Arthritis and deep muscle pain disease
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
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, usually in the leg. Muscle spasms, though, can involve any muscle.
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 having low blood levels of potassium can also predispose a person to muscle spasms.
Another cause of muscle spasms is nerve root irritation. An example of this would be a herniated disk irritating nerves as they exit the spine.
Spasms in the calf commonly occur while exercising; they can also occur at night while in bed. Spasms in the cervical spine muscles (neck) can also occur and are often a sign of stress.
A strain is when a muscle becomes overstressed and tears. This painful injury, can be caused by trauma, improper use of a muscle, or overuse of a muscle.
Causes of muscle strain are:
•Excessive physical activity
•Improper warming up or stretching before a physical activity
Electrolye imbalance can also cause muscle cramping. Electrolytes are minerals in the blood that carry an electric charge. Electrolytes affect many important metabolic processes. Sweating depletes electrolytes and water.Improper electrolyte balance can facilitate cramping.
Muscle pain also can be a sign of infection such as the flu.
Disorders that affect connective tissues, such as lupus, can also cause deep muscle aches.
The following material comes in part from the National Institutes of Health
The most common causes are:
Dermatomyositis is an autoimmune disease 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 that affects 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 may occur.
A malignancy can sometimes be associated with this disorder. A similar condition is called polymyositis when the symptomsoccurs 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 3 percent of the U.S. population.
Fibromyalgia is a common condition characterized by widespread pain in joints, muscles, tendons, and other soft tissues. Other symptoms commonly linked to fibromyalgia include fatigue, morning stiffness, sleep problems, headaches, numbness of the hands and feet, depression, and anxiety. Fibromyalgia can develop on its own, or be 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 are located at specific stereotypical areas.
The primary characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points.
Fibromyalgia pain can look like and feel like the pain that occurs with other types of arthritis. However, the significant swelling, destruction, and deformity of joints seen in diseases such as rheumatoid arthritis does not occur with fibromyalgia.
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. They say, "I feel like I've been hit by a truck." Or.."I feel like I've been beaten up."
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.
• The presence of pain in at least 11 of 18 tender points when touched or pressed with force amounting to the equivalent of 4 kg. or 9 lbs.
More recent data indicates that there may be an increased sensitivity to pain; 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 neurotransmitter dysfunction. Response to stress and psychobehavioral factors may also contribute to fibromyalgia.
The primary symptoms are:
•Fatigue, night sweats and sleep disturbances.
•Memory difficulties and cognitive difficulties.
•Tension or migraine headaches, temporomandibular joint syndrome, rib cage pain (noncardiac chest pain), chronic pelvic pain, plantar or heel pain.
•Fluctuations in weight, heat or cold intolerance, subjective feeling of weakness.
•Ear-nose-throat complaints, multiple chemical sensitivities and a wide array of allergic symptoms.
•Hearing, vision, and vestibular (balance) abnormalities.
•Heartburn, palpitations and irritable bowel syndrome.
•Evidence on echocardiogram of mitral valve prolapse, esophageal dysmotility (muscles of esophagus not working properly), neurologic conditions causing hypotension (low blood pressure) and syncope (fainting).
•Mood disorders such as depression and anxiety occur more commonly in people who have fibromyalgia.
Rhabdomyolysis is the breakdown of muscle fibers resulting in the release of muscle enzymes into the circulation. In large quantities, these are toxic to the kidney and frequently result in kidney damage.
Myoglobin is an oxygen-binding protein found in skeletal muscle. When skeletal muscle is damaged, myoglobin is released into the bloodstream. It is filtered by the kidneys. Myoglobin may clog up structures in the kidney, causing damage such as acute tubular necrosis or kidney failure.
Myoglobin breaks down into potentially toxic compounds, which will also add to kidney failure. Necrotic (dead tissue) skeletal muscle may cause massive fluid shifts from the bloodstream into the muscle, reducing the circulatory system fluid volume 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 or exercise such as marathon running
•Muscle damage from arterial occlusion or deep venous thrombosis
•Use or overdose of drugs-especially cocaine, amphetamines, heroin, or PCP
•Alcoholism (with muscle tremors)
•Low phosphate levels
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), and atorvastatin (Lipitor). Statin drugs are known to cause muscle pains and inflammation of 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 increases tremendously to one person out of every 20 to 100 who receive the combination. The risk of muscle damage is 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 is reversible 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 levels for CPK, a muscle enzyme, are mildly elevated. This condition also is generally reversible, 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, they also become weak. Heart muscle can be affected. Blood testing for the muscle enzyme, CPK, is markedly elevated. When the muscles are severely damaged, rhabdomyolysis can occur. This can lead to kidney failure and require dialysis.
Lupus is an autoimmune disease. The immune system attacks the body's own cells. This leads to inflammation and damage of various body tissues. Lupus can affect many organ systems, 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 can 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 aggressive treatment, and most people with the disease can lead active, healthy lives. Lupus is characterized by periods of flares, and periods of remission. 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.
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.
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 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 patient’s 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 can be elevated in any number of conditions. Before making a diagnosis of polymyalgia rheumatica, the doctor may perform additional tests to rule out other conditions, including rheumatoid arthritis.
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.
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.
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.
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