What causes arthritis?

The causes of many types of arthritis are not fully known. Most forms of arthritis are thought to be caused by a fault in the immune system that causes the body to attack its own tissues in the joints. This may be inherited genetically.

Other forms of arthritis can be caused by problems with the immune system or by a metabolic condition, such as gout.

Environmental factors that may contribute to the development of osteoarthritis include:

• obesity, which puts added strain on joints
• activities that involve repetitive movements of a particular joint
• previous damage to a joint, such as from a sports injury

You are also more likely to develop arthritis if you smoke and if you don’t do enough physical activity.

Arthritis caused by an infection is called ‘reactive arthritis’. It’s very difficult to diagnose and can develop at any age, but is more commonly seen in younger people. Reactive arthritis can last between a few weeks to 6 months.

When should I see my doctor?

Joints get sore and swollen for many reasons. It could be due to an injury, overuse, or doing a new type of physical activity.

See your doctor if you have pain and stiffness that starts with no clear reason, lasts for more than a few days, and also causes swelling, redness and warmth. It is important to start treatment as soon as possible to prevent the condition from getting worse and causing long-term damage.

How is arthritis diagnosed?

Your doctor will examine you and ask about your symptoms. They will look for signs of arthritis or that you may have an autoimmune disease.

Blood tests may be taken to look for signs of inflammation or other signs of arthritis. Sometimes a sample of fluid may be taken from a joint. An x-ray, ultrasound or CT scan may be done to look for loss of cartilage or narrowing of the space in the joint.

Some types of arthritis can be difficult to diagnose, so it may take a few visits and tests to get a definite diagnosis. Your doctor may also need to refer you to a rheumatologist, who specialises in conditions that affect the joints.

How is arthritis treated?

For many types of arthritis, there are treatments available that can help control symptoms and prevent damage to the joints.

The most appropriate treatment will depend on which type of arthritis you have, which joints are affected, and the symptoms you have.

Treatment might include:

• medicines, such as painkillers, anti-inflammatory medicines or medicines to slow down the disease (called disease-modifying antirheumatic drugs, or DMARDs, used for inflammatory forms of arthritis such as rheumatoid arthritis, ankylosing spondylitis and juvenile idiopathic arthritis)
• pain management techniques, such as meditation

In severe cases, surgery may be needed to replace or repair damaged joints.

Living with arthritis

There are many things you can do to help manage arthritis. Maintaining a healthy lifestyle can help control the symptoms.

Diet

Eating well is important for your overall health and wellbeing. A healthy diet can help you maintain a healthy weight, which reduces the pressure put on your joints. This might help reduce joint pain.

There is some evidence to suggest that eating healthy fats, such as monounsaturated and omega-3 fats, rather than unhealthy fats such as polysaturated fats, can help reduce the symptoms of arthritis. While these benefits are modest compared to medication, they have no side effects and have other benefits, such as reducing your risk of heart disease.

If you have arthritis, you should aim to eat:

• a healthy balanced diet
• a more Mediterranean-style diet, with plenty of fish, pulses, nuts, olive oil, fruit and vegetables
• more saturated fats, such as in vegetable oils, avocados and many nuts and seeds
• more omega-3 fatty acids, such as from oily fish
• less saturated fats, such as from red meat, poultry, and full-fat dairy
• less energy dense foods, such as in fatty and sugary foods to avoid gaining weight
• an adequate calcium Dairy products do not cause arthritis. The calcium in dairy products is important for strong bones, which is especially important for people with arthritis, who may be at increased risk of osteoporosis (weak and brittle bones). Eat plenty of calcium-rich foods including dairy products (milk, cheese and yoghurt), nuts, seeds and fish, such as sardines or whitebait (particularly if you eat the bones).

If you have gout, avoid foods containing purines (meat, seafood, foods containing yeast)

Others believe acidic fruits, such as lemons, oranges and grapefruit, and nightshade vegetables, such as potatoes, eggplants and capsicum, can make symptoms worse. However, there is no proof of this, and avoiding these foods may do more harm than good.

