Arthritis

Arthritis is a collective term for more than 150 different conditions that affect joints, bones, and muscles. The condition is defined as an acute or chronic inflammation in one or more joints, often accompanied by pain, stiffness, and in many cases structural damage. Arthritis can be caused by several underlying mechanisms, including degeneration, autoimmunity, infections, or crystal deposition. Knowing which type of arthritis a patient has is crucial in order to initiate correct and targeted treatment¹.

Although arthritis is often associated with older adults, it can affect people of all ages – including children and young individuals. Arthritis can occur across gender, ethnicity, lifestyle, and socioeconomic background¹.

Causes and Subgroups

The cause of arthritis varies depending on the type. In osteoarthritis, the most common form, mechanical factors and age-related processes play a central role. Risk factors include advanced age, female sex, previous joint injuries, and overweight. Genetic mutations in collagen types II, IV, V, and VI have also been identified as possible contributors².

The most important subgroups of arthritis include:

• Degenerative conditions: Osteoarthritis

• Post-traumatic arthritis: Secondary to injury

• Spondyloarthritides: Including psoriatic arthritis, ankylosing spondylitis (axial spondyloarthritis), reactive arthritis, and enteropathic arthritis

• Autoimmune and autoinflammatory conditions: Such as rheumatoid arthritis and systemic lupus erythematosus

• Crystal deposition: Gout (urate crystals) and pseudogout (calcium pyrophosphate crystals)

• Infectious arthritis: Septic arthritis

• Idiopathic forms: Such as juvenile idiopathic arthritis³

In addition, several systemic diseases can lead to joint involvement. Examples include celiac disease, Lyme disease, and psoriasis.

Differential Diagnoses in Arthritis-like Symptoms

A number of conditions can cause symptoms similar to arthritis but with different pathophysiology and requiring other treatment strategies. These include:

• Systemic lupus erythematosus (SLE)

• Fibromyalgia

• Polymyalgia rheumatica

• Mechanical back and neck pain

• Tendinopathies and enthesopathies

It is important to distinguish these from arthritis through clinical assessment, laboratory testing, and imaging.

Multidisciplinary Treatment Team and the Role of Physiotherapy

The treatment of arthritis often requires a multidisciplinary approach due to the disease’s broad impact both locally in the joints and systemically. An optimal team includes a physician, rheumatologist, physiotherapist, occupational therapist, pharmacist, pain specialist, orthopedic surgeon, nurse, and clinical nutritionist⁴.

The physiotherapist plays a central role by contributing to:

• Movement economy and joint mobility: Individually tailored joint mobilization and movement training

• Strength and function: Specific exercises to preserve muscle strength and prevent muscle atrophy

• Pain reduction: Stretching, heat/cold therapy, electrotherapy, and manual techniques

• Education and coping: Guidance in activity regulation, use of assistive devices, and ergonomic principles

Aquatic exercise has proven to be particularly effective in arthritis, as it reduces joint load while allowing for functional strength and endurance training⁴. Combined with weight reduction, this can significantly reduce pain and improve mobility.

Pharmacological and Medical Management

Patients with arthritis are often prescribed multiple medications simultaneously, making polypharmacy a real concern. Pharmacists therefore play an important role in monitoring interactions, side effects, and ensuring correct use of medications. In cases of severe pain, the use of opioids may be considered, but this requires close follow-up to avoid dependency.

Clinical Presentation and Physiotherapeutic Management of Arthritis

Arthritis is a collective term for conditions characterized by inflammation in one or more joints, encompassing a wide spectrum of diseases with different causes and manifestations. Although symptoms may vary significantly between the different types, there are a number of common features.

