Arthritis and deep muscle pain disease
There are many connections between arthritis and deep muscle pain. The first topic is the old charley horse. A charley horse is the common name for a muscle spasm, particularly in the leg. Muscle spasms can occur in any muscle in the body. When a muscle is in spasm, it contracts involuntarily and does not relax. Muscle spasms commonly occur when a muscle is over-used or injured. Working out when dehydrated or with low levels of potassium can also predispose a person to muscle spasms. Some spasms are caused when the nerve that connects to a muscle is irritated. The classic example of this would be a herniated disk irritating spinal nerves as they exit the back causing pain and spasm. Spasms in the calf commonly occur while kicking during swimming and can also occur at night while in bed. Upper leg spasms are more common with running or jumping activities. Spasm in the cervical spine (neck) can be a sign of stress. A strain is when a muscle becomes overstretched and tears. This painful injury, also called a "pulled muscle," can be caused by an accident, improper use of a muscle, or overuse of a muscle. Causes of muscle strain are: Excessive physical activity or effort Electrolye imbalance can also cause muscle cramping. Electrolytes are minerals in your blood and other body fluids that carry an electric charge. It is important for the balance of electrolytes in your body to be maintained, becausethey affect the amount of water in your body, blood pH, muscle action, and other important processes. You lose electrolytes when you sweat, and these must be replenished by drinking lots of fluids.Electrolytes exist in the blood as acids, bases, and salts (such as sodium, calcium, potassium, chlorine, magnesium, and bicarbonate) and can be measured by laboratory studies of the blood serum.Muscle pain is most frequently related to tension, overuse, or muscle injury from exercise or physically demanding work. n these situations, the pain tends to involve specific muscles and starts during or just after the activity. It is usually obvious which activity is causing the pain. Muscle pain also can be a sign of conditions affecting your whole body, like some infections (including the flu) and disordersthat affect connective tissues throughout the body (such as lupus).One common cause of muscle aches and pains is fibromyalgia, a condition that includes tenderness in your muscles and surrounding soft tissue, sleep difficulties, fatigue, and headaches. The most common causes are: Tension or stress Dermatomyositis is connective-tissue disease that is characterized by inflammation of the muscles and the skin. The cause of this disorder is unknown. It is theorized that an autoimmune reaction or a viral infection of the skeletal muscle may cause the disease. It can affect people at any age, but most commonly occurs in people 40 to 60 years old, or in children from 5 to 15 years old. It affects women much more often than men. Muscle weakness may appear suddenly or occur slowly over weeks or months. There may be difficulty with raising the arms over the head, rising from a sitting position, and climbing stairs. A dusky, purplish red rash may appear over the face, neck, shoulders, upper chest, and back. Joint pain, inflammation of the heart, and lung (pulmonary) disease may occur. A malignancy may sometimes be associated with this disorder. A similar condition is called polymyositis when the symptoms occur without any skin manifestations. Fibromyalgia is another rheumatic condition associated with deep muscle pain. Symptoms can overlap with autoimmune diseases and other musculoskeletal conditions making it difficult to diagnose. It is estimated that fibromyalgia syndrome affects about 2 percent of the U.S. population. Fibromyalgia is a common condition characterized by widespread pain in joints, muscles, tendons, and other soft tissues. Some other problems commonly linked to fibromyalgia include fatigue, morning stiffness, sleep problems, headaches, numbness in hands and feet, depression, and anxiety. Fibromyalgia can develop on its own, or secondary to other musculoskeletal conditions, such as rheumatoid arthritis, or systemic lupus. Diagnosis of fibromyalgia requires a history of a least three months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. These tender-point sites include fibrous tissue or muscles of the: Neck The major characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points. Tender points are distinct from trigger points seen in other pain syndromes. Unlike tender points, trigger points can occur in isolation and represent a source of radiating pain, even in the absence of direct pressure. Fibromyalgia pain can look like and feel like the pain that occurs with various types of arthritis. However, the significant swelling, destruction, and deformity of joints seen in diseases such as rheumatoid arthritis does not occur with fibromyalgia syndrome alone. The soft-tissue pain of fibromyalgia is described