Arthritis

Arthritis describes disorders affecting joints and bones — primarily, osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis occurs due to natural wear and tear on your body’s joints, while RA is an autoimmune disease that physically attacks the joints and the surrounding tissues.

Other forms include gout, psoriatic arthritis, hemarthrosis, Still’s disease, septic arthritis, and ankylosing spondylitis.

Arthritis can cause cartilage to break down, and all forms of arthritis are considered rheumatic diseases, or diseases that specifically affect joints, ligaments, muscles, tendons, and bones.

Here are some quick facts about arthritis:

• Nearly one in five adults in the US struggle with it. In 2022, 18.9 percent of US adults were diagnosed with arthritis, with over 20 million experiencing severe functional limitations. It’s more common in women (21.5 percent) than men (16.1 percent).
• It’s not exclusively an elderly disease. It most commonly affects older adults, but is also sometimes observed in younger people — such as with juvenile idiopathic arthritis (JIA).
• It can drastically affect patient quality of life. Arthritis causes pain, swelling, inflammation, reduced movement, and decreased quality of life in those it affects. It’s the leading cause of disability in the US, costing an estimated $100 billion annually.
• It’s manageable with the right treatment. Treatments for arthritis include non-opioid analgesics, NSAIDs, counterirritants, corticosteroids, DMARDs for RA, physical activity, physiotherapy, and surgery. Medical cannabis may reduce pain and inflammation, offering similar benefits to other pain management treatments with fewer side effects.

Arthritis Causes

There are 150 types of arthritis, all with different causes, including one or more of lifestyle, environment, and genetics.

The most common type of arthritis is osteoarthritis, which is caused by wear and tear from aging.

Osteoporosis — a condition that causes thinning, weakness, and fragility in the bones — does not cause pain unless there has been a fracture, but may complicate issues arising from arthritis.

Rheumatoid arthritis is caused by the body’s own immune system attacking the body’s joints and surrounding tissue.

Psoriatic arthritis affects the skin and joints of people with psoriasis, another type of autoimmune disease.

Other forms of arthritis, such as gout, are caused by the buildup of crystals in the joints caused by metabolic disorders (diabetes, hypertension, obesity).

Other than arthritis caused by autoimmune diseases, the most common factors that may increase the likelihood of arthritis include:

• Increasing age.
• Having a family history of arthritis.
• Obesity or being overweight.
• Smoking.
• Activities that involve repetitive movements of a joint.
• Previous damage to a joint, such as from an injury.

In rare instances, infectious arthritis, caused by a bacterial or viral infection, can develop and present with a sudden onset of chills, fever, and joint pain.

Arthritis Symptoms & Health Effects

All types of arthritis tend to include one or more of the following signs or symptoms:

• Inability to use one or both hands or walk
• Stiffness in one or more joints
• Rash or itch (especially lupus or rheumatoid arthritis)
• Malaise and fatigue
• Weight loss
• Insomnia and sleep problems
• Muscle aches and pains
• Tenderness
• Reduced flexibility
• Muscle weakness
• Difficulty moving the joint – reduced range of motion
• Decreased aerobic fitness

However, different types of arthritis can vary in severity and how their symptoms present. Here are the signs and symptoms for the three most common types: osteoarthritis, rheumatoid arthritis, and gout.

Osteoarthritis

• Slower speed of onset — usually months or even years.
• Usually located in the hands and weight-bearing joints, such as knees, hips, and spine.
• Lower-grade inflammation when compared to other types of arthritis.
• Bouchard’s and Heberden’s nodes, or hard or bony swellings or outgrowths.
• Narrowed joint space.
• Osteophytes, or bony projections that form along joint margins.
• Local osteosclerosis, or abnormal hardening of bone and an elevation in bone density.
• Subchondral cysts, or cysts that form inside bones.

Rheumatoid Arthritis

• Onset is usually weeks or months.
• Usually located in the hands, wrists, ankles, knees, and hips.
• Often accompanied by inflammation.
• Narrowed joint space.
• Bone erosions.
• Can cause hand deformities.
• Attacks occurring most often in the morning, and stiffness lasting 30 minutes or more.
• Elevated ESR and C-reactive protein (CRP), rheumatoid factor, and anti-citrullinated protein antibody in lab tests.

