Is It Arthritis — or Something Else? 

Released May 27, 2025

 

PODCAST OPEN:      

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. This podcast and other life-changing resources are made possible by gifts from donors like you. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts.

This episode of the Live Yes! With Arthritis podcast is brought to you in part by Amgen and Boehringer Ingelheim.

MUSIC BRIDGE

 

Cristina Schaefer: Hi, welcome to the Live Yes! With Arthritis podcast. I'm Cristina Schaefer, your host for this episode. I was diagnosed with rheumatoid arthritis 20 years ago, and I've been living with the ups and downs of this disease ever since. I'm also a longtime volunteer with the Arthritis Foundation and serve in various capacities at the local level here in Houston, Texas, and at the national level as well.

 

If you're like a lot of people with arthritis, you probably saw a number of different doctors with different ideas of what you had before you got the correct diagnosis. That's especially true with autoimmune arthritis, because the symptoms can look like other diseases.

 

For this episode, we're going to talk about why arthritis can sometimes be hard to diagnose and about some of the other diseases that may be confused with arthritis, especially those that can occur along with arthritis. Joining me for this conversation today is rheumatologist Dr. Eric Ruderman of Northwest Feinberg School of Medicine. Welcome to the podcast, Dr. Ruderman.

 

Dr. Eric Ruderman: Thank you, Cristina. It's a pleasure to be here today.

 

Cristina Schaefer: Thank you, Dr. Ruderman. Tell us a little bit about yourself and your area of specialty.

 

Dr. Eric Ruderman: Sure. I'm a rheumatologist, as you said, at Northwestern in Chicago. I've been there now for about 25 years. I've actually been in rheumatology for a bit more than that. And my area of focus primarily is inflammatory arthritis, rheumatoid arthritis, axial spinal arthritis, psoriatic arthritis. I do see people with systemic diseases like lupus or scleroderma, although we have real experts at our institution on those diseases, who often sort of take the lead with those patients.

 

Cristina Schaefer: How often do you get new patients that have been previously misdiagnosed?

Dr. Eric Ruderman: It varies. It depends on what the problem is. For people with rheumatoid arthritis, I think the misdiagnosis is often just missing it. The primary care docs don't understand that not all arthritis is just osteoarthritis through wear and tear; that there are active kinds of arthritis that cause joint pain and inflammation. I see less and less of that actually in the last 10 or 15 years. I think we've really made some headway as rheumatologists in primary care on giving them the things to think about and try to understand when they should be concerned about something a little bit more.

 

The one place that I do see a lot of misdiagnosis is axial spinal arthritis. These are typically young people with inflammatory back pain, and that can be really problematic. And very often they've seen a number of different other providers who've just tried, basically, to manage them as mechanical back pain without recognizing the underlying issue. And until you do that, you can't really make any headway at making them better and feel better.

 

Cristina Schaefer: Aside from the back pain, what other symptoms can be misleading for doctors when they are diagnosing?

 

Dr. Eric Ruderman: I think one of the things that I am very cautious about, and I try to work with the primary care docs who refer to us, are lab tests. Lab tests are helpful if they support what's going on clinically. But there are very few cases where you can make a diagnosis just based on a lab test. In rheumatoid arthritis, for example, probably 75 or 80% of people who have that disease have a positive rheumatoid factor. Well, that means that many don't, and so having that test be positive or not isn't the diagnosis; it's a piece of the diagnosis. And by the same token, there are people with a positive test who don't have disease, that sometimes you just get false positives.

 

So, I think that's a big issue, sort of not being misled by what shows up on the lab test and assuming that that's the primary issue, if it doesn't fit what's going on clinically, what the patient is telling you. The number one thing to focus on is symptoms and not the labs. It can be challenging, because a lot of the symptoms of our diseases — rheumatoid arthritis, for example, psoriatic arthritis, lupus — are very nonspecific: fatigue, pain, just feeling unwell, rashes, you know. And again, there's no single thing that helps you say, OK, this is the diagnosis, or it isn't.

 

It really is a combination of everything and listening to everything that's going on, and then saying, well, OK, what is the most likely reason for all this? And then that's where labs come in. Can I use lab testing or X-rays or other imaging studies to confirm it, so that we can move ahead at treating somebody?

 

Cristina Schaefer: What advice do you have for people who feel like they've been misdiagnosed?

