Arthritis: Warning Signs & Early Management

Published January 9, 2018

By Dr. Enrico Villanueva

Arthritis is a very common condition, impacting more than 50 million Americans, according to the Arthritis Foundation. There are more than 100 different types of arthritis, which affect individuals and their joints in many different ways. As with many diseases and conditions, early detection and early treatment will lead to the best possible outcomes, so it is critical to understand what arthritis is, what the warning signs look like, and the many treatment options so patients can seek appropriate care. 

Arthritis can cause mechanical changes in the joints. It can be caused by mechanical degeneration or inflammation of the joints. In my practice of rheumatology, I commonly see non-inflammatory arthritis which is the degeneration of joints as a result of gradual wear and tear as we age, and inflammatory arthritis from inflammation in the joints. I take care of older patients who are experiencing the degenerative arthritic process, as well as the younger population who could be afflicted with the inflammatory arthritic conditions. 

Inflammatory conditions such as rheumatoid arthritis are the more serious types of arthritis, which are systemic conditions that affect joints and other organs. The majority of these conditions are autoimmune processes, leading to inflammation. There are many factors that play a role in these conditions, such as genetic and environmental, but there is no clear answer why people have inflammatory arthritis. 

In nearly every type of arthritis, both non-inflammatory and inflammatory, the most common symptom is joint pain. In non-inflammatory arthritis, patients may also experience short-lived stiffness in the joints which improves as they move around. Patients suffering from inflammatory arthritis will experience persistent stiffness that minimally improves despite moving around. These patients may also see swelling of the joint, which causes the joint to appear enlarged. We often see patients who are concerned about visible deformities in their joints as a result of swelling. 

While treatment plans vary based on the patient and the type of arthritis, we often recommend anti-inflammatory medications (NSAIDs), non-opioid or non-narcotic medications and topical analgesics for those with non-inflammatory arthritis. For arthritis impacting weight-bearing joints, such as hips, knees and the back, exercise and weight loss is also an integral part of managing the arthritis. For certain non-inflammatory arthritis conditions, there are also joint injections that can be done swell as Physical Therapy.

We typically recommend the same anti-inflammatory medications to patients who have inflammatory arthritis. Some patients can benefit from the use of steroids as well, though not all patients can take steroids. There are medications for the treatment of inflammatory arthritis that are classified as Disease Modifying Antirheumatic Drugs (DMARDs), which can help slow the progression of the disease. In the past 20 years, we have seen a huge advancement in the treatment of inflammatory conditions such as rheumatoid and psoriatic arthritis through biologic agents. 

There are also many supplements that patients can avail of, though I do not specifically recommend them as a mainstay of treatment for arthritis, as there is no scientific evidence to prove that supplements help with pain and stiffness. 

Patients can, of course, turn to joint replacement surgery, but my medical philosophy is to try conservative treatments first. Joint replacement surgery is typically an elective surgery, and I encourage my patients to consider the risks and benefits of surgery based on how the arthritis has impacted their quality of life.

While the many different types of arthritis require different methods of treatment, we can often manage the disease conservatively when it is caught and treated early. 

Dr. Enrico T. Villanueva is board-certified in Rheumatology . He treats patients suffering from a variety of rheumatic disorders and autoimmune diseases including rheumatoid arthritis, osteoarthritis, osteoporosis, lupus, gout, scleroderma, polymyositis, vasculitis and more. His goal is to make a difference in his patients’ lives and to help prevent chronic conditions from becoming debilitating. He practices with the Mid-Maryland Musculoskeletal Institute, The Centers for Advanced Orthopaedics  and sees patients in Frederick, Hagerstown and Olney.