Gout

• Onset can be a matter of hours for an attack.
• Tends to affect toes, ankles, knees, and elbows.
• Often accompanied by inflammation.
• Monosodium urate crystals, called tophi.
• Increased risk of kidney stones as a result of crystal formation.
• Bone erosions that look like the bone has been “punched out.”

What Patients Say About Their Symptoms

Arthritis Diagnosis

Arthritis can occur on its own (primary arthritis) or due to another health issue (secondary arthritis). Diagnosis starts with a qualified healthcare professional and usually involves a referral to a rheumatologist.

Tests like X-rays, ultrasounds, MRIs, blood tests, and synovial fluid tests help determine the type. Blood tests like ESR (“sed rate”) and C-reactive protein (CRP) measure inflammation, while Vectra DA tests look at multiple markers even when inflammation is low.

The most common types of arthritis include:

• Osteoarthritis
• Rheumatoid arthritis
• Gout and pseudogout
• Psoriatic arthritis
• Hemarthrosis
• Septic arthritis
• Ankylosing spondylitis
• Juvenile idiopathic arthritis
• Still’s disease

Secondary arthritis is commonly associated with the following conditions, many of which are autoimmune diseases:

• Psoriasis
• Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
• Celiac disease
• Non-celiac gluten sensitivity
• Reactive arthritis
• Ehlers–Danlos syndrome (EDS)
• Iron overload
• Hepatitis
• Lyme disease
• Sjögren’s disease
• Hashimoto’s thyroiditis
• Henoch–Schönlein purpura
• Hyperimmunoglobulinemia D with recurrent fever
• Sarcoidosis
• Whipple’s disease
• TNF receptor associated periodic syndrome
• Granulomatosis with polyangiitis (and many other vasculitis syndromes)
• Familial Mediterranean fever
• Systemic lupus erythematosus

A rheumatologist often teams up with a radiologist to figure out what type of arthritis you have. If you’re having these tests, it’s best to wear comfy, loose-fitting clothes that are easy to take off or adjust. Results usually come back within one to two weeks.

What Patients Say About Their Diagnosis

Living with arthritis: What’s it like to be diagnosed at a young age?

Living with ankylosing spondylitis – Amanda Geard’s story

Anterior Hip Replacement for Osteoarthritis – Rachelle’s Story

Arthritis Prognosis

Although arthritis doesn’t reduce life expectancy alone, other conditions that can accompany it—such as metabolic syndrome or hepatitis—can.

Arthritis can also have a negative impact on quality of life measures and can make everyday living difficult. As movement can be painful, exercise becomes more difficult, leading to worsening outcomes.

Arthritis Treatments

Unfortunately, there’s no cure for arthritis. Luckily, many treatments can slow it down and make living with these diseases more manageable. These include:

• Lifestyle interventions like a healthy diet, getting plenty of exercise, and reducing your alcohol intake are key.
• Using supplements like omega-3 and omega-6 oils, as well as turmeric and curcumin may help slow down swelling and inflammation to make daily life more manageable.
• Pain relief medications like antibiotics, NSAIDs, and certain steroids can also help manage pain associated with various types of arthritis.
• Certain surgeries, especially in severe cases, may be utilized in order to improve your overall quality of life.

Remember: Arthritis is a surprisingly common medical condition that affects nearly one in five adults in the US. It’s an extremely well-researched health problem that tens of millions of people live with every day.

Once you find a treatment (or combination of treatments) that works for your unique health needs, living with arthritis becomes easier.

First-Line Treatments

First-line treatments for arthritis — especially in patients where the disease hasn’t advanced significantly — include lifestyle changes like getting more physical activity, cutting out certain foods (like dairy, processed sugar, and sometimes gluten), reducing alcohol intake, quitting smoking, and getting more sunlight (with sunblock). Physical therapy is also helpful.

