Arthritis Defined
Arthritis literally means joint Inflammation, and it can affect joints in any part of the body. Joints are places in the body where two bones meet.

Many people use the term arthritis to refer to rheumatic diseases; {mosgoogle right} however, the different kinds of arthritis comprise just a portion of the rheumatic diseases.

Arthritis is often a chronic disease, which means that it can affect you over a long period of time. Many forms of arthritis cause swelling, redness, heat, and Pain.

Arthritis Defined - Osteoarthritis
Osteoarthritis is the most common form of arthritis among older people.

Osteoarthritis occurs when cartilage, the tissue that cushions the ends of the bones within the joints, breaks down and wears away. In some cases, all of the cartilage may wear away, leaving bones that rub up against each other.

Symptoms range from stiffness and mild pain that comes and goes to severe joint pain. Osteoarthritis affects hands, low back, neck, and weight-bearing joints such as knees, hips, and feet.

Osteoarthritis is one of the most frequent causes of physical disability among older adults.

The disease affects both men and women. Before age 45, osteoarthritis is more common in men than in women. After age 45, osteoarthritis is more common in women. By age 65, more than half of the population has x-ray evidence of osteoarthritis in at least one joint.

Osteoarthritis affects only joints, not internal organs.

Arthritis Defined - Rheumatoid Arthritis
Stages of rheumatoid arthritis. Rheumatoid arthritis not only affects the joints, but may also attack tissue in the skin, lungs, eyes, and Blood vessels. People with rheumatoid arthritis may feel sick, tired, and sometimes feverish.

Rheumatoid arthritis is classified as an autoimmune disease. An autoimmune disease occurs when the Immune system turns against parts of the body it is designed to protect.

Rheumatoid arthritis generally occurs in a symmetrical pattern. This means that if one knee or hand is involved, the other one is, too. It can occur at any age, but usually begins during a person's most productive years.

Rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease.

Arthritis Defined - Gout
Gout is a disease that causes the sudden onset of intense pain and swelling in the joints, which also may be warm and red. Attacks frequently occur at night and can be triggered by stressful events, alcohol or drugs, or the presence of another illness.

Before an attack, needle-like crystals of uric acid build up in connective tissue, in the joint space between two bones, or in both.

Uric acid is a substance that results from the breakdown of purines, which are part of all human tissue and are found in many foods. Early attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years.

Adult men, particularly those between the ages of 40 and 50, are more likely to develop gout than women, who rarely develop the disease before menstruation ends.

Sometime during the course of the disease, gout will affect the big toe in about 75 percent of patients. Gout frequently affects joints in the lower part of the body such as the ankles, heels, knees, or toes.

Causes and Risk Factors
Scientists do not yet fully understand what causes the various forms of arthritis. They are studying risk factors to determine why some people develop the disease and others do not.

Scientists have some understanding of the factors that cause osteoarthritis, rheumatoid arthritis, and gout. These are the three most common forms of arthritis among older adults.

Causes and Risk Factors - Osteoarthritis
Researchers suspect that osteoarthritis is caused by a combination of factors in the body and the environment. The chance of developing osteoarthritis increases with age. By age 65, half of the population has x-ray evidence of osteoarthritis in at least one joint, most often in the hips, knees, or fingers.

Osteoarthritis often results from years of wear and tear on joints. This wear and tear mostly affects the cartilage, the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when the cartilage begins to fray, wear away, and decay.

Putting too much Stress on a joint that has been previously injured, improper alignment of joints, and excess weight all may lead to the development of osteoarthritis.

Causes and Risk Factors - Rheumatoid Arthritis
Rheumatoid arthritis results from the interaction of many factors such as genes, hormones, and the environment. Research suggests that a person's Genetic makeup is an important part of the picture, but not the whole story.

Some evidence shows that infectious agents, such as viruses and Bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. However, a specific agent or agents are not yet known.

It is important to note that rheumatoid arthritis is not contagious. A person cannot catch it from someone else.

Causes and Risk Factors - Gout
Researchers have discovered some of the risk factors for gout. Up to 8 percent of people with gout have a family history of the disease. In addition to inherited traits, diet, weight, and alcohol play a role in the development of gout. The disease is more common in men.

Most people with gout have too much uric acid in their blood, a condition called hyperuricemia. The extra uric acid moves from the blood to the joints, which may trigger the inflammation seen in gout.