as deep-aching, radiating, gnawing, shooting or burning, and ranges from mild to severe. Fibromyalgia sufferers tend to wake up with body aches and stiffness. For some patients, pain improves during the day and increases again during the evening, though many patients with fibromyalgia have day-long, unrelenting pain. Pain can increase with activity, cold or damp weather, anxiety, and stress. In 1990, the American College of Rheumatology (ACR) listed two primary criteria for the classification of fibromyalgia. A history of widespread pain involving all four quadrants of the body (right side, left side, above waist, below waist) for a period of at least 3 months. More recent data indicates that there may be an increased sensitivity to pain throughout the body, pain may be migratory (move around) or may exist as chronic regional pain. Most experts are said to believe fibromyalgia results from abnormal central nervous system function. Response to stress and psychobehavioral factors may also contribute to fibromyalgia. Fibromyalgia primarily occurs in women of childbearing age. Children, the elderly, and men can also be affected. Besides the defining symptoms of pain and tenderness, there are many nondefining symptoms associated with fibromyalgia including: Fatigue, night sweats and sleep disturbances. Memory difficulties and cognitive difficulties. Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle fiber contents into the circulation. Some of these are toxic to the kidney and frequenty result in kidney damage. Myoglobin is an oxygen-binding protein pigment found in the skeletal muscle. When the skeletal muscle is damaged, the myoglobin is released into the bloodstream. It is filtered out of the bloodstream by the kidneys. Myoglobin may occlude the structures of the kidney, causing damage such as acute tubular necrosis or kidney failure. Myoglobin breaks down into potentially toxic compounds, which will also cause kidney failure. Necrotic (dead tissue) skeletal muscle may cause massive fluid shifts from the bloodstream into the muscle, reducing the relative fluid volume of the body and leading to shock and reduced blood flow to the kidneys. The disorder may be caused by any condition that results in damage to skeletal muscle, especially trauma.Risk factors include the following: Severe exertion such as marathon running or calisthenics Lipitor is a member of a class of cholesterol-lowering drugs called statins. The statins include lovastatin (brand name: Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor), and cerivastatin (Baycol) (Baycol was withdrawn from the market in August, 2001). Statin drugs are known to cause muscle pains and inflammation around the muscle cells (myositis). It should also be noted that the risk of muscle injury is greater when a statin is combined with other drugs that also cause muscle damage by themselves. For example, when lovastatin (Mevacor) is used alone to lower cholesterol, muscle damage occurs on the average in one person out of about every 500. However, if lovastatin (Mevacor) is used in combination with other drugs such as niacin, gemfibrozil (Lopid) or fenofibrate (Tricor) to further reduce cholesterol levels, the risk of muscle injury skyrockets to one person out of every 20 to 100 who receive the combination. The risk of muscle damage is thus multiplied 5 to 25-fold by using a combination of a statin and another cholesterol-lowering drug rather than by just using statin alone. The manufacturers of statins recommend that any patient taking a statin "should be advised to report promptly any unexplained muscle pain, tenderness or weakness.... When a muscle disease is suggested, the doctor stops the statin drug." Statin drugs cause three types of muscle conditions. First, they can cause muscle aching. This condition generally reverses itself within weeks of discontinuing the drugs. Second, they can cause muscle pains and mild muscle inflammation that may also be accompanied by minor weakness. Blood testing for the muscle enzyme, CPK, is mildly elevated. This condition also generally reverses, but it may take several months to resolve. Third, statins can cause severe muscle inflammation and damage so that not only are the muscles painful all over the body, they also become severely weakened. Heart muscle can even (rarely) become affected. Blood testing for the muscle enzyme, CPK, is markedly elevated. When the muscles are severely damaged, the muscle cells release proteins into the blood that collect in and can damage the kidneys. This can lead to kidney failure and require dialysis. Lupus is a type of immune system disorder known as an autoimmune disease. In autoimmune diseases, the body harms its own healthy cells and tissues. This leads to inflammation and damage of various body tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Although people with the disease may have many different symptoms, some of the most common ones include extreme fatigue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and