Diagnosis

During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also want to see how well you can move your joints.

Depending on the type of arthritis suspected, your doctor may suggest some of the following tests.

Laboratory tests

The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid.

Imaging

These types of tests can detect problems within your joint that may be causing your symptoms. Examples include:

• X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays y not reveal early arthritic damage, but they are often used to track progression of the disease.

• Computerized tomography (CT): CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues.

• Magnetic resonance imaging (MRI): Combining radio waves with a strong magnetic field, MRI can produce more-detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments.

• Ultrasound: This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid-containing structures near the joints (bursae). Ultrasound is also used to guide needle placement for joint aspirations and injections.

Medications

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

• Painkillers: These medications help reduce pain, but have no effect on inflammation. An over-the- counter option includes acetaminophen (Tylenol, others). For more-severe pain, opioids might be prescribed, such as tramadol (Ultram, ConZip), oxycodone (OxyContin, Roxicodone, others) or hydrocodone (Hysingla, Zohydro ER). Opioids act on the central nervous system to relieve pain. When opioids are used for a long time, they may become habit-forming, causing mental or physical dependence.

• Nonsteroidal anti- inflammatory drugs (NSAIDs): NSAIDs reduce both pain and inflammation. Over- the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach irritation and may increase your risk of heart attack or stroke. Some NSAIDs are also available as creams or gels, which can be rubbed on joints.

• Counterirritants: Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.

• Disease-modifying anti- rheumatic drugs (DMARDs): Often used to treat rheumatoid arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall, Rasuvo, others) and hydroxychloroquine (Plaquenil).

To be continued in the next issue

Dr. Pargat Singh Bhurji
MD,FRCP ( C ) Consultant Pediatrician Surrery BC