Questions and Answers About
Arthritis and Rheumatic Diseases
This fact sheet answers basic questions
about arthritis and rheumatic diseases. The National Arthritis
and Musculoskeletal and Skin Diseases Information Clearinghouse
(NAMSIC) has other fact sheets that provide more information
about specific forms of arthritis and rheumatic diseases.
NAMSIC also has information about exercise and arthritis and
diet and arthritis.
At the end is a list of key words to help
you understand the terms used in this fact sheet. If you have
further questions after reading this fact sheet, you may wish
to discuss them with your doctor.
What Are Rheumatic Diseases and What Is
There are more than 100 rheumatic
diseases. These diseases may cause pain, stiffness, and
swelling in joints and other supporting structures of the body
such as muscles, tendons, ligaments, and bones. Some rheumatic
diseases can also affect other parts of the body, including
various internal organs.
Many people use the word “arthritis” to
refer to all rheumatic diseases. However, the word literally
means joint inflammation; that is, swelling, redness, heat, and
pain caused by tissue injury or disease in the joint. The many
different kinds of arthritis comprise just a portion of the
rheumatic diseases. Some rheumatic diseases are described as
connective tissue diseases because they affect the body’s
connective tissue—the supporting framework of the body and its
internal organs. Others are known as autoimmune diseases
because they are caused by a problem in which the immune system
harms the body’s own healthy tissues. Examples of some
rheumatic diseases are provided on the next page.
Examples of Rheumatic Diseases
- Osteoarthritis—Also known as
degenerative joint disease, osteoarthritis is the most
common type of arthritis, affecting an estimated 20.7
million adults in the United States. Osteoarthritis
primarily affects cartilage, which is the tissue that
cushions the ends of bones within the joint. Osteoarthritis
occurs when cartilage begins to fray, wear, and decay. In
extreme cases, the cartilage may wear away entirely, leaving
a bone-on-bone joint. Bony spurs (pointy bulges of bone) may
form at the edges of the joint. Osteoarthritis can cause
joint pain, reduced joint motion, loss of function, and
disability. Disability results most often when the disease
affects the spine and the weight-bearing joints (the knees
- Rheumatoid arthritis—Rheumatoid
arthritis is an inflammatory disease of the synovium, or
lining of the joint, that results in pain, stiffness,
swelling, deformity, and loss of function in the joints.
Inflammation most often affects joints of the hands and feet
and tends to be symmetrical (occurring equally on both sides
of the body). This symmetry helps distinguish rheumatoid
arthritis from other types of arthritis. About 1 percent of
the U.S. population (about 2.1 million people) has
- Fibromyalgia—Fibromyalgia is a
chronic disorder that causes pain and stiffness throughout
the tissues that support and move the bones and joints. Pain
and localized tender points occur in the muscles and
tendons, particularly those of the neck, spine, shoulders,
and hips. Patients may experience widespread pain, fatigue,
and sleep disturbances.
- Systemic lupus erythematosus—Systemic
lupus erythematosus (also known as lupus and SLE) is an
autoimmune disease in which the immune system harms the
body’s own healthy cells and tissues. In SLE, this can
result in inflammation of and damage to the joints, skin,
kidneys, heart, lungs, blood vessels, and brain.
- Scleroderma—Also known as
systemic sclerosis, the word scleroderma means “hard skin.”
It refers to several diseases that almost always affect the
skin, blood vessels, and joints. A more serious form also
affects internal organs such as the lungs and kidneys. In
scleroderma, there is an abnormal and excessive production
of collagen (a fiber-like protein) in the skin or internal
- Juvenile rheumatoid arthritis—This
is the most common form of arthritis in childhood, causing
pain, stiffness, swelling, and loss of function in the
joints. The arthritis may be associated with rashes or
fevers, or may affect other parts of the body.
- Ankylosing spondylitis—This
type of arthritis primarily affects the spine, but may also
cause arthritis in the hips, shoulders, and knees. The
tendons and ligaments around the bones and joints in the
spine become inflamed, resulting in pain and stiffness,
especially in the lower back. Ankylosing spondylitis tends
to affect people in late adolescence or early adulthood.
