Arthritis (Arthritis)
1) Disease Description (Causes and Symptoms)
- Disease name confirmation: Arthritis is a general medical term widely used to refer to a condition in which inflammation and structural damage occur in the joints, causing pain, stiffness, and swelling. It includes several subtypes (degenerative arthritis [osteoarthritis], rheumatoid arthritis, septic arthritis, ankylosing spondylitis, etc.).
- Summary of pathophysiology:
- Osteoarthritis (OA): Pain and limited movement caused by degenerative damage to articular cartilage, formation of bone spurs, and local inflammation.
- Rheumatoid arthritis (RA): Persistent autoimmune synovitis causes synovial proliferation (swelling) and cartilage and bone loss.
- Septic (infectious) arthritis: Microbial invasion of the joint space causes acute inflammation → risk of joint destruction.
- Ankylosing spondylitis and other conditions cause stiffness and fusion of the spine and joints as inflammatory arthropathies.
- Main symptoms:
- Pain and joint stiffness (particularly prolonged morning stiffness, which is common in inflammatory arthritis)
- Redness (erythema), localized swelling, tenderness, and limited range of joint motion
- Systemic symptoms: fever and fatigue (particularly in infectious and rheumatoid arthritis)
- Commonly used tests for diagnosis (summary):
- Imaging: X-ray (bone spurs and reduced joint space), ultrasound (synovitis and synovial fluid), MRI (early cartilage damage)
- Blood tests: ESR and CRP (inflammatory markers), RF and anti-CCP (rheumatoid markers), CBC
- Joint aspiration and fluid analysis: Differentiation of infection and crystal arthritis (culture and cytological examination)
2) Treatment Methods
- Goals: Relieve pain, preserve and improve function, slow progression, and prevent complications
- Medication treatment
- Pain relievers: acetaminophen (mild to moderate pain)
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Control pain and inflammation (caution regarding gastrointestinal and kidney side effects)
- Topical NSAIDs, capsaicin, etc. (topical treatment)
- Corticosteroids: Control acute inflammation (oral or intra-articular injection; long-term use is limited)
- Disease-modifying antirheumatic drugs (DMARDs): Basic treatment for rheumatoid arthritis (methotrexate, sulfasalazine, etc.)
- Biologics/biopharmaceuticals: TNF inhibitors, etc. (for severe disease or insufficient response to DMARDs)
- Antibiotics: In septic arthritis, immediate treatment with antibiotics based on culture results or empiric antibiotics
- Procedures/Surgery
- Intra-articular steroid injection (short-term symptom relief)
- Arthroscopic debridement or synovectomy (selective)
- Joint replacement (e.g., knee or hip arthroplasty) — when pain is severe and functional limitation is substantial
- Nonmedication and lifestyle management
- Weight loss (particularly alleviates symptoms and progression in knee and hip OA)
- Regular strength and flexibility exercises (physical therapy and joint protection techniques)
- Use of assistive devices (cane, braces, custom shoes)
- Nutrition: Maintain bone health with calcium and vitamin D; consuming omega-3s (oily fish) may help alleviate inflammation; vegetables and fruits containing antioxidants (such as broccoli, tomatoes, and spinach) are recommended. Avoid excessive salt and processed food intake.
- Caution regarding drug interactions: Cyclosporine and some medications interact with grapefruit (grapefruit should be avoided)
- Precautions and risk of complications
- Increased risk of infection during immunosuppressive treatment (checking vaccination status is recommended)
- Long-term NSAID use may cause gastrointestinal and kidney damage and may pose cardiovascular risks
- Delayed early treatment may result in joint destruction, functional impairment and deformity, and reduced quality of life
- Prognosis
- Varies by subtype: OA progresses gradually, but function can be improved through lifestyle management and surgery. RA may achieve remission with early DMARD treatment, but the prognosis varies depending on treatment response and complications. In septic arthritis, prompt antibiotics and drainage are essential; delayed treatment may result in permanent joint damage.
3) Checkpoints Before an Outpatient Visit (Items to Bring and Records — Including Example Questions)
- Items to bring (recommended)
- A list of all medications currently being taken (including prescription drugs, OTC medications, and supplements), with doses and times of administration
- Copies or summaries of previous test results (blood tests, X-rays, MRI, etc.)
- Allergy history (medications, food, latex, etc.)
- Symptom diary: onset date, pain intensity (pain scale 0–10), duration of morning stiffness, changes in swelling/redness, and presence of fever
- Photos (if there is joint swelling or redness, take photos before the visit)
- History of previous surgery and injections (such as intra-articular steroid injections)
- Information to show the doctor during the outpatient visit
- Recent weight changes, changes in exercise or job duties, and a history suggestive of infection
- Family history (rheumatic diseases, etc.)
- Matters to tell the doctor first during the consultation
- Possibility of pregnancy or whether you are breastfeeding
- Whether you are currently using immunosuppressants or anticoagulants
- Example questions (for checking your symptoms)
- "When did the pain begin, and what factors make it worse or better?"
- "How should the duration of morning stiffness be interpreted?"
4) Examples of General Questions to Ask the Doctor
- What are the expected effects and possible side effects of this medication (or treatment)?
- What is the likelihood of disease progression (prognosis) in my condition?
- What specific changes should I make to my lifestyle (exercise, diet, and weight)?
- If I start medication (particularly DMARDs or biologics), how often should I have follow-up visits and blood tests?
- Are there vaccination recommendations (before/during immunosuppression) or ways to prevent infection?
5) Examples of Condition-Specific Questions
- Is my arthritis degenerative arthritis (OA), or is it an inflammatory disease such as rheumatoid arthritis (RA)? Will additional tests (such as anti-CCP or joint fluid analysis) be needed to confirm this?
- Given my current pain and functional status, could you evaluate whether it is time to recommend joint replacement (e.g., knee replacement) or whether improvement is possible with nonsurgical treatment?
Note: Treatment and testing decisions vary depending on the individual condition (symptoms, test results, underlying diseases, etc.). An appropriate testing and treatment plan should be determined through consultation with the attending physician.