Arthritis affects more than 58.5 million adults in the United States, with prevalence increasing dramatically with age. According to the Centers for Disease Control and Prevention, nearly half of all adults aged 65 and older have doctor-diagnosed arthritis. This common condition causes joint pain, stiffness, and reduced mobility that can significantly impact quality of life, independence, and ability to perform daily activities. However, comprehensive arthritis management combining medications, physical therapy, lifestyle modifications, and sometimes procedures can effectively control pain, maintain function, and enable seniors to remain active.

Understanding Arthritis: Joint Inflammation and Damage

Arthritis isn't a single disease but rather an umbrella term for more than 100 conditions affecting joints and surrounding tissues. All forms of arthritis involve joint inflammation, pain, and in many cases, progressive damage to joint structures. Joints are places where two bones meet, with cartilage covering bone ends to provide smooth, cushioned movement, synovial membrane lining the joint capsule producing lubricating fluid, and ligaments connecting bones and providing stability.

In arthritis, inflammation damages these joint structures. Over time, cartilage can break down, bones may change shape, the synovial membrane can become inflamed, and ligaments can weaken. This damage causes the pain, stiffness, swelling, and limited motion characteristic of arthritis. Different types of arthritis damage joints through different mechanisms and at different rates.

Arthritis commonly affects hands, wrists, knees, hips, shoulders, spine, and feet, though it can occur in any joint. As arthritis progresses, daily activities like walking, climbing stairs, opening jars, writing, and dressing can become challenging and painful. Understanding your specific type of arthritis is crucial because treatment approaches differ based on the underlying disease process.

Osteoarthritis: The Most Common Form

Osteoarthritis (OA), also called degenerative joint disease or "wear and tear" arthritis, is by far the most common form of arthritis, affecting more than 32.5 million U.S. adults. OA develops when cartilage—the smooth, cushioning tissue covering bone ends in joints—gradually breaks down over time. As cartilage deteriorates, bones begin to rub against each other, causing pain, stiffness, and swelling.

OA most frequently affects weight-bearing joints including knees, hips, and spine, as well as hands, particularly the base of the thumb and finger joints. Risk factors for OA include increasing age (risk rises dramatically after age 50), previous joint injury or surgery, repetitive stress on joints from occupation or sports, obesity (excess weight increases stress on weight-bearing joints, and fat tissue produces inflammatory proteins that can damage joints), genetics (family history increases risk), and gender (women over 50 are more likely than men to develop OA).

OA symptoms develop gradually and worsen over time. Joint pain during or after movement is the hallmark symptom. Stiffness is most noticeable upon waking or after periods of inactivity but typically improves with movement within 30 minutes. Loss of flexibility makes full range of motion difficult. Grating sensation (crepitus) or hearing popping or crackling sounds during joint movement is common. Bone spurs—extra bits of bone that feel like hard lumps—may form around affected joints. Swelling may occur due to soft tissue inflammation around the joint.

OA diagnosis is based on symptoms, physical examination, and imaging studies. X-rays reveal cartilage loss (shown by narrowing of space between bones), bone spurs, and bone changes. MRI provides detailed images of bone and soft tissues including cartilage damage not visible on X-rays. Blood tests help rule out other types of arthritis. Joint fluid analysis can identify infection or gout crystals.

Rheumatoid Arthritis: Autoimmune Joint Disease

Rheumatoid arthritis (RA) is an autoimmune disease where the immune system mistakenly attacks the synovial membrane lining joints, causing chronic inflammation. Unlike OA's mechanical breakdown, RA involves systemic immune dysfunction that can affect joints throughout the body simultaneously, typically in a symmetrical pattern (both hands, both knees).

RA affects approximately 1.5 million Americans, with onset typically occurring between ages 30 and 60, though it can develop at any age. Women are two to three times more likely than men to develop RA. The disease causes the synovial membrane to become inflamed and thickened, producing excess synovial fluid. This chronic inflammation damages cartilage and bone over time. Unlike OA, RA can also affect organs including the skin, eyes, lungs, heart, and blood vessels.

