Arthritis Pain

By Dr. Robert Schwartz

The diagnosis and treatment of osteoarthritis is more effective when related conditions are considered. Arthritis is a general term that refers to many rheumatic diseases that can cause pain, stiffness, and swelling in the joints and other connective tissues. These diseases can also affect supporting structures such as muscles, tendons, ligaments, and other parts of the body. Some common types of arthritis are:

• Osteoarthritis
• Rheumatoid arthritis
• System lupus erythematosus
• Gout
• Ankylosing spondylitis
• Psoriatic arthritis 

Osteoarthritis, which is very common, is also referred to as degenerative joint disease (especially when it occurs in the spine). It occurs when bone-on-bone surfaces become irregular. Think of a tight, squeaky door hinge, where the surface of the hinge has become rough or maybe a bit rusted. Osteoarthritis may involve any joint; however, large joints such as the hip or knee and small joints in the fingers are often involved. After age 30, almost everyone has some kind of x-ray evidence of osteoarthritis, so it is easy to see why it is frequently diagnosed for aches and pains.

There is, however, a lot more to the story. Many people who have x-ray findings of arthritis have no pain at all and others obtain full relief of their pain by treating associated non-arthritic conditions.

Anything that can affect how the joint or hinge functions can also cause pain that feels like it is coming from the joint. When these sources are outside the joint they are called extra-articular sources of pain. Examples include a loose hinge pin (the ligaments that hold the joint together are weak), an irritated nerve that supplies the joint, a hinge that is jammed (the joint is subluxed), or a joint that closes improperly (the muscles surrounding the joint are so tight that motion results in jamming).

Making it Better

Arthritis doesn’t have to get worse if you take care of the joint (hinge). By treating all of the structures that surround or affect the joint, both pain relief and prevention are possible. One simple technique is to give the joint freedom of motion by stretching muscles that are tight or inhibited around the joint and strengthening both the muscles and ligaments around it.

If a nerve is irritated, then the muscles that are supplied by it will go into spasm. In this case, stretching provides short-term relief and the nerve irritation must be treated medically to provide lasting relief. Proper nutrition and disease management are very important too, as optimal wound healing cannot occur without it.

Injections may be used to reduce inflammation of the joint or associated nerve, reduce muscle spasm, and to regenerate (proliferate) the ligament. If the joint itself is badly arthritic, an injection of artificial cartilage to help lubricate the joint or natural growth stimulating factors can also be effective. Most of these treatments are combined with exercise, anti-inflammatory medicines, and physical therapy.

In the most severe cases, joint replacement surgery may be required. If you have non-osteoarthritic rheumatism, than medical management directed toward stopping inflammation is important as well. In any instance, treating extra-articular structures (when they are involved) provides more options for people with pain, weakness, or functional impairment from arthritis, regardless of its form.

About the Author: Dr. Schwartz is an advisory board member on Pain.com, and is the owner and medical director of Piedmont Physical Medicine & Rehabilitation, P.A. in South Carolina. You can learn more about his services at www.piedmontpmr.com.