kidney problems. Lupus is also known as a rheumatic disease. The rheumatic diseases are a group of disorders that cause aches, pain, and stiffness in the joints, muscles, and bones. At present, there is no cure for lupus. However, the symptoms of lupus can be controlled with appropriate treatment, and most people with the disease can lead active, healthy lives. Lupus is characterized by periods of illness, called flares, and periods of wellness, or remission. Understanding how to prevent flares and how to treat them when they do occur helps people with lupus maintain better health. Intense research is underway and scientists funded by the NIH are continuing to make great strides in understanding the disease, which ultimately may lead to a cure. Two of the questions researchers are studying are who gets lupus and why. We know that many more women than men have lupus. Lupus is three times more common in black women than in white women and is also more common in women of Hispanic, Asian, and Native American descent. In addition, lupus can run in families, but the risk that a child or a brother or sister of a patient also will have lupus is still quite low. It is difficult to estimate how many people in the United States have the disease because its symptoms vary widely and its onset is often hard to pinpoint. Although "lupus" is used as a broad term, there actually are several kinds of lupus: Systemic lupus erythematosus (SLE), which is the form of the disease that most people are referring to when they say "lupus." The word "systemic" means the disease can affect many parts of the body. The symptoms of SLE may be mild or serious. Although SLE usually first affects people between the ages of 15 and 45 years, it can occur in childhood or later in life as well. This booklet focuses on SLE. Discoid lupus erythematosus primarily affects the skin. A red, raised rash may appear on the face, scalp, or elsewhere. The raised areas may become thick and scaly. The rash may last for days or years and may recur. A small percentage of people with discoid lupus later develop SLE. Drug-induced lupus refers to a form of lupus caused by medication. It causes some symptoms similar to those of SLE (arthritis, rash, fever, and chest pain, but not kidney disease) that go away when the drug is stopped. Common medications that may cause drug-induced lupus include hydralazine (Apresoline), procainamide (Procan, Pronestyl), methyldopa (Aldomet), quinidine (Quinaglute), isoniazid (INH), and some anti-seizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol). Neonatal lupus can affect some newborn babies of women with SLE or certain other immune system disorders. Babies with neonatal lupus may have a serious heart defect. Other affected babies may have a skin rash, liver abnormalities, or low blood counts. Physicians can now identify most at-risk SLE patients, allowing for prompt treatment of the infant at birth. Neonatal lupus is very rare, and most infants of mothers with SLE are entirely healthy. Lupus is a complex disease whose cause is unknown. It is likely that there is no single cause but rather a combination of genetic, environmental, and possibly hormonal factors that work together to cause the disease. The exact cause may differ from one person to another. Scientists are making progress in understanding the causes of lupus, as described here and in the Current Research section of this booklet. Research suggests that genetics plays an important role; however, no specific "lupus gene" has been identified. Instead, it appears that several genes may increase a person's susceptibility to the disease. The fact that lupus can run in families indicates that development of this disease has a genetic basis. In addition, studies of identical twins have shown that lupus is much more likely to affect both members of a pair of identical twins, who share the exact same set of genes, than two nonidentical twins or other siblings. Because the risk for identical twins is far less than 100 percent, however, scientists think that genes alone cannot account for who gets lupus. Other factors must also play a role. Some of the factors that scientists are studying include sunlight, stress, certain drugs, and infectious agents such as viruses. Even though a virus might trigger the disease in susceptible individuals, a person cannot "catch" lupus from someone else. In lupus, the body's immune system doesn't work as it should. A healthy immune system produces antibodies, which are special proteins that help fight and destroy viruses, bacteria, and other foreign substances that invade the body. In lupus, the immune system produces antibodies against the body's healthy cells and tissues. These antibodies, called autoantibodies ("auto" means self), contribute to the inflammation of various parts of the body, causing swelling, redness, heat, and pain. In addition, some autoantibodies join with substances from the body's own cells or tissues to form molecules called immune