 

Dr. Eric Ruderman: You have to listen to your body. So, if you really feel like they haven't gotten to the truth or the issue, then you have to advocate for yourself. And don't be afraid to tell the physician you're seeing, or whoever you're seeing, “You know, I'm not sure. I think there's more to it than that. I don't feel like that's the answer to everything.” And talk to them about it. Because sometimes there are issues or symptoms that they didn't realize you had that weren't clear, and that may change the story.

 

At the end of the day, it's really about talking to your provider, whether it's a physician or a nurse practitioner or a PA, whoever's working with you, to say, you know, “Does this really identify what's going on, or are we missing something?” And just be open with them.

 

Cristina Schaefer: Now, some people feel awkward about getting a second opinion. When do you suggest that somebody get a second opinion, and what would you tell a patient that's considering a second opinion?

 

Dr. Eric Ruderman: I think that can be a great idea in lots of situations. I always tell my own patients, "Look, if you don't think that I've got the right answer, go talk to somebody else." I'm not disturbed by that. Sometimes it's not even just a second opinion; it's just not a good fit, and it's not a good connection. And I tell people, “If your physician is somehow angry about you seeking a second opinion or unhappy with it, yeah, that's probably not the right physician for you.” That you need to find somebody who’s willing to say, “Look, the first thing we're trying to do is make you better. And if I don’t have the answers for you, if somebody else can weigh in and give us some ideas, I think that’s great.”

 

On the other hand, be aware that when you go for a second opinion, if the second opinion says, “Yep, that’s what I think is going on,” maybe they were on the right track in the first place. And then you have to sort of rethink your own situation and reframe what’s going on and say, “OK, maybe that’s what it is. Now let’s figure out what we're going to do about it.”

 

Cristina Schaefer: OK, great. Thank you.

 

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Cristina Schaefer: I'd like to talk about some conditions that sort of overlap with arthritis and are considered arthritis-related, but aren't arthritis, like Sjögren's or fibromyalgia, lupus. How are these related to arthritis and what are they?

 

Dr. Eric Ruderman: That's a great question, and think those things come up a lot. I'm going to step back a little bit and just talk about: What is arthritis? So as a rheumatologist, we see people with arthritis. The Arthritis Foundation has talked about this for a long time, that there are more than a hundred different kinds of arthritis.

 

When you think about arthritis, I think the first thing you have to remember is: There are really two broad categories. There's osteoarthritis, or degenerative arthritis, which is really a function of basically wear and tear, you know, in your knees, in your hips, sometimes in your hands. In the spine, it's degeneration of the discs over time that leads to arthritis in the vertebrae. And that's a very different story, because, to date, we don't really have any good treatments to stop that process. It's a real sort of progressive, degenerative process. But most of our treatments, they are aimed at treating the symptoms and managing the symptoms. And in the worst cases of terrible knee or hip osteoarthritis, it's joint replacement surgery, to say, "Well, this joint is not working anymore. Let's put in a new joint."

 

The other kind of arthritis is inflammatory arthritis, where there's a process, in many cases, a more systemic sort of body-wide process that drives inflammation and swelling and pain and fluid in the joints. And there we've made huge progress in the last 20 or 30 years, with medications that can really block that process and shut it off and really improve symptoms. And so, when we talk about arthritis-related diseases, I think there we're sort of thinking about arthritis as a symptom of the disease, but not the sort of diagnosis per se.

 

So, people with Sjögren's, which is a disease of glands, where they get dry eyes, dry mouth, because their tear glands don't work very well, their salivary glands don't work as well, those people can get joint symptoms with that, sometimes pretty severe joint symptoms. That's really part and parcel of the whole disease. Same with lupus. Lupus we think of as an autoimmune disease where you have your own immune system sort of targeting different places in your body and disrupting normal processes, whether it's kidneys or lungs or what have you, or skin, in the case of rash. And there again, they can have arthritis. That's part of the bigger picture.

 

So, it's not so much that you've misdiagnosed that disease as arthritis or vice versa, but more that you have to recognize that the arthritis is sort of part of the bigger picture disease. And if you don't see the bigger picture, you're not going to really address things as well as you can and make people feel better and do better.

 

Fibromyalgia is a little bit different, and fibromyalgia is a pain syndrome, it's a central pain syndrome. These are people who have pain in lots of different places that's really out of proportion to what's happening there. Like, if you do imaging or X-rays, the joints don't look disrupted, they don't look abnormal, there's no inflammation at the spot. And there it's really more about pain and the way your brain processes pain signaling.