Common Symptoms of Arthritis

Patients with arthritis may experience a range of joint-related and systemic symptoms. The most common include:

• Joint pain, often worsened by activity

• Swelling, redness, and warmth in affected joints

• Stiffness, particularly after rest or in the morning (often lasting more than 30 minutes in inflammatory types)

• Reduced mobility or impaired function in the affected joint

• Persistent joint swelling for more than three days, or frequent episodes (>3 times/month)

Some forms of arthritis, such as rheumatoid arthritis and psoriatic arthritis, may also cause extra-articular manifestations, including:

• Fatigue and lack of energy

• Fever and unintentional weight loss

• Skin changes (e.g., psoriasis or rash)

• Nail changes in fingers and toes

• Hair loss, particularly around the hairline or in patches⁵

Diagnostic Examinations

Diagnosis of arthritis requires a combination of clinical evaluation and technical investigations:

• Medical history: Mapping of symptoms, onset, duration, pattern, triggering factors, as well as family history and comorbidities

• Clinical examination: Inspection and palpation of affected joints, assessment of range of motion, function, and possible systemic signs (rash, eye inflammation, temperature, etc.)

• Imaging: X-ray to detect structural changes. Ultrasound and MRI can visualize inflammation, joint fluid, and soft tissue. CT is used more selectively⁶

• Laboratory tests: Include inflammatory markers (CRP, ESR), autoantibodies (e.g., anti-CCP, RF), as well as genetic markers when specific diseases are suspected (such as HLA-B27 in spondyloarthritis)

• Referral to specialist: In suspected inflammatory or systemic arthritis, the patient is

  usually referred to a rheumatologist for further assessment and treatment⁷

Multidisciplinary Treatment and Follow-up

Treatment and follow-up of arthritis are tailored to the type of disease, severity, and which joints or organs are affected. Management should take place in collaboration between several professionals:

• General practitioner and rheumatologist

• Physiotherapist and occupational therapist

• Pharmacist and psychologist

• Nutritionist/dietitian

• Orthopedic surgeon when surgery is required⁷

The goals of treatment are to:

• Reduce pain and inflammation

• Prevent structural joint damage

• Improve function and quality of life

• Promote patient self-management

Pharmacological Treatment

The choice of medications depends on the type of arthritis:

• Analgesics: Paracetamol, tramadol, and opioids if necessary for symptom relief, without effect on inflammation

• NSAIDs: Reduce both inflammation and pain; available as tablets and topical formulations

• Corticosteroids: Prednisolone and cortisone are used in severe exacerbations

• DMARDs: For inflammatory types, especially rheumatoid arthritis. Examples: methotrexate, sulfasalazine, hydroxychloroquine

• Biologics: Targeted therapies against cytokines or cell surfaces (e.g., TNF-alpha inhibitors such as infliximab and etanercept)

• Counterirritants: Topical ointments such as menthol and capsaicin reduce joint pain by modulating pain pathways⁸,⁹

The Role of the Physiotherapist and Physiotherapy Interventions

Physiotherapists are central to the non-pharmacological management of arthritis. They contribute with:

• Functional assessment and individualized exercise plan

• Joint mobility training to maintain or improve range of motion

• Strength training, especially in osteoarthritis of weight-bearing joints such as the knee and hip

• Aquatic exercise, which reduces joint load and provides effective cardiovascular and strength training

• Stretching and flexibility exercises to reduce stiffness

• Guidance in joint-sparing techniques and the use of assistive devices

In knee osteoarthritis, quadriceps and VMO strengthening, straight leg raises (SLR), and weight-bearing exercises are recommended. Exercises must be tailored to disease activity and daily condition.

Self-Management and Lifestyle Advice

Although arthritis cannot be cured, symptoms and disease progression can often be managed through self-care strategies:

• Regular physical activity and structured exercise

• Weight management to reduce joint load

• Nutritional advice to reduce inflammation and improve overall health

• Good sleep hygiene and stress management

• Joint protection, such as using larger joints when carrying and applying ergonomic techniques

• Rest during disease flare-ups, while avoiding prolonged inactivity

• Good medication adherence

The physiotherapist should educate the patient in disease understanding, encourage active participation in treatment, and provide support in lifestyle changes.

Refrences:

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8. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88.

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