Living With Chronic Pain

Arthritis; Diagnosis To Treatment

Last week I discussed different types of arthritis. Now let’s talk about the way those are diagnosed and treated.

Symptoms

The most common presentation is due to:

  • Swelling
  • Redness
  • Tenderness to the touch
  • Pain or soreness during movement
  • Reduced mobility and range of motion
  • Any growths or abnormalities in the joint
  • Unusual positioning of the joints
  • Symptoms in other areas of the body, like the eyes, lungs, and skin

Physical exam 

A thorough exam is critical to defining the particular etiology of the pain, as well as the general health or underlying medical concerns that could exacerbate or affect arthritic complaints. It’s imperative to define if it’s just joint pain or are the surrounding tendons, muscles and ligaments involved. Is it due to an acute problem such as a fracture or overuse? While there are many causes of joint pain and stiffness, figuring out the precise reason will depend on specific symptoms and exam findings.

For example, osteoarthritis -arthritis in which the cartilage between joints begins to wear down -is differentiated from other types by complaints of:

  • Joint pain becomes more severe as the day progresses
  • Joint pain starts after being sedentary or after excessive use
  • Pain or difficulty with walking, standing or using the stairs
  • Limping
  • Poor posture 

Whereas rheumatoid arthritis usually presents with:

  • Tiredness, weakness and even a low grade fever
  • Muscle pain first thing in the morning, or after sitting in one spot for too long
  • Depression, losing weight and appetite 
  • Joint pain on both sides of the body such as the hands, feet

Tests 

Tests help providers evaluate the underlying cause. From radiographic studies that can show the severity of the arthritic damage (including baseline X-rays of joints that can be potentially affected to define their status and assess progression) to blood tests. There are markers that can be found in some types of arthritis such as lupus, rheumatoid, or sjogrens. An elevated erythrocyte sedimentation rate (ESR, or sed rate), C-reactive protein (CRP) may indicate the presence of an inflammatory process in the body. 

Treatments

Treatments aims to control pain, minimize joint damage, and improve or maintain function and quality of life. A range of medications and lifestyle strategies can help achieve this and protect joints from further damage. 

  • Medications
  • Non-pharmacologic therapies
  • Physical or occupational therapy
  • Splints or joint assistive aids
  • Patient education and support
  • Weight loss
  • Surgery, including joint replacement

Medications

There are a myriad of treatment options depending on the source of the pain. They include:

  • Analgesics: these reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab). 
  • Non-steroidal anti-inflammatory drugs (NSAIDs): these reduce both pain and inflammation. NSAIDs include over the counter such as Aleve or Advil to prescription ones in pill form or topicals. These are great short term but can’t be used in conjunction with blood thinning agents such as xeralto or Coumadin or those with liver, gastrointestinal or kidney issues.
  • Counterirritants: some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these on the skin over a painful joint can modulate pain signals from the joint and pain.
  • Disease-modifying antirheumatic drugs (DMARDs): used to treat RA, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
  • Biologics: used with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).
  • Corticosteroids: prednisone and cortisone reduce inflammation and can also suppress the immune system that’s attacking the joints.
  • Muscle relaxants: to decrease spasms in the surrounding muscles. Some can be taken during the day to lessen the impact on muscles during busy and active days others have sedative effects to aid in sleep.

Physical therapies

I’m a big advocate of physical therapy to help patients learn ways to overcome the challenges of living with arthritis. It can take many forms, including:

  • Warm water therapy: exercises in a warm-water pool. The water supports weight and puts less pressure on the muscles and joints
  • Physical therapy: specific exercises tailored to the condition and individual needs, sometimes combined with pain-relieving treatments such as ice or hot packs and massage
  • Occupational therapy: practical advice on managing everyday tasks, choosing specialized aids and equipment, protecting the joints from further damage and managing fatigue

Ultimately the goal is to decrease the acute inflammation or flare and teach ways to effectively relieve pain at home.

Diet

There is no specific diet that treats arthritis, but some types of food may help reduce inflammation. Generally fish, nuts, fruits, vegetables beans, olive oil and whole grains are thought to be beneficial.

Self-management

Key strategies include:

  • Staying physically active
  • Achieving and maintaining a healthy weight
  • Getting regular check-ups 
  • Protecting joints from unnecessary stress
  • Hot and cold therapies, baths, salts
  • Improving sleep
  • Ask for help when needed 

Natural therapies

I have discussed natural remedies including supplements, herbs, spices and foods that may help different types of arthritis. Always check with your provider before starting since they may interact with medications or exacerbate certain medical concerns.

Living with chronic pain is overwhelming. Just knowing we aren’t alone and that viable options exist to make our lives easier can make all the difference. Talk to your provider today.



-cdc.gov/lupus/facts/detailed.html

-mayoclinic.org/diseases-conditions/arthritis/diagnosis-treatment/drc-20350777

-google.com/search?q=arthritis+exam&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari

-.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653

-everydayhealth.com/arthritis/physical-examination.aspx

-hopkinsmedicine.org/health/treatment-tests-and-therapies/arthritis-diagnosis

-arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/12-best-foods-for-arthritis

-arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/best-spices-for-arthritis

-medicalnewstoday.com/articles/7621#natural_remedies

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