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Achy, Creaky, Painful Joints: Is it Arthritis? (Arthritis Series: part 1)

Sometimes if you have joint pain and stiffness and you are middle aged or older it can just be assumed that you have arthritis. I have had many patients say that they were told by their doctor that their joints are getting old and are now arthritic. Some people blame their arthritic knees on the football they played in high school and while there may be some truth to that, it is not the whole story.

We can have more wear and tear on certain joints if we have injuries that never fully healed or we have imbalances in the body that put extra strain on certain joints or muscle groups. But our joints should recover if given the right care and nutrition.

So what is Arthritis?

Arthritis is defined as acute or chronic inflammation of a joint, often accompanied by pain and structural changes and having diverse causes, such as infection, crystal deposition, or injury. (1) Characterized as painful inflammation of the joints arthritis is not a single disease, but there are more than 100 different types of arthritis and related conditions. Affecting more than 50 million adults and 300K children worldwide, it is the leading cause of disability in the US (2). Risks of developing arthritis increase with age and is more commonly seen in women.

The symptoms of arthritis can vary in intensity and presentation. Pain is the most common symptom for all types of arthritis. The pain can range from mild to severe and can come and go or be constant, it can be dull and achy or sharp and stabbing. There can be inflammation of the joints seen as swelling, pain, warmth, and redness which can also come and go. Most people find the pain and stiffness worse in the morning or after periods of inactivity. They might be very stiff and sore when they first get out of bed but then get better as the day goes on and they are up and around. Pain can be better with movement, but overdoing can also aggravate the pain. Over time there may be decreased range of motion of the affected joints making some daily activities, such as climbing stairs, difficult. As the disease progresses the joints may become deformed and other tissues around joint may become affected.

Some types of arthritis can affect the heart, eyes, lungs, kidneys, skin as well as joints. Other secondary symptoms often reported with arthritis include fatigue, malaise (feeling unwell), weight loss, loss of strength, muscle atrophy, depression, and insomnia. When the disease flares there might also be fever, and swollen glands.

If you go you a primary care doctor for joint pain and stiffness, it is likely that they will send you for some x-rays or imaging (MRI) and possibly some blood work. Your primary care doctor may send you to a Rheumatologist who will do further testing to try and determine the type of arthritis you have. Like I said there are about 100 different types of arthritis, but here is the basic rundown on the four most common types.

Osteoarthritis (OA) is the most common type of arthritis. It is a condition where the padding of the joint wears away and over time the joint space shrinks and the bones start to rub against one another. This causes swelling and pain with stiffness at the joints. Onset of OA is usually gradual, starting in third to fourth decade of life and progressing through old age. Almost all persons have some pathological changes in joints by the age of 40, though few will have symptoms.(3) OA commonly starts at the bigger, weight bearing joints such as the hips and knees, but can progress to the smaller joints as well. As the disease progresses there may be muscle atrophy and loss of strength. The bones will start to deteriorate at the point of articulation. On x-ray the joint space will be smaller than it should be and the ends of the bones may look ragged and rough.

Pain is the first outward symptom to appear, although joint damage has already occurred. Pain is often worse first thing in the morning with stiffness improving as joints get warmed up and start moving. At times the joints can swell and have visible inflammation.

OA is diagnosed by clinical presentation, and x-rays. Blood work may be done to rule out other types of arthritis or other joint conditions. Conventional treatment approach includes some lifestyle modification, possible physical therapy for exercise and stretching, and medications including NSAIDs for inflammation and muscle relaxants for muscle strain. As the disease progresses surgeries to “clean up the joints” or full joint replacement may be needed.

Gout arthritis was once call the “disease of kings” and thought of as a disease of the privileged because it was brought on by eating a rich diet. The disease is due to a buildup of uric acid crystals in the joints. Most common joint affected is the big toe, but it can also affect the joints of foot, ankles, hands, and wrists. Symptoms are usually severe and come on suddenly, and will alternate in waves of remission and flaring. First gout flare usually comes on at night after excess consumption of alcohol or other uric acid producing food, or a recent trauma or surgery.

Western diagnosis is done first with presentation and health history, then confirmed with checking uric acid levels in the joint fluid during an acute flare. Levels of uric acid in the blood may also be tested but can be misleading, often elevated, but sometimes normal or even low. Colchicine has been the standard treatment of gout since the 1800s (3) but due to its side effects of nausea, vomiting, and diarrhea, NSAIDS or steroids have now become the most common course of treatment. It is also recommended to avoid alcohol and other rich uric acid producing foods.

Rheumatoid Arthritis (RA) is an autoimmune type of arthritis where the body mistakes its own tissue as foreign and begins to attack it. About 1.5 million people in the United States have RA.(2) The cause of RA is not well understood, but onset is more common from age 30-60 and more likely in females than males. RA attacks the smalls joints in the hands and feet and will have symmetrical damage, affecting both sides of the body evenly. Joint deformity is common and joint damage is thought to be irreversible.

Diagnosis for RA is done with signs and symptoms and blood work. It is treated with NSAIDS, Corticosteroids, immunosuppressive drugs, and physical therapy. If needed surgery with joint replacement is also possible.

Psoriatic Arthritis, another autoimmune condition, is a combination of joint inflammation (arthritis) and skin inflammation (psoriasis). The skin disease precedes the joint disease in about 80% of people. Common joints affected are knees, ankles and feet, but it can also affect the back and fingers. Psoriatic Arthritis can also cause fatigue and inflammation of other organs such as eyes, lungs, and aorta.(4) Psoriatic mutilans is the most severe form of Psoriatic arthritis affecting about 5% of those with Psoriatic arthritis. Without treatment it can progress to destruction of multiple joints where bone tissue is reabsorbed by the body causing tissue collapse. Swollen fingers or toes, known as Dactylitis, is another common symptom occurring in 40% of Psoriatic Arthritis patients where there is inflammation along the entire tendon that runs along the finger or toe. Unlike RA, the joint pain in Psoriatic arthritis is asymmetrical affecting only one knee and not the other.

Diagnosis for Psoriatic arthritis is done with signs and symptoms, and possible blood work looking for genetic marks of predisposition for the condition. There have now been about 25 known genetic variants that can make a person more likely to develop psoriatic disease. Treatment for Psoriatic Arthritis, depending on the type and severity of disease, includes NSAIDs, Disease-Modifying Antirheumatic Drugs (DMARDs) and Biologics such as Enbrel or Humira.

For any autoimmune condition to be expressed, including RA and Psoriatic Arthritis, 2 factors must be present: A genetic predisposition and a triggering event. Common triggers include stress, some medications, infections, or trauma.

If you would like to learn more about arthritis and a natural approach to living pain free stay tuned to the next in this series on arthritis "Getting to the Root of Joint Pain" or check out my ebook The Arthritis Answer: Your Step by Step Guide to Living Pain Free.

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