Medications include NSAIDs (like ibuprofen), non-opioid pain relievers (like paracetamol), steroids (like prednisone), topical treatments (like capsaicin, menthol, or steroid-based creams), and supplements (like calcium, vitamin D, omega-3, turmeric, glucosamine, hyaluronic acid, and black pepper).

Early diagnosis allows for a quicker treatment plan to reduce inflammation and increase the chances of remission. While arthritis can’t be cured, you can reduce inflammation and flare-ups. A treatment plan often includes low-impact exercises to improve movement, dietary changes, medications, physical therapy, and ways to manage any anxiety or insomnia that may come with arthritis.

What Patients Say About Their Treatment

Living with rheumatoid arthritis: Suzanne’s story

Osteoarthritis: Elaine’s story | NHS

Lily’s I’m Back Story – Juvenile Idiopathic Arthritis

Other Treatments

If your arthritis is severe and you don’t respond to other treatments, your healthcare provider may recommend surgery. Types of surgery include:

• Arthrodesis (fusion surgery). A surgical procedure to stabilize a joint by removing cartilage and fusing the bones across the joint with surgical implants.
• Arthroscopy. A type of surgery that utilizes a tiny camera system called an arthroscope to observe and fix damaged cartilage and joints. Arthroscopy is minimally invasive.
• Joint resurfacing. A procedure that involves filling any holes in cartilage, allowing for a surgeon to smooth the joints without greatly altering the structure of the patient’s joints.
• Osteotomy. A procedure that involves cutting and reshaping the patient’s bone, or inserting a wedge near the damaged joint/s to prevent further damage. This invasive procedure is usually only recommended for younger patients.
• Synovectomy. A procedure that involves removing most or all of the inflamed and damaged synovium to reduce pain and inflammation. Synovial joints are the most common types of joints in the body and include fingers, wrists, elbows, shoulders, hips, and knees.
• Total joint replacement (TJR). Where the entire joint is removed and replaced by an artificial implant, called a prosthetic.
• Partial joint replacement. Removing only part of the damaged tissue and bone, and then replacing with a prosthetic joint.
• Joint revision. Replacing a malfunctioning or damaged implant.

Depending on the type of surgery, recovery can take three weeks or more, and crutches may be required. Swelling and inflammation as a result of the surgery can last a while longer — anything from three months to a year.

Adjunctive Therapy & Alternative Treatments

Common alternative treatments include herbal supplements such as turmeric, ginger, black pepper, Boswellia serrata (aka Indian frankincense), devil’s claw, willow bark extract, and feverfew.

Extracts of Boswellia serrata have been shown to reduce pain and improve function in arthritic patients. Turmeric/curcumin, black pepper/piperine, and ginger extracts may reduce pain and inflammation associated with arthritis.

Several meditation techniques may be used to manage arthritis. Of these, the most effective form is mindfulness-based stress reduction (MBSR).

MBSR involves being present in the moment and acknowledging and accepting thoughts, feelings and sensations in an open, nonjudgmental way.

This technique allows a patient to accept pain and let it go. Other forms of meditation, such as yoga breathing and exercise, transcendental meditation, and guided imagery have also been shown to be effective in managing pain associated with arthritis.

Cannabis for Arthritis

As the US and much of the Western world has an aging population, arthritis is becoming an increasingly prevalent health problem. Although current treatment methods are generally effective, some can have negative effects, especially where surgery is involved.

Some types of medication, such as steroids, can cause bone thinning when used long-term, which can worsen arthritis symptoms. This means that safe, effective, cost-effective, and preferably non-invasive treatment methods are needed. And medicinal cannabis may be at least part of the answer.

A study by Dr. Sheng-Ming Dai of China’s Second Military Medical University found unusually high concentrations of CB2 receptors in the joint tissue of arthritic patients.

Cannabidiol (CBD) may help activate the pathway of these CB2 receptors and decrease inflammation. The terpene beta-caryophyllene targets CB2 receptors to help reduce inflammation.

Other studies, like those by Dr. Jason McDougall and Melissa O’Brien, indicate that cannabinoids may help repair joint tissue.