- Gout—This type of arthritis
results from deposits of needle-like crystals of uric acid
in the connective tissue, joint spaces, or both. Uric acid
is a normal breakdown product of purines, which are present
in body tissues and in many foods. Usually, uric acid passes
through the kidney into urine and is eliminated. If the
concentration of uric acid in the blood rises above normal
levels, sodium urate crystals may form in the tendons,
ligaments, and cartilage of the joints. These needle-like
crystals cause inflammation, swelling, and pain in the
affected joint. The joint most commonly affected is the big
- Infectious arthritis—This is a
general term used to describe forms of arthritis that are
caused by infectious agents, such as bacteria or viruses.
Parvovirus arthritis, gonococcal arthritis, and Lyme disease
are examples of infectious arthritis. In those cases caused
by bacteria, early diagnosis and treatment with antibiotics
relieve the arthritis symptoms and cure the disease.
- Reactive arthritis—This form
of arthritis develops after an infection involving the lower
urinary tract, bowel, or other organs. It is commonly
associated with eye problems, skin rashes, and mouth sores.
Reiter’s syndrome is an example of reactive arthritis.
- Psoriatic arthritis—This form
of arthritis occurs in some patients with psoriasis, a
common scaling skin disorder. Psoriatic arthritis often
affects the joints at the ends of the fingers and is
accompanied by changes in the fingernails and toenails. Some
people also have spinal involvement.
- Bursitis—This condition
involves inflammation of the bursae, small, fluid-filled
sacs that help reduce friction between bones and other
moving structures in the joints. The inflammation may result
from arthritis in the joint or injury or infection of the
bursae. Bursitis produces pain and tenderness and may limit
the movement of nearby joints.
- Tendinitis (Tendonitis)—This
refers to inflammation of tendons (tough cords of tissue
that connect muscle to bone) caused by overuse, injury, or
related rheumatic conditions. Tendinitis produces pain and
tenderness and may restrict movement of nearby joints.
What Causes Rheumatic Disease?
The causes of rheumatic diseases vary
depending on the type of disease. Researchers have pinpointed
the cause or causes of some rheumatic diseases, such as
infectious arthritis and gout.
The causes of most rheumatic diseases are
still under investigation. In osteoarthritis, excessive stress
on the joint, from repeated injury or inherited cartilage
weakness, may play a role. In lupus, rheumatoid arthritis, and
scleroderma, the combination of genetic factors that determine
susceptibility, the influence of certain hormones, and
environmental triggers are believed to be important.
Scientists are also studying the risk
factors that determine why some people develop rheumatic
diseases and others do not. For example, being overweight
increases the likelihood that a person will develop
osteoarthritis. The chance of developing osteoarthritis also
increases with age. Genes and family history play a role in
many rheumatic diseases including gout, rheumatoid arthritis,
lupus, ankylosing spondylitis, scleroderma, and some others.
Certain rheumatic conditions, such as
lupus, rheumatoid arthritis, scleroderma, and fibromyalgia, are
more common among women (see below for details). This indicates
that hormones or other male-female differences play a role in
the development of these conditions.
Who Is Affected by Arthritis and
An estimated 40 million people in the
United States have arthritis or other rheumatic conditions. By
the year 2020, this number is expected to reach 59 million.
Rheumatic diseases are the leading cause of disability among
adults age 65 and older.
Rheumatic diseases affect people of all
races and ages. Some rheumatic conditions are more common among
certain populations. For example:
- Rheumatoid arthritis occurs two to
three times more often in women than in men.
- Scleroderma is more common in women
than in men.
- Nine out of 10 people who have lupus
- Nine out of 10 people who have
fibromyalgia are women.
- Gout is more common in men than in
- Lupus is three times more common in
African-American women than in Caucasian women.
- Ankylosing spondylitis is more common
in men than in women.
Common Symptoms of Arthritis
- Swelling in one or more joints
- Stiffness around the joints that
lasts for at least 1 hour in the early morning
- Constant or recurring pain or
tenderness in a joint
- Difficulty using or moving a
- Warmth and redness in a joint
What Are the Symptoms of Arthritis?
Different types of arthritis have
different symptoms. In general, people who have arthritis have
pain and stiffness in the joints. Some of the more common
symptoms are listed in the box on this page. Early diagnosis
and treatment help decrease further joint damage and help
control symptoms of arthritis and many other rheumatic
How Are Rheumatic Diseases Diagnosed?
Diagnosing rheumatic diseases can be
difficult because some symptoms and signs are common to many
different diseases. A general practitioner or family doctor may
be able to evaluate a patient or refer him or her to a
rheumatologist: a doctor who specializes in treating arthritis
and other rheumatic diseases.
