Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Dec 23, 2018
Last Modified Date: Dec 23, 2018
Published Date: Dec 23, 2018
TABLE OF CONTENTS
Chapter 1: Arthritis: The Basics Chapter 2: Symptoms of Arthritis Chapter 3: Diagnosis and Treatment of Arthritis Chapter 4: Commonly Asked Questions about Arthritis Chapter 5: Arthritis: Thousands of Young Adults Live with Its Symptoms and Challenges Chapter 6: What is Seronegative Arthritis?
Arthritis: The Basics
Arthritis is a term used to describe a number of diseases and conditions that affect the joints and connective tissues. More than 100 types of arthritis have been identified, affecting millions of Americans. While it is often thought of as a disease of the elderly, it can actually affect people of all ages, including children. Since treatment varies according to the type present, its underlying causes as well as the severity of its symptoms, effective arthritis treatment and management begins by identifying these factors through medical evaluation and testing.
Though arthritis is a word that means “joint inflammation”; it is typically referred to as a single disease. It is a general term used for a group of more than a hundred medical conditions that affect up to 50 million adults and 300,000 American children, creating disability and medical expenses that exceed $124 billion a year within the U.S. alone. It is predicted that as our population ages, there will be a corresponding rise in the number of people diagnosed with arthritis.
This very common condition characterized by the inflammation of one or more joints/connective tissues, has been affecting people’s lives for years now. Most forms of arthritis are progressive, causing gradual deterioration in the affected joints that can become debilitating. In fact, arthritis is the leading cause of disability in the United States. The most common forms are osteoarthritis (OA), rheumatoid arthritis (RA) and juvenile arthritis (JA).
All the different types of arthritis affect the musculoskeletal system, especially the joints. The most common form is osteoarthritis (OA), affecting mostly people over 60, but it can start in infants and children too. Pain, stiffness, inflammation and damage to the smooth tissue that covers the end of bones (cartilage) are the most frequent complaints. Some forms, like rheumatoid arthritis (RA), are systemic; meaning that they affect the entire body and can damage organs including the heart, lungs, kidneys, vessels and skin. Juvenile arthritis (JA) affect children under the age of 16 and can take various forms. An infectious type of arthritis, is one that can attack the fluid surrounding your joints and is usually caused by bacteria.
Global Burden of Arthritis
Arthritis is a chronic condition that is expected to exert a massive burden on future populations. Early testing and diagnosis are the best two ways to make sure you detect such a condition before it progresses. To truly understand the magnitude of the problem, one has to study the relevant numbers associated with this condition.
For example, it makes sense to realize how many people I the united states suffer from this painful condition. It is expected that more than 52 million Americans, which is about 22% f the total population of this country, have been diagnosed with arthritis. When you want to dissect these numbers by age, one would break it as such that among those who have a doctor diagnosed condition, 7.3% of them are between the ages of 18 and 44 while 30% are between the ages of 45 and 64, and 49% are over 65 years of age.
For the doctor diagnosed condition, 2.9 million are Hispanic and 4.6 million black non-Hispanic. Also, 26% of them are women while 19% are men. When looking at expectations, it is estimated that 67 million people that are adults, are expected to have arthritis.
When it comes to osteoarthritis, a 21 million rise in cases was seen between year 1990 and 2005. In 2005, more than 27 million people living in the United States had osteoarthritis. Also, 2 out of every three obese people were expected to have osteoarthritis at some point in their life. Among those diagnosed with arthritis, more than 16% are either underweight or have a normal weight, while 23% are overweight or obese.
In 2015, around 15 million American adults reported being diagnosed with severe joint paint. In the USA, it was estimated that 300 billion American dollars are spent yearly on cost related to arthritis. The rates vary among states due to may factors. For example, a study showed that in 2015, rates of arthritis were different between different states due to general health characteristics as well as leisure-time physical activity, existing co-morbidities, and obesity. Here were their findings:
- As a result of the heavy burden exerted by arthritis, thirteen cities embraced the BRFSS arthritis management module for patients to get the proper educational tools, helping them manage their condition. These states were California, Kansas, Kentucky, Michigan, Minnesota, Missouri, Montana, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, and Utah. The BRFSS stands for Behavioral Risk Factor Surveillance System and is an active surveillance system to collect and understand statistics and behaviors associated with certain conditions.