Cannabinoids in cannabis — including tetrahydrocannabinol (THC) — may help manage arthritis in the following ways:

• CBD may help fight inflammation and keep joints lubricated.
• Some studies show that cannabidiolic acid (CBDA) and tetrahydrocannabinolic acid (THCA) may also be helpful for their anti-inflammatory properties.
• Even low-to-moderate doses of THC may help treat joint pain and inflammation.
• Cannabigerol (CBG) could be useful for its anti-inflammatory properties.

As for terpenes, beta-caryophyllene (which is also a cannabinoid found in spices such as black pepper)  has painkilling and anti-inflammatory properties that could help manage arthritic pain and inflammation. Other terpenes that could help manage some of the symptoms of arthritis include:

• Limonene
• Phellandrene
• Terpinene
• Borneol
• Linalool
• Triterpene glycosides

These terpenes are of interest for their sedative, antioxidant, antimicrobial, anxiolytic, and anti-inflammatory properties.

Those interested in trying medical marijuana to manage their arthritis should consider CBD-, beta-caryophyllene- rich cannabis varieties such as Remedy, ACDC, Ringo’s Gift, Harle-Tsu, Sour Diesel, and Bubba Kush. Talk to your doctor to discuss what cannabis products are best for your condition.

Additional Information for Arthritis Patients

Arthritis is a very common health problem and the leading cause of disability in the US. Insurance plans typically cover most traditional treatments for arthritis, including surgery and prescription drugs.

Under the Affordable Care Act (ACA), you cannot be refused insurance coverage, be charged higher premiums, or get dropped from coverage because of your arthritis. Under the ACA, insurance companies cannot impose lifetime limits on services that are deemed essential health benefits.

Support groups are available, with many run by charities like Arthritis Foundation or American Arthritis Foundation. Support groups can be an invaluable resource, helping patients process and overcome anxiety, frustration, and other forms of emotional distress caused by anxiety.

Being a part of a support group can help patients find appropriate healthcare specialists when needed.

Arthritis can be a qualifying condition for medicinal cannabis in states with a medical marijuana/cannabis program. Although arthritis may not be mentioned as a qualifying condition for medical cannabis directly, it may be covered via chronic pain or at the qualifying physician’s discretion.

Arthritis FAQs

Does arthritis pain ever go away?

Arthritis is not curable and is a chronic, lifelong condition. However, it is possible to reduce arthritic pain to a point where it’s considered in remission.

This involves following the treatment plans developed by your physician and other healthcare professionals.

Are there any foods I should avoid if I have arthritis?

Patients with arthritis may find that certain types of food can trigger an arthritis flare-up.

Common culprits include dairy products, refined sugars such as high fructose corn syrup, refined carbohydrates such as packaged cereals, and products containing white flour, gluten, and processed and fried foods such as bacon and fried chicken.

Excessive salt intake and foodstuffs with high amounts of advanced glycation end products (AGPs) (e.g. red meat, mayonnaise) should also be avoided.

Soda, diet soda, or any drink containing artificial or sugary sweeteners should be avoided.

What’s the fastest way to treat arthritis?

The most common recommendations to manage arthritis symptoms quickly include:

• Weight management
• Exercise
• Heat and cold therapy, such as heating pads or ice packs and electric blankets
• Lifestyle changes, such as reducing or eliminating alcohol intake and improving one’s diet
• Medications such as NSAIDs (e.g. ibuprofen, naproxen)
• Use of assistive devices (e.g. jar openers, electric can openers, massage machines, grabbers)

Can I treat arthritis on my own?

If you suspect you have arthritis, it’s best to get it diagnosed by a healthcare professional and follow an appropriate treatment plan to get support and increase the chances of remission.

It’s possible to treat pre-arthritis (early signs of arthritis, such as brief pain in the joints, minor stiffness and swelling, and muscle weakness) via exercise and lifestyle changes, but fully-developed arthritis may require professional medical intervention.

Arthritis is irreversible, but treating it as early as possible can slow the progression of the disease significantly.

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