Featuring Dr. Isabelle Amigues, MD
Founder and CEO of Unabridged MD

Arthritis is a term that is widely used. For many people it just means “joint pain”. For those that are affected with rheumatologic disorders, and for their rheumatologists, arthritis means a lot more than just joint pain. During the month of May, rheumatologists highlight National Arthritis Awareness month to draw attention to the different types of arthritis that we see and treat.

This month, special guest Isabelle Amigues, MD, founder and CEO of Unabridged MD, a Direct Care Rheumatology practice in Denver, Colorado helps break down the different types of arthritis and how rheumatologists are involved in treating these conditions.

While osteoarthritis is often associated with aging or injury (also called wear-and-tear) arthritis can affect anyone regardless of age and gender. In rheumatology we distinguish two major types of arthritis: inflammatory and mechanical. It is important to understand the differences between these types of arthritis, as this is how we determine the appropriate treatment to manage each condition.

Inflammatory Arthritis

Inflammatory arthritis is caused by an inflammatory process that is typically triggered by the immune system. The most common causes of inflammatory arthritis include crystalline arthropathies (such as gout and pseudogout), rheumatoid arthritis, psoriatic arthritis, as well as Sjogren’s syndrome, lupus and vasculitis.

Sometimes these types of conditions are referred to as autoimmune arthritis. In this case, our immune system begins to attack healthy joint tissue and this leads to painful swelling of the joints and often decreased range of motion or movement, often warmth or redness, and overall decreased function of the joint affected. This can be in large joints such as the knees and shoulders, or small joints like the knuckles, wrists, or toes.

Symptoms of Inflammatory Arthritis

Other symptoms that help identify this type of arthritis include:

• Joint pain that is worse in the morning
• More than 30-60 minutes of joint stiffness, usually in the morning or after decreased activity
• Back pain that begins before the age of 40 without injury or trauma
• Presence of swelling of an entire digit like a finger or toe
• Abrupt change in activity or decreased ability to perform daily activities like dressing, bathing, cooking, cleaning

Often, patients affected by inflammatory arthritis have other symptoms such as fever, weight loss, severe fatigue, and may even present with a rash or psoriasis.

When this type of inflammatory arthritis is not treated, other parts of the body may become affected, and this more widespread inflammation is then called systemic. The immune system may cause irreversible damage to the joints and organs if the inflammation and swelling is present for an extended period of time. The goals of treatment are to alleviate pain and stiffness, improve joint function and maintain organ function, and remain in remission, or free from flare-ups that can trigger more damage to the body.

Treatment for Inflammatory Arthritis

Inflammatory arthritis typically responds well to steroids like prednisone or methylprednisolone. Treatments may also include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids. Biologic medications, either in the form of injectable medications or infusions, can also be very helpful for this type of arthritis. Physical therapy, exercise, and lifestyle modifications such as stress management, an anti-inflammatory diet, and maintaining a healthy weight can also help decrease inflammation and improve overall function.

Mechanical Arthritis

Mechanical arthritis is often a primary topic during Arthritis Awareness Month. This form of arthritis is caused by wear and tear on the joints over time, commonly caused by osteoarthritis. This condition usually affects older adults and is characterized by cartilage breakdown, causing bones to rub against each other. This mechanical strain leads to pain and stiffness. The most commonly affected joints include the knees, hips, thumbs, and spine.

Symptoms of Mechanical Arthritis

Symptoms of mechanical arthritis include:

• joint stiffness
• aching
• decreased movement, especially after periods of inactivity or overuse.

This type of arthritis is felt for a few minutes after waking up in the morning, after standing from a seated position or getting out of the care, or after exercising or using a particular joint for an activity.

Mechanical pain is categorized by pain that is worse at the end of the day, with movement and use, and less than 30 minutes of joint stiffness in the morning.

Treating Mechanical Arthritis

Although mechanical joint pain is not associated with an increased risk for other organ damage, there are no specific treatments. We do not have a way to change the natural progression of wear and tear on our joints and there are no medications that alter the way joints may look from osteoarthritis.  Sometimes the knuckles in the hands begin to appear larger with osteoarthritis and X-rays of the whole hand can help us identify if there is boney enlargement from osteophytes or extra bone formation. This happens much like how a callous forms on areas of repeat friction; the bones begin to appear larger when there is osteoarthritis.

Treatment for osteoarthritis symptoms may include pain-relieving medications, physiotherapy, and exercise to improve joint flexibility and strength. The joints affected by osteoarthritis will often feel better and more lubricated with low-impact exercise. Surgery with joint replacement is indicated in severe cases. Rheumatologic or autoimmune medications do not treat joint pain from osteoarthritis. It is also important to consider the impact of body weight on joint pain as well. The heavier or more overweight a person is, the more pressure and force is applied to the joint to cause pain and discomfort. This is particularly important when considering how likely a person is to succeed after a joint replacement surgery.

Why is joint health important?

Arthritis Awareness Month promotes year-long management of all types of arthritis. Understanding what type of arthritis you may have is very valuable to understand how certain medications may help you. Not all joint pain is the same and not all inflammation is the same.

Rheumatologists are specialists trained to identify and treat the inflammatory arthritis syndromes more aggressively because these are the types of arthritis that can cause damage to the body and other organs if not treated. Patients can develop joint deformities and severely restricted range of motion of the affected joints if not started on appropriate medications. Fortunately, there are many great options for treatment and disease remission is the goal for all of our patients.

Together, with nutrition, exercise, and medications, Rheumatologists are able to help patients feel better and live longer with inflammatory arthritis.

Learn more about Dr. Isabelle Amigues, MD and UnabridgedMD at www.unabridgedmd.com

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