Learn signs that differentiate simple joint pain from arthritis

Most of us at one time or another check in with our doctor with some type of joint pain. This becomes increasingly common as we get older. It’s helpful to learn what might be a simple overuse injury or mild degenerative arthritis, and what might be something more systemic like inflammatory arthritis. Here are some tips to help you sort things out.

Patients frequently come into my office with a painful or stiff joint, saying, “my knee is killing me,” but not feeling sure of the cause. Sometimes it’s an acute injury from overuse or damage that may take nothing more than a short period of rest or rehabilitation to resolve. But when people show up with warm, red, puffy joints, it can also be a sign that there might be inflammatory arthritis which can lead to damage and destruction of the joint.

There are many different forms of arthritis and related diseases. By far the most common is osteoarthritis, or OA, which we associate with swollen finger joints, aching ankles and painful knees and hips caused by the breakdown of cartilage in the joint. Osteoarthritis is a degenerative disease from wear and tear, injury, or aging, as well as contributing factors such as obesity or even previous surgery. Lifestyle modification such as weight loss, lower impact exercises and strength training can have a significant impact on the pain and disability caused by this disease.

Rheumatoid arthritis is an autoimmune disease where the immune system mistakenly attacks the membrane that lines healthy joints, causing inflammation and pain and eventually damaging the cartilage and bone. Another common type, gout, tends to affect one joint at a time, often the big toe initially. It is acutely and severely painful but quite treatable and manageable with medications and diet changes.

Aches and stiffness from age, injury or arthritis can all feel similar to many people. Here are some signs and symptoms that may indicate that you should get assessed for arthritis:

• Joint pain: Mild or severe pain in one or more joints, often worse in the morning or after long periods of sitting or inactivity, and sometimes with a grating feeling.

• Stiffness: Joints that feel stiff, difficult to move, or “locked up.”

• Swelling: Joints, especially in the hands, with swelling, red appearance, or feeling warm or tender to the touch.

• Reduced range of motion: Difficulty to perform certain activities or move your joints through their full range of motion.

• Fatigue: Some kinds of arthritis can cause fatigue and a generally unwell feeling or even fevers or skin rashes such as seen with Lupus.

Rheumatoid arthritis symptoms also tend to be symmetric – both hands, both knees, etc. – but are not always.

A physical exam, review of your medical history, and imaging tests or blood tests can determine if you have arthritis and what type it may be so you can get back onto the road to wellness.

For degenerative arthritis like osteoarthritis, a first line of treatment as symptoms flare up is often an anti-inflammatory NSAID (nonsteroidal anti-inflammatory drug) like ibuprofen or naproxen, or a pain reliever like extra strength Tylenol (which has no anti-inflammatory effects), taken for a few days with food and plenty of water. Please note that NSAIDs can have side effects including ulcers, kidney toxicity, stomach toxicity and high blood pressure, so you’ll want to discuss with your provider and use with care.

A patient recently came to see me with high blood pressure readings which were quite alarming, and they were concerned they had developed hypertension. After reviewing the patient’s medical history, we found that the patient had been taking ibuprofen regularly for arthritis in their knee. The NSAID was raising that patient’s blood pressure and once the medication was stopped, the blood pressure returned to normal, avoiding the need for anti-hypertensive medication.

Two things that can really accelerate both pain and damage from arthritis in all its forms are immobility and carrying excess weight. Reaching or maintaining your healthy weight can take stress off the joints in addition to all the other health benefits.

Movement is generally good for arthritis. There’s science behind the saying “motion is lotion.” Cartilage in the joints, which provides cushioning and support for the joint, breaks down and gets damaged from arthritis causing pain and stiffness as well as instability. Unfortunately, these structures are avascular – they don’t have a blood supply. Joint fluid helps to nourish and repair cartilage, but it needs to be circulated regularly through movement and joint motion can help with the healing process.

Finding the right low-impact exercise for you can improve function and reduce pain. Activities where the impacted joints aren’t bearing weight like cycling, swimming or water aerobics can also help slow the joint’s deterioration and adds motion and all the health benefits of regular exercise including weight loss. You may want to talk to your provider about what activities might be best suited to your needs, and about considerations like old injuries or cartilage repairs. Many health plans also include fitness memberships to get you going.

One other common form of arthritis with lifestyle considerations is gout, caused by a buildup of uric acid in the blood that can cause joint inflammation and pain. It’s often sudden and in just a single joint, painful to the point of making it hard to walk or move around. Increased alcohol consumption, high protein meals, sugary foods and lack of hydration all increase the risk for gout. It’s not uncommon to get a call from a patient vacationing at a beach resort saying their knee or big toe is so swollen and painful that they can hardly walk. The hot, dehydrating weather combined with extra helpings of steak, seafood, pina coladas and beer has resulted in an acute attack of gout. Not how you want to spend your vacation! Fortunately, lifestyle changes and some medicines can reduce risk for gout since it tends to reoccur.

If you are still having symptoms that are impacting your life after trying other approaches, there are surgical options for some types of arthritis including joint replacements and cartilage trimming. The rehabilitation process from these surgeries can be significant so conditioning and weight loss prior to surgery can make a huge difference in recovery. Consult with an orthopedist for osteoarthritis on your specific needs and considerations.

For rheumatoid arthritis, there are several disease-modifying medications, including the newer biologic agents, which can significantly reduced pain and joint destruction. These generally require referral and management by a rheumatologist.

About 23% of Americans have been diagnosed with arthritis and those numbers continue to rise with the increasing aged population. Joints wearing and breaking down over time can be a normal part of aging. But when arthritis or injury-related joint pain and stiffness begin to limit your life, cause frequent pain and impact what you are able to do, it’s time to get assessed by your provider.