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There are four subtypes of arthritis, a disease characterized by inflammation of joints. This article outlines the four main types of arthritis subtypes — degenerative, inflammatory, infectious and metabolic arthritis.

Arthritis, which refers to joint inflammation, is a painful and disabling condition that leads to joint stiffness and pain — or rather, actually, a collection of diseases, as there are more than 100 different types of arthritis and closely related conditions.

Arthritis develops in people of all ages, genders and ethnicities. There are four main types of arthritis — degenerative arthritis, inflammatory arthritis, infectious arthritis and metabolic arthritis.

Degenerative arthritis

Degenerative arthritis is also commonly known as osteoarthritis, degenerative joint disease, and wear-and-tear arthritis. This type of arthritis develops when the joint cartilage (the cushioning surface at the ends of bones) and the underlying bone start to deteriorate (wear away), which leads to pain, stiffness and joint malformation.

Degenerative arthritis can occur in any joint, though it typically manifests in the weight-bearing joints including the hips, knees, and spine, as well hands, feet, shoulder and neck. A diagnosis of degenerative arthritis is based on symptoms of the disease and imaging tests.

The risk factors for the development of degenerative arthritis include obesity, a family history, age and a previous injury (such as an anterior cruciate ligament, ACL, tear). Osteoarthritis can be avoided by being physically active, having a healthy weight, and preventing injury and repetitive movements.

Treatment of the disease depends on how severe the symptoms are and can include:

  • Heat or ice application
  • Making sure to have a rest from activity
  • Regular physical activity
  • Having a healthy weight 
  • Strengthening the muscles around the joint
  • The use of assistive devices 
  • Over-the-counter pain killers or anti-inflammatory medicines
  • Not doing excessive repetitive movements
  • In severe cases, surgery can be used for joint replacement

Inflammatory arthritis

Generally, the immune system is there to protect you. However, when the immune system becomes deregulated, it can attack healthy joints, leading to uncontrolled inflammation, joint erosion and damage to internal organs, eyes and other parts of the body. This is known as autoimmunity, and inflammatory arthritis is an autoimmune disease.

There are several types of inflammatory arthritis, which include diseases that have multi-system organ involvement (including rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, and scleroderma), as well as disease that is just limited to the joints, ligaments and tendons (known as spondyloarthritis).

Studies have shown that a combination of genetics and environmental factors can lead to the development autoimmunity. For example, smoking has been shown to trigger rheumatoid arthritis in people with certain genes.

In the case of inflammatory arthritis, it is vital to diagnose and aggressively treat the disease early on before too much damage has set in. Therapies for autoimmune and inflammatory arthritis include treatment with disease-modifying antirheumatic drugs (DMARDs).

Infectious arthritis

Oftentimes, inflammation can be triggered when a foreign pathogen, such as bacteria, a virus or fungus, enters the body and spreads to the joint or the synovial fluid (the fluid that surrounds the joint). Generally, the infection starts in a different part of the body and spreads through the bloodstream and into the joint tissue. This type of arthritis is known as infectious arthritis (also referred to as septic arthritis).

The organisms that enter the body often do so through surgery, open wounds or injections. The types of organisms that can trigger inflammation and affects joints include salmonella and shigella (which can result due to food poisoning or contamination), chlamydia and gonorrhea (which are transmitted sexually), and hepatitis C (which is a blood-to-blood infection through shared needles or transfusions).

Generally, infectious arthritis only affects one joint, such as the knee, hip or shoulder. It also occurs most commonly in children, older patients or people who use illegal drugs.

In the case of infectious arthritis, treatment with antibiotics can help clear the joint infection, but sometimes the arthritis becomes chronic or long-term.

Metabolic arthritis

Metabolic arthritis (also known as gout) is a type of arthritis that develops in patients who have high levels of uric acid in their blood. Uric acid is a substance that is formed as the body breaks down purines, which is a product found in cells and food. Furthermore, some people just naturally have high levels of uric acid because they produce more uric acid than their body needs or they have an inability to get rid of their uric acid quickly enough. Therefore, gout is actually not an autoimmune inflammatory disease but is related to how how our body metabolizes (or process) substances.

In some patients, uric acid tends to build up and form needle-like crystals in joints, causing sudden spikes of extreme joint pain, tenderness, redness warmth and swelling. This type of pain may go on for hours or weeks, and makes it very difficult to perform everyday tasks.

Gout can be episodic, so it come and go. However, if uric acid levels aren’t reduced, then gout can become chronic, causing constant pain and disability.

Lifestyle factors can affect the prevalence of gout. For example, eating a diet that is rich in certain high-purine foods (which include red meats or shellfish), being overweight or obese and high levels of alcohol intake can lead to the development of gout.

  • Jacobson, Jon A., et al. "Radiographic evaluation of arthritis: degenerative joint disease and variations." Radiology 248.3 (2008): 737-747.
  • McGonagle, Dennis, Wayne Gibbon, and Paul Emery. "Classification of inflammatory arthritis by enthesitis." The Lancet 352.9134 (1998): 1137-1140.
  • Smith, James W., and Elizabeth A. Piercy. "Infectious arthritis." Clinical infectious diseases (1995): 225-230.
  • Falasca, Gerald F. "Metabolic diseases: gout." Clinics in dermatology 24.6 (2006): 498-508.
  • Photo courtesy of SteadyHealth.

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