The doctor will review the patient’s
medical history, conduct a physical examination, and obtain
laboratory tests and X rays or other imaging tests. The doctor
may need to see the patient more than once to make an accurate
It is vital for people with joint pain to
give the doctor a complete medical history. Answers to the
following questions will help the doctor make an accurate
- Is the pain in one or more joints?
- When does the pain occur?
- How long does the pain last?
- When did you first notice the pain?
- What were you doing when you first
noticed the pain?
- Does activity make the pain better or
- Have you had any illnesses or
accidents that may account for the pain?
- Is there a family history of any
arthritis or rheumatic diseases?
- What medicine(s) are you taking?
It may be helpful for people to keep a
daily journal that describes the pain. Patients should write
down what the affected joint looks like, how it feels, how long
the pain lasts, and what they were doing when the pain started.
Physical Examination and Laboratory Tests
The doctor will examine all of the
patient’s joints for redness, warmth, deformity, ease of
movement, and tenderness. Because some forms of arthritis, such
as lupus, may affect other organs, a complete physical
examination including the heart, lungs, abdomen, nervous
system, and eyes, ears, and throat may be necessary. The doctor
may order some laboratory tests to help confirm a diagnosis.
Samples of blood, urine, or synovial
Common Laboratory Tests
- Antinuclear antibody (ANA)—This
test checks blood levels of antibodies that are often
present in people who have connective tissue diseases or
other autoimmune disorders, such as lupus. Since the
antibodies react with material in the cell’s nucleus
(control center), they are referred to as antinuclear
antibodies. There are also tests for individual types of
ANA’s that may be more specific to people with certain
autoimmune disorders. ANA’s are also sometimes found in
healthy people. Therefore, having ANA’s in the blood does
not necessarily mean that a person has a disease.
or joint aspiration is done to obtain a sample of synovial
fluid. The doctor injects a local anesthetic, inserts a
thin, hollow needle into the joint, and removes the synovial
fluid into a syringe. The test provides important diagnostic
information. For example, the test allows the doctor to see
whether crystals (found in patients with gout or other types
of crystal-induced arthritis) or bacteria or viruses (found
in patients with infectious arthritis) are present in the
- Complement—This test measures
the level of complement, a group of proteins in the blood.
Complement helps destroy foreign substances, such as germs,
that enter the body. A low blood level of complement is
common in people who have active lupus.
- Complete blood count (CBC)—This
test determines the number of white blood cells, red blood
cells, and platelets present in a sample of blood. Some
rheumatic conditions or drugs used to treat arthritis are
associated with a low white blood count (leukopenia), low
red blood count (anemia), or low platelet count
(thrombocytopenia). When doctors prescribe medications that
affect the CBC, they periodically test the patient’s blood.
- Creatinine—This blood test is
commonly ordered in patients who have rheumatic diseases to
monitor for underlying kidney disease.
- Erythrocyte sedimentation rate (sed
rate)—This blood test is used to detect inflammation in
the body. Higher sed rates indicate the presence of
inflammation and are typical of many forms of arthritis,
such as rheumatoid arthritis and ankylosing spondylitis, and
many of the connective tissue diseases.
- Hematocrit (PCV, packed cell
volume)—This test and the test for hemoglobin (a
substance in the red blood cells that carries oxygen through
the body) measure the number of red blood cells present in a
sample of blood. A decrease in the number of red blood cells
(anemia) is common in people with inflammatory arthritis and
- Rheumatoid factor—This test
determines whether rheumatoid factor is present in the
blood. Rheumatoid factor is an antibody found in the blood
of most (but not all) people who have rheumatoid arthritis.
Rheumatoid factor may be found in many other diseases
besides rheumatoid arthritis, and sometimes in normal,
- Urinalysis—In this test, a
urine sample is studied for protein, red blood cells, white
blood cells, or casts. These abnormalities indicate kidney
disease, which may be seen in several rheumatic diseases
such as lupus or vasculitis. Some medications used to treat
arthritis can also cause abnormal findings on urinalysis.
- White blood cell count (WBC)—This
test determines the number of white blood cells present in a
sample of blood. The number may increase as a result of
infection or decrease in response to certain medications, or
with certain diseases, such as lupus. Low numbers of white
blood cells increase a person’s risk of infections.
Work With Your Doctor To Limit Your Pain
The role you play in developing your
treatment plan is very important. It is vital for you to have a
good relationship with your doctor so that you can work
together. You should not be afraid to ask questions about your
condition or treatment. You must understand the treatment plan
and tell the doctor whether or not it is helping you. Studies
have shown that patients who are well informed and participate
actively in their own care experience less pain and make fewer
visits to the doctor than other patients do.