- 23% was the prevalence rate of arthritis across all 50 states with different numbers among the different states: for example, in Hawaii, the prevalence was 17%, while West Virginia was 33.6%. Some states were at the high prevalence rates of Arthritis, such as Alabama, Arkansas, Kentucky, Michigan, Missouri, Tennessee, and West Virginia. So, if you are living in these states, it would make sense to get checked for this condition.
- Existing co-morbidities had an effect on developing arthritis. For example, the prevalence rates for those who are obese was 30.9%, while it was 44.5% for those who have heart problems, and 37% for diabetic.
- Pains associated with arthritis were also different between states. For example, 46% of patients with arthritis had severe joint pain, while only the number was 20% in Utah. The rates were higher in the South states.
Age-standardized prevalence of arthritis-attributable severe joint pain among adults aged greater than or equal to 18 years with arthritis, by state — Behavioral Risk Factor Surveillance System, United States, 2015
Symptoms of Arthritis
While symptoms vary to some degree among different forms of arthritis, some basic joint-related symptoms are common to most. Among these are:
- Joint pain
- Joint stiffness
- Swelling and/or redness near joints
- Decreased range of motion in affected joints
In osteoarthritis, joint pain, stiffness and poor coordination are the most common symptoms. Symptoms usually develop gradually; and, are typically most pronounced during the morning hours, after activity and toward the end of the day. Joints most commonly affected are the hips, knees and lower back, but other areas can be affected.
Rheumatoid arthritis, in which the immune system attacks the joints, causing progressive damage and deformity, presents the basic symptoms of arthritis listed above along with a few unique ones. These can include inflammation and damage in organs, including the heart, fatigue, and warmth, swelling and redness in the joints. Typically, symptoms appear in a symmetrical pattern, meaning that it affects the same joints on both sides of the body, with symptoms in just one knee or wrist, for example, rare. Symptoms can change from one day to another, and may suddenly increase in intensity, an event commonly known as a flare.
Juvenile arthritis most frequently affects children younger than 16 and often presents with fatigue or flu-like symptoms, along with joint swelling or pain.
Diagnosis and Treatment of Arthritis
There is no cure for arthritis. However, with early and accurate diagnosis and treatment, most forms of arthritis can be controlled, reducing symptoms and slowing disease progression. For that reason, individuals who experience symptoms that may indicate arthritis should see a physician for an evaluation as soon as possible.
Typically, that evaluation includes a physical examination of the joints, checking for swelling, redness and warmth as well as evaluating pain levels and range of motion. Then, medical tests may be ordered depending upon the type of arthritis suspected in each particular case. These may include imaging of affected joints such as X-rays, CT or MRI scans. Laboratory testing is frequently ordered as well, and may include testing of joint fluid, blood and urine to detect signs of infection, enzymes and proteins related to inflammation, or antibodies and other biomarkers that can indicate autoimmune activity, among others.
Once the type and cause of arthritis present has been determined, treatment can begin. Arthritis treatment generally includes pain medications, physiotherapy, and lifestyle changes, such as weight management, dietary changes and physical exercise. Corticosteroids and anti-inflammatory medications are often used to gain symptom relief, and in severe cases, surgery may be recommended. In rheumatoid arthritis, disease modifying anti-rheumatic drugs are often used to slow the progress of the disease and minimize joint damage.
Commonly Asked Questions about Arthritis
What causes arthritis?
Understanding how joints work is the first step in knowing what causes arthritis. In simple terms, a joint is wherever one bone moves on another bone. Holding the two joints together are ligaments. Similar to elastic bands, these ligaments keep the joints in place as muscles relax or expand, making the joint move.
To prevent bones from rubbing together, their surface is covered by cartilage, allowing the bones to move without pain or discomfort. Each joint also has a capsule surrounding it that contains synovial fluid that nourishes both the joint and cartilage.
In arthritis, something goes wrong with the joint: depending upon what type of arthritis you have, it could be worn cartilage, reduced synovial fluid, infection, autoimmune disorders, or a combination of several factors. Research shows that it’s usually several things happening together that result in an arthritic condition.
What are the primary symptoms of arthritis?
Much depends upon what type of arthritis you have, but in general, symptoms often develop slowly (particularly in osteoarthritis) and get progressively worse. Among the symptoms: pain, stiffness, swelling, tenderness when pressure is applied to the joint, loss of flexibility.
