Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Part 2 of 11 in Diagnosis and Management of Arthritis in Joints
What Is Arthritis? Understanding Its Main Types and Causes
September 6, 2026
Dr. Mannu Bhatia opened his Jivo Masterclass session with a plain definition: arthritis is a global restriction of movement. A twenty-year-old walks comfortably and plays football without a thought; by the time he reaches fifty, his mobility is restricted, his joints hurt, and everyday activities become difficult. That gradual loss of function, wherever it shows up in the body, is what doctors call arthritis.
Any joint can be affected
Arthritis can affect the knee, the hip, the shoulder or the smaller joints of the hand and foot. Its presentation also varies by geography: in Dr. Bhatia's practice, roughly nine of every ten patients from India present with knee arthritis, while among patients from Africa, around eight of ten present with hip arthritis instead.
Cartilage is the joint's protective covering
A joint is made up of bone, covered by a layer of cartilage. As long as that cartilage is intact, the joint functions normally. The moment the cartilage breaks down, whether from injury, ageing, ongoing physical stress, an autoimmune condition, or in rarer cases an infection such as tuberculosis, arthritis begins. The synovium, the structure surrounding the joint that produces its lubricating synovial fluid, is also affected once the joint space narrows and the underlying bone becomes exposed. That is the point at which patients typically feel their life is being affected and seek a doctor.
Three main types
Dr. Bhatia grouped the disease into three broad types: osteoarthritis, the degenerative, age-related wear that is by far the most common, affecting an estimated 32 million people in the United States alone; autoimmune arthritis, principally rheumatoid arthritis, which is far less common worldwide but highly disabling where it occurs; and post-traumatic arthritis, which follows an earlier injury to the joint.
This article is based on a Jivo Masterclass session conducted by Dr. Mannu Bhatia, Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Mannu Bhatia taught doctors across Africa on February 2, 2025.
FROM THE LIVE Q&A
Moderator
I have a patient with intermittent elbow pain, treated with oral and topical NSAIDs followed by PRP injections. What is the outcome of PRP for this patient in Ethiopia?
Dr. Mannu Bhatia
I am not a strong advocate for PRP. Once the joint surface and the cartilage are already gone, PRP cannot regenerate them, so I don't believe it delivers a real result. I would want to see the patient's X-rays, and an MRI if needed, before deciding what should actually be done.
Frequently Asked Questions
What are the absolute contraindications for joint replacement?▼
As surgical techniques progress, more countries are attempting these surgeries, but two things need to be in place regardless: a genuinely sterile operating theatre, and excellent post-operative facilities, since that is what actually gets the patient the benefit of the surgery. There are no absolute contraindications beyond the patient having a poor overall medical condition, for example a cardiac condition that would make operating on them risky.
Is it possible to do a bilateral hip replacement in a patient with a slipped hip joint?▼
Bilateral hip replacement can always be done, either in the same sitting or with a gap between the two sides, depending on the patient's condition. If the body can tolerate it, both sides can be done together. If the body, or the finances, don't allow that, there can be a gap in between, but rehabilitation and the expected result need to be planned accordingly.
What is the best NSAID to use for osteoarthritis?▼
I would not advise continuous use of NSAIDs, since they can have a harmful effect on the kidneys over time. Short-term use for pain relief is fine.
How affordable are these surgeries at your facility?▼
They are very affordable in India, around half the cost of the same surgery in Nigeria, and much less than the cost in Europe or the US, with better results.
What is the definitive treatment for osteoarthritis?▼
The definitive treatment is that the patient should be visiting the doctor regularly. If the condition is detected and treated at an early stage, that is the definitive treatment. A patient who ignores an ACL injury, skips the recommended MRI, skips the recommended surgery and skips the medicines is the one who progresses to osteoarthritis and eventually needs a knee replacement. Patients with a problem in one knee who don't get it treated often go on to develop the same problem in the other knee, then the hips, then the spine. The definitive treatment is listening to the doctor and following through, whether that means physiotherapy or treatment for rheumatoid arthritis.
What are the three main types of arthritis?▼
Osteoarthritis (degenerative, age-related wear), autoimmune arthritis such as rheumatoid arthritis, and post-traumatic arthritis following an earlier injury.
What actually happens inside a joint when arthritis develops?▼
The cartilage that covers the bone breaks down, whether from injury, ageing, physical stress, autoimmune disease or infection. As the joint space narrows and the underlying bone is exposed, pain and reduced movement follow.
How common is osteoarthritis compared to rheumatoid arthritis?▼
Osteoarthritis affects far more people; Dr. Bhatia cites an estimated 32 million people in the United States alone. Rheumatoid arthritis affects a much smaller number worldwide but is highly disabling in those it affects.
In This Series: Diagnosis and Management of Arthritis in Joints
- 1.Diagnosis and Management of Arthritis in Joints
- 2.What Is Arthritis? Understanding Its Main Types and Causes
- 3.Who Is at Risk of Osteoarthritis: Age, Weight, Occupation and Injury
- 4.Recognising Joint Arthritis: Pain, Swelling, Crepitus and Instability
- 5.Diagnosing Joint Arthritis: Why X-Rays Come Before an MRI
- 6.Non-Surgical Management of Arthritis: Weight, Physiotherapy and Mobility Aids
- 7.Medicines and Joint Injections for Arthritis: What Works and What Doesn't
- 8.When Arthritis Needs Surgery: Hip, Knee, Shoulder and Elbow Replacement
- 9.Recovery After Joint Replacement: Rehabilitation and Activity Limits
- 10.Joint Replacement Case Studies: Patients Who Travelled From Africa for Surgery
- 11.The Cost of Joint Replacement Surgery in India for International Patients