X Rays and Other Imaging Procedures
To see what the joint looks like inside,
the doctor may order X rays or other imaging procedures. X rays
provide an image of the bones, but they do not show the
cartilage, muscles, and ligaments. Other noninvasive imaging
methods such as computed tomography (CT or CAT), magnetic
resonance imaging (MRI), and arthrography (joint X ray) show
the whole joint. The doctor may also use an arthroscope (a
small, flexible tube that transmits the image of the inside of
a joint to a video screen) to examine damage to a joint. The
arthroscope is inserted into the affected joint through a very
small incision in the skin. This procedure, called arthroscopy,
allows the doctor to see inside the joint. Doctors also use
arthroscopy to perform surgery for some types of joint injury.
What Are the Treatments?
Treatments for arthritis include rest and
relaxation, exercise, proper diet, medication, and instruction
about the proper use of joints and ways to conserve energy.
Other treatments include the use of pain relief methods and
assistive devices, such as splints or braces. In severe cases,
surgery may be necessary. The doctor and the patient work
together to develop a treatment plan that helps the patient
maintain or improve his or her lifestyle. Treatment plans
usually combine several types of treatment and vary depending
on the rheumatic condition and the patient.
Rest, Exercise, and Diet
People who have a rheumatic disease
should develop a comfortable balance between rest and activity.
One sign of many rheumatic conditions is fatigue. Patients must
pay attention to signals from their bodies. For example, when
experiencing pain or fatigue, it is important to take a break
and rest. Too much rest, however, may cause muscles and joints
to become stiff.
Physical exercise can reduce joint pain
and stiffness and increase flexibility, muscle strength, and
endurance. It also helps with weight reduction and contributes
to an improved sense of well-being. Before starting any
exercise program, people with arthritis should talk with their
doctor. People with arthritis can participate in a variety of
sports and exercise programs. Exercises that doctors often
- Range-of-motion exercises to
help maintain normal joint movement, maintain or increase
flexibility, and relieve stiffness.
- Strengthening exercises to
maintain or increase muscle strength. Strong muscles help
support and protect joints affected by arthritis.
- Aerobic or endurance exercises
to improve cardiovascular fitness, help control weight, and
improve overall well-being. Studies show that aerobic
exercise can also reduce inflammation in some joints.
Another important part of a treatment
program is a well-balanced diet. Along with exercise, a
well-balanced diet helps people manage their body weight and
stay healthy. Weight control is important to people who have
arthritis because extra weight puts extra pressure on some
joints and can aggravate many types of arthritis. Diet is
especially important for people who have gout. People with gout
should avoid alcohol and foods that are high in purines, such
as organ meats (liver, kidney), sardines, anchovies, and gravy.
A variety of medications are used to
treat rheumatic diseases. The type of medication depends on the
rheumatic disease and on the individual patient. At this time,
the medications used to treat most rheumatic diseases do not
provide a cure, but rather limit the symptoms of the disease.
The one exception is treatments for infectious arthritis. If
caught early enough, arthritis associated with an infection
(such as Lyme disease) can usually be cured with antibiotics.
Medications commonly used to treat
rheumatic diseases provide relief from pain and inflammation.
In some cases, the medication may slow the course of the
disease and prevent further damage to joints or other parts of
the body. This fact sheet describes the medications most
commonly used to treat pain and inflammation.
The doctor may delay using medications
until a definite diagnosis is made, because medications can
hide important symptoms (such as fever and swelling) and
thereby interfere with diagnosis. Patients taking any
medication, either prescription or over-the-counter, should
always follow the doctor’s instructions. The doctor should be
notified immediately if the medicine is making the symptoms
worse or causing other problems, such as an upset stomach,
nausea, or headache. The doctor may be able to change the
dosage or medicine to reduce these side effects.
Analgesics (pain relievers) such as
aspirin; other nonsteroidal anti-inflammatory drugs (NSAID’s)
such as ibuprofen (Motrin,¹ Advil, Nuprin);
and acetaminophen (Tylenol) are used to reduce the pain caused
by many rheumatic conditions. Aspirin and NSAID’s have the
added benefit of decreasing the inflammation associated with
arthritis. Certain analgesics, such as aspirin and NSAID’s, can
have side effects, such as stomach irritation, that can be
reduced by changing the dosage or the medication. The dosage
will vary depending on the particular illness and the overall
health of the patient. The doctor and patient must work
together to determine which analgesic to use and the
appropriate amount. If analgesics do not ease the pain, the
doctor may use other medications, depending on the diagnosis.
