The Importance of Early Diagnosis in Arthritis Management

Arthritis is a pervasive and debilitating condition that affects over 10 million people in the UK, which equates to around one in six. Those with arthritis are 20% less likely to work than those without the condition and around 23.3 million working days are lost every day because of musculoskeletal (MSK) conditions. 

Arthritis is characterised by inflammation of the joints and can manifest in various forms, including:

• Osteoarthritis
• Rheumatoid arthritis
• Juvenile arthritis
• Reactive arthritis

The ramifications of arthritis are more than just discomfort. The condition often leads to a significant decline in the overall quality of life. As such, early diagnosis can drastically improve outcomes, as swift intervention and appropriate treatment at the earliest stages can alter the disease trajectory.

Understanding arthritis

Arthritis is a broad term that encompasses different types of joint-related conditions. The condition is a collective descriptor for inflammatory disorders affecting the joints. Arthritis can affect anyone, irrespective of age or background. It is characterised by pain, stiffness and swelling in and around the joints. 

The two most common and widely recognised forms of arthritis are osteoarthritis and rheumatoid arthritis. The former is associated with the wear and tear of joints over time, leading to cartilage breaking down. This causes pain and reduced mobility. 

Conversely, rheumatoid arthritis is an autoimmune condition. This is where the body’s immune system attacks the joints—specifically the membrane lining them, the synovium—causing inflammation and joint damage.

Other types of arthritis include juvenile arthritis, ankylosing spondylitis and psoriatic arthritis, but there are plenty more. 

The prevalence of arthritis underscores the importance of understanding the conditions and the need for early detection and intervention. 

Early warning signs and symptoms

Early diagnosis can only happen when people recognise the early warning signs. Initially, there are subtle cues during the early stages of the condition. Arthritis often has a range of different symptoms, which together form the bigger picture. Here are some common indicators:

Joint pain

Persistent pain or discomfort in one or more joints can be an early sign of arthritis. This is particularly true for periods following inactivity or after movement. The pain can be mild to severe and it may affect one or multiple joints. 

Stiffness

Stiffness in the morning that lasts more than half an hour is a hallmark of early arthritis symptoms. This stiffness tends to impede the normal movement of the joint and it eases slowly with activity. 

Swelling

Swelling around the joints along with tenderness and warmth is a sign of inflammation. This is an indicator for arthritis, especially if there has been no trauma to the joint or injury.

Reduced motion

Arthritis leads to a gradual decrease in the range of motion in the joints affected. This might be noticed in activities like walking, lifting or bending as they no longer feel effortless.

Fatigue

A feeling of exhaustion or fatigue is often associated with arthritis. This affects overall wellbeing and daily activities. 

Joint deformation

Sometimes, arthritis causes visible deformities. This is particularly true for inflammatory arthritis like rheumatoid arthritis. 

Consequences of delayed diagnosis

If the early signs go unnoticed and there is a delay in discovering the condition, there is the possibility that arthritis causes irreversible damage quickly. With delayed diagnosis and treatment, an individual risks negative outcomes like:

• Joint damage and deformities: Without appropriate intervention, arthritis leads to irreversible joint damage. Persistent inflammation erodes the cartilage, which impairs mobility and causes joint deformities.
• Chronic pain and discomfort: Left unchecked, arthritis often results in chronic pain and discomfort. The longer the wait to receive a diagnosis, the more entrenched the pain becomes. This can impact a person’s ability to perform daily tasks and diminish their quality of life.
• Functional impairment: When arthritis advances, it can compromise the function of the joint. This makes simple tasks increasingly challenging. The loss of flexibility and mobility can affect independence and a person might be unable to exercise, work or engage in their preferred social activities.
• Reduced quality of life: Delayed diagnosis allows arthritis to progress physically but it also takes its toll on a person’s mental and emotional wellbeing. Chronic pain and physical limitations as well as the uncertainty of an undiagnosed condition contribute to the diminished overall quality of life.
• Impact on other systems: Certain types of arthritis, like rheumatoid arthritis, affect other parts of the body as well as the joints. If there is a delay in diagnosis, this can lead to complications and effects on other organs like the heart, lungs and eyes.
• Limited options for treatment: Timely intervention means people have more treatments available to try. This can be lifestyle modifications, physiotherapy and medications. With delayed diagnosis, there are fewer options and it becomes more challenging to manage the arthritis and its progression.

Benefits of early diagnosis

The advantages of early diagnosis are manifold. They range from enhanced outcomes to improved pain control and the preservation of joint function. By understanding the benefits of early identification, individuals and healthcare professionals can ensure the condition is managed effectively from the start. Here are some of the benefits of early identification in more detail:

Timely and targeted treatment

Early identification of arthritis means that healthcare professionals can implement targeted treatment strategies. This can involve medicines that alleviate symptoms and slow disease progression. It can also include medicines that control the immune response in cases of autoimmune arthritis, like rheumatoid arthritis. Quick action also means that treatment is best for the specific type of arthritis.

Pain management

During the early stages of arthritis, symptoms are manageable. Identifying them early can help pain management so that people can maintain a better quality of life. Earlier pain relief like medication as well as modifications to lifestyle can slow the progression of the disease. 

Preservation of joint function

With early intervention, the joint function can be preserved before irreversible damage is made. Mitigating inflammation, reducing stiffness and safeguarding the cartilage against erosion means the patient has optimal joint function and mobility for longer. 

Improved quality of life

When arthritis is addressed early, it can help maintain the quality of life and minimise the impact of the disease on daily activities. It promotes independence for longer. This leads to people having a fuller and more active lifestyle.

