Ask Dr. Rodanthi Kitridou,Does Bursitis Lead to Arthritis?

Ask Dr. Rodanthi Kitridou,Does Bursitis Lead to Arthritis?
Janet, Canada

Q: What is bursitis? Could this lead to arthritis? What should you do if you have it?

A: There are definitely strategies you can use to ease bursitis, but first let me explain what you're dealing with. A bursa is a small fluid-filled sac of tissue, which lubricates and protects the pressure points between your bones and the muscles and tendons that surround your joints. There are approximately 160 bursas in the human body, most located over bony prominences (shoulders, elbows, knees). Bursitis occurs when a bursa becomes inflamed, which leads to pain when you move or press on the spot. This inflammation can be due to several factors, including trauma, calcium salt deposits, gout (urate crystal deposits), rheumatoid arthritis, reactive arthritis (Reiter syndrome), or infection.
The most common areas where bursitis occurs are the tip of the elbow (olecranon bursitis), the shoulder (subacromial, or subdeltoid, bursitis), the knee (prepatellar bursitis, anserine bursitis), the wrist (ulnar styloid bursitis), and the ankle (malleolar bursitis). You'll probably experience aching and stiffness and the area may feel swollen or warm. However, bursitis is best diagnosed by a rheumatologist or an orthopedic surgeon. The rheumatologist can also determine whether it's an isolated problem or part of a systemic ailment. Infectious bursitis is due to bacteria or other infective agents and needs antibiotic treatment, or even surgical removal of the bursa.

The short answer to your second question is no — bursitis can be caused by arthritis but it does not lead to it.

Finally, how do we treat most cases of bursitis? In general, a shot of a cortisone-type drug works well (as long as the bursitis is an isolated problem and is not due to infection). In addition, your doctor will probably recommend immobilizing the area and giving it time to heal. Ice packs (applied for 20 minutes a couple of times a day) and nonsteroidal anti-inflammatory drugs (NSAIDs) can also help relieve pain and reduce inflammation. Moist heat is effective on stiffness once the area is no longer warm or red, and keeping the area elevated can also help reduce swelling. Your doctor may also suggest exercises or physical therapy to restore your range of motion and strengthen the muscles in an effort to keep the bursitis from recurring. All bursitis should be treated promptly, but especially shoulder bursitis, because it could lead to frozen shoulder, a condition with extremely limited and painful shoulder motion.

You can help prevent bursitis or decrease its severity by incorporating these tactics into your daily life:

*Warm up and/or stretch before any physical activity.

*Avoid performing repetitive tasks without taking frequent breaks.

*Get up and move around periodically if you generally sit for long periods of time.

*Be mindful of your posture (no slouching or leaning on the elbows).

*Use cushions (e.g., knee and elbow pads) to protect your joints.

*Make sure your shoes fit well and you regularly replace worn-down heels.
Last Updated: 12/04/2006

Dr. Rodanthi Kitridou is a rheumatologist and professor emerita of Medicine at the USC School of Medicine, Los Angeles County-USC Medical Center.

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