Joint Inflammation

WHEN TO SEE YOUR DOCTOR

* Your joint is hot, red, swollen and extremely painful, and you don't know the cause.

* The inflammation doesn't respond to over-the-counter pain relievers like aspirin or ibuprofen.

What Your Symptom Is Telling You

One of your joints feels like it has a little electric heater in it and someone left the setting on high. It's hot, it's red and it burns.

Obviously, there's no heater?but there probably is arthritis, the most likely cause of joint inflammation. The most common type of arthritis is osteoarthritis, which produces tiny growths called spurs on the bony part of the joint. Those spurs dig into surrounding muscles, tendons and ligaments, causing irritation and inflammation.

Gout is another form of arthritis, and its searing attacks of pinpoint inflammation?frequently confined to the big toe?can last up to a week. The inflammation comes from crystals of uric acid that lodge in the joint like slivers of glass. You get gout because your body can't metabolize a protein called purine, and the excess forms uric acid. In some cases gout is inherited; in others, it's a side effect of medication.

A third (and much less common) type of arthritis that causes inflamed joints is rheumatoid arthritis. This is actually what scientists call an autoimmune disease, in which the immune system treats the body like an infection and attacks it. In this case, the body part that is attacked is the joints. Lupus is another autoimmune disease that can cause joint inflammation.

But a real infection can also inflame the joints. For example, Lyme disease?a bacterial infection spread by the bite of the deer tick?can inflame one or many joints. (It frequently picks the knee.)

Two less likely causes of joint inflammation are a kind of rheumatism called polymyalgia rheumatica and a form of arthritis called ankylosing spondylitis.

And, of course, if someone kicks you in the knee (or you injure any joint) it's going to get inflamed. (Even an old injury can act up, causing inflammation.)

Symptom Relief

Half the battle in healing an inflamed joint is detecting the cause. Inflammations caused by an injury are usually obvious?you fell on your elbow or banged your knee and it flared up.

Beyond that, diagnosis is murky and medical, and you should see your doctor so he can figure out what's wrong. He may use a needle to draw a fluid sample out of the inflamed joint. The fluid might contain bleeding from a recent injury, bacteria from an infection, uric acid crystals or serum, a substance that shows the inflammation is from an old injury that's acting up.

Help for Arthritis Inflammation

Arthritis is a serious medical problem, and you should work with your doctor to create a total program of coping strategies and pain control. Here are a few helpful suggestions.

Put your joints under wrap. A wrap or splint using an elastic bandage will help keep a painfully inflamed joint stable, says Robin Dore, M.D., a rheumatologist in private practice in Anaheim, California. Get your doctor to show you how to put on the wrap or splint, and ask him how long you should use it without removing it.

Let those dishes sit. "If you have rheumatoid arthritis, save your dinner dishes for the next morning," suggests Bill Arnold, M.D., a rheumatologist and chairman of the Department of Medicine at Lutheran General Hospital in Park Ridge, Illinois. "Many people with painful hands love to do dishes in the morning, because the warm water feels so good." (For more tips on dealing with stiff, painful, inflamed finger joints, see Finger Deformity on page 184.)

Be precise with your prescription. Rheumatoid arthritis generally responds well to a combination of methotrexate (a powerful drug that helps slow the destruction of the joint) and nonsteroidal anti-inflammatory (NSAID) medicines, says Robert Thoburn, M.D., clinical associate professor of rheumatology at the University of Florida in Gainesville. "NSAIDs have a high potential for stomach ulceration, however, so be sure to follow your prescription exactly." If you're disabled by the pain, your doctor may prescribe a steroid medication, which brings quick relief until the methotrexate begins to work.

Banishing Gout Pain

There are several things you can do to ease the painful inflammation of an acute attack of gout.

Wait out a bout. Elevate the affected joint and rest it as much as possible, says Edward Lally, M.D., chief of rheumatology at Brown University and Roger Williams General Hospital in Providence, Rhode Island. Attacks of gout usually last no longer than four to seven days.

Wash out the acid. "Drink lots of water to wash the uric acid out of your system and help prevent uric acid kidney stones," says Dr. Dore.

Use medicines short-term. The pharmaceutical weapons of choice for battling gout are anti-inflammatory drugs, says Dr. Lally. They're usually prescribed for short-term use?the length of a typical attack. To treat the pain as well as the inflammation, doctors sometimes prescribe Indocin, Naprosyn or Voltaren. The most often used medication is colchicine, which is usually very effective. If the attack is particularly severe, your doctor may prescribe injections or tablets of steroid anti-inflammatories, such as cortisone.

Review your other medications. Medications that you're taking for other problems can spark an attack of gout, says Dr. Lally. Some diuretics, for example, can cause your body to retain uric acid. Ask your doctor to check your prescriptions and over-the-counter drugs to see if they need to be changed.

Avoid purines. In many cases, gout can be controlled by medications. However, it may be helpful for those with high uric acid levels to avoid purine-rich foods, such as organ meats, gravies and some seafoods like anchovies, sardines and herring. These are only some of the culprits that can trigger an attack. For further purine protection, ask your doctor about a medicine called allopurinol, which lowers uric acid levels.

Treating Other Types of Inflammation

Lyme disease is cured with intravenous antibiotic therapy, says Leonard Sigal, M.D., chief of rheumatology at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School in New Brunswick. You can receive the three to four-week treatment at home.

Polymyalgia is curable with steroid medicines. You may have to take them for three to five years, but they do the job, says Herbert Kaplan, M.D., a rheumatologist at the Denver Arthritis Clinic.

The more serious joint-inflaming conditions, such as rheumatoid arthritis, ankylosing spondylitis and lupus, require ongoing medical treatment. Your doctor will prescribe specific medications and appropriate exercises, says Dr. Dore.

See also Joint Pain; Joint Stiffness; Joint Swelling