Empowerment through education

When people know about their condition early, they can educate themselves about it. Knowing about arthritis and its triggers can help individuals use effective management strategies and modify their lifestyle to alleviate symptoms and delay disease progression. 

Diagnostic methods

Healthcare professionals use a range of methods to diagnose arthritis. These include imaging studies, laboratory testing and clinical assessment to confirm the presence of the condition and determine its type. 

Physical examination

A thorough examination of the joints is often the first part of the diagnostic procedure. This assesses the function of the joint, its range of motion and whether there is any tenderness or swelling. Observing symptoms like deformities and warmth helps to narrow down the type of arthritis that could be present.

Blood tests

Blood tests are helpful in diagnosing arthritis, especially with rheumatoid arthritis. Tests may show elevated levels of specific antibodies and markers of inflammation like:

• Rheumatoid factor (RF). This is a protein made by the immune system that attacks healthy tissue. Those with rheumatoid arthritis have high levels of RF in their blood.
• Anti-cyclic citrullinated peptide (anti-CPP) antibodies. People who test positive for anti-CP in their blood are very likely to develop rheumatoid arthritis. However, sometimes people (1 in 20) will have a positive test without rheumatoid arthritis. Not everyone with rheumatoid arthritis has this antibody present.
• C-reactive protein (CRP). This measures the level of inflammation.
• Erythrocyte sedimentation rate (ESR). This is another measure of inflammation in the body.

The person commissioning the blood tests will also request a full blood count (FBC) to help rule out any other possible causes for symptoms. Anaemia is also common with rheumatoid arthritis so this test will show whether it’s present or not. 

Imaging studies

Doctors will book a range of imaging studies to see what the joints look like. These might include:

• X-rays: These can help visualise the bones and joints. In arthritis, you might be able to see changes in bone density and narrowing of spaces between the joints. There might also be bone spurs called osteophytes, which are indicative of arthritis. However, X-rays can only do so much. They don’t show any stages of inflammation that occur during the early stages of the disease.
• Magnetic Resonance Imaging (MRI): MRI scans show details of soft tissues, ligaments and cartilage. These can show early signs of arthritis and are useful in assessing any damage to joints.
• Computer Tomography (CT) scans: These provide cross-sectional images of joints and bones and help detect abnormalities in the joint structure.
• Ultrasound: This can help to visualise the joints and their surrounding tissues. Ultrasound can detect thickening of the synovial fluid. It can also identify early signs of arthritis.
• Bone scans: These involve a small amount of radioactive material being injected into the bloodstream. This highlights areas of increased bone activity, which helps to show the extent of arthritis and joint inflammation.

Analysis of synovial fluid

If there is evidence of joint inflammation, patients may undergo analysis of the synovial fluid. This is a viscous fluid located in joint cavities. It is like egg white in consistency and reduces friction in movement. The fluid can be analysed if arthritis is suspected as it can show if there is inflammation, crystallisation or infection. This helps to pinpoint the cause of the problem. 

Treatment options

There are lots of treatments available for arthritis and these are often tailored to the individual, the type of arthritis they have and the stage of the condition. Treatments often include medication, physiotherapy, occupational therapy, lifestyle modifications, biologic therapies, surgery and even alternative and complementary therapies.

Medications

There are several classes of medication used for pain management in arthritis. Early diagnosis provides a strategic advantage in how these medications are used. Here are some examples of medications often prescribed for arthritis:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – These drugs, like ibuprofen and naproxen, are some of the first medications prescribed for arthritis in its early stages. These anti-inflammatory drugs reduce inflammation and pain, which provides relief from arthritis symptoms. These are used with caution, however, as they sometimes cause side effects like cardiovascular risks and gastrointestinal problems.
• Disease-modifying antirheumatic drugs (DMARDs) – These drugs are used to treat autoimmune forms of arthritis like rheumatoid arthritis. Two examples are methotrexate and hydroxychloroquine. These target the immune system dysfunction that underlies arthritis. Starting DMARD therapy early is crucial because it can help modulate the immune response, thus slowing down the progression of joint damage. It helps to preserve the structure and function of the joint.
• Corticosteroids –
  These are powerful anti-inflammatory medications that help manage arthritis symptoms. They are administered either orally or through injections into the joint. These drugs relieve inflammation to provide relief. They also have potential side effects like weight gain, increased susceptibility to injection and bone density loss so they’re only offered short term usually.

Physical therapy 

This is an important part of arthritis management. Having physiotherapy early can help to maintain the flexibility of the joints and strengthen supporting muscles. This also helps to improve overall functioning. These therapists tailor exercise programmes to patients’ individual needs to promote joint health and mobility.

Lifestyle changes

Arthritis can be improved by adopting a healthy lifestyle. Weight management and regular exercise with a balanced diet can contribute to better joint health. With an early diagnosis, individuals can be proactive and help slow down the progression of their disease.

Occupational therapy

OTs assist people in adapting their daily activities to minimise the stress and strain on affected joints. They help people to preserve their joint function and conserve energy by using different techniques. 

Biologic therapies

Since DMARDs suppress the entire immune system, they need to be given carefully. Biologic therapies, on the other hand, are newer treatments that target specific aspects of the condition. They work by blocking the cause of the inflammation. 

Surgery

When there is extensive joint damage and conservative measures haven’t worked, surgery may be considered. This might be something like joint replacement surgery, i.e. a hip or knee replacement.

Complementary and alternative therapies

Some people find relief from alternative treatments like acupuncture and dietary supplements. Though these aren’t a substitute for conventional treatments, they can complement medical interventions and provide a holistic approach to managing the condition.