Living With Chronic Pain

Does Joint Pain Always Point To Arthritis?

People frequently ask me if they have arthritis because they have joint pain. The word arthritis means inflammation of the joints. Add “itis” to anything and you get inflammation of that area:

Myositis, inflammation of the muscles
Vasculitis- inflammation of the blood vessels
Diverticulitis- inflammation of the colon
Hepatitis – inflammation of the liver.

Joints are no different. Inflammation is key but the underlying causes vary.

Arthritis is an umbrella term covering over 100 conditions that affect the joints, tissues around the joint and other connective tissues. According to the Centers for Disease Control and Prevention (CDC), 54.4 million adults in the United States have received a diagnosis of some form of arthritis and 300,000 children according to the Arthritis Foundation. Of these, 23.7 million people have their activity curtailed in some way because of this condition. 

A diagnosis of arthritis is often due to acute or chronic inflammation of a joint, which is often accompanied by pain and structural changes. The specific causes of arthritis are unknown, but may be triggered by infection, crystal deposition, genetics, injury or repetitive use. Specific symptoms vary depending on the type of arthritis, but usually include joint pain and stiffness.

The most common type is osteoarthritis. Osteoarthritis (OA) is often referred to as “wear and tear” arthritis or degenerative joint disease. It is estimated to affect over 30 million people in the Unites States alone, this equals almost 1 in every 10 people dealing with the painful effects of arthritis. As a degenerative joint disease, osteoarthritis (OA) over time, causes inflammation and loss of cartilage in the joints leading to inflexibility, pain, swelling, stiffness, and decreased range of motion. It usually occurs in weight-bearing joints such as the knees, hips and spine. But any joint can be affected. Unlike systemic, autoimmune forms of arthritis (Lupus, Rheumatoid Arthritis), Osteoarthritis does not affect organs in the body. Decreasing weight and learning how to safely mobilize and stretch the affected joints can make a difference in its impact and progression.

Auto immune types of arthritis:

Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease. Patients with RA have an immune system that attacks healthy cells in their body by mistake. RA commonly affects joints in the hands, wrists, and knees, but can attack any joint in the body. Individuals with rheumatoid arthritis (RA) have an autoimmune disease where the body is attacking “self tissues,” beginning in the thin tissue membrane that lines joints. Because the body’s immune system is “fighting” itself, fluid builds in the joints, creating swelling, inflammation and significant pain throughout the body.

To date, rheumatoid arthritis is not a curable disease but there are many viable options for relief. Rheumatoid arthritis produces chronic symptoms, but some sufferers can feel just fine for several days, weeks or months, and then experience an acutely painful “flare,” while others feel the disease continuously.

Lupus is an autoimmune disease that attacks patients’ own tissues, producing widespread inflammation. The cause of lupus is unknown. The most common form of lupus is Systemic Lupus Erythematosus (SLE) which can affect the joints, skin, brain, lungs, kidneys, and blood vessels.  Lupus is known as an autoimmune disorder because the body begins to wage battle with itself by destroying healthy tissue. There are four different forms of Lupus that show significantly different symptoms. 

One test that can be a marker for Lupus is the Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies – produced by your immune system -indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. It is important to realize that even though 98% of people with lupus will have a positive ANA, ANAs are also present in healthy individuals (5-10%) and people with other connective tissue diseases, such as scleroderma and rheumatoid arthritis. Moreover, about 20% of healthy women will have a weakly positive ANA, and the majority  will never develop any signs of lupus. That’s why a thorough exam with more specific tests are required to make the diagnosis.

Psoriatic arthritis (PsA) with this arthritis the body’s own immune system becomes overactive and attacks normal tissues in the body. Patients with PsA can experience swelling, stiffness and pain in their joints and surrounding tissues, as well as nail changes and extreme fatigue. Psoriatic arthritis (PsA) is an autoimmune disease; the body’s own immune system becomes overactive and attacks normal tissues in the body. According to the National Psoriasis Foundation (NPF), up to 30 percent of people with psoriasis will develop psoriatic arthritis. 

People with psoriatic arthritis experience the red patches of skin and silvery scales that psoriasis patients experience as well as the joint pain and stiffness associated with autoimmune forms of arthritis. PsA can affect any part of your body, including your fingertips and spine, and the disease severity may range from relatively mild to severe. For patients with psoriatic arthritis, disease flare ups are relatively unpredictable as they often alternate with periods of remission.

Gout is a very common form of arthritis, usually affecting one joint at a time – often starting with the big toe joint in the foot. Uric acid crystals build up causing severe pain. Gout is most common in men and obese adults. It was once known as the “Disease of Kings” because a diet full of red meat and alcohol often leads to a buildup of uric acid crystals causing a gouty flare. The poor couldn’t afford those luxuries so the rich were primarily affected.

As the uric acid crystals build up in the toe joint, it becomes swollen, red and painful, making it hard to walk and move about. If left untreated, repeated bouts of gout can lead to gouty arthritis, which is a more aggressive form of arthritis. There is currently no cure for gout, but there are ways to treat and manage your symptoms with medication and diet. (see post) 

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way the brain processes pain signals. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

Ankylosing spondylitis is an inflammatory condition that, if left untreated, can result in some of the vertebrae in the spine fusing together. When vertebrae fuse, the spine is less flexible. This can lead to pain, inflammation, poor posture, difficulty breathing and a reduced quality of life. Ankylosing spondylitis (AS) is an inflammatory condition that affects more men more than women, often showing up in early adulthood. While AS mostly affects the spine, inflammation can be experience in other areas of the body as well, most notably, in the eyes.

Don’t despair, whatever you suffer from, in this day and age, there are great options for intervention that can give relief to painful joints. The first step? Talk to your provider and get a thorough and comprehensive exam so an accurate diagnosis can be assessed and treatment options discussed. I’ll explain next week what that entails.


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