Relieving joint pain caused by arthritis is the most common reason people are coming to our clinic to have an ultrasound-guided injection. Unfortunately, arthritis and its variants of osteoarthritis and rheumatoid arthritis will eventually affect everyone.

What is arthritis?

The term arthritis literally means inflammation or swelling of the joints. According to the Arthritis Foundation, arthritis is a general term that is used to describe over 100 conditions that affect over 8.5M people in the U.K. These conditions have similar symptoms of pain, swelling, and stiffness of the joints and surrounding areas. The two most commonly diagnosed types of arthritis are osteoarthritis and rheumatoid arthritis.

What is Osteoarthritis?

Osteoarthritis, the most common form of arthritis, is degenerative arthritis. Osteoarthritis commonly affects portions of the wrists, ankles, fingers, and toes, as well as the knees, hips, neck, and lower spine.

The arthritic pain described by osteoarthritis patients includes morning stiffness and stiffness following the inactivity of the affected joint. This stiffness rarely lasts for more than 30 minutes. As osteoarthritis progresses, patients report arthritic pain with movement of the joint and resolution of pain upon resting the joint. In advanced disease, patients report pain at rest and pain that awakens them from sleep.

What is rheumatoid Arthritis?

Rheumatoid arthritis, the second most common form of arthritis, is the chronic swelling and inflammation of the joints. The hallmark rheumatoid arthritis symptom is pannus-a swelling and overgrowth of rough tissue (called granular tissue) over the smooth connective tissue that surrounds the area around and between the bones and joints. Although some cases of rheumatoid arthritis are mild, this type of arthritis is often chronic and progressive and leads to deformities and disability.

What are the risk factors and causes of arthritis?

Although researchers have been searching for the cause of arthritis for decades, the cause of arthritis remains unknown. There are three promising theories about the cause of arthritis. These include:

  • Genetic or hereditary factors
  • Immune system abnormalities or autoimmune disease
  • A persistent or triggering infection.

Because more women have arthritis than men, some scientists believe there is a hormonal component to the disease as well.

Other arthritis risk factors are:

  • Age: With the exception of juvenile rheumatoid arthritis, arthritis symptoms often begin after age 40.
  • Gender: Women are at higher risk of arthritis. Of the 21 million Americans with osteoarthritis, 16 million of them are women. Other forms of arthritis, including rheumatoid arthritis, lupus and fibromyalgia, occur more often in women than in men. Men have a higher risk of gout (another common arthritis), and they experience osteoarthritis in greater numbers after age 55.
  • Weight: As few as 10 extra pounds can translate into a higher risk for arthritis, especially in weight-bearing joints like the knees. This increased weight places more pressure on joints and causes the cushioning layer between bones in a joint (cartilage) to break down.
  • Past injuries: A severe joint injury, such as a knee injury that damages cartilage, can add to the overall risk of arthritis.
  • Ethnicity: Ethnic background affects the risk of arthritis. For example, 25% of Caucasians carry the genetic marker for rheumatoid arthritis compared to 10% of African Americans.

What are the symptoms of arthritis?

Because there are 100 conditions* that fall under the term arthritis, it would be difficult to list the symptoms of all of them. However, many of the conditions share similar symptoms. Rheumatoid arthritis symptom list:

  • Gradual onset
  • Weakness, fatigue, and loss of appetite (anorexia)
  • Joint swelling, tenderness, and loss of motion, especially in the wrists, ankles, and fingers
  • Dislocations and joint contractures
  • Chronic inflammation of tendons
  • Possible tendon rupture
  • Rheumatoid nodules over bony areas such as the elbow and wrist.
  • Enlarged spleen
  • Pericarditis (inflammation of the heart wall), and vasculitis (inflammation of the blood vessels)

Osteoarthritis symptom list:

    • Stiffness, pain, and a noisy grating of the joints (crepitus)
    • Joint tenderness, swelling
    • Decreased range of motion
    • Crepitus with motion
    • Bony overgrowths
    • Pain with movement
    • Finger joint involvement leads to the development of nodular swellings.

How is arthritis diagnosed or evaluated?

It is important to see a doctor to be diagnosed properly. Because there are so many types of arthritis, it may take some time to get the correct arthritis diagnosis. Successful diagnosis depends on patient history, symptoms, blood tests, physical examination, and X-rays or radiographic studies. There are no definitive laboratory tests for osteo or degenerative arthritis. Blood work for osteoarthritis is usually normal or inconclusive. A blood test for rheumatoid factor, an autoantibody found in the blood of people with rheumatoid arthritis, can help with a diagnosis of rheumatoid arthritis. X-rays can help with an arthritis diagnosis. An X-ray of an arthritic joint will show joint space narrowing, new and abnormal bone formation, and abnormal, dense tissue growth.

Because many types of arthritis develop slowly, a doctor may suspect one kind of arthritis before other symptoms make the diagnosis clear. Patients should develop a rapport with their doctors and keep a diary of arthritis symptoms to help with diagnosis.