 

Those patients end up in rheumatology very often because of the pain as their sort of presenting symptom, and that's something we see a lot in our arthritis patients. But it isn't arthritis, it isn't the joints themselves where the problem is. It's really in sort of the way your pain circuits are working, that they're sort of firing on too many cylinders, and that has to be dialed back. You have to deal with it differently, because many of the things that we use to treat the inflammation and the primary process don't really address that kind of pain, because that's not what's making that pain happen.

 

Cristina Schaefer: What about polymyalgia rheumatica and spondylitis?

 

Dr. Eric Ruderman: Yeah. So, those are two important things to think about. So, polymyalgia rheumatica, it's interesting, when you see the name, it's actually misnamed. Myalgia is muscle, right? Myalgia we think of as muscle pains and muscle aches. And patients with polymyalgia rheumatica, or PMR, which is what it's usually referred to as, often have a lot of shoulder and hip pain. The original thinking was, well, that was something wrong with the muscles around the shoulder joint, the muscles around the hip joint, but in fact, it's the joints. And if you do some more advanced imaging, which we don't typically do, because we don't need to, there's actually inflammation and arthritis in the joints per se, in the shoulders and the hips. So, it's really an arthritis itself. It's just a different kind of arthritis that tends to, for reasons we don't really understand, focus on those particular areas: the shoulders and the hips. Although it can actually be in many other joints as well.

 

Spondyloarthritis or spondylitis, the spondy there, the root there is spine. So spondy is sort of spine disease, and you have to sort of recognize what's causing the problem in the spine. When we think about spondylitis, a lot of times we're thinking of inflammation. And is this an inflammatory disease that's causing inflammation in the spine and therefore pain? And you can see that with some of our other kinds of arthritis, rheumatoid arthritis patients, particularly. People who've had really severe disease for a long period of time can get neck involvement and get a lot of inflammation in the joints around their cervical spine and their neck, which is part of the rheumatoid arthritis.

 

People with psoriatic arthritis can get lower back involvement in the lumbar spine, sort of above the hips. Sometimes people will get termed as spondylitis, and what somebody's really referring to there is, they looked at an X-ray of your back and saw a lot of bone spurs and where the discs have sort of narrowed down. That's, again, more degenerative, and you have to sort of separate those things out.

 

As we get older, our discs, which are our shock absorbers in our back, they tend to work less well as shock absorbers. They tend to sort of lose some of the water in them, so they're a little more brittle, and they don't really absorb the shock in your spine as you walk around from day to day. And without that, then the bones around them become more arthritic, they develop bone spurs, just because of the different pressures that are at play because you don’t have the shock absorption qualities.

 

Cristina Schaefer: When we hear the term, rheumatic disease, what's the difference between arthritis and rheumatic disease?

 

Dr. Eric Ruderman: Arthritis is a broad term, and it's just anything that's causing a problem in the joint. And that includes both osteoarthritis, or wear and tear, or rheumatoid arthritis or other kinds of inflammatory arthritis. And when we think about rheumatic diseases, there's no specific answer to that, but that's sort of a broader term to talk about the things in which arthritis is a part of the process, but it's a much more global process.

 

I guess the key there would be: If you have osteoarthritis in a knee or in a hip or in your spine, that's where the problem is. It's a local problem in that joint that's hurting you, and it's causing trouble for you. But if you have rheumatoid arthritis, even if it's the knee that's hurting you today, it's a bigger picture. It's a bigger problem, because it's a whole body-wide disease that can cause all sorts of other problems, either in other organs or as a result of the inflammation.

 

And it may move to another joint, which is something that osteoarthritis doesn't do.  You may eventually get it in the other knee, or you may eventually get it in your hip, but it doesn't move around as much. And it's not like, well, this month it's my knees that are hurting me, next month it's my wrists, or a year from now it's my fingers. It isn't like that. And so, when we think about rheumatic diseases, we're thinking about things where it's really systemic. It's the whole body that's involved with the disease and the process. And if you don't see that and recognize that, then you miss the opportunity to treat people appropriately, because you have to treat that whole general systemic process.

 

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Cristina Schaefer: What are some rheumatic diseases that can occur along with arthritis?