If you need advice about your diet, ask your doctor to refer you to a dietitian.

Exercise regularly

Getting regular exercise is one of the most effective ways that you can treat arthritis. Exercise can help in many ways, including:

• helping with balance
• keeping muscles strong to support the joints
• reducing joint stiffness
• reducing pain and tension in your joints
• decreasing fatigue and depression
• keeping you mobile
• boosting your energy and mood
• improving sleep

The type of exercise that is best for you will depend on the type of arthritis. It is important to find the right type and level of exercise. Try to be realistic about the amount of exercise you are able to do and choose an activity you enjoy.

There are 3 types of exercise that combine to make up a good fitness program. They are:

• range of movement — this helps improve strength and flexibility and promotes good posture; try swimming, tai chi and golf
• strengthening — this will help build the muscles, which in turn provide better support for your joints; try weight training
• aerobic — this raises your heartbeat, which helps to improve your level of fitness by strengthening your heart; some of the best forms of aerobic exercise are brisk walking, cycling and tennis

You may experience some pain when you first start a new exercise program. This is often due to new muscles being used. However, if you feel pain for longer than 2 hours after exercising, or you have any pain in the joints, consult your doctor or physiotherapist before doing the exercise again.

If you have osteoarthritis, a moderate exercise program is far more beneficial than a strenuous program. Too much exercise can cause further pain and joint degeneration. Try to do small exercises every day to improve your range of movement. Never force a painful joint.

If you have rheumatoid arthritis, make sure you get the right balance between rest and activity. Exercise when you are least tired and try to do small exercises every day in every joint. Swimming and cycling are good low impact choices. You can still exercise during a flare-up, but you should reduce the intensity of your workout.

Manage your pain

Pain can be caused by inflammation, damage to the joints and muscle tension. It can be worse when you are tired or stressed.

Some things you can do to manage pain include:

• taking pain killers. Your doctor or pharmacist can advise you
• exercising regularly to keep the joints moving
• using hot (a warm bath, heat pack or hot water bottle) or cold (ice pack) treatments throughout the day
• looking after your joints by avoiding activities that make pain worse
• using therapies such as massage, acupuncture, transcutaneous electrical nerve stimulation (TENS) or mindfulness techniques

Modify your home

If you have arthritis, it’s important to protect your joints by finding the best techniques for doing daily tasks and making good use of equipment designed to make your life easier.

Products and equipment are available that can, for example, help you to:

• turn doorknobs and keys
• reach for and pick up objects
• get in and out of chairs
• get dressed
• prepare food
• do household cleaning
• manage in the bathroom

If your arthritis makes you unsteady, make sure you reduce your risk of falls.

To find out more:

• read Arthritis Australia’s booklet ‘At home with arthritis’
• visit Independent Living Centres
• see an occupational therapist

Seek support when you need it

If you have arthritis and you work, there are many services available to help you. Arthritis is a recognised disability, which means you have certain rights. You may also be eligible for extra support, such as by modifying equipment or changing your work schedule.

To find out more:

• Read Arthritis Australia’s booklet ‘Stepping out: a guide for young adults with arthritis.
• visit JobAccess.

Can arthritis be prevented?

Some of the causes of arthritis can’t be prevented, such as your family history, age or sex. But there are some risk factors you can do something about:

• Eat a healthy diet.
• Be physically active.
• Maintain a healthy weight.
• Don’t drink too much alcohol.
• Quit smoking.

Complications of arthritis

Arthritis can affect people’s quality of life due to pain and immobility. It can lead to problems with sleep, fatigue, depression and anxiety.

Some types of arthritis also increase the risk of developing other chronic conditions such as lung disease, diabetes and cardiovascular disease. Lack of physical activity due the pain of arthritis can lead to frailty, loss of function, loss of independence and social isolation.