In cases of rheumatoid (RA), fingers, arms, legs and wrists are most commonly affected on both sides, with symptoms worsening upon waking. Fatigue and weight loss may also occur. With infectious arthritis there is fever, inflamed joint and swelling.
Juvenile arthritis (JA) causes children to experience fevers that tend to peak in the evening, poor appetite, weight loss, as well as stiffness/soreness in the neck, hips or other joints. A blotchy rash may appear on the arms or legs.
What are the different types of this disease and how are they treated?
Though the disorder can take many forms, there are three major types:
Osteoarthritis (OA) – the most common form, it affects about 27 million Americans; occurs when cartilage loses its elasticity; tends to be progressive and degenerative. Risks for OA that affects the knees increase 20-fold if body mass index (BMI) is higher than 30.
Rheumatoid (RA) – About 1.3 million Americans affected; occurs when the immune system that normally attacks foreign bacteria and viruses begins to attack by mistake the cells lining the joints, causing inflammation, pain, stiffness and swelling; symptoms are often worse in the a.m.; can result in severe joint damage; more common in women than men and tends to strike between the ages of 30 and 60.
Juvenile (JA) – strikes children 16 and under; can take various forms that range from mild and limited to systemic that affects multiple joints and organs.
What is Osteoarthritis (OA)
Sometimes referred to as “garden variety arthritis” due to its frequency, osteoarthritis? (OA) is a chronic condition that tends to develop slowly and get progressively worse as cartilage (shock absorbers for the bones) break down. The end result is that bones can begin to rub against each other, causing pain, stiffness and lack of flexibility. In severe cases, those with OA find it difficult to climb stairs, walk, or perform daily tasks. Most commonly affected areas are hips, hands, knees and spine.
To diagnose the condition, you may need an X-ray of the affected joints, be asked about medical history and need blood or other diagnostic tests performed. There is no cure. Treatment includes medications to relieve pain, physical or occupational therapy to improve strength and function, or in rare cases when mobility is threatened, surgery may be performed. Nonsteroidal anti-inflammatory agents are the number one form of treatment for OA.
What is Rheumatoid Arthritis? (RA)
Considered the most debilitating of the three main types of arthritis, RA affects up to 1.5 million people in the U.S. with 70 percent of those patients being women. It begins most commonly between the ages of 30 and 60, with symptoms that vary widely from one person to another.
A sudden increase in symptoms is called a “flare” and can last for days or months. Symptoms include: pain, fatigue, and swollen reddish joints that are warm to the touch. Usually, when one side of the body is affected, so is the other. RA patients say their symptoms are often worse in the morning.
Diagnosis is made through medical history, blood and other diagnostic testing. Early diagnosis and treatment help prevent the joint destruction and organ damage that can occur with RA. As with osteoarthritis, there is no cure for RA, but many effective treatments are available to relieve symptoms. The goal is remission and less severe symptoms during a flare. Physical and occupational therapy are often prescribed in patients with RA. Function levels should be periodically assessed by a healthcare provider, inflammation levels checked through regular blood testing; and, joint damage determined through imaging tests.
Self-care is important by staying active to reducing joint stiffness and strengthening the muscles that protect joints, managing weight, eating healthy and getting plenty of rest.
What is Juvenile Arthritis?
Just as adults have many forms of arthritis, so do juveniles. Juvenile arthritis (JA) refers to a group of diseases or conditions that can affect the joints, bone, muscles, cartilage and other connective disease. It’s a general term used to describe a number of autoimmune and inflammatory conditions in children ages 16 and younger. Besides the joints, JA can affect the eyes, skin and intestinal tract. The most common type of JA is juvenile idiopathic arthritis (JIA), which often involves swelling in one or more joints. At present, there is no known cause, though research points toward some genetic predisposition.
Besides a blood test, diagnosis is determined by a complete physical exam and family medical history; often referral is made to a pediatric rheumatologist. While there is currently no cure, there are ways to relieve inflammation, control pain and improve quality of life. Medication, physical activity, eye care and healthy eating habits are all part of a general treatment plan.
What are some myths associated with arthritis?
Though information about arthritis is readily available; misinformation and misconceptions remain. Among the most common myths:
Myth: Everyone gets aches and pains as they get older. Fact: Arthritis, which comprises up to 100 different musculoskeletal disorders, strikes people of all ages, including about 300,000 children in the U.S.