 

Dr. Eric Ruderman: Those are the things that we've talked about already a little bit, things like Sjögren's disease, or lupus, or scleroderma. And in many of those, the systemic manifestations, the systemic problems, really are front and center, and the arthritis is kind of a piece of it, maybe sometimes even a smaller piece of it. Which is different from something like rheumatoid arthritis, for example, where the joints are really the primary issue for many, most people. And yet you can't forget that there are systemic issues and systemic implications. And so, you just have to sort of think about the sort of bigger picture and make sure you're addressing all of that and not just focusing on the joints that hurt.

 

Cristina Schaefer: Are conditions like bursitis, tendinitis and carpal tunnel syndrome rheumatic diseases?

 

Dr. Eric Ruderman: Not generally in the same way that we think about, you know… when a rheumatic disease as I just described it. So, bursitis and tendinitis are more local problems. Bursitis in the shoulder, or bursitis at the hip, or in the knee. Tendinitis, they're local inflammation, in a tendon where it attaches to the bone, or in a bursa. And a bursa helps protect the tendons from rubbing on the bone, and they can get inflamed and irritated, but it's kind of a local problem. It gets a little bit more confusing, because bursitis and tendinitis can pop up as part of a bigger picture, like rheumatoid arthritis or psoriatic arthritis. But in many, many cases, it's really just local and doesn't necessarily represent something broader and more systemic.

 

Carpal tunnel can be a little tricky. Most often, carpal tunnel syndrome is a local problem. But in some people with hypothyroidism, who have a low thyroid, that's an endocrine problem, not rheumatology. But they can get some swelling, and they're more prone to getting carpal tunnel syndrome. Pregnant women frequently get carpal tunnel syndrome. But where it gets more challenging is that, in some cases, it actually is part of a rheumatic disease, and it's not uncommon for somebody with rheumatoid arthritis to tell you that, as much as a year or two before they developed their joint symptoms, they had a really troublesome carpal tunnel syndrome area issue. Sometimes that is sort of the first sign of wrist arthritis and inflammation in the wrist.

 

Cristina Schaefer: Now what about Lyme disease? How is that classified, and how does that affect patients?

 

Dr. Eric Ruderman: Lyme disease is an infectious disease. It's caused by a particular kind of bug, called the borrelia burgdorferi. It's a kind of a… It's not a bacteria, but it's like a sort of a cross between bacteria and a virus. And it was actually first identified many years ago in Lyme, Connecticut. And it was first recognized by a rheumatologist, because some of those patients, as part of the infection with this particular bug, can get arthritis later. And so, arthritis can be one of the symptoms of it.

 

It's not part of the acute infection. Acutely, you can get a rash, you can get some sort of fever and just feeling unwell symptoms, but the arthritis and some other sort of late manifestations of that issue can come up later after the infection. And it requires a different sort of treatment. It's around — I think people think about that probably much more than it actually is the case, because it's not a very, very common cause of arthritis. And it's something we think about most if you have one or two particularly swollen, persistent joints and you don't have another good explanation, then we sort of look for that.

 

Cristina Schaefer: Another question we have for you: With so many people that suffer from osteoarthritis, what kind of doctors should someone see if they have local problems with osteoarthritis or bursitis?

 

Dr. Eric Ruderman: When you have osteoarthritis, your treatments are going to be things that address the local issue, medicines that help with pain. Physical therapy, exercise, ultimately even surgery. And those are things that your primary doctor can typically do. We get involved when we think there's something broader and a bigger picture going on, because they don't have the expertise for that. I mean, you wouldn't expect your primary care physician to know all the possible biologic medicines that we're using to treat rheumatoid arthritis. But treating osteoarthritis with an anti-inflammatory or pain medicine, or referring you to physical therapy, is a little bit more straightforward, and they're certainly going to be able to do it.

 

And I think the other thing that… One of the challenges we've struggled with is: There are a lot of people with arthritis. There are not enough rheumatologists to see all those people with arthritis. And so, we try very much to make sure that we're using the time we have available in clinic and in our office to see patients, to see the patients where we have specific expertise that can really help manage their disease. And that's the rheumatoid arthritis and the lupus and the psoriatic arthritis and all those things we've talked about.

 

Cristina Schaefer: What should people with arthritis do if they start experiencing symptoms that are new or different?