complexes. A buildup of these immune complexes in the body also contributes to inflammation and tissue injury in people with lupus. Researchers do not yet understand all of the factors that cause inflammation and tissue damage in lupus, and this is an active area of research. Each person's experience with lupus is different. Symptoms can range from mild to severe and may come and go over time. Common symptoms of lupus include extreme fatigue, painful or swollen joints, unexplained fever, and skin rashes. A characteristic skin rash may appear across the nose and cheeks - the so-called butterfly or malar rash. Other rashes occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands. Other symptoms of lupus include chest pain, hair loss, sensitivity to the sun, anemia (a decrease in red blood cells), and pale or purple fingers and toes from cold and stress. Some people also experience headaches, dizziness, depression, or seizures. New symptoms may continue to appear years after the initial diagnosis, and different symptoms can occur at different times. Common Symptoms of Lupus Painful or swollen joints and muscle pain Unexplained fever Extreme fatigue Red rash or color change on the face Chest pain upon deep breathing Unusual loss of hair Pale or purple fingers or toes from coldor stress (Raynaud's phenomenon) Sensitivity to the sun Swelling (edema) in legs or around eyes Swollen glands In some people with lupus, only one system of the body such as the skin or joints is affected. Other people experience symptoms in many parts of their body. Just how seriously a body system is affected also varies from person to person. Most commonly, joints and muscles are affected, causing arthritis and muscle pain. Skin rashes also are quite common. Polymyalgia rheumatica is a rheumatic disorder that is associated with moderate to severe muscle pain and stiffness in the neck, shoulder, and hip area. Stiffness is most noticeable in the morning. This disorder may develop rapidly--in some patients, overnight. In other people, polymyalgia rheumatica develops more gradually. The cause of polymyalgia rheumatica is not known; however, possibilities include immune system abnormalities and genetic factors. The fact that polymyalgia rheumatica is rare in people under the age of 50 suggests it may be linked to the aging process. Polymyalgia rheumatica may go away without treatment in 1 to several years. With treatment, the symptoms of polymyalgia rheumatica are quickly controlled, but relapse if treatment is stopped too early. Giant cell arteritis, also known as temporal arteritis and cranial arteritis, is a disorder that results in swelling of arteries in the head (most often the temporal arteries, which are located on the temples on each side of the head), neck, and arms. This swelling causes the arteries to narrow, reducing blood flow. Early treatment is critical for good prognosis. It is unclear how or why polymyalgia rheumatica and giant cell arteritis are related, but an estimated 15 percent of people in the United States with polymyalgia rheumatica also develop giant cell arteritis. Patients can develop giant cell arteritis either at the same time as polymyalgia rheumatica or after the polymyalgia symptoms disappear. About half of the people affected by giant cell arteritis also have polymyalgia rheumatica. When a person is diagnosed with polymyalgia rheumatica, the doctor also should look for symptoms of giant cell arteritis because of the risk of blindness. With proper treatment, the disease is not threatening. Untreated, however, giant cell arteritis can lead to serious complications including permanent vision loss and stroke. Patients must learn to recognize the signs of giant cell arteritis, because they can develop even after the symptoms of polymyalgia rheumatica disappear. Patients should report any symptoms to the doctor immediately. White women over the age of 50 are most at risk of developing polymyalgia rheumatica and giant cell arteritis. Women are twice as likely as men to develop the conditions. Both conditions almost exclusively affect people over the age of 50. The average age at onset is 70 years. Polymyalgia rheumatica and giant cell arteritis are quite common. In the United States, it is estimated that 700 per 100,000 people in the general population over 50 years of age develop polymyalgia rheumatica. An estimated 200 per 100,000 people over the age of 50 develop giant cell arteritis. The primary symptoms of polymyalgia rheumatica are moderate to severe stiffness and muscle pain near the neck, shoulders, or hips. The stiffness is more severe upon waking or after a period of inactivity, and typically lasts longer than 30 minutes. People with this condition also may have flu-like symptoms, including fever, weakness, and weight loss. Early symptoms of giant cell arteritis also may resemble the flu. People are likely to experience headaches, pain in the temples, and blurred or double vision. Pain may also affect the jaw and tongue. No single