Myth: Arthritis is not a particularly serious health problem. Fact: A leading cause of disability, arthritis costs are rising due to the increase in outpatient clinics and hospitalizations. By 2030, it is estimated that up to 67 million Americans will have arthritis as a result of our aging population among other factors.
Myth: It’s best not to exercise if you have arthritis. Fact: As in most health conditions, exercise plays an important role in promoting bone and joint strength and endurance, along with weight management. Even one pound of weight loss can result in four pounds of reduced pressure on joints.
Myth: Medical specialists can’t do much about arthritic conditions. Fact: Though an incurable condition at present, pain relief and treatments to reduce other symptoms is readily available, greatly improving quality of life.
What should I expect from the first doctor’s visit?
If you have been having these pains and are worried that it might be arthritis; then, getting that first appointment with your doctor is important. Many worry when they have no awareness as to what happens at their first arthritis diagnosis appointment. Here is what can help you picture it better:
1- The doctor will ask you few questions, such as if there is a family history for arthritis or any other chronic illness. He will also ask you about if you have pain, how long it has been, when does it happen the most, along other problems.
2- Second, he will take a note of any medication you might be taking.
3- Then, conducting his physical examination would be necessary to do his diagnosis.
4- Finally, any diagnosis would need some kind of tests to make a solid conclusion. So, the doctor will take some blood and urine samples along other laboratory tests necessary. Sometimes, x-rays, or other imaging procedures, are recommended
After all these are collected, the doctor will discuss with you all the results of the above; and, a management plan will be developed.
Are there some short-term pain relief when it comes to arthritis?
Yes, there are some quick fixes that would probably be of great benefit for those suffering from osteoarthritis that is normally accompanied by minimal inflammation. In that case, taking acetaminophen can present a temporary relief. For those whose pain emanate from rheumatoid arthritis, aspirin or any non-steroidal anti-inflammatory drug could help. This includes Ibuprofen.
Some who prefer not to take medicines can use hot and cold compresses. But, you need to discuss it with your doctor to make sure it is right for you. For those who have a poor blood circulation, for example, using cold packs is not recommended.
Does Massage help arthritis?
If your massage therapist is knowledgeable about techniques that are compatible with arthritis; then, massages can help alleviate stressed area from pain. But, your therapist need to keep in mind that the joints of people with arthritis are sensitive and need to be handled calmly. Some even resort to acupuncture, where thin needles are inserted at a given part of the body. These needles are thought to stimulate the release of some natural pain relievers from the brain or nervous system.
There are numerous ways to manage a condition, especially one that leads to pain. So, adopting many methods is recommended to improve one’s quality of life. But, the first goal for anyone with arthritis would be to maintain the right weight, and engage in appropriate low impact exercising routines.
Can pets get arthritis too?
Yes, dogs, especially, are as prone to arthritic conditions as humans. In fact, osteoarthritis affects one in five dogs during their lifetime. Large breed dogs are more prone to develop arthritis than small dogs and heavy dogs more likely to experience symptoms. Degenerative arthritis is more apparent in the mornings or after a nap.
Diagnosis is made by undergoing joint X-rays that may show bone spurs, or varying degrees of narrowing in the joint space with increased bone density around the joint. There is no cure, but treatment can help alleviate certain symptoms that tend to make the dog uncomfortable or in apparent pain. Moderate exercise helps (swimming is excellent); and, similar to humans, some weight loss and having a healthy diet can be very beneficial to your pet. Acupuncture and physical therapy are sometimes recommended to relieve symptoms.
Though less common, the disease does occur in cats, causing pain and inflammation in a feline’s joints with symptoms that include stiffness, swelling of the joints, lameness, a decrease in energy level and obvious discomfort when the cat is handled. The elbow is more often affected; but, it can occur anywhere on your pet’s body. Have your vet conduct a thorough exam, take radiographs and perform other diagnostic tests to confirm if arthritis is present.
Mostly older cats are affected, with joints degenerating as part of aging, but if trauma or infection is present, arthritis can occur at any age. As with dogs, treatment and therapeutic changes can reduce the pain and discomfort, improving your cat’s quality of life.
What’s the latest research on arthritis?
Through the national Arthritis Foundation, more than $450 million in grants have been funded to learn more about causes, treatment and prevention of arthritis in its three most common forms.