 

Dr. Eric Ruderman: If you have a rheumatologist, talk to your rheumatologist, or a primary care doctor, because, you know, that's always a signal to me that maybe something new is going on. In someone who has rheumatoid arthritis, for example, who's been doing really well, if they suddenly have tremendous pain and swelling in one joint that just wasn't there a lot, I worry a little bit about an infection or something else going on that has changed. So, I think really the issue is: Talk to your physician, talk to your rheumatologist if you have one, and say, "Listen, this is the story of my disease, this is what I'm used to. Something's new, something's different."

 

Sometimes it's just the disease itself has sort of shifted and changed a little bit, and it may very well be that's all it is. But if you know that this is how you usually feel, and particularly if you say, "Look, when my RA is active, when I'm feeling it's a flare, this is how it feels; and this is different, something's different." I always listen to people when they tell me that, because they know that this is the way this disease usually tells me it's flared up, and it feels like something else is going on. Then you’ve got to look around and see is there something more happening.

 

Cristina Schaefer: Absolutely. I mean, in the 20 years that I've had rheumatoid arthritis, there have been different parts of my body at different periods of my life that have affected me. For example, my last few flares, my knees and hands, they're fine, but it was my lungs and eyes that were being affected. And of course, working with my rheumatologists and seeing an eye specialist, seeing a pulmonologist to double check on some of those things, was helpful. But again, having those conversations with my rheumatologist.

 

Dr. Eric Ruderman: Absolutely. And I'm sure when you went to your rheumatologist, said, "Listen, I have got an eye problem." They said, "Well, wait a minute, we do see that with rheumatoid arthritis sometimes, and we better check into it." And your rheumatologist is going to say, "And I'm not the person who can tell you what it is. You need to see an ophthalmologist who can really look into it and tell us." That's a perfect example, and it's you notice that something is new for you, it's worth checking out.

 

On the other hand, I will say that I always listen to people when they say —well, it's not even the other hand, same thing — when they say, "This is how my flare always is, and this is not like that, something's different." In our hospital, very frequently, somebody who comes into the emergency room with a symptom and has a history of lupus or Sjögren's or rheumatoid arthritis, the first thing they say in the ER is, "Oh, it must be that." And it isn't always that. And a lot of times, they don't always listen, but a lot of times, patients know that. So, when a patient comes in and says, "This is how my disease always feels like when I'm flaring, and this feels different." I listen to that, because they know what's going on, and it's worth taking another look to say, "What are we missing?"

 

Cristina Schaefer: Are there other things people should know about arthritis-related conditions or arthritis-like conditions?

 

Dr. Eric Ruderman: So, I mean, certainly with arthritis, and particularly things like rheumatoid arthritis or psoriatic arthritis or whatever, you do need to know that this is your whole body, just like you experienced, Cristina. I mean, when your eyes are involved, that was obviously not likely to be the first thing on your mind when you said, "Well, this must be my rheumatoid arthritis." It isn't necessarily.

 

The thing people need to know is that, when we're dealing with the kinds of things we're talking about, rheumatic disease, systemic arthritis, there are other parts of the body, other organs, that can be involved that aren't just joints. And so, be aware of that. Sometimes it is something totally different, and I think that's important, but be aware of that so that you can look into it. On the other hand, if you have osteoarthritis and you have an eye problem, it's not going to be related to the osteoarthritis. It just doesn't happen, that's a local problem. I guess it's just awareness of the general sort of systemic nature of disease, to bring that up and say, "Listen, what else is happening here?"

 

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Cristina Schaefer: For this episode we asked our social media followers: "Have you ever had symptoms you thought were from arthritis but turned out to be something else? What was it?" We actually had hundreds of really interesting responses, ranging from the medication side effects, to torn ligaments, to diseases they never knew existed, like Fong's disease and 70 hereditary hemocytosis. So, here's a few, maybe you can weigh in, Dr. Ruderman. We had Melissa Palmer, who said, "Frozen shoulder. I thought I had arthritis in my upper right arm. It turned out it's a symptom of menopause."

 

Dr. Eric Ruderman: So, it can be, but it can be a symptom of a lot of other things. So, that was an interesting one. The shoulder is a joint, but the actual joint part of the shoulder is very small. Much of what makes up what we think of as the shoulder joint is not bone; it's not joint per se, it's the rotator cuff, and that's ligaments and tendons around the shoulder, which is what allows you to have such tremendous mobility of your shoulder. A frozen shoulder happens when you've had usually some injury or some problem with the rotator cuff. And as a result, it just tightens up, and the whole cuff sort of tightens up, and it makes it harder to move your shoulder around.

