Inflammatory arthritis is an umbrella term. You may have early inflammatory arthritis if your new joint pain is associated with joint swelling and early morning stiffness for more than 30 minutes.
Your GP will carry out a number of tests and you may be referred for a rheumatology assessment. Established inflammatory arthritis is subdivided into several diseases and needs to be differentiated from osteoarthritis and persistent pain.
Osteoarthritis (OA) is a condition where surfaces within joints become damaged so the joint doesn’t move as smoothly as it should. This can cause joint pain and stiffness and over the longer term cause joint damage. Older terms for OA are degenerative joint disease or ‘wear and tear arthritis’. OA can affect any joint but commonly the knees, hips, hands, back, neck and feet.
When a joint develops osteoarthritis, some of the cartilage covering the ends of the bones gradually roughens and becomes thin, and the bone underneath thickens. In severe osteoarthritis, the cartilage can become so thin that bones rub against each other and start to wear away. The loss of cartilage and the wearing of bone can change the shape of the joint, and results in joint damage.
The symptoms of OA are joint pain which is worse with activity and weight bearing and at the end of the day. Joints may grind or creak and may appear swollen due to bone thickening or thickening of the joint lining and extra fluid. Muscles may weaken or appear wasted and mobility or movements associated with affected joints may be impaired. There is no cure for OA and the most important self care measures include remaining active and maintaining a healthy weight. Painkillers may be helpful to maximise activity but some patients will go on to need joint replacement surgery.
Joint hypermobility (JH) is common and often referred to as being ‘double jointed’. People with JH have very flexible joints and most have no symptoms or problems.
Some patients do have other symptoms associated with their JH such as muscle and joint pains and some level of fatigue. Easy bruising and clicking of joints are common symptoms that should not cause concern. JH is a spectrum with many people having no symptoms but a few having several problems and the new terminology of ‘hypermobility spectrum disorder (HSD) has replaced older terms such as EDS type 3 or joint hyper-mobility syndrome.
The associated symptoms of HSD may include abdominal pain with or without some levels of bladder and bowel dysfunction and even more rarely, postural orthostatic tachycardia syndrome (POTS), hernia, uterine or rectal prolapse and joint subluxation and dislocation.
There is often confusion regarding terminology in hypermobility as JH can be one of many features in some extremely rare, complex disorders such as Ehlers Danlos syndrome and Marfans. It is important to recognise that most people with hypermobile joints do not have these rare, serious diseases.
Many people need only reassurance to carry on normal activities when JH is present but where treatment is needed to help with joint pain, physiotherapy, occupational therapy and non-medical pain management are beneficial. The aims of treatment for JH and HSD are to improve current symptoms, as well as avoiding de-conditioning, muscle weakness and persistent pain. Associated non-joint symptoms may need referral to relevant medical specialities.