Have you twisted an ankle or banged-up a joint? Chances are that you have, and most likely it was followed by some inflammation— a normal part of the healing process. Puffy, red, tender joints may indicate that your immune system is working to remove damage and promote the growth of new tissue, a healthy kind of inflammation. But sometimes the immune system launches unhealthy, chronic inflammation in the joints, for no apparent reason. This leads to pain, stiffness, and joint damage known as inflammatory arthritis.
The attack on joints
It’s often unknown what triggers the immune system to unleash an assault on the joints, but we do know what the cells are up to once they’re in action.
Rheumatoid arthritis— a common type of inflammatory arthritis— consists of a variety of immune cells in the lining and fluid of the joint. Due to their attractive forces, many other immune cells join together, causing a thickening of the joint lining, new blood vessel formation, and, eventually, joint damage.
Chronic inflammation in the joints can damage cartilage, bones, tendons (which attach muscle to bones), or ligaments (which hold joints together). Along with that, it also irritates nerves and produces a long list of symptoms, including pain, swelling, and stiffness. The joint damage may be progressive and irreversible.
There are many types of inflammatory arthritis. Common ones include these:
Rheumatoid arthritis (RA). RA occurs when the immune system attacks the lining of the joints, especially in the hands, wrists, and feet. RA may also affect the heart, lungs, and eyes. RA is also classified as an autoimmune disorder, which means that the nervous system sends errant messages to the immune cells to attack the body’s own joint tissues.
Gout. Gout is characterized by a buildup of uric acid, which can form crystals in the joints — especially in the big toe, and sometimes in the hands, wrists, or knees. The crystals activate a temporary inflammatory response that can become chronic.
Calcium pyrophosphate deposition disease (CPPD, or pseudogout). In CPPD, calcium crystals settle in the joints, especially the knee, wrist, shoulder, ankle, or elbow. Like the uric acid crystals in gout, the calcium crystals in CPPD prompt the body to respond with inflammation; over time, this may become chronic.
Finally there is Psoriatic arthritis. About 30% of people with psoriasis (an autoimmune condition that causes raised patches of scaly skin) develop psoriatic arthritis, which can affect the knees, ankles, wrists, or fingers.
Why is osteoarthritis so different?
Osteoarthritis, a wearing away of the smooth cartilage lining joints, has long been considered a noninflammatory form of arthritis. However, it is now recognized that some inflammatory cells are present in osteoarthritis, but the inflammation is much less prevalent than compared to RA or other types of inflammatory arthritis.
The finding of mild chronic inflammation in osteoarthritis has been significant enough for researchers to begin investigating whether the condition can be treated with some of the same types of medications used to treat inflammatory arthritis.
Treatment
Many types of drugs are used to treat inflammatory arthritis. They include
nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), which reduce levels of prostaglandins — chemicals that promote inflammation
oral or injected steroids, which reduce inflammation and suppress the immune system
injections or intravenous infusions of nonbiologic disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex, Trexall), which suppress the immune system
injections or infusions of biologic DMARDs, antibodies such as adalimumab (Humira) that suppress the immune system in a more targeted way than nonbiologic DMARDs
Janus kinase inhibitors, such as tofacitinib (Xeljanz), which interrupt inflammatory signals
drugs that lower uric acid levels (for gout).
Results with drug treatment are often good. Medications that aim to lower the levels of uric acid can almost eliminate the symptoms of gout. As technology improves, more advanced medications will be made for all kinds of arthritis, including biologics and Janus kinase inhibitors, both of which allow people to gain protection from ongoing joint damage.
Other ways to live with arthritis
Other ways to help reduce pain and inflammation include exercising, avoiding processed foods (which promote inflammation), reducing stress, not smoking, and getting enough sleep. Wearing a splint or brace on affected joints and seeking physical therapy may also ease your pain and keep you mobile and active.
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