 

There are a lot of things that can do that. It can happen just because. It can happen because of a previous shoulder injury that might have happened. It tends to happen more, for reasons I'm not sure I entirely understand, in people with diabetes. But it is a real problem, and it is arthritis, because it's the shoulder, the greater shoulder joint, that's involved. But there's a different issue, and the management is very different. It is really sort of more about local management, with injection potentially, or physical therapy, to sort of get your range of motion back.

 

Cristina Schaefer: Lori Morrow Gordon said, "I was five hours into a heart attack, believing it was a bad flare. My hands and arms hurt so bad."

 

Dr. Eric Ruderman: I want to be careful about it, because I don't know exactly what was going on, but I would say one of the things that comes to mind when I hear this is to remember that our patients who have lupus or rheumatoid arthritis or any other diseases are much more prone to cardiovascular issues: heart disease, heart attack, strokes, things like that. And it's because of the inflammation associated with the disease.

 

People with rheumatoid arthritis, you know, people don't end up dying or in the hospital because of the rheumatoid arthritis; it's typically a stroke or a heart attack or something else. Because all of the inflammation from the rheumatoid arthritis affects all your blood vessels, and that could be a problem. Thankfully, we see a lot less of that now, because the medications that we use are so good at treating the inflammation and treating the underlying process that that sort of downstream effect doesn't happen as much.

 

The other piece of this, too, is women get unrecognized. Women who have a heart attack, and I mean, nobody ever thinks that a 42-year-old woman is having a heart attack. I mean, it just doesn't make any sense. And so, you go to the ER and people tend to blow you off. And yet our patients with lupus or rheumatoid arthritis, they're the ones where that can happen. And even more importantly, women with heart attacks can present with very different symptoms. They're not the typical sort of crushing chest pain that goes down your left arm that you read about. That's the sort of standard symptom that men have with a heart attack; women get different symptoms.

 

The lesson to be learned is if you have a rheumatic disease, and you get any kind of discomfort in your chest, it's usually not going to be a heart attack. But be aware that it's something to think about in your situation when maybe somebody otherwise wouldn't if you didn't have your underlying disease.

 

Cristina Schaefer: Several people mentioned fibromyalgia. One in particular, Julie Ash, said, "I was diagnosed by a rheumatologist as having arthritis, and I was on medication for arthritis that made me ill. It turned out I had fibromyalgia all along. They assumed I had arthritis because I suffer with psoriasis."

 

Dr. Eric Ruderman: The key there is they recognize that fibromyalgia can cause a lot of similar symptoms. It causes a lot of pain, it can be pain in joints, but the difference is often it's pain in joints and muscles and other places as well, and not specifically in the joints. And as I sort of mentioned at the outset, it's even more complicated, because many of our patients, many of the people I see with rheumatoid arthritis, for example, have some component or some element of fibromyalgia. Which is really that they have pain that was probably triggered by their rheumatoid arthritis pain, but it isn't inflammation pain. And so, changing their medication, if they're on a biologic medicine and they're having more pain, changing that isn't going to fix the pain if it's not the inflammation that's driving the pain in the first place.

 

The psoriatic arthritis that she's talking about or the psoriasis is even a bit more complex, because about a quarter of people who have psoriasis will get some arthritic symptoms associated with it. Either tendon problems or joint problems or spine problems or whatever. And there aren't good, clear-cut ways of diagnosing that and making sure that's what it is. And that's where it gets a little bit tricky. Not everybody who has psoriasis, who develops some joint pain, has psoriatic arthritis. Sometimes it is osteoarthritis, and sometimes it's fibromyalgia; sometimes it's just pain.

 

And you know, I suspect that what she found was that the medicine she was taking to try to treat the arthritis didn't help. Well, they didn't help, because that wasn't what was causing the pain. And so, you always have to think about: Where's the pain coming from? And sometimes it's both. I have many, many people I treat who are on biologic therapy for their inflammatory arthritis but also have this other kind of fibromyalgia-like pain and need other approaches to deal with that. Whether it's medicine, or physical therapy, or exercise, or better sleep; all those things.

 

Cristina Schaefer:

So, speaking of medication, Carol Arbaczewski said that she was affected by a blood pressure medication. She said, "After my rheumatologist said she didn't think my foot swelling was from RA, I read all the info about the blood pressure medication, and sure enough, swelling of feet was listed near the top of possible side effects."

