Arthritis joint pain

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

[The following material was obtained from The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)]

All of the bones in the body, with the exception of the hyoid bone in the neck, form a joint.

Joint are often categorized by the amount of motion they allow. Some of the joints are fixed, like those in the skull, allow for no movement. Other joints, like those between the vertebrae of the spine, allow for some, albeit very little, movement.

Most of the joints are free moving synovial joints. Arthritis can affect any type of joint, but joints lined with synovial tissue are the most affected.

Some of the common joints affected by arthritis are:

Ball and Socket Joint: This type of joint allows for a wide range of rotation and movement. The shoulder and hip are ball and socket joints.

Condyloid Joint: This type of joint allows movement but no rotation. There are condyloid joints in the jaw and fingers.

Gliding Joint: This type of joint allows bones to glide past each other. There are gliding joints in your ankles, wrists and spine.

Hinge Joint: This type of joint allows for movement much like that of a door hinge. The knee and ulna part of the elbow are hinge joints.

Pivot Joint: This type of joint allows bones to spin and twist around other bones. There are pivot joints in the neck and the radius part of the elbow.

Saddle Joint: This type of joint allows for back and forth and side to side motion but limited rotation. There is a saddle joint at the base of the thumb.

The word arthritis literally means joint inflammation, but it is used to refer to a group of more than 100 rheumatic diseases that can cause pain, stiffness, and swelling in the joints. These diseases may affect not only the joints but also other parts of the body, including important supporting structures such as muscles, bones, tendons, and ligaments, as well as some internal organs.

Pain is the body's "early warning system", alerting the patient that something is wrong. The International Association for the Study of Pain defines it as an unpleasant experience associated with actual or potential tissue damage to a person's body. Specialized nervous system cells (neurons) that transmit pain signals are found throughout the skin and other body tissues.

These cells respond to things such as injury or any kind of tissue damage. For example, when a harmful agent such as a sharp knife comes in contact with the skin, chemical signals travel from neurons in the skin through nerves in the spinal cord to the brain, where they are interpreted as pain.

Most forms of arthritis are associated with pain that can be divided into two general categories: acute and chronic. Acute pain is short-lived. It can last a few seconds or longer but wanes as healing occurs. Some examples of things that cause acute pain include burns, cuts, and fractures. Chronic pain, such as that seen in people with osteoarthritis and rheumatoid arthritis, ranges from mild to severe and can last weeks, months, and years to a lifetime.

Obesity impacts weight-bearing joints and can increase the pain of arthritis.

Research has shown that during walking the hips, knees, and ankles bear three to five times a person's total body weight. For every pound a person is overweight, three to five pounds of extra weight is added to each knee during walking. In contrast, a ten pound weight loss causes 30 to 50 pounds of extra stress to be relieved from the joints.

For a person with arthritis, extra pounds stress the joints and lead to increased inflammation and pain. Osteoarthritis, the wear-and-tear type of arthritis, is more common among overweight people.

Recent data indicates that fat produces inflammatory chemicals called cytokines that make pain worse.

Losing weight can help slow the progression of arthritis too.The pain of arthritis may come from different sources. These may include inflammation of the synovial membrane (tissue that lines the joints), the tendons, or the ligaments; muscle strain; and fatigue. A combination of these factors contributes to the intensity of the pain.

The pain of arthritis varies greatly from person to person, for reasons that doctors do not yet understand completely. Factors that contribute to the pain include swelling within the joint, the amount of heat or redness present, or damage that has occurred within the joint. In addition, activities affect pain differently so that some patients note pain in their joints after first getting out of bed in the morning, whereas others develop pain after prolonged use of the joint. Each individual has a different threshold and tolerance for pain, often affected by both physical and emotional factors.

These can include depression, anxiety, and even hypersensitivity at the affected sites due to inflammation and tissue injury. This increased sensitivity appears to affect the amount of pain perceived by the individual. Social support networks can make an important contribution to pain management.

The assessment of weight consists of the body mass index (BMI), waist circumference, and risk factors for diseases and conditions related to obesity. The BMI equals a person's weight in pounds divided by their height in inches squared, multiplied by 704.5. Overweight is defined as a BMI of 27.3 percent or more for women and 27.8 or more for men. Obesity is defined as a BMI of 30 or more. A BMI of 30 is approximately equivalent to 30 pounds overweight.

When considering weight loss strategy and diet one must be reasonable and realistic. Fad diets and quick weight loss schemes are not only unrealistic but can be unhealthy, unbalanced, and deplete the body of essential nutrients. An estimated 95 percent of dieters losing weight on quick weight loss diets gain back the weight within a year. The formula is simple, to lose weight a person must burn off calories by either:

• decreasing food intake.
• increasing energy output through regular exercise.