Symptoms and Diagnosis
Different types of arthritis have different symptoms. In general, people with most forms of arthritis have pain and stiffness in their joints. To make a diagnosis, most doctors use a combination of methods and tests including a medical history, a physical examination, x rays, and laboratory tests.

It is important for people with joint pain to give the doctor a complete medical history. Answering these questions will help your doctor make an accurate diagnosis:* Is the pain in one or more joints?

• * When does the pain occur and how long does it last?
• * When did you first notice the pain?
• * Does activity make the pain better or worse?
• * 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 medicines are you taking?
• * A medical history is the patient's description of symptoms and when and how they began. The description covers pain, stiffness, and joint function, and how these have changed over time.
• * A physical examination includes the doctor's examination of the joints, skin, reflexes, and muscle strength. The doctor observes the patient's ability to walk, bend, and carry out activities of daily living.

Symptoms and Diagnosis - Osteoarthritis
The doctor will use a combination of tests to try to find out if osteoarthritis is causing the symptoms. A patient's attitudes, daily activities, and levels of Anxiety or Depression have a lot to do with how severe the symptoms of osteoarthritis may be.

Osteoarthritis usually develops slowly and can occur in any joint, but often occurs in weight bearing joints. Early in the disease, joints may ache after physical work or Exercise. Most often, osteoarthritis occurs in the hands, hips, knees, neck, or low back.

Common signs of osteoarthritis include joint pain, swelling, and tenderness; stiffness after getting out of bed; and a crunching feeling or sound of bone rubbing on bone. Not everyone with osteoarthritis feels pain, however. In fact, only a third of people with x-ray evidence of osteoarthritis report pain or other symptoms.

X-Rays are limited in their capacity to reveal how much joint damage may have occurred in osteoarthritis. X-rays usually don't show osteoarthritis damage until there has been a significant loss of cartilage.

Symptoms and Diagnosis - Rheumatoid Arthritis
Rheumatoid arthritis is characterized by inflammation of the joint lining. This inflammation causes warmth, redness, swelling, and pain around the joints. A person also feels sick, tired, and sometimes feverish.

Rheumatoid arthritis generally occurs in a symmetrical pattern. If one knee or hand is affected, the other one is also likely to be affected.

Rheumatoid arthritis can be difficult to diagnose in its early stages for several reasons. First, there is no single test for the disease. In addition, symptoms differ from person to person and can be more severe in some people than in others.

One common test for rheumatoid arthritis is the rheumatoid factor test. However, not all people with rheumatoid arthritis test positive for rheumatoid factor, especially early in the disease. Also, some people who do test positive never develop the disease. Another test is called the citrulline antibody test.

Other common tests for rheumatoid arthritis include the erythrocyte sedimentation rate, which indicates the presence of inflammation in the body; a test for white blood cell count; and a blood test for Anemia.

Also, symptoms of rheumatoid arthritis can be similar to those of other types of arthritis and joint conditions, and it may take some time to rule out other conditions. Finally, the full range of symptoms develops over time, and only a few symptoms may be present in the early stages.

Symptoms and Diagnosis - Gout
Hyperuricemia -- high levels of uric acid in the body -- contributes to arthritis that develops in one day, producing a swollen, red, and painful joint. Gout attacks usually begin at night.

Gout typically attacks one joint at a time. Gout normally attacks joints in the lower part of the body, such as the knee, ankle or big toe. For many people the joints in the big toe are the first to be attacked. In fact, sometime during the course of the disease, gout will affect the big toe in about 75 percent of patients.

To confirm a diagnosis of gout, the doctor inserts a needle into the inflamed joint and draws a sample of synovial fluid, the substance that lubricates a joint. A laboratory technician places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If crystals are found in the joint fluid, the person usually has gout.

Treatment and Research
Although there is no cure for most forms of arthritis, various therapies can help patients manage symptoms and improve their overall quality of life. The choice of treatment depends on the type of arthritis, the severity of symptoms, the patient's general health, and other factors.
Treatment and Research - Osteoarthritis
Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans can include exercise, rest and joint care, pain relief, weight control, medicines, surgery, and non-traditional treatment approaches.

Current treatments for osteoarthritis can relieve symptoms such as pain and disability, but right now there are no treatments that can cure osteoarthritis.

Exercise is one of the best treatments for osteoarthritis. It can improve mood and outlook, decrease pain, increase flexibility, and help you maintain a healthy weight.

The amount and form of exercise will depend on which joints are involved, how stable the joints are, whether or not the joint is swollen, and whether a joint replacement has already been done. Ask your doctor or physical therapist what exercises are best for you.