New medications, including inhibitors and nonsteroidal anti-inflammatory drugs as well as some antibiotics, are being tested for treatment usage and possible side effects. Latest research shows that women who consumed alcohol over a 10-year period reduced their risk of RA; but, with that kind of behavior comes many warnings about consumption levels. The CDC recommends no more than one alcoholic drink a day for women.
Sugary drinks can contribute to weight gain and put more strain on the joints, according to one study. Another study explains that eating foods high in purines (compounds found in protein-rich foods like red meat) can lead to inflammatory processes nearly five times more likely; eating cherries (10-12 over a two-day period) can lower the risk of a gout attack and RA flare-ups
Living with Arthritis: what can I do to improve my quality of life?
Even without a cure and no definitive way to know who will get arthritis in their lifetime, there are numerous ways to improve one’s daily life when diagnosed with the disorder. First, you have to seek medical treatment if you suspect you have arthritis. Learn what type you may have and follow your healthcare provider’s treatment plan. Watch your weight, stay active and eat a healthy, well-balanced diet. Weight training improves muscle strength that better supports joints.
In addition, here are some tips and tricks for around-the-house daily tasks:
- Try to keep your joints loose and ward-off stiffness by stretching every hour or so. During long car rides, try to squeeze in frequent stops so you can get out of the car and move around.
- Wear driving gloves if you have trouble gripping the steering wheel.
- Keep household items within closer reach, including most-used items in pantries and cupboards at the front, with taller goods behind shorter goods.
- Don’t drag heavy bottles around; look for easy-to-carry containers.
- Use a scrubbing mitt rather than a washcloth in the shower that can be much easier on arthritic hands and fingers.
- If swollen fingers are a problem and a ring must be removed, apply lip balm or Vaseline around the knuckles for easier removal.
- Use a pizza wheel rather than a knife to cut through sandwiches and other soft foods, including casseroles.
- Purchase battery-operated devices – from can openers to stirring utensils – to minimize twisting joints.
- At the computer, use a wrist support cushion and take frequent breaks – at least one every hour.
My Knees are hurting me: Does it mean I have Arthritis?
Your knees are weight-bearing joints. They feel the strain as you walk, dance, run or jump – basically any time you are on your feet. Given that daily stress, it is no surprise that knee pain is a common complaint, and since knee arthritis is a common condition, doctors often hear the question “Is my knee pain due to arthritis?” from their patients who experience this sort of pain. Below are some common causes of knee pain.
Injuries and Knee Pain
Acute (sudden) injuries and overuse injuries, which develop gradually due to excessive wear or functional problems, are frequent causes of knee pain. Among the most common are: ACL injury – This injury is a tear in the anterior cruciate ligament (ACL), which is one of four ligaments that run between the shin and thigh bones. ACL injuries occur most common in athletes who play sports, such as soccer, basketball or football that frequently require sudden changes in direction.
Torn meniscus – Generally caused by twisting the knee with significant force, this injury occurs when the meniscus – a tough, rubbery bit of cartilage meant to absorb shock in the knee – is torn.
Patellar tendinitis – The patellar tendon connects the thigh muscles to the shin, and tendinitis – swelling and irritation in tendons – is a fairly common cause of knee pain, especially in runners or people who bicycle or ski regularly.
Bursitis – Bursa are small sacs of fluid that cushion the knee joint. Bursitis happens when these sacs become inflamed, or swollen due to overuse or acute injury.
Iliotibial band syndrome – A large tendon that runs between the hip and the outer part of the knee, the iliotibial band can become inflamed or irritated, causing pain in the knee.
Dislocated kneecap – This injury occurs when the kneecap slips out of position, causing pain and swelling.
Along with knee pain, symptoms of acute or overuse injuries may also include swelling, bruising, redness, warmth and stiffness in the knee and the area that surrounds it.
Common Causes of Chronic Knee Pain
Chronic knee pain, which is pain, is often accompanied by swelling, stiffness and warmth, recurs or is constant over a period of months or years. This kind of knee pain can also have a number of causes. Among the more common possibilities are:
Osteoarthritis – The wear and tear form of arthritis, this condition occurs as the cartilage that cushions the joints erodes, causing a gradual deterioration condition and function, as well as pain, inflammation and stiffness. Since this form of arthritis most commonly affects weight-bearing joints, arthritis knee pain is common in osteoarthritis sufferers.