RA symptoms often begin gradually with minor symptoms that come and go, affecting both sides of the body. Joint pain, tenderness, swelling, and warmth characterize active RA. Morning stiffness lasting more than 30 minutes (sometimes for hours) is a distinguishing feature—much longer than typical OA stiffness. Fatigue, fever, and loss of appetite can occur during disease flares. Small joints in hands and feet are typically affected first, with larger joints affected as disease progresses. Joint deformity can develop as RA damages joint structures.

RA diagnosis involves blood tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are present in 60-80% of people with RA. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) indicate inflammation. Imaging studies including X-rays, ultrasound, and MRI detect joint damage and inflammation. Early diagnosis and aggressive treatment are crucial to prevent irreversible joint damage.

Medication Options for Arthritis Management

Medications form the cornerstone of arthritis treatment, with different approaches for OA versus RA. For osteoarthritis, pain relief is the primary medication goal. Acetaminophen (Tylenol) is often the first medication recommended for mild to moderate OA pain. When used as directed (maximum 3,000-4,000 mg daily depending on formulation), it's generally safe, though people with liver disease should use caution and lower doses.

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce both pain and inflammation. Over-the-counter options include ibuprofen (Advil, Motrin) and naproxen (Aleve). Prescription-strength NSAIDs like celecoxib (Celebrex), meloxicam (Mobic), and diclofenac are also available. NSAIDs are effective but carry risks particularly concerning for seniors, including gastrointestinal bleeding, increased blood pressure, kidney damage, and increased cardiovascular risk. Use the lowest effective dose for the shortest time necessary.

Topical NSAIDs like diclofenac gel (Voltaren Gel) provide pain relief with lower systemic absorption and fewer side effects than oral NSAIDs, making them particularly appropriate for seniors. Topical capsaicin cream derived from chili peppers reduces pain by depleting substance P, a chemical that transmits pain signals. It requires consistent use for several weeks to achieve maximum benefit.

Duloxetine (Cymbalta), an antidepressant, is FDA-approved for chronic musculoskeletal pain including OA and has good evidence for effectiveness. Tramadol, a weak opioid, may be used for severe OA pain when other treatments are insufficient, though it carries risks of dependence, falls, and confusion in older adults.

For rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs) are essential to slow disease progression and prevent joint damage. Methotrexate is typically the first-line DMARD, slowing RA progression and reducing inflammation. It requires regular monitoring through blood tests. Hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), and leflunomide (Arava) are additional conventional DMARDs.

Biologic DMARDs target specific components of the immune system. TNF inhibitors like etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) block tumor necrosis factor, a key inflammatory protein. Other biologics target different immune pathways, including rituximab (Rituxan), abatacept (Orencia), and tocilizumab (Actemra). JAK inhibitors like tofacitinib (Xeljanz) are newer oral medications that block inflammation signals.

Corticosteroids like prednisone quickly reduce inflammation and are used for disease flares or while waiting for DMARDs to take effect. Long-term use causes significant side effects including bone loss, diabetes, cataracts, and increased infection risk, so they're used at the lowest dose for the shortest time necessary.

Non-Medication Treatments and Physical Therapy

Physical therapy plays a crucial role in arthritis management. A physical therapist designs individualized exercise programs to improve strength, flexibility, range of motion, and function. Range-of-motion exercises maintain or improve joint flexibility. Strengthening exercises build muscles supporting joints, reducing stress on them. Low-impact aerobic exercise like walking, swimming, or cycling improves overall fitness and endurance without stressing joints.

Physical therapists teach joint protection techniques that reduce stress on affected joints during daily activities, proper body mechanics for lifting and carrying, and assistive device use including canes, walkers, braces, or splints. They may also provide pain-relief modalities including heat therapy to reduce stiffness, cold therapy to reduce inflammation and swelling, ultrasound therapy, and electrical stimulation (TENS).