 

Dr. Eric Ruderman: Yeah, anytime you take a medicine, especially when you add a new medicine, if you get new symptoms, the number one thing on your list needs to be to say, "Well, maybe the medicine is the problem here." And many blood pressure medicines lower your blood pressure by trying to dilate your arteries. The blood is sort of spread out more, and the pressure goes down. But in doing so, sometimes they cause the arteries to be a little leaky, and that's how you develop edema and swelling in your feet; it's not uncommon with lots of different kinds of blood pressure medicine.

 

And so, you have to sort of think about, "Well, what is it?" And you know, I suspect that what the rheumatologist was saying is, "Look, you have swelling in your feet, but it's not joints, it's all the tissue in the feet. And so, there's some other reason."  I see that a lot. People come in and say, "Well, I think this is my arthritis." If it's your arthritis, the swelling should be at the base of your toes or in your ankle or around your joints. But if it's like the whole foot and leg that's swollen, something else may be going on, whether it's a blood clot or medicine or something else. I think the lesson from this is: If you ever get new symptoms, and you've recently or fairly recently started a new medicine, that should be on the list of things to think about. Is it possible that that's what caused those symptoms?

 

Cristina Schaefer: Other people posted about garlic allergy, muscular sclerosis, long Covid and a lot of other surprising problems that can look like arthritis. We encourage our podcast listeners to go read them for themselves and chime in, on the Arthritis Foundation's Facebook page.

 

So finally, we wrap up each episode with our top takeaways from our discussion. Dr. Ruderman, would you like to go first?

 

Dr. Eric Ruderman: I'll take a crack at it. The first takeaway I would want you to have is to recognize that there are sort of different kinds of arthritis, and arthritis is not all the same. And if nothing else, realize that there are local kinds of arthritis, that's more wear and tear degenerative, and stuff that's more systemic and needs different kinds of treatment. I would say that the symptoms of arthritis are often not terribly specific. Sometimes your symptoms aren't necessarily arthritis, because they could be symptoms of something else. But sometimes symptoms that turn out to be from arthritis, you don't recognize that because you didn't know that the people were thinking about other things. So, just be aware of the sort of non-specific nature of a lot of the symptoms that people get with arthritis.

 

I would go back to something we talked about earlier, and that was the second opinion question. And listen to your body, and know that if the answers you're getting aren't really addressing what you've got, look for more. And the best case is to talk to your own doctor and say, "Listen, I don't think so. I think there's something else going on." And work together to get to that. But if, in the worst case, you feel like you're just not getting those answers and you need another opinion, there's nothing wrong with doing that.

 

Cristina Schaefer: Yeah, I had very similar takeaways. With over a hundred forms of arthritis, it sounds like people can be easily misdiagnosed, or something can appear as something else. So, really important to track symptoms and communicate. As you just said, never be afraid to get a second opinion. It doesn't need to be awkward. But also, one thing that you said here towards the end, that if you do get a new medication, that can equate to some new side effects. So, you really just have to pay attention to what your body is telling you and different side effects you may be experiencing.

 

Dr. Eric Ruderman: I would add a caveat there, and I would just say: Be a little bit careful, because if you have a side effect, or if you have an issue, and you look up the medicine online, the list of side effects is endless. And before you assume that something's going on as a side effect, talk to your doctor to make sure: Is that really a common side effect? Or is it more likely that something else is going on? Just be careful about over-interpreting the side effects that you see if you Google the medicine online.

 

Cristina Schaefer: Dr. Ruderman, you've done an excellent job explaining everything today. We really appreciate your time.

 

Dr. Eric Ruderman: It was a pleasure, Cristina. Thank you for having me on here. The Arthritis Foundation is always a great source of information. We work very closely with them as rheumatologists and, you know, they do tremendous work on getting information out to people to help them find the ways to help themselves.

 

Cristina Schaefer: Well, that's it for this episode of the Live Yes! With Arthritis podcast. For more resources, educational opportunities and information about living with arthritis, be sure to visit arthritis.org.

 

PODCAST CLOSING:

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. For a transcript and show notes, go to arthritis.org/podcast. Subscribe, rate and review us wherever you get your podcasts. If you subscribe through Spotify, leave a comment on their platform, letting us know what you think about this episode. And stay in touch!