For temporary relief of pain from osteoarthritis, you can use warm towels, hot packs, or a warm bath or shower. In some cases, cold packs such as a bag of ice or frozen vegetables wrapped in a towel can relieve pain or numb the sore area.

A doctor or physical therapist can recommend if heat or cold is the best treatment. For osteoarthritis in the knee, wearing insoles or cushioned shoes may reduce joint stress.

Doctors consider a number of factors when choosing medicines for their patients. In particular, they look at the type of pain the patient may be having and any possible side effects from the drugs.

For pain relief, doctors usually start with Acetaminophen because the side effects are minimal. If acetaminophen does not relieve pain, then non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be used.

In addition, COX-2 inhibitors such as celecoxib and valdecoxib may be used. These medicines reduce inflammation similarly to traditional NSAIDs, but they cause fewer gastrointestinal side effects. However, these medications occasionally are associated with harmful reactions ranging from mild to severe.

Corticosteroids, hyaluronic acid, and topical creams are also used. Most medicines used to treat osteoarthritis have side effects, so it is important for people to learn about the medicines they take. For example, people over age 65 and those with any history of ulcers or Stomach bleeding should use non-steroidal anti-inflammatory drugs, or NSAIDs, with caution.

Protecting and supporting the affected joint or joints is important. Some people use canes and splints to protect and to take pressure off the joints. Splints or braces are used to provide extra support for weakened joints.

For some people, surgery helps relieve the pain and disability of osteoarthritis. A doctor may perform surgery to smooth out, fuse, or reposition bones, or to replace joints.

The decision to have an operation depends on several factors. Both surgeon and patient should consider the patient's level of disability, intensity of pain, lifestyle, age, and occupation. Today, more than 80 percent of surgeries for osteoarthritis involve replacing the hip or knee joint.

Researchers suspect that heredity plays a role in 25 to 30 percent of osteoarthritis cases. Scientists have identified a mutation, or gene defect, affecting collagen -- an important part of cartilage -- in patients with an inherited kind of osteoarthritis that starts at an early age.

In the future, a test to determine who carries a genetic defect or defects could help people reduce their risk for osteoarthritis with lifestyle adjustments.

Tissue engineering is an exciting area of research in osteoarthritis. This approach involves removing cells from a healthy part of the body and placing them in an area of diseased or damaged tissue. In some cases, this improves joint movement.

Researchers also are studying whether exercise can treat or prevent osteoarthritis. Studies on knee osteoarthritis and exercise found that strengthening the thigh muscle, also known as the quadriceps, can relieve symptoms of knee osteoarthritis and prevent more damage.

Studies also show that people with knee osteoarthritis who exercise feel less pain and function better.

Early research suggests that Acupuncture, which is the use of fine needles inserted at specific points in the skin, may provide pain relief for some patients. Some people claim that the dietary supplements glucosamine and chondroitin sulfate can relieve the symptoms of osteoarthritis.

The NIH is currently funding the Glucosamine and Chondroitin Arthritis Intervention Trial, or GAIT, to test whether or not glucosamine and/or chondroitin have a beneficial effect for people with knee osteoarthritis. The results of the recently completed first phase of the study indicate that these supplements have a limited effectiveness for most patients with osteoarthritis. Click here to see information on the GAIT trial.

Treatment and Research - Rheumatoid Arthritis
Treatments for rheumatoid arthritis can help relieve your pain, reduce swelling, slow down or help prevent joint damage, increase your ability to function, and improve your sense of well-being.

Exercise, medication, and, in some cases, surgery are common treatments for rheumatoid arthritis.

People with rheumatoid arthritis need a good balance between rest and exercise; they should rest more when the disease is active and exercise more when it is not.

Reducing stress also is important. Doing relaxation exercises and taking part in support groups are two ways to help reduce stress. For more information on exercise classes, you may want to contact the Arthritis Foundation at 1-800-283-7800.

Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation. Still others, called disease-modifying anti-rheumatic drugs or DMARDs, can often slow the course of the disease.

DMARDs include methotrexate, leflunomide, sulfasalazine, and cyclosporine. Steroids, which are also called corticosteroids, are another type of drug used to reduce inflammation for people with rheumatoid arthritis. Cortisone, hydrocortisone, and prednisone are some commonly used steroids.

New types of drugs called biological response modifiers also can help reduce joint damage. These drugs include etanercept, infliximab, and anakinra.