test is available to definitively diagnose polymyalgia rheumatica. To diagnose the condition, a physician considers the patients medical history, including symptoms that the patient reports, and results of laboratory tests that can rule out other possible diagnoses. The most typical laboratory finding in people with polymyalgia rheumatica is an elevated erythrocyte sedimentation rate, commonly referred to as the sed rate. This test measures how quickly red blood cells fall to the bottom of a test tube of unclotted blood. Rapidly descending cells (an elevated sed rate) indicate inflammation in the body. While the sed rate measurement is a helpful diagnostic tool, it alone does not confirm polymyalgia rheumatica. An abnormal result indicates only that tissue is inflamed, which also is a symptom of many forms of arthritis and/ or other rheumatic diseases. Before making a diagnosis of polymyalgia rheumatica, the doctor may perform additional tests to rule out other conditions, including rheumatoid arthritis, because symptoms of polymyalgia rheumatica and rheumatoid arthritis can be similar. The doctor may recommend a test for rheumatoid factor (RF). RF is an antibody sometimes found in the blood. (An antibody is a special protein made by the immune system.) People with rheumatoid arthritis are likely to have RF in their blood, but most people with polymyalgia rheumatica do not. If the diagnosis still is unclear, a physician may conduct additional tests to rule out other disorders. Doctors and patients both need to be aware of the risk of giant cell arteritis in people with polymyalgia rheumatica and should be on the lookout for symptoms of the disorder. Severe headaches, jaw pain, and vision problems are typical symptoms of giant cell arteritis. In addition, physical examination may reveal an abnormal temporal artery: tender to the touch, inflamed, and with reduced pulse. Because of the possibility of permanent blindness, a temporal artery biopsy is recommended if there is any suspicion of giant cell arteritis. In a person with giant cell arteritis, the biopsy will show abnormal cells in the artery walls. Some patients showing symptoms of giant cell arteritis will have negative biopsy results. In such cases the doctor may suggest a second biopsy. Polymyalgia rheumatica usually disappears without treatment in 1 to several years. With treatment, however, symptoms disappear quickly, usually in 24 to 48 hours. If there is no improvement, the doctor is likely to consider other possible diagnoses. The treatment of choice is corticosteroid medication, usually prednisone. Polymyalgia rheumatica responds to a low daily dose of prednisone. The dose is increased as needed until symptoms disappear. Once symptoms disappear, the doctor may gradually reduce the dosage to determine the lowest amount needed to alleviate symptoms. The amount of time that treatment is needed is different for each patient. Most patients can discontinue medication after 6 months to 2 years. If symptoms recur, prednisone treatment is required again. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen also may be used to treat polymyalgia rheumatica. The medication must be taken daily, and long-term use may cause stomach irritation. For most patients, NSAIDs alone are not enough to relieve symptoms. Giant cell arteritis carries a small but definite risk of blindness. The blindness is permanent once it happens. A high dose of prednisone is needed to prevent blindness and should be started as soon as possible, perhaps even before the diagnosis is confirmed with a temporal artery biopsy. When treated, symptoms quickly disappear. Typically, people with giant cell arteritis must continue taking a high dose of prednisone for 1 month. Once symptoms disappear and the sed rate is normal and there is no longer a risk of blindness, the doctor can begin to gradually reduce the dose. When treated properly, giant cell arteritis rarely recurs. People taking low doses of prednisone rarely experience side effects. Side effects are more common among people taking higher doses. But all patients should be aware of potential effects, which include: fluid retention and weight gain People taking corticosteroids may have some side effects or none at all. A patient should report any side effects to the doctor. When the medication is stopped, the side effects disappear. Because prednisone and other corticosteroid drugs change the bodys natural production of corticosteroid hormones, the patient should not stop taking the medication unless instructed by the doctor. The patient and doctor must work together to gradually reduce the medication.Most people with polymyalgia rheumatica and giant cell arteritis lead productive, active lives. The duration of drug treatment differs by patient. Once treatment is discontinued, polymyalgia may recur; but once again, symptoms respond rapidly to prednisone. When properly treated, giant cell arteritis rarely recurs.
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