Which type of arthritis do I have?

A persistent pain in or around a joint , or swelling of a joint might make you worry that you have arthritis.

First, make sure you see your doctor and discuss your concerns. The likelihood of which arthritis you might have depends to a degree on your age.

Which type of arthritis do I have?

There are many types of arthritis. Arthritis means ‘inflammation’ or ‘disease’ of joints. I will describe the commonest types of arthritis here (‘commonest’ if you live in most places in the world where infective/septic arthritis is not common; for example, TB arthritis is common in TB endemic areas). The likelihood of which type of arthritis starts up when, depends somewhat on age. For young and middle aged adults, the 3 main arthritis types are:

1. Psoriatic arthritis

2. Spondyloarthritis

3. Rheumatoid arthritis

For older adults, the 3 most common types of arthritis are:

1. Osteoarthritis

2. Calcium pyrophosphate and other calcium crystal induced arthritis

3. Gout

It is possible, as an older adult, to get one of the first three types of arthritis, and some people in their 40s can get gout or osteoarthritis - but in the lists above we are considering what is most usual. Children and adolescents get arthritis too. The appearance, nature and course of arthritis in children and adolescents is very much different to adults and is called Juvenile Idiopathic Arthritis (JIA). Arthritis is not just due to ageing! It is a disturbance in the body’s immune system that can strike at any age.

Psoriatic arthritis. This type of arthritis is highly variable in how it occurs, not always present at the same time as the skin rash psoriasis, and it can come and go on its own. Psoriatic arthritis often starts in someone’s 20s or 30s. It can affect one joint or many; it can cause backpains, it can cause tendonitis, and pains at the insertion of tendons and ligaments (called enthesitis; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976708/ ). Psoriatic arthritis is often missed or overlooked by doctors and healthcare workers; indeed many people in whom I make the diagnosis have an unfortunate story of recurrent pains happening for some years without a proper diagnosis being made.

Spondyloarthritis. This type of arthritis starts typically between the ages of 16-40y old, often by causing backpains at night, first thing in the morning or after periods of sitting still for a while. This is due to inflammation in the spinal or pelvis structures (‘hips’). Pains, including enthesitis (see above) can come and go (heel, hips, elbows etc). This condition, like psoriatic arthritis, can be missed and its well known that the final diagnosis can be made many years after the first symptoms. The organisation NASS has a campaign to make doctors and health care workers more aware of the condition https://nass.co.uk/

Rheumatoid Arthritis. This arthritis typically starts by causing pain and stiffness in the small joints of the hands, wrists and toe joints. Symptoms are generally worst first thing in the morning. This arthritis can be particularly destructive to the joints so its very important that people with such symptoms are referred immediately to a Rheumatologist for special treatments like methotrexate, which limits the damage to the joints (see: https://drgavinclunie.co.uk/conditions)

Osteoarthritis is when the cartilage (which lines tthe bone at a joint surface) cracks and degenerates which then weakens the joint and the moving part of the joint then begins to wear away. This causes pain particularly when the joint is moved. Often osteoarthritis occurs after cartilage is damaged through acute trauma or repetitive trauma (over some years). Such repetitive trauma can be as simple as being overweight for some years - continually overloading the knee joint cartilage. A generalised form of Osteoarthritis, termed GOA, can evolve typically in the small hand joints any time after the age of 40 years. This type of arthritis needs to be discriminated from rheumatoid arthritis, psoriatic arthritis and Calcium Pyrophosphate Crystal induced arthritis - see below. Essentially only a Rheumatologist is skilled or experienced enough to tell the difference.

Calcium Pyrophosphate arthritis is very common in older adults (>70y old) and is caused by calcium crystals getting into joints and tendon insertions then causing pain and inflammation. Sometimes there is an underlying metabolic reason why the crystals form (like kidneys not working well in excreting calcium and phosphate or the condition primary hyperparathyroidism causing calcium to accumulate in the body’s tissues). Crystals can get into the spine, upper part of the neck and some other places also. One form of the condition is called ‘pseudogout’ because it can mimic gout. Check out the article: https://static1.squarespace.com/static/5c14e46b85ede1ceeca358ae/t/5c1f5229575d1f59f76ff1e2/1545556527246/CPPDpaper.pdf

Gout occurs when the body has accumulated too much uric acid and it then crystallises (in and around joints) then causes inflammation. The onset of gout is usually abrupt with bad acute pain and swelling - often affecting a single toe, ankle or wrist. Gout is more common in people who are either obese, who drink a lot of alcohol or who have kidney problems or are on medications to treat kidney and blood pressure disease.

Its important to know that all these types of arthritis can be treated! However, before treatment is decided, the type of arthritis needs diagnosing. Blood tests, X-Rays and sometimes scans are used to help a Rheumatologist make the diagnosis.