Early treatment with powerful drugs and drug combinations -- including biological response modifiers and DMARDs -- instead of single drugs may help prevent the disease from progressing and greatly reduce joint damage.

In some cases, a doctor will recommend surgery to restore function or relieve pain in a damaged joint. Surgery may also improve a person's ability to perform daily activities. Joint replacement and tendon reconstruction are two types of surgery available to patients with severe joint damage.

Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although such approaches may not be harmful, scientific studies have not yet shown any benefits.

An overall nutritious diet with the right amount of calories, protein, and calcium is important. Some people need to be careful about drinking alcoholic beverages because of the medications they take for rheumatoid arthritis.

Scientists are making rapid progress in understanding the complexities of rheumatoid arthritis. They are learning more about how and why it develops and why some people have more severe symptoms than others.

New drugs called biologic response modifiers and combinations of drugs are under study. Research efforts are focused on developing drugs that can reduce inflammation and slow or stop the disease with few side effects.

Some evidence shows that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. Investigators are trying to identify the infectious agents and understand how they work. This knowledge could lead to new therapies.

Researchers are also exploring why so many more women than men develop rheumatoid arthritis. In the hope of finding clues, they are studying complex relationships between the hormonal, nervous, and immune systems in rheumatoid arthritis.

For example, they are exploring whether and how the normal changes in the levels of steroid hormones such as estrogen and Testosterone during a person's lifetime may be related to the development, improvement, or flares of the disease. Scientists are also examining why rheumatoid arthritis often improves during pregnancy.

Treatment and Research - Gout
With proper treatment, most people with gout are able to control their symptoms and live productive lives.

The goals for treatment are to ease the pain that comes from sudden attacks, prevent future attacks, stop uric acid buildup in the tissues and joint space between two bones, and prevent kidney stones from forming.

The most common treatments for an attack of gout are high doses of non-steroidal anti-inflammatory drugs, or NSAIDs, which are taken by mouth, or corticosteroids, which are taken by mouth or injected into the affected joint. Patients often begin to improve within a few hours of treatment. The attack usually goes away completely within a week or so.

Since NSAIDs are now available over the counter, it is important to check with your doctor concerning the safety of using these drugs and to verify the proper dosage.

When NSAIDs or corticosteroids fail to control pain and swelling, the doctor may use another drug, colchicine. This drug is most effective when taken within the first 12 hours of an acute attack.

Scientists are studying which NSAIDs are the best ones to treat gout. They are analyzing new compounds to develop safe, effective medicines. Current research is also focusing on the structure of certain enzymes to gain a better understanding of defects that can cause gout.

Scientists are studying the effect of crystal deposits on cartilage cells for clues to treatment. They are also looking at the role of calcium deposits and how they contribute to the development of gout in the hope of finding new treatments.

In addition, researchers are investigating how genetics and the environment may influence the level of uric acid in the blood.

Frequently Asked Questions

1. What is arthritis?
Arthritis literally means joint inflammation, but it is often used to identify a group of more than 100 rheumatic diseases that may cause pain, stiffness, and swelling in the joints and in areas close to the joints. Joints are places in the body where two bones meet.

Arthritis is often a chronic disease, which means that it can affect you over a long period of time. Many forms of arthritis cause swelling, redness, heat, and pain.

2. How many people have arthritis?
More than 40 million people in the United States have some form of arthritis, and many have chronic pain that limits daily activity. Osteoarthritis is by far the most common form of arthritis, affecting more than 20 million people.

Rheumatoid arthritis is the most disabling form of arthritis. More than 2 million people have this disease. Gout occurs in approximately 840 out of every 100,000 people. It is rare in children and young adults.

3. What is osteoarthritis?
Osteoarthritis is the most common form of arthritis among older people. It affects hands, low back, neck, and weight-bearing joints such as knees, hips, and feet.

Osteoarthritis occurs when cartilage, the tissue that cushions the ends of the bones within the joints, breaks down and wears away. This causes bones to rub together, causing pain, swelling, and loss of motion of the joint.

4. How common is osteoarthritis in older adults?
The chance of developing osteoarthritis increases with age. By age 65, half of the population has x-ray evidence of osteoarthritis in at least one joint, most often in the hips, knees, or fingers.

5. Does having osteoarthritis impact activities of daily living?
Yes. Osteoarthritis is one of the most frequent causes of physical disability among older adults. Many people with osteoarthritis find their movements or activities limited to some degree because of stiffness, limited range of motion, and pain.

