How It Hurts
Different types of arthritis can cause different types of pain.
For many Americans, arthritis and related diseases cause debilitating, life-changing pain. According to the Centers for Disease Control and Prevention, more than third of the adults who have arthritis report that it limits their leisure activities and work. And 25 percent of them say it causes severe pain (seven or higher on a zero to 10 point scale).
There are more than 100 different forms of arthritis and related diseases. The most common types include osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), fibromyalgia and gout. All of them can cause pain in different ways.
Here’s an overview of what you may expect if you’ve been diagnosed with one of these conditions, as well as how to manage it.
In osteoarthritis (OA), the protective cartilage and fluid inside the joint begin breaking down due to years of use or injuries. This makes the movement of affected joints more difficult and painful. In time, bones may rub directly against one another inside the joint, causing severe pain. Inflammation can also result from this constant, painful friction. OA most often affects knees, hips, hands, and the spine. In most cases, OA does not affect the same joint on both sides of the body, such as both knees.
The intensity of pain varies from person to person. It can range from mild to moderate and may be manageable with drugs and regular physical activity. But for some it can be debilitating, making any movement of the affected joint almost impossible.
To ease pain and reduce inflammation, regular doses of nonsteroidal anti-inflammatory drugs (NSAIDs) are needed. To only relieve pain, acetaminophen may be effective with fewer gastrointestinal side effects. If pain is severe, an analgesic combined with an opioid, such as codeine or hydrocodone, is prescribed. In severe cases, surgery to replace the damaged joint may be the only effective treatment.
Non-medicinal pain relief has proven very beneficial for people with OA. These treatments include hot & cold therapy, topical rubs, exercise, physical therapy, and others.
In rheumatoid arthritis (RA), the joints are attacked by the body’s own immune system. The immune system normally protects a person from viruses, bacteria and other invaders. In people with autoimmune conditions (like RA), it becomes overactive and attacks healthy tissue. In the case of RA, the immune system goes after the lining of the joints, called the synovium. This causes a severe, chronic inflammation in the affected joints as well as low-grade inflammation throughout the whole body. Over time, the persistent inflammation breaks down the joint and damages it permanently. RA typically affects the joints on both sides of the body, such as both knees or both hands. Besides joints, RA can also affect internal organs like the liver, heart, spleen, and eyes.
People with RA often have flares of pain caused by sudden onsets of severe inflammation. The flares may last for days or weeks.
The pain caused by RA is usually treated by medications to control the disease by calming down the malfunctioning immune system. These include disease-modifying antirheumatic drugs (DMARDs) and biologic response modifiers (biologics). In addition, NSAIDs or analgesics may be taken.
In children, this type of inflammatory arthritis is called juvenile idiopathic arthritis (JIA).
Like in RA, in psoriatic arthritis (PsA) the immune system attacks the joints and causes inflammation and pain. It typically appears in people who have psoriasis. PsA can affect any joint in the body.
Besides swollen joints, PsA often causes tenderness or pain in the connective tissue where tendons or ligaments attach to bones (called the enthesis), such as at the heel or bottom of the foot. Lower back pain is also common.
The pain and inflammation in PsA is managed similarly to RA.
In fibromyalgia, chemicals that transmit signals between nerve cells (called neurons) are out of balance. This may cause the brain to sense pain more intensely. The imbalance can also disrupt the person’s ability to sleep deeply, which can lead to an increased sensitivity to pain. Fibromyalgia pain affects the body’s soft tissues, including muscles, rather than the bones and joints.
Unlike in other arthritis-related diseases, in fibromyalgia there are no visible signs of the disease or injury in the affected areas. Fibromyalgia is characterized by widespread musculoskeletal pain. Areas of pain are often near joints, and are usually very sensitive to touch and prone to intense pain. The pain may come and go or it may be constant. It can also migrate from one area of the body to the next (from the neck to shoulders and elbows). Besides pain, fibromyalgia is associated with other symptoms, such as fatigue, concentration problems, and mood disturbance.
To relieve fibromyalgia pain, doctors often prescribe drugs that fix the balance in the neurochemicals. These include antidepressants like selective serotonin re-uptake inhibitors (SSRIs) and anticonvulsant drugs like pregabalin (Lyrica). Among non-pharmacologic treatments, they also prescribe exercise, and acupuncture is helpful too.
In gout, high levels of uric acid is the problem. Uric acid forms when the body breaks down purines, substances that are found in the body as well as in some foods. When body the is unable to remove the uric acid quickly enough or if the body produces too much, it can build up in the blood (called hyperuricemia). Excess uric acid can form crystals in the joint. This results in painful joint swelling and inflammation. If gout goes untreated, these crystals can form lumps (tophi) in the affected joints or even surrounding tissues. Gout usually strikes in the large joint of the big toe, but can also affect other joints.
Most forms of arthritis pain develop and intensify slowly over time. With a gout flare, however, you can go to bed feeling fine and wake up with excruciating pain and tenderness.
First, the pain and inflammation of the initial attack is treated with NSAIDs, corticosteroids, or a drug called colchicine (Colcrys). Once the gout attack subsides, usually within days, several medications designed to control uric acid levels are available. You and your doctor will decide which one is best for you. Lifestyle changes, such as drinking more water and avoiding alcohol and purine-rich foods can also help prevent future gout attacks.
Other Arthritis-Related Diseases
Other forms of arthritis that cause joint pain include:
- Ankylosing Spondylitis—typically affects the spine and the joints of the pelvis;
- Polymyalgia Rheumatica—typically affects upper arms, neck, buttocks and thighs, and the aches and stiffness are most severe in the morning; the disease affects people over 50 years old and responds quickly to treatment with corticosteroids;
- Tendinitis and Bursitis—soft-tissue rheumatic conditions, in which the connective tissues and cushioning joint components become inflamed and painful.
The treatment includes NSAIDs, corticosteroids, DMARDs, biologics, or analgesic drugs.