Rheumatoid arthritis – An autoimmune inflammatory disorder, in which the body's immune system attacks the joints.
Gout – This form of arthritis is characterized by the buildup of excessive uric acid levels in the blood. This results in the formation of uric acid crystals, which collect in joints, including the knee, causing pain, stiffness and swelling.
Baker’s cyst – This condition occurs when synovial fluid, which lubricates joints, builds up behind the knee.
If you have knee pain, whether it appeared suddenly due to an obvious injury or has developed over time, seeing your doctor is important. Proper diagnosis and treatment can lead to pain relief, as well as maintaining or restoring proper joint function. Some knee problems may require surgery to correct and for some conditions, medication may be required to slow or halt the progression of arthritis.
Arthritis: Thousands of Young Adults Live with Its Symptoms and Challenges
While arthritis is generally thought of as a disease of the aging, this is a misconception. Arthritis, a family of musculoskeletal disorders that consists of more than 100 different diseases, affects young people too. In fact, according to the Arthritis Foundation, of the 50 million Americans affected by arthritis, two-thirds are under age 65, including 300,000 children in whom the disease develops at age 16 or younger. That means that arthritis in young adults is quite common, a disease that can present a wide range of everyday challenges. To illustrate the difficulties faced by younger arthritis sufferers, we'll take a look at the stories of a few young adults living with extreme cases of arthritis.
A Story of Delayed Diagnosis and Determination
Diagnosed with a severe form of Rheumatoid arthritis at age twelve, Toni Neufville's struggle with the disease began with walking difficulties when the North London girl was a toddler. Doctors told her family she had growing pains. By age 9, according to a Daily Mail interview, Toni's joints were hurting, she was walking stiffly and she had begun to have periodic incidents of joint swelling. By the age of 12, Toni was going to the hospital as often as once a month, just to be informed that there was nothing wrong with her.
Finally, during an incident in which both knees became severely swollen, she was taken to a different hospital, where her condition was quickly recognized as rheumatoid arthritis – an autoimmune disease in which the immune system attacks the body, causing inflammation that gradually damages joints and organs throughout the body. Doctors prescribed anti-inflammatory and immune-suppressant drugs to relieve symptoms and slow disease progression.
Unfortunately, during those undiagnosed years, a great deal of damage had already been done. Toni had arthritis in all of her joints, with her hands, wrists, knees, ankles and feet most severely affected. At the age of 14, Toni spent 5 months in a wheelchair. After learning pain management techniques, Toni was able to do away with the wheelchair. Although she still suffers with joint pain, swelling and fatigue that make writing and typing difficult, she has since, through sheer determination, excelled in academic pursuits and plans to become a barrister.
Young, Healthy, and Athletic; then Suddenly Arthritic? The Story of a Young Adult Diagnosed at age 19 with Rheumatoid arthritis, Carol Eustice of About.com also went through a period of misdiagnosis and uncertainty before her condition was properly identified – as is often happens in cases of arthritis in young adults. A healthy athlete who had played basketball, volleyball and tennis in school, her struggle with arthritis began around age 18, when she experienced pain and fluid buildup in her right knee. Under the assumption that it was a sports injury, her doctor referred her to an orthopedic surgeon, who recommended that she take 8 aspirins per day and exercise daily to strengthen her leg muscles.
Approximately six months later, intense pain suddenly appeared in her left hip. Since more than one joint and both sides of her body were now affected, doctors suspected a more serious problem. X-rays revealed joint damage consistent with arthritis, and 5 years later, she needed hip replacement surgery. With proper disease management and treatment, along with a great deal of determination, this young woman went on to earn a degree, marry and build a successful career, despite having to change professions midstream due to arthritis symptoms.
Overcoming Arthritis: A Young Man's Challenges
Niall McLaughlin, who is now 26 years old, was diagnosed with juvenile arthritis at the age of 12. As in most cases of arthritis in young adults, Niall has faced significant challenges throughout his life. Waking with stiffness every morning, he needed extra time to get ready for the day. He was unable to run, get down on the floor to play with his young nephews and faces side-effects from medications that make weight management a challenge. Despite these challenges, Niall is pursuing a degree in music, determined not to allow the difficulties and frustrations of arthritis to hold him back.
