What Is Inflammatory Arthritis?

Inflammatory arthritis refers to any type of arthritis where your body's immune system mistakenly attacks healthy tissue, causing inflammation. It often affects multiple joints at the same time, including those in the spine, hands, and feet.

This article describes the types of inflammatory arthritis, as well as symptoms, causes, treatment options, and more.

Types of Inflammatory Arthritis

Inflammatory arthritis typically affects the joints. But it can also be systemic, with symptoms that affect other areas of the body—such as the skin or digestive system.

Chronic inflammatory arthritis is caused by inflammatory diseases, while acute inflammatory arthritis can be caused by inflammatory diseases, infections, and medications.

There are many types of inflammatory arthritis, including:

• Rheumatoid arthritis (RA): RA is one of the most common form of inflammatory arthritis. It typically affects joints in the hands, wrists, and knees.
• Psoriatic arthritis (PsA): PsA is a chronic (long-lasting) form of arthritis that typically occurs in people with psoriasis—an autoimmune condition that speeds up the growth of skin cells. Roughly 30% of people with psoriasis develop PsA.
• Ankylosing spondylitis (AS): AS is a chronic form of arthritis that causes inflammation of the spine and sacroiliac joints (where the spine connect with the pelvis). It can also affect the hips and knees.
• Systemic lupus erythematosus (SLE): SLE is the most common type of lupus—up to 70% of people with lupus have it. SLE causes inflammation in multiple organs and systems in the body. It can affect the heart, lungs, kidneys, and brain. Often referred to as simply "lupus."
• Gout: Gout is the most common inflammatory arthritis in adults. Roughly 4% of adults in the U.S. have the condition. More than 50% of gout attacks start in the big toe. Gout attacks almost always occur at night without warning.

Chronic Inflammatory Arthritis

The three most common types of chronic inflammatory arthritis are rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Spondyloarthropathy, pauciarticular juvenile arthritis, undifferentiated polyarthritis, inflammatory osteoarthritis, mixed connective tissue disease, lupus, scleroderma, Sjogren's syndrome, or adult Still's disease, are a few of the less common causes,

Musculoskeletal symptoms can occur due to inflammatory conditions that do not have joint involvement and may include bursitis, tendinitis, or polymyalgia rheumatica.

Acute Inflammatory Arthritis

Acute inflammatory conditions such as gout and pseudogout usually involve between one and three joints

Acute inflammatory conditions may involve four or more joints. Causes include viral arthritis, drug-induced arthritis, early connective tissue disease, rheumatic fever, palindromic rheumatism, or remitting seronegative symmetrical synovitis with pitting edema (RS3PE).

Lyme disease is an infectious type of inflammatory arthritis that can become chronic.

Inflammatory Arthritis Symptoms

All types of inflammatory arthritis The primary symptoms of inflammatory types of arthritis are pain and stiffness in the morning or after periods of rest or inactivity. With inflammatory arthritis, the period of morning stiffness typically exceeds 60 minutes.

Swelling, redness, and warmth also are common in or around the affected joints.

Symptoms often worsen during the cold winter months.

Inflammatory arthritis can cause complications, such as hearing loss or heart disease.

Inflammatory arthritis can affect people of all ages but is more common after age 50.

Each type of inflammatory arthritis can also have its own set of symptoms.

Causes

The main cause of inflammatory arthritis is inflammation around one or more joints In the body.

The different types of inflammatory arthritis have different underlying causes of inflammation. Some are related to immune system dysfunction. This can be hereditary, but it is not always inherited.

Infectious inflammatory arthritis occurs when the body's immune system has an abnormal reaction to an infection.

Diagnosis

Inflammatory arthritis is diagnosed based on a complete medical assessment that includes a review of symptoms, physical examination, and blood tests. Sometimes imaging tests or a sample of fluid from around the joint are needed as well.

Your healthcare provider will ask you how often your symptoms occur, whether you had recent exposure to infection, and what medications or medical conditions you have. Sometimes, physical signs can provide clues about the cause. For example, lupus can cause a characteristic redness of the face, and infectious inflammatory arthritis may cause a fever. But physical signs aren't always present with inflammatory arthritis.

Blood tests that can be part of inflammatory arthritis diagnosis include:

• Complete blood count (CBC): Provides a white blood cell (WBC) count, red blood cell (RBC) count, and platelet count. WBCs can be elevated due to inflammation. The types of white blood cells that are too high or too low can vary with certain conditions, such as infection. Low RBCs can be a sign of chronic disease.
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• Rheumatoid factor
• Anti-CCP
• Anti-nuclear antibody (ANA)
• Ferritin
• Haptoglobin
• Ceruloplasmin
• Complement
• Testing for certain genetic markers can be helpful. For example, HLA-B27 positivity is strongly associated with ankylosing spondylitis.

These tests aren't diagnostic, but they can aid in narrowing the diagnosis. For example, not everyone with rheumatoid arthritis is positive for rheumatoid factor (seropositive). About 20 percent of patients diagnosed with rheumatoid arthritis are negative for rheumatoid factor (seronegative). The specificity is also not good in early rheumatoid arthritis, since other conditions may be associated with a positive rheumatoid factor (e.g., lupus, Sjogren's syndrome).

Synovial fluid analysis from an inflamed joint is typically yellow and turbulent, with white cell counts above 10,000 cells/mm, with the greatest percentage being neutrophils.

X-ray evidence of inflammatory arthritis may include soft tissue swelling, chondrocalcinosis, joint effusion, osteopenia near the joint, symmetric loss of cartilage, joint space narrowing, and bony erosions.

Treatment

Inflammatory arthritis can be treated symptomatically, and often the underlying cause is treated as well. Treatment for each underlying cause is specific to that cause. Many people only have mild symptoms that can be well controlled with lifestyle changes, such as diet and exercise.

Symptomatic treatments may include medications used to manage pain, which can be applied topically to a painful joint, or taken by mouth.

Treatment for the underlying cause includes prescription therapies such as anti-inflammatories and biologics.

For infectious causes, antimicrobial therapy may be prescribed until the infection resolves. However. after an infection resolves, anti-microbial therapy will not help reduce the inflammatory process, and other treatments might be needed.

Prognosis

Some types of inflammatory arthritis will resolve with time. Chronic forms of inflammatory arthritis can often be managed with medication and typically require long-term treatment.

Coping

Living with inflammatory arthritis can be a challenge. For some people, the symptoms are mild and might not limit daily activities. However, inflammatory arthritis can be severe and disabling.

You and your healthcare provider will need to work together to determine what level of activity you are able to tolerate, and how you can stay active. You will likely be able to continue some form of exercise that doesn't exacerbate your symptoms—such as swimming, yoga, or walking. For some people, massage or physical therapy can be helpful too.

Diet can have an impact on some types of inflammatory arthritis—such as gout.

Summary

Inflammatory arthritis encompasses a broad range of diseases that cause joint inflammation, stiffness, swelling, pain, warmth, or redness. These conditions usually affect several joints and may have systemic (whole-body) effects too. The causes are as varied as the types of conditions, and diagnosis usually relies on a combination of tests. Treatment can help control the underlying condition and reduce symptoms.

A Word From Verywell

Inflammatory arthritis can have a substantial effect on your day-to-day life, potentially causing discomfort and limitations In your movement. Rest assured that some types of inflammatory arthritis are curable, and even the types that are not curable can be managed with medication and lifestyle strategies. While a diagnosis of inflammatory arthritis can change your life, you can still have an excellent quality of life, stay active, and live without pain.