"Do I Have Arthritis?"

Gary S. Meredith, MD, FACP, FACR

Do I have arthritis? This is the single most common question posed to a rheumatologist at a patient’s initial office visit. Usually they have been referred from their primary care physician for joint pain with abnormal laboratory studies suggesting an autoimmune condition. Autoimmune literally means an immune response against one’s own tissues. Arthritis is one of the most common manifestations of many autoimmune diseases and usually will need to be evaluated by a rheumatologist.

At the initial visit or consultation, the doctor will take a complete history, conduct a physical exam and then order appropriate additional studies if indicated to determine the type of arthritis you may have. These may include laboratory tests, x-rays, or additional tests such as an MRI or CT scan. The two major types of arthritis include osteoarthritis and inflammatory arthritis. Although the term arthritis means “joint inflammation”, osteoarthritis usually has only a minimal amount of inflammation. For that reason, we often use the term degenerative joint disease. This is a typical wear and tear form of arthritis.

The signs of inflammation include: pain, heat, redness, swelling and loss of function.

It is important to differentiate between inflammatory arthritis and osteoarthritis, as this will be critical in defining the best treatment plan.

Osteoarthritis (OA):  

  • The most common form of arthritis
  • Characterized by progressive loss of cartilage
  • Most common in weight bearing joints (hips, knees, spine)
  • Risk factors – age, prior trauma such as fracture, obesity, genetics, excessive wear and tear such as seen in professional athletes
  • Evaluation generally reveals normal blood tests with abnormal x-rays.
  • Treatment includes analgesics/anti-inflammatory agents, exercise, weight reduction, joint injections, physiotherapy and surgery

Inflammatory Arthritis:   

  • Most common types are rheumatoid arthritis (RA), crystal arthritis (gout and pseudogout), psoriatic arthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, and arthritis associated with other diseases such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
  • More commonly associated with significant morning stiffness and swelling and can result in more significant deformity and disability
  • Laboratory studies often abnormal
  • Treatment includes those noted above for OA but may include medications aimed at modulating the immune system to prevent ongoing damage

There are over 100 different kinds of arthritis and knowing the type that you have is critical to proposing the proper treatment plan. Therefore, it may be more important to ask, “Doc, what type of arthritis do I have?” so that a plan can be developed to allow the least pain and the best function for the future.

 

 

Gary S. Meredith, MD, FACP, FACR completed graduate studies in Biochemistry at The University of Michigan and received his Medical Degree at New York University School of Medicine, graduating from the Honors Program for Research in Medicine. He trained as an Intern, Resident, and was Chief Fellow at NYU-Bellevue and has remained on the faculty at NYU where he is Clinical Assistant Professor of Medicine. Dr. Meredith has recently received a teaching appointment at Hofstra Medical School. He has been the Chief of Rheumatology at Franklin Hospital Medical Center since 1990 and has been an attending physician at Mercy Medical Center and South Nassau Communities Hospital.

Dr. Meredith is board certified in Internal Medicine and Rheumatology and is a Fellow of The American College of Physicians and The American College of Rheumatology. He is active in the Long Island Bone and Rheumatology Association and The New York State Rheumatology Society. Dr. Meredith has been listed in Top Doctors: New York Metro Area in all 14 editions.