6. What causes osteoarthritis?
Osteoarthritis often results from years of wear and tear on joints. This wear and tear mostly affects the cartilage, the tissue that cushions the ends of bones within the joint. Osteoarthritis occurs when the cartilage begins to fray, wear away, and decay.

Putting too much stress on a joint that has been repeatedly injured may lead to the development of osteoarthritis, too. A person who is overweight is more likely to develop osteoarthritis because of too much stress on the joints. Also, improper joint alignment may lead to the development of osteoarthritis.

7. How can I reduce my chances of developing osteoarthritis?
Maintaining a healthy weight, avoiding injury, and engaging in moderate daily physical activity are all ways to decrease your chances of developing osteoarthritis.

8. What are some common symptoms of osteoarthritis?
Common symptoms of osteoarthritis include joint pain, swelling, or tenderness; stiffness after getting out of bed; and a crunching feeling or sound of bone rubbing on bone. Not everyone with osteoarthritis develops symptoms. In fact, only a third of people with x-ray evidence of osteoarthritis report pain or other symptoms.

9. How is osteoarthritis diagnosed?
No single test can diagnose osteoarthritis. When a person feels pain in his or her joints, it may or may not be osteoarthritis.

The doctor will use a combination of tests to try to determine if osteoarthritis is causing the symptoms. These may include a medical history, a physical examination, x-rays, and laboratory tests. A patient's attitudes, daily activities, and levels of anxiety or depression have a lot to do with how much the symptoms of osteoarthritis affect day-to-day living.

10. Is there a cure for osteoarthritis?
There is no cure for osteoarthritis and no way to reverse the joint damage once it occurs. However, current treatments can relieve symptoms.

Exercise is one of the best treatments. Exercise can improve mood and outlook, decrease pain, and assist in maintaining a healthy weight.

Warm towels, hot packs, or a warm bath or shower can provide temporary pain relief. Medications such as non-steroidal anti-inflammatory drugs, or NSAIDs, help reduce pain and inflammation that result from osteoarthritis.

11. Can glucosamine and chondroitin sulfate relieve symptoms of osteoarthritis?
For some people, glucosamine and chondroitin sulfate may help relieve the symptoms of osteoarthritis. Scientific studies have shown that these supplements may have some benefit for people with osteoarthritis. However, the effectiveness of these supplements is still under investigation.

The NIH is currently funding the Glucosamine and Chondroitin Arthritis Intervention Trial, or GAIT, to test whether or not glucosamine and/or chondroitin have a beneficial effect for people with knee osteoarthritis. The results of the recently completed first phase of the study indicate that these supplements have a limited effectiveness for most patients with osteoarthritis.

12. What is rheumatoid arthritis?
Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It can cause mild to severe symptoms.

People with rheumatoid arthritis may feel sick, tired, and sometimes feverish. Sometimes rheumatoid arthritis attacks tissue in the skin, lungs, eyes, and blood vessels.

The disease generally occurs in a symmetrical pattern. If one knee or hand is involved, usually the other one is, too. It can occur at any age, but often begins between ages 40 and 60. About two to three times as many women as men have rheumatoid arthritis.

13. What causes rheumatoid arthritis?
Scientists believe that rheumatoid arthritis results from the interaction of many factors such as genetics, hormones, and the environment. Although rheumatoid arthritis sometimes runs in families, the actual cause of rheumatoid arthritis is still unknown.

Research suggests that a person's genetic makeup is an important part of the picture, but not the whole story. Some evidence shows that infectious agents, such as viruses and bacteria, may trigger rheumatoid arthritis in people with an inherited tendency to develop the disease. The exact agent or agents, however, are not yet known.

It is important to note that rheumatoid arthritis is not contagious. A person cannot catch it from someone else.

14. What are some common symptoms of rheumatoid arthritis?
Rheumatoid arthritis is characterized by inflammation of the joint lining. This inflammation causes warmth, redness, swelling, and pain around the joints.

The pain of rheumatoid arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint.

15. How is rheumatoid arthritis diagnosed?
Rheumatoid arthritis can be difficult to diagnose in its early stages because the full range of symptoms develops over time, and only a few symptoms may be present in the early stages.

As part of the diagnosis, your doctor will look for symptoms such as swelling, warmth, pain, and limitations in joint motion throughout your body. Your doctor may ask you questions about the intensity of your pain symptoms, how often they occur, and what makes the pain better or worse.

