying out household chores.

The most common types of arthritis are:

• Osteoarthritis – usually follows a slowly progressive course of inflammation, breakdown, and eventually loss of cartilage in the joints.
  
• Rheumatoid arthritis – inflammation and swelling of the joints caused by the body’s own immune system attacking the joints.
  
• Gout – joint inflammation, pain and swelling caused by small crystals of uric acid that form in and around the joint.
  
• Juvenile arthritis – a general term for any arthritis that affects people under 16 years of age.
  

Read on for more detail about each of these diseases. 

Osteoarthritis usually follows a slowly progressive course of inflammation, breakdown, and eventually loss of cartilage in the joints. There may be a sudden and severe deterioration in symptoms, or symptoms may fluctuate over many years. 

The joint pain is usually worse during activity and is better with rest. There may be some stiffness after inactivity, or in the morning, but this is usually for a shorter time than in rheumatoid arthritis.

Symptoms

Symptoms may vary from person to person, and also depend on the joints affected. These can include:

• joint pain that is worse during activity and is better with rest. Pain at night or during rest can occur in advanced disease
  
• joint stiffness that may be worse in the morning or after rest, which gets better soon after movement
  
• tenderness around the joint
  
• crepitus (a crinkly, crackling or grating feeling in the joint)
  
• swelling, caused by a build-up of fluid in the joint
  
• enlarged joints caused by bony growths called osteophytes that form as the cartilage breaks down.
  

Find out more about osteoarthritis 

Diagnosis

Diagnosis is based on history, symptoms and a physical examination of affected joint(s). For example, the doctor might examine your knees by moving them forward and back to note your range of motion, and to find out which movements cause pain. X-rays and other imaging scans such as MRI may not be necessary for diagnosis.

Find out about how Dr Mel Deery diagnoses osteoarthritis

Treatment

Treatment for osteoarthritis focuses mainly on pain relief. There are a number of medicine options available, such as topical treatments (creams or gels) and oral medicines such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioid-based medicines.

• Dealing with pain fact sheet from Arthritis Australia
  
• Find out more about managing chronic pain
  

Living with osteoarthritis

Living with osteoarthritis can be difficult with pain, stress, fatigue and depression affecting each other. Techniques to deal with pain and fatigue are important, and there are many options available.

Exercise is an important part of managing osteoarthritis symptoms, and can help to reduce pain, as well as improving physical function and quality of life. A healthy diet and weight loss can help stop your osteoarthritis getting worse as well as lessen the disability.

Find out more about managing osteoarthritis

Rheumatoid arthritis involves inflammation and swelling of the joints caused by the body’s own immune system attacking the joints. 

Symptoms are usually worse in the morning and are symmetrical (the same joints on both side of the body are affected).

Symptoms

Symptoms include joint pain and swelling, and early morning stiffness lasting longer than an hour. Rheumatoid arthritis is more likely if there is:

• family history of rheumatoid arthritis
  
• swelling in five or more joints
  
• the same joints are affected on both sides of the body.
  

If you think that you, or someone you know, may have rheumatoid arthritis, it’s important to see a doctor immediately. If treatment is started soon after onset, the disease may be slowed and permanent joint damage prevented.

Diagnosis

Diagnosis is based on history, symptoms and a physical examination, as well as blood tests to show evidence of body-wide inflammation.

Treatment

Treatment for rheumatoid arthritis has changed over the last 20 years, and focuses on early prevention of potentially permanent joint damage. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are used as a first-line therapy, and can change the course of the disease if they are applied early after onset, and used consistently.

Living with rheumatoid arthritis

Living with rheumatoid arthritis requires management, monitoring, and cooperation between the patient and their medical team. This team may include a rheumatologist, GP and other health professionals such as physiotherapists.

While there is no cure for rheumatoid arthritis, with early diagnosis and the right treatment, most people with this condition can lead full and active lives.

Further reading about rheumatoid arthritis

Arthritis Australia. Arthritis Information Sheet: Rheumatoid arthritis. Sydney: Arthritis Australia, 2007

Gout occurs as a result of high uric acid levels in the body. It is one of the most common types of inflammatory arthritis, with around 1.7% of the Australian population thought to be affected, and this rate is even higher in Aboriginal Australians (9.7% in men and 2.9% in women, in 2002).

Prevalence rates are increasing globally, associated with increases in population overweight and obesity. Anyone can get gout, but it is seen more commonly in older men.

Symptoms

Symptoms of gout can come on very quickly, often overnight. Gout can affect any joint of the body, but it commonly affects the joints of the big toe. Joints become very red, swollen, and extremely painful.

Without the correct treatment, an attack of gout can last for around one week. While another attack may not come on for many months, unless your gout is well-managed, the time between attacks can become shorter, and each attack more severe. Higher uric acid levels over an extended period of time can lead to permanent joint and cartilage damage, and constant mild pain and inflammation.

Diagnosis

Diagnosis of gout is confirmed on the basis of urate crystals found in samples of joint fluid. A small amount of fluid is withdrawn by needle from one of the affected joints, and examined under a microscope. If joint fluid isn’t available, a provisional diagnosis can sometimes be made on the basis of other clinical and laboratory features.

If crystals are not seen in the joint fluid, other causes of your symptoms will be investigated, such as infection.

Treatment

Treatment of gout follows a two-pronged approach. On one side, medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids are often used in the management of an acute attack of gout. The types of medicines your doctor will prescribe will depend on whether you are taking other medicines for different conditions.

However, you will also need to take medicines that lower your uric acid levels, and prevent future attacks of gout. These medicines need to be taken regularly, regardless of whether you are having any gout symptoms.

Living with gout

Following a healthy lifestyle, such as keeping off excess weight, and avoiding sugary drinks and excessive alcohol can also help with the management and prevention of gout. Early diagnosis and the right treatment are crucial in preventing long-term complications from gout. Untreated gout can cause permanent damage to the joints. Know your target uric acid level and learn ways to prevent gout attacks.

Further reading about gout

Arthritis Australia has good information about gout and how to manage it. 

Juvenile arthritis (also called juvenile idiopathic arthritis) is a general term for all types of arthritis that begin before 16 years of age. It is a serious, yet common medical condition, and at any one time it affects at least 5000 children in Australia.

Symptoms

Symptoms of juvenile arthritis are similar to those seen in adults, and can include stiffness and swollen, red, painful joints. A fever or rash may also occur, and sometimes there is inflammation of the eyes and lymph nodes. Internal organs can be affected.

Diagnosis

Diagnosis of juvenile arthritis can sometimes require a lengthy and detailed investigation of medical history, physical examination, and laboratory tests, X-rays and scans. There is no single test that can confirm the specific type of juvenile arthritis, and the tests and examinations performed will depend on what type of juvenile arthritis is suspected.

Paediatric rheumatologists specialise in treating children with juvenile arthritis, and should be consulted for an accurate diagnosis. This is a crucial step in ensuring that the condition is treated appropriately.

Treatment

Treatment is very dependent on the type of juvenile arthritis, but it is always a team effort between the family, school, child, rheumatologists and other health care providers. The main aims of the team treatment plan are to reduce symptoms, manage pain, and ensure quality of life.

Living with juvenile arthritis

One of the most important aspects of treatment, aside from the support of the team, is learning self-care and self-management techniques, so that the child is able to manage their own prescribed care plan, and has the knowledge and skills to live well and stay healthy and happy.

Further reading about juvenile arthritis

• Arthritis Australia. Juvenile arthritis. Sydney: Arthritis Australia, 2015
  
• Arthritis Foundation. Juvenile arthritis. USA: Arthritis Foundation, 2017