Moderate physical activity on most or all days of the week is recommended. Besides its contribution to weight loss, exercise strengthens joints and bones, lowers blood pressure, and improves the cardiovascular system. Walking a mile burns about 100 calories. Gardening for 30 to 45 minutes, raking leaves for 30 minutes and certain other ordinary activities burn up about 150 calories.

It is recommended that a person eat healthy, balanced meals and avoid unhealthy between meal snacks. It is also recommended that a person decrease dietary fat and be mindful of nutritional needs such as calcium, zinc, potassium, fiber, vitamins D, B12, and E. Cutting caloric intake by 500 calories a day every day will lead to a loss of a pound a week. A reasonable time frame for a 10 percent reduction in body weight is 6 months of treatment, with a loss of 1 to 2 pounds per week.

Tips for eating better include:

• Eat only lean cuts of red meat in small quantities, or no red meat with poultry and fish as an alternative.
• Trim away fat and skin.
• Cook by steaming, grilling, baking, or microwaving; avoid frying.
• Eat non-fat cheeses and yogurt; frozen yogurt instead of ice cream; drink skim or 1 percent milk.
• Starchy foods are healthy and satisfying like bread, rice, potatoes, and pasta; don't add fattening sauces or butter.
• Chips, cookies, cakes, pies should be replaced with fruits, vegetables, and lowfat convenience foods.
• Use spices/herbs to flavor food rather than butter and heavy dressings.
• Go light for dessert like angel food cake, gelatin, or fruit salad.
• Drinking water is another helpful tip for those trying to lose weight. Drinking 6 to 8 eight ounce glasses of water per day in addition to other beverages is recommended. Drinking water is both healthy and helps to suppress the appetite.

The key to successful weight loss is to find a balance between exercise and healthy diet which can contribute to calorie reduction, but at a reasonable, undramatic pace so that the weight loss will be maintained through the new healthy lifestyleAnalgesic and non-steroidal anti-inflammatory drugs help with symptoms but are also associated with side effects. Risks and benefits must be balanced.

The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, applied for about 15 minutes may relieve the pain. An ice pack wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop the pain.

Patients with poor circulation should probably avoid using cold packs.

Joint protection-Using a splint or a brace to allow joints to rest and protect them from injury can be helpful. A physician or physical therapist can make recommendations.

Transcutaneous electrical nerve stimulation(TENS)-A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception.

Massage- This may increase blood flow and bring warmth to a stressed area. However, arthritis-involved joints are very sensitive, so the therapist must be familiar with the problems of the disease. The long-term goal of pain management is to help a person cope with a chronic, often disabling disease. They may be caught in a cycle of pain, depression, and stress. To break out of this cycle, they need to be an active participant with the doctor and other health care professionals in managing their pain. This may include physical therapy, cognitive-behavioral therapy, occupational therapy, biofeedback, relaxation techniques (for example, deep breathing and meditation), and family counseling therapy.

The Multipurpose Arthritis and Musculoskeletal Diseases Center at Stanford University, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), has developed an Arthritis Self-Help Course that teaches people with arthritis how to take a more active part in their arthritis care.


Biological response modifiers -These new drugs used for the treatment of rheumatoid arthritis reduce inflammation.

Non-steroidal anti-inflammatory drugs (NSAIDs) -The NSAIDs are used to reduce pain and inflammation and may be used for both short-term and long-term relief.

Disease-modifying anti-rheumatic drugs (DMARDs) - These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

Corticosteroids -These are very effective in treating arthritis but cause many side effects. Corticosteroids can be taken by mouth or given by injection. Because frequent injections may cause damage to the cartilage, they should be done only once or twice a year.

Weight reduction -Excess pounds put extra stress on weight-bearing joints such as the knees or hips.

Exercise -Swimming, walking, low-impact aerobic, stretching and range-of-motion exercises may reduce joint pain and stiffness. A physical therapist can help plan an exercise program.

Regenerative techniques using stem cells and platelet-rich plasma are effective in restoring and healing damaged tissue.

Surgery -In select patients, surgery may be necessary. Total joint replacement has provided not only dramatic relief from pain but also improvement in motion. The Arthritis Self-Help Course is taught by the Arthritis Foundation and consists of a 12- to 15-hour program that includes lectures on osteoarthritis and rheumatoid arthritis, exercise, pain management, nutrition, medication, doctor-patient relationships, and nontraditional treatment.

Some Things To Do To Manage Arthritis Pain

• Eat a healthy diet.

• Get 8 to 10 hours of sleep at night.

• Keep a daily diary of pain and mood changes to share with your physician.

• Choose a caring physician.

• Join a support group.

• Stay informed about new research on managing arthritis pain.

Get more information about arthritis joint pain as well as...

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• And much more...

Click here Second Opinion Arthritis Treatment Kit

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