What you don’t know CAN hurt you
by Dr. Ed Behling, CMO
As we accumulate birthdays, it often takes a little longer to get started in the morning. However, if you wake up with stiffness, and it takes an excessive amount of time to get moving, it could be a sign of a more serious condition.
The term “arthritis” is used to describe pain in the joints. Osteoarthritis, the most common type of arthritis, is a degenerative disease and occurs due to wear and tear on the joints, and there is very minimal inflammation. This type of arthritis is usually not associated with any significant degree of morning stiffness, and pain is aggravated by activity and improves with rest. Joint pain caused by osteoarthritis usually occurs after age 50 and is not linked to diseases of other organs.
On the other hand, inflammatory arthritis is an entirely different disease. This condition is caused by an overactive immune system that attacks the body’s own tissue. This generally causes warm joints that are swollen (“fever in the joints”), prolonged morning stiffness, and is frequently associated with signs and symptoms that involve other organ systems. This category of arthritis includes rheumatoid arthritis, lupus, psoriatic arthritis, gout, and other similar conditions.
The most common type of inflammatory arthritis is rheumatoid arthritis. While osteoarthritis affects men and women equally, rheumatoid arthritis is more common in women, especially if there is a family history of this disease. Because this is actually a disorder of the immune system, other organs, such as the skin, eyes, and lungs are often affected. Psoriatic arthritis, for example, is associated with a serious skin rash. The rash and joint pain are both improved with treatment.
In addition to the associated symptoms of inflammatory arthritis, this condition usually presents with a specific pattern. HopeHealth Rheumatologist Dr. Supen Patel states that the initial goal in evaluating patients with joint pain “is to determine if symptoms are caused by an inflammatory or non-inflammatory condition.” The age of onset of symptoms, number of joints, types of joints, family history, factors that make the pain better or worse, and other relevant information can be critical in achieving the correct diagnosis. Laboratory studies and x-rays are usually essential in this process.
Some people may feel that, as long as their pain is improved by an over the counter medication and a heating pad, they don’t need to seek additional evaluation. Actually, not knowing the cause of the joint pain can indeed hurt you – literally! Although controlling pain is part of the treatment, the main goal is to use medications to prevent the destruction of the joint which occurs over time. “The majority of people with auto-immune conditions are prescribed medications that manipulate the immune system,” said Dr. Harrell Docherty, a rheumatologist at HopeHealth. “Generally, symptoms will not improve without some type of treatment.” The body produces chemicals that attack the tissue in the joint, and the joint is destroyed, causing worsening pain and permanent damage.
Medications called “disease-modifying antirheumatic drugs” (DMARDs) can dramatically change the course of the disease, improve pain and function, and impact the patient’s life span. For this reason, it is critical for these disorders to be diagnosed early and treated promptly. Postponing therapy can have devastating consequences. These medications are often expensive, and individuals receiving treatment need to be monitored very closely.
As with all chronic conditions, the first step is an evaluation by a primary care provider. If an inflammatory condition is suspected, a referral to a subspecialist may be necessary. The goal of your health care team is to reduce pain and damage, improve physical comfort and mobility, and prevent the progression of symptoms and development of internal organ diseases. With proper treatment, many patients are able to achieve remission of the disease and lead normal lives.