There is no single, definitive test for rheumatoid arthritis. One common test is for rheumatoid factor, an antibody that is eventually present in the blood of most rheumatoid arthritis patients. An antibody is a special protein made by the immune system that normally helps fight foreign substances in the body. Not all people with rheumatoid arthritis test positive for rheumatoid factor, however, especially early in the disease.

Another test is the citrulline antibody test. Other common tests include one called the erythrocyte sedimentation rate that indicates the presence of inflammation in the body, a white blood cell count, and a blood test for anemia.

X-rays are often used to determine the degree of joint destruction. They are not useful in the early stages of rheumatoid arthritis before bone damage is evident, but they can be used later to monitor the progression of the disease.

16. How is rheumatoid arthritis treated?
Medication, exercise, and, in some cases, surgery are common treatments for this disease. Most people who have rheumatoid arthritis take medications. Some drugs only provide relief for pain; others reduce inflammation.

People with rheumatoid arthritis can also benefit from exercise, but they need to maintain a good balance between rest and exercise. They should get rest when the disease is active and get more exercise when it is not.

In some cases, a doctor will recommend surgery to restore function or relieve pain in a damaged joint. Several types of surgery are available to patients with severe joint damage. Joint replacement and tendon reconstruction are examples.

17. What are some non-drug therapies that can help people with rheumatoid arthritis?
Both rest and exercise can help people with rheumatoid arthritis. Rest helps reduce active joint inflammation and pain and fights tiredness. Exercise can help people sleep well, reduce pain, and maintain a positive attitude. An overall nutritious diet with the right amount of calories, protein, and calcium is important.

Some people find that using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Assistive devices may help reduce stress and lessen pain in the joints. Examples include zipper pullers and AIDS to help with moving in and out of chairs and beds.

18. What kind of surgery is available for people with rheumatoid arthritis or osteoarthritis?
Several types of surgery, including joint replacement and tendon reconstruction, are available to people with rheumatoid arthritis and osteoarthritis. A doctor may perform surgery to smooth out, fuse, or reposition bones, or to replace joints.

The purpose of these procedures is to reduce pain, improve joint function, and improve a person's ability to perform activities of daily living. For people with arthritis, surgery is one way to help relieve pain and disability.

If you are considering surgery for osteoarthritis or rheumatoid arthritis, there are important factors to discuss with your doctor beforehand. These include your age and occupation, the extent of your disability and pain, and how much the disease interferes with your everyday life.

Today, most surgery for osteoarthritis involves replacing the hip or knee joint. Surgeons may replace affected joints with artificial ones called prostheses.

19. What is gout?
Gout is one of the most painful rheumatic diseases. It occurs when needle-like crystals of uric acid build up in connective tissue, in the joint space between two bones, or in both.

Adult men, particularly those between the ages of 40 and 50, are more likely than women to develop gout. Women rarely develop the disease while still menstruating.

Sometime during the course of the disease, gout will affect the big toe in about 75 percent of patients. Gout frequently affects joints in the lower part of the body such as knee, ankles, or toes.

20. What causes gout?
Researchers have discovered several key risk factors for developing gout. In addition to inherited traits, diet, weight, and alcohol play a role in the development of gout. Up to 8 percent of people with gout have a family history of the disease.

Most people with gout have too much uric acid in their blood, a condition called hyperuricemia. Uric acid is a substance that results from the breakdown of purines, which are part of all human tissue and are found in many foods. Hyperuricemia occurs when high levels of uric acid build up in the bloodstream.

21. What are some common symptoms of gout?
Gout frequently first attacks the joints in the big toe. The affected joint may become swollen, red, or warm. Attacks usually occur at night.

22. How is gout diagnosed?
To confirm a diagnosis of gout, the doctor inserts a needle into the inflamed joint and draws a sample of synovial fluid, the substance that lubricates a joint. A laboratory technician places some of the fluid on a slide and looks for uric acid crystals under a microscope. If uric acid crystals are found in the fluid surrounding the joint, the person usually has gout.

23. What are the most common treatments for an acute attack of gout?
Physicians often prescribe high doses of non-steroidal anti-inflammatory drugs, or NSAIDs, or steroids for a sudden attack of gout. NSAIDs are taken by mouth and corticosteroids are either taken by mouth or injected into the affected joint. Patients often begin to improve within a few hours of treatment, and the attack usually goes away completely within a week or so.