Occupational therapy helps you modify activities and environments to reduce joint stress. Occupational therapists recommend assistive devices for dressing, bathing, cooking, and household tasks, home modifications to improve safety and accessibility, and energy conservation techniques to manage activities while minimizing pain and fatigue.

Weight management is particularly important for arthritis affecting weight-bearing joints. Excess weight increases mechanical stress on knees, hips, and spine while fat tissue produces inflammatory chemicals that can worsen arthritis. Research shows that losing just 10% of body weight significantly reduces pain and improves function in people with knee OA. Combining reduced calorie intake with regular exercise achieves best results.

Injections, Procedures, and Surgical Options

When medications and physical therapy don't provide adequate relief, procedures may help. Corticosteroid injections directly into affected joints reduce inflammation and provide pain relief lasting weeks to months. They're particularly useful for acute flares but are limited to three to four injections per joint per year due to potential cartilage damage with repeated use.

Hyaluronic acid injections (viscosupplementation) for knee OA provide lubrication and cushioning. Evidence for effectiveness is mixed, with some people experiencing significant improvement while others notice minimal benefit. Medicare covers these injections under specific circumstances.

Joint aspiration removes excess fluid from swollen joints, reducing pressure and pain. Fluid can be analyzed to rule out infection or gout. Platelet-rich plasma (PRP) injections use concentrated platelets from your own blood to potentially promote healing. Evidence is preliminary, and insurance typically doesn't cover PRP.

When conservative treatments fail and arthritis severely impacts quality of life and function, surgery may be necessary. Joint replacement (arthroplasty), particularly hip and knee replacement, removes damaged joint surfaces and replaces them with metal, plastic, or ceramic prosthetic components. Joint replacement can dramatically reduce pain and restore function, with most replacements lasting 15-20 years or longer.

Joint fusion (arthrodesis) permanently joins bones in a joint, eliminating motion but also eliminating pain. This is typically used for smaller joints like those in the spine, ankle, or wrist. Osteotomy reshapes bones to shift weight away from damaged joint areas, typically used for knee arthritis. Joint debridement removes damaged tissue, bone spurs, or loose cartilage fragments through arthroscopy (minimally invasive surgery).

Living Well with Arthritis

Beyond medical treatments, lifestyle strategies help manage arthritis and maintain quality of life. Stay physically active through low-impact activities like walking, swimming, water aerobics, cycling, and tai chi. Exercise reduces pain, improves function, and enhances mood. Start slowly and gradually increase activity levels.

Balance activity and rest, pacing activities to avoid overexertion that triggers pain flares while avoiding excessive rest that leads to stiffness. Use heat and cold therapy—heat before activities to reduce stiffness, and cold after activities to reduce inflammation and swelling. Protect your joints by using larger, stronger joints when possible, avoiding positions that stress affected joints, and using assistive devices that reduce joint strain.

Manage stress and emotional health, as chronic pain and physical limitations can lead to depression and anxiety. Cognitive behavioral therapy helps develop coping strategies. Support groups connect you with others facing similar challenges. Mindfulness meditation and relaxation techniques reduce stress and may reduce pain perception.

Consider complementary approaches including acupuncture, which some people find helpful for pain relief though evidence is mixed, massage therapy for muscle tension and relaxation, and supplements like glucosamine and chondroitin, which have modest evidence for OA benefit. Always discuss supplements with your healthcare provider, as they can interact with medications.

Work closely with your healthcare team including your primary care provider, rheumatologist (for RA or complex arthritis), physical and occupational therapists, and orthopedic surgeon if surgery is being considered. Attend regular appointments, communicate openly about pain levels and function, and follow treatment plans consistently.

Arthritis is a chronic condition requiring ongoing management, but effective treatments and strategies enable most people to control pain, maintain function, and continue engaging in meaningful activities. Early diagnosis, appropriate treatment, regular physical activity, weight management, and proactive self-care make the crucial difference in living well with arthritis.