These cases of arthritis in young adults illustrate the importance of early detection and treatment. Arthritis is a progressive disease that can be slowed when caught and treated in its early stages, minimizing the degree of damage to the joints – and therefore the level of pain and disability caused by the disease. For that reason, any signs of joint pain or inflammation should be examined by a doctor, and arthritis testing done, including x-rays and blood tests, which can detect many forms of the disease.
What is Seronegative Arthritis?
Seronegative Arthritis – Diagnosis and Treatment
Seronegative is a blood testing term that indicates a negative result: a blood test that did not find the particular indicator it is designed to detect. In the case of seronegative arthritis, the term generally means that blood testing found no rheumatoid factor (RF) or anti-cyclic citrullinated peptides (anti-CCPs) in the blood. These are antibodies made by the immune system that can attack healthy tissues in the body. They are typical indicators together with the joints – in people who suffer from autoimmune conditions, like rheumatoid arthritis (RA). However, unlike other negative results, a seronegative arthritis result can mean a positive diagnosis for something else. Here we'll get into the details of testing for and diagnosing RA, including the meaning of a seropositive or seronegative arthritis diagnosis.
About Diagnosing Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory form of arthritis that is caused by an autoimmune activity in the body, the immune system attacking the linings of the joints to cause swelling, pain, warmth and stiffness in affected joints, as well as progressive joint damage and, in many cases, joint deformity. The inflammation that this disease causes can also affect other areas of the body, including vital organs like the heart.
Diagnosing this disease begins with an evaluation of signs and symptoms. What doctors look for as they examine a patient includes pain and swelling in the joints, inflammation in several joints in conjunction with morning stiffness in those joints lasting longer than 45 minutes, and X-ray results that show joint damage or joint nodules characteristic of RA. If signs and symptoms are present that indicate RA, blood testing is the next step. Generally, lab tests that look for RF or anti-CCP are the first to be done, and if results for either or both of these antibodies are positive – a seropositive result – this is generally considered, in symptomatic patients, a confirmation of RA. In some cases, doctors may order additional blood tests that measure inflammation, such as CRP and ESR tests, to aid in confirming an RA diagnosis.
What Does A Seronegative Result Mean in a Symptomatic Patient?
Between 70 and 80 percent of patients presenting RA symptoms have seropositive rheumatoid arthritis. For those with seronegative results, yet who suffer with clear symptoms, seronegative rheumatoid arthritis may be diagnosed, or they may suffer from one of several conditions, similar to RA, known as spondyloarthropathies. Common forms of spondyloarthropathy include:
Ankylosing spondylitis – This condition causes lower back pain and stiffness, which may, over time, migrate from the lower back to the upper back. Other areas of the body, including the hips, knees, chest and heels, may also be affected.
Reiter's syndrome – This rheumatic disease causes pain and inflammation in the joints, especially the sacroiliac joint that connects the lower back and pelvis, as well as joints in the fingers, toes and feet. Swelling of fingers and toes is common, and the condition can also cause fever, rash and weight loss.
Psoriatic arthritis – This form of arthritis is associated with psoriasis, a skin condition that causes red, scaly patches on the skin. Joint symptoms include pain and swelling in large joints, such as the hips and sacroiliac joints, and in some cases, swelling and pain in fingers and toes.
Enteropathic arthritis – This type of arthritis is associated with intestinal inflammation that occurs with inflammatory bowel disease flares, and typically affects large joints, like the knees, hips elbows or ankles.
While the exact causes of spondyloarthropathies are not known, heredity is thought to factor into the development of these chronic joint conditions, since they are more likely to run in families than other forms of rheumatic disease, like lupus or RA. Tentative confirmation of that premise has been found in ankylosing spondylitis, with the presence of a gene, called HLA-B27, often associated with the disease.
While it may lead to confusion and a harder time getting a definitive diagnosis, the good news about seronegative arthritis, seronegative RA or seronegative spondyloarthropathy is that patients who have seronegative results in RF and anti-CCP testing tend to develop less serious joint disease and have fewer complications than those with seropositive results. This is by no means a certainty, since predicting the future course of any of these chronic joint diseases in any patient cannot be done with any level of accuracy, but the odds are in your favor for a less painful future if you are diagnosed with seronegative arthritis, as compared to a diagnosis of seropositive arthritis.
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