¹ Brand names included in this fact sheet
are provided as examples only, and their inclusion does not
mean that these products are endorsed by the National
Institutes of Health or any other Government agency. Also, if a
particular brand name is not mentioned, this does not mean that
the product is unsatisfactory.
Corticosteroids, such as prednisone,
cortisone, solumedrol, and hydrocortisone, are used to treat
many rheumatic conditions because they decrease inflammation
and suppress the immune system. The dosage of these medications
will vary depending on the diagnosis and the patient; again,
the patient and doctor must work together to determine what
dose is best for the patient.
Corticosteroids can be given by mouth, in
creams applied to the skin, or by injection. Short-term side
effects of corticosteroids include swelling, increased
appetite, weight gain, and emotional ups and downs. These side
effects generally stop when the drug is stopped. It can be
dangerous to stop taking corticosteroids suddenly, so it is
very important that the doctor and patient work together when
changing the corticosteroid dose. Side effects that may occur
after long-term use of corticosteroids include stretch marks,
excessive hair growth, osteoporosis, high blood pressure,
damage to the arteries, high blood sugar, infections, and
Although some rheumatic diseases respond
to analgesics and corticosteroids, others may not. Rheumatoid
arthritis, gout, lupus, scleroderma, and fibromyalgia are some
of the rheumatic diseases that routinely require other
medications; these are prescribed to slow the course of the
disease or to treat disease-specific symptoms.
Heat and Cold Therapies
Heat and cold can both be used to reduce
the pain and inflammation of arthritis. Both therapies come in
different forms, and the patient and doctor can determine which
form works best. Studies have shown heat and cold therapies to
be equally effective in reducing pain, although they are
usually avoided in acute gout.
Heat therapy increases blood flow,
tolerance for pain, and flexibility. Heat therapy can involve
treatment with paraffin wax, microwaves, ultrasound, or moist
heat. Physical therapists are needed to apply paraffin wax, or
use microwave or ultrasound therapy, but patients can apply
moist heat themselves. Some ways to apply moist heat include
placing warm towels or hot packs on the inflamed joint or
taking a warm bath or shower.
Cold therapy numbs the nerves around the
joint (which reduces pain) and relieves inflammation and muscle
spasms. Cold therapy can involve cold packs, ice massage,
soaking in cold water, or over-the-counter sprays and ointments
that cool the skin and joints.
Hydrotherapy, Mobilization Therapy,
and Relaxation Therapy
Hydrotherapy involves exercising or
relaxing in warm water, which helps relax tense muscles and
relieve pain. Exercising in a large pool is easier because
water takes some weight off painful joints. This type of
exercise improves muscle strength and joint movement.
Mobilization therapies include traction
(gentle, steady pulling), massage, and manipulation (using the
hands to restore normal movement to stiff joints). When done by
a trained professional, these methods can help control pain,
increase joint motion, and improve muscle and tendon
Relaxation therapy helps reduce pain by
teaching people various ways to release muscle tension
throughout the body. In one method of relaxation therapy, known
as progressive relaxation, the patient tightens a muscle group
and then slowly releases the tension. Doctors and physical
therapists can teach patients progressive relaxation and other
The most common assistive devices for
treating arthritis pain are splints and braces, which are used
to support weakened joints or allow them to rest. Some of these
devices prevent the joint from moving; others allow some
movement. A splint or brace should be used only when
recommended by a doctor or therapist, who will show the patient
the correct way to put the device on, ensure that it fits
properly, and explain when and for how long it should be worn.
The incorrect use of a splint or brace can cause joint damage,
stiffness, and pain.
A person with arthritis can use other
kinds of devices to ease the pain. For example, the use of a
cane when walking can reduce some of the weight placed on an
arthritic knee or hip. A shoe insert (orthotic) can ease the
pain of walking caused by arthritis of the foot or knee.
Surgery may be required to repair damage
to a joint after trauma (a torn meniscus, for example) or to
restore function or relieve pain in a joint damaged by
arthritis. The doctor may recommend arthroscopic surgery, bone
fusion (surgery in which bones in the joint are fused or joined
together), or arthroplasty (also known as total joint
replacement, in which the damaged joint is removed and replaced
with an artificial one).