What are the treatments and drugs to treat arthritis?

The goals of arthritis treatment are simple:

  • Relief arthritis pain
  • Minimize joint stiffness
  • Reduce inflammation
  • Preserve muscle and joint function
  • Maintain a normal lifestyle
  • Minimize side effects of arthritis medication.

A basic common sense approach achieves these goals for a majority of patients. Although this approach is not an arthritis cure, it helps patients maintain their quality of life. This arthritis treatment approach consists of

  • adequate rest
  • anti-inflammatory therapy
  • physical therapy to maintain joint function
  • drug therapy to slow the progression of the disease (in some patients).

One of the most important aspects of arthritis relief is the control of inflammation and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) help control these symptoms. There are several types of these arthritis medicines. Some of these medicines are safer to use than others.

NSAIDs include salicylates, traditional NSAIDs and COX-2 inhibitors. Aspirin is a salicylate. Traditional NSAIDs are medicines like over-the-counter Motrin, Advil, and other ibuprofen-containing brands and Aleve and other naproxen/naproxen sodium-containing brands. Other drugs in this NSAID class include ketoprofen, flurbiprofen, oxaprozin, nabumetone, tolmetin, indomethacin, sulindac, piroxicam, diclofenac, diflunisal, and etodolac. Aspirin and NSAIDs can cause GI upset, bleeding and ulcers in some patients.

COX-2 inhibitors are newer agents which bind only to COX-2 receptors. COX-2 inhibitors are less likely to cause GI symptoms than traditional NSAIDs. However, COX-2 inhibitors may not be safe choices for all patients. Recently, Vioxx, a popular COX-2 inhibitor, was removed from the market due to increased risks of stroke and heart attack with long-term use. Another COX-2 inhibitor, Bextra, may cause similar side effects. Celebrex, a third COX-2 inhibitor, may be a safer alternative.

It is important to remember that these drugs do not modify the progression of the disease but simply help with pain and inflammation, which can significantly improve the patient’s quality of life.

Other types of arthritis medication are disease-modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine, gold, penicillamine, the immunosuppressive agent methotrexate, and azathioprine. These drugs can help slow the progress of the disease. Because these drugs have severe side effects for some patients, it is important that the patient be followed closely by their physician.

Steroid injections

Sonoscope offers injections of a long-acting steroid that may be given directly into a particularly painful joint, especially the knee or thumb. The injection often starts to work within a day or so and may improve pain for several weeks or months. Steroid injections are mainly used for very painful osteoarthritis or for sudden, severe pain caused by crystals in the joint.

How is cortisone injection administered?

Cortisone injections are most commonly given into joints to provide pain relief. They can also be given into tendons near the joint (tender points). The cortisone is injected directly into the painful joint with a needle and syringe. Ultrasound may be used to guide the needle into the correct position.

You will usually have the injection while you’re awake, although you may be given a sedative first if you’re anxious. The skin over the injection site is numbed with a local anaesthetic before the cortisone is injected.

Cortisone injections usually take a few seconds to administer. You will usually be able to go home soon after having the injection.


No one arthritis medicine’s best for all patients. Each patient responds differently to each medication. Some doctors prescribe an alternative arthritis remedy such as acupuncture to help control pain. In a recent study, acupuncture worked better than arthritis medication for the control of the pain and swelling of osteoarthritis of the knee.

Regular exercise and appointments with a physical therapist can help preserve a range of motion for arthritis patients and delay disability.

Other aspects of arthritis treatment can include simple interventions such as the local application of heat or ice, periods of rest at selected times during the day, exercise to maintain joint motion and muscle power, and reduction of weight on painful joints by the use of canes or crutches. Patients also need patient education and emotional support. Surgical procedures may be necessary in patients with severe hip or knee involvement or spinal nerve compression.




Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomized controlled trial. British Medical Journal. 18 November 2004; 329: 1216-9.

Arnett, FC. Rheumatoid Arthritis. IN: Cecil Textbook of Medicine, 21st ed. Philadelphia, PA: W. B. Saunders Company; 2000: 1492 – 1499.

Arthritis Foundation. What is Arthritis? Available at:
Accessed November 18, 2004.

Arthritis Foundation. Arthritis. What Are The Risks? Available at:
Accessed November 19, 2004.

Bathon, JM and Ling, SM. Osteoarthritis. IN: Rakel, MD. Textbook of Family Practice, 6th ed. Philadelphia, PA: W. B. Saunders Company; 2002: 1044-1048.

Mercier, LR. Arthritis, Rheumatoid. IN: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2005 ed. St. Louis, MO: Mosby, Inc; 2005: 89.

Mercier, LR. Osteoarthritis. IN: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2005 ed. St. Louis, MO: Mosby, Inc; 2005: 578.

Stedman, TL. Stedman’s medical dictionary. 26th ed. Baltimore, MD: Williams & Wilkins; 1995: 149.