Myths About Treating Arthritis
At this time, the only type of arthritis
that can be cured is that caused by infections. Although
symptoms of other types of arthritis can be effectively managed
with rest, exercise, and medication, there are no cures. Some
people claim to have been cured by treatment with herbs, oils,
chemicals, special diets, radiation, or other products.
However, there is no scientific evidence that such treatments
are helpful in patients with arthritis and, moreover, they may
actually cause harm with the development of side effects.
Patients should talk to their doctor before using any therapy
that has not been prescribed or recommended by the health care
team caring for the patient.
What Can Be Done To Help?
Studies show that an estimated 18 percent
of Americans who have arthritis or other rheumatic conditions
believe that their condition limits their activities. People
with arthritis may find that they can no longer participate in
some of their favorite activities, which can affect their
overall well-being. Even when arthritis impairs only one joint,
a person may have to change many daily activities to protect
that joint from further damage and reduce pain. When arthritis
affects the entire body, as it does in people with rheumatoid
arthritis or fibromyalgia, many daily activities have to be
changed to deal with pain, fatigue, and other symptoms.
Changes in the home may help a person
with chronic arthritis continue to live safely, productively,
and with less pain. People with arthritis may become weak, lose
their balance, or fall in the bathroom. Installing grab bars in
the tub or shower and by the toilet, placing a secure seat in
the tub, and raising the height of the toilet seat can help.
Special kitchen utensils can accommodate arthritic hands to
make meal preparation easier. An occupational therapist can
help people who have rheumatic conditions identify and make
adjustments in their homes to create a safer, less painful, and
more efficient environment.
Friends and family can help a patient
with a rheumatic condition by learning about that condition and
understanding how it affects the patient’s life. Friends and
family can provide emotional and physical assistance. Their
support, as well as support from other people who have the same
disease, can make it easier to cope. The Arthritis Foundation
(see the list of resources at the end of this fact sheet) has a
wealth of information to help people with arthritis.
What Is Some of the Current Research
Being Done on Arthritis?
The National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a part of the
National Institutes of Health (NIH), leads the Federal medical
research effort in arthritis and rheumatic diseases. The NIAMS
sponsors research and research training on the NIH campus in
Bethesda, Maryland, and at universities and medical centers
throughout the United States.
The NIAMS supports three types of
centers: Multipurpose Arthritis and Musculoskeletal Diseases
Centers (MAMDC’s), Specialized Centers of Research (SCOR’s),
and Core Centers.
The MAMDC’s foster a multidisciplinary
approach to the many problems of arthritis and musculoskeletal
diseases and develop new capabilities for research into other
diseases. Centers develop and carry out research in basic or
laboratory and clinical science, professional and patient
education, and epidemiology and health services.
Each SCOR focuses on a single disease:
currently, rheumatoid arthritis, systemic lupus erythematosus,
osteoarthritis, osteoporosis, and scleroderma. By doing
laboratory and clinical studies under one roof, these centers
aim to speed up basic research on the causes of these diseases
and to hasten transfer of advances from the laboratory to the
bedside and improve patient care.
Core Centers promote interdisciplinary
collaborative efforts among scientists engaged in high-quality
research related to a common theme. By providing funding for
facilities, pilot and feasibility studies, and program
enrichment activities at the Core Center, the Institute
reinforces and amplifies investigations already ongoing in
NIAMS program areas. Core Centers are currently targeted for
skin diseases (Skin Disease Research Core Centers) and for
musculoskeletal disorders (Core Centers for Musculoskeletal
Some current NIAMS research efforts in
rheumatoid arthritis, osteoarthritis, lupus, and scleroderma
are outlined below.
Researchers are trying to identify the
causes of rheumatoid arthritis in the hope that understanding
the cause will lead to new treatments. They are examining the
role that the endocrine (hormonal), nervous, and immune systems
play, and the ways in which these systems interact with
environmental and genetic factors in the development of
rheumatoid arthritis. Some scientists are trying to determine
whether an infectious agent triggers rheumatoid arthritis.
Others are studying the role of certain enzymes (specialized
proteins in the body that carry out biochemical reactions) in
breaking down cartilage. Researchers are also trying to
identify the genetic factors that place some people at higher
risk than others for developing rheumatoid arthritis.
Moreover, scientists are looking at new
ways to treat rheumatoid arthritis. They are experimenting with
new drugs and “biologic agents” that selectively block certain
immune system activities associated with inflammation. Recent
studies suggest that these represent promising approaches to
treatment. Other investigators have shown that minocycline and
doxycycline, two antibiotic medications in the tetracycline
family, have a modest benefit for people with rheumatoid
Researchers are working to understand
what role certain enzymes play in the breakdown of joint
cartilage in osteoarthritis and are testing drugs that block
the action of these enzymes. In addition, a gene that may be
linked to an inherited form of osteoarthritis has recently been
Systemic Lupus Erythematosus
Researchers are looking at how genetic,
environmental, and hormonal factors influence the development
of systemic lupus erythematosus. They are trying to find out
why lupus is more common in certain populations. There has been
very promising progress in identifying the genes that may be
responsible for lupus. Promising areas of treatment research
include biologic agents; newer, more selective drugs that
suppress the immune system; and efforts to correct immune
abnormalities with bone marrow transplantation. Clinical
studies are underway to determine the safety of estrogens for
hormone replacement therapy and birth control in women with
lupus. Contrary to the widely held belief that estrogens can
make the disease worse, recent data suggest that these drugs
may be safe for some women with lupus.
Current studies on scleroderma are
focusing on three areas of the disease: overproduction of
collagen, blood vessel injury, and abnormal immune system
activity. Researchers hope to discover how these three elements
interact with each other to cause and promote scleroderma. In
one recent study, researchers found evidence of fetal cells
within the blood and skin lesions of women who had been
pregnant years before developing scleroderma. The study
suggests that fetal cells may play a role in scleroderma by
maturing immune cells that promote the overproduction of
collagen. Scientists are continuing to study the implications
of this finding.
Where Can People Find More Information
- Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
800/283–7800, or call your local chapter (listed in the
World Wide Web address: http://www.arthritis.org/
This is the main voluntary organization
devoted to arthritis. The foundation publishes free pamphlets
on many types of arthritis and a monthly magazine for members
that provides up-to-date information on arthritis. The
foundation also can provide physician and clinic referrals.
- American College of
Rheumatology/Association of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345–4300
World Wide Web address: http://www.rheumatology.org/
This association provides referrals to
rheumatologists and physical and occupational therapists who
have experience working with people who have rheumatic
diseases. The organization also provides educational materials
and guidelines about many different rheumatic diseases.
- National Arthritis and
Skin Diseases Information Clearinghouse (NAMSIC)
National Institutes of Health
1 AMS Circle
Bethesda, Maryland 20892–3675
World Wide Web address:
This clearinghouse, a public service
sponsored by the NIAMS, provides information about various
forms of arthritis and rheumatic disease. The clearinghouse
distributes patient and professional education materials and
also refers people to other sources of information.
The NIAMS gratefully acknowledges the
assistance of John H. Klippel, M.D., and Reva Lawrence of NIAMS;
Barri Fessler, M.D., of the Cleveland Clinic Foundation; and
Eric Matteson, M.D., of the Mayo Clinic, in the review of this
Analgesic: A medication or treatment that
Ankylosing spondylitis: A rheumatic
disease that causes arthritis of the spine and sacroiliac
joints and, at times, inflammation of the eyes and heart
Antibodies: Special proteins produced by
the body’s immune system that help fight and destroy viruses,
bacteria, and other foreign substances (antigens) that invade
the body. Occasionally, abnormal antibodies develop that can
attack a part of the body and cause autoimmune disease. These
abnormal antibodies are called autoantibodies.
Antigen: A foreign substance that
stimulates an immune response.
Arthrography: An x-ray procedure that
provides a detailed image of the joint when air or a contrast
substance is injected into the joint space.
Arthroscopy: A procedure performed with
an arthroscope (a small, flexible tube that transmits the image
of the inside of a joint to a video monitor). Arthroscopy is
used for diagnosis as well as treatment of some types of joint
injury. The arthroscope is inserted through a small incision in
the skin near the affected joint.
Bursa (plural, bursae): A small sac of
tissue located between bone and other moving structures such as
muscles, skin, or tendons. The bursa contains a lubricating
fluid that allows smooth gliding between these structures.
Bursitis: A condition involving
inflammation of the bursae.
Cartilage: A resilient tissue that covers
and cushions the ends of the bones and absorbs shock.
Collagen: The main structural protein of
skin, bones, tendons, cartilage, and connective tissue.
Connective tissue: The supporting
framework of the body and its internal organs.
Computed tomography (CT or CAT): A
diagnostic technique that uses a computer and an x-ray machine
to take a series of images that can be transformed into a clear
and detailed image of a joint.
Corticosteroids: Potent anti-inflammatory
hormones that are made naturally in the body or synthetically
for use as drugs. The most commonly prescribed drug of this
type is prednisone.
Fibromyalgia: A chronic disorder
characterized by widespread musculoskeletal pain, fatigue, and
tenderness in localized areas of the neck, spine, shoulders,
and hips called “tender points.”
Fibrous capsule: A tough wrapping of
tendons and ligaments that surrounds the joint.
Gout: A type of arthritis resulting from
deposits of needle-like crystals of uric acid in the connective
tissue, joint spaces, or both.
Hydrotherapy: Therapy that takes place in
Infectious arthritis: Forms of arthritis
caused by infectious agents, such as bacteria or viruses.
Inflammation: A typical reaction of
tissue to injury or disease. It is marked by four signs:
swelling, redness, heat, and pain.
Joint: The place where two or more bones
are joined. Most joints are composed of cartilage, joint space,
fibrous capsule, synovium, and ligaments.
Joint space: The area enclosed within the
fibrous capsule and synovium.
Juvenile arthritis: A term used to refer
to the types of arthritis that affect children. Juvenile
rheumatoid arthritis is the most common type.
Ligaments: Stretchy bands of cordlike
tissues that connect bone to bone.
Lupus: A type of immune disorder known as
an autoimmune disease that can lead to inflammation of and
damage to joints, skin, kidneys, heart, lungs, blood vessels,
Lyme disease: A disease caused by the
bacterium Borrelia burgdorferi in which arthritis is often a
prominent symptom. Rash, heart disease, and nervous system
involvement may also occur.
Magnetic resonance imaging (MRI): A
diagnostic technique that provides high-quality cross-sectional
images of a structure of the body without X rays or other
Manipulation: A treatment by which health
professionals use their hands to help restore normal movement
to stiff joints.
Microwave therapy: A type of deep heat
therapy in which electromagnetic waves pass between electrodes
placed on the patient’s skin. This therapy creates heat that
increases blood flow and relieves muscle and joint pain.
Mobilization therapies: A group of
treatments that include traction, massage, and manipulation.
When performed by a trained professional, these methods can
help control a patient’s pain and increase joint and muscle
Nonsteroidal anti-inflammatory drugs (NSAID’s):
A group of medications, including aspirin, ibuprofen, and
related drugs, used to reduce inflammation that causes joint
pain, stiffness, and swelling.
Osteoarthritis: A type of arthritis that
causes the cartilage in the joints to fray and wear. In extreme
cases, the cartilage may wear away completely.
Polymyalgia rheumatica: A rheumatic
disease that involves tendons, muscles, ligaments, and tissues
around the joints. Pain, aching, and morning stiffness in the
neck, shoulders, lower back, and hips characterize the disease.
It is sometimes the first sign of giant cell arteritis (a
disease of the arteries characterized by inflammation,
weakness, weight loss, and fever).
Polymyositis: A rheumatic disease that
causes weakness and inflammation of muscles.
Psoriatic arthritis: Joint inflammation
that occurs in about 5 to 10 percent of people with psoriasis
(a common skin disorder).
Reactive arthritis: A form of arthritis
that develops after an infection involving the lower urinary
tract, bowel, or other organs.
Rheumatic: A term referring to a disorder
or condition that causes pain or stiffness in the joints,
muscles, or bone.
Rheumatoid arthritis: An inflammatory
disease of the synovium, or lining of the joint, that results
in pain, stiffness, swelling, deformity, and loss of function
in the joints.
Rheumatologist: A doctor who specializes
in diagnosing and treating disorders that affect the joints,
muscles, tendons, ligaments, and bones.
Risk factor: Something that increases a
person’s chance of developing a disease, such as age, gender,
ethnicity, and genetics (family history).
Scleroderma: A disease of the connective
tissues and blood vessels that leads to hardening of the skin.
Scleroderma can also damage internal organs such as the
kidneys, lungs, heart, or gastrointestinal tract.
Synovial fluid: Fluid released into
movable joints by surrounding membranes. The fluid lubricates
the joint and reduces friction.
Synovium: A thin membrane that lines a
joint and releases a fluid that allows the joint to move
Tendinitis (tendonitis): Inflammation of
tendons caused by overuse, injury, or related rheumatic
Tendon: Tough, fibrous cords of tissue
that connect muscle to bone.
Transcutaneous: Through the skin.
Ultrasound: A treatment that uses sound
waves to provide deep heat and relieve pain.