Causes for inflammation in joints and muscular 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
Inflammation is a condition where the body's immune system protects a person from infection and foreign invaders such as bacteria and viruses.
In some diseases, unfortunately, the immune system triggers an inflammatory response when there are no foreign invaders to fight off. These conditions, called autoimmune diseases, cause the body's immune system to attack its own tissues. This process is termed “autoimmune-related inflammation.”
Many types of joint and muscle disease are the result of “autoimmune-related inflammation.” Some types of arthritis associated with this type of inflammation include:
• Rheumatoid arthritis
• Psoriatic arthritis
• Reiter’s disease
• Polymyalgia rheumatica
Forms of inflammatory arthritis not associated with autoimmunity are gout and pseudogout.
Other painful conditions of the joints and musculoskeletal system that are generally not considered inflammatory include fibromyalgia and muscle strain. Previously, it was felt that osteoarthritis was not inflammatory; however, that theory has been squashed.
Inflammation is characterized by:
• Joint pain
Further symptoms of inflammation include:
• Joint stiffness
• Loss of joint function
Inflammation may also be associated with constitutional symptoms including:
• Malaise (loss of energy)
• Loss of appetite
• Muscle stiffness
When inflammation occurs, chemicals from the body's white blood cells- called “cytokines”- are released into the blood or affected tissues. Cytokines increase blood flow to the area of injury or infection and result in redness and warmth. Some of these chemicals cause fluid to leak from blood vessels into surrounding tissues, resulting in swelling.
The inflammatory cells and cytokines within the joint cause more inflammation to occur leading to wearing down of cartilage and swelling of the joint lining.
Muscle inflammation can be cause by infections (trichinosis, viruses, etc.) or autoimmune conditions such as polymyositis and dermatomyositis.
Inflammatory diseases are diagnosed with:
• Medical history and physical exam
• Diagnostic tests
Inflammation can affect internal organs. The type of symptoms depend on which organs are affected. For example:
• Inflammation of the heart (myocarditis) may cause shortness of breath or fluid retention (eg., lupus, virus infection)
• Inflammation of the tubes that transport air to the lungs may cause an asthma attack
• Inflammation of the kidneys (nephritis) may cause high blood pressure or kidney failure (lupus, Wegener’s disease)
• Inflammation of the large intestine (colitis) may cause cramps and diarrhea (Crohn’s)
Pain may not be a symptom of systemic inflammatory disease, since many internal organ systems do not have pain-sensitive nerves. Treatment of organ inflammation is directed at the cause of inflammation.
There are a number of treatment options for inflammatory joint and muscle diseases including medications, rest and exercise, with surgery as a final resort to correct joint damage. The type of treatment prescribed will depend on several factors including the type of disease, the person's age, type of medications he or she is taking, overall health, medical history and severity of symptoms.
The goals of treatment are to:
•Avoid activities that aggravate pain
•Relieve pain (pain-relieving medications) and anti-inflammatory medications
•Maintain joint movement and muscle strength
•Decrease stress on the joints
There are medications available to decrease joint pain, swelling and inflammation and prevent or minimize the progression of the inflammatory disease. The medications include:
•Non-steroidal anti-inflammatory drugs (NSAIDs - such as aspirin, ibuprofen or naproxen)
•Corticosteroids (such as prednisone)
•Anti-malarial medications (such as hydroxychloroquine)
•Disease-modifying anti-rheumatic drugs (DMARDS) such as methotrexate, azathioprine, sulfasalazine, leflunomide
•Biologics such as etanercept, adalimumab, infliximab, anakinra, golimumab, certolizumab, abatacept, tocilizumab, and rituximab.
Muscle aches and pains are common and can involve more than one muscle. Muscle pain also can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs together.
Thyroid disease, particularly hypothroidism, can cause muscle aches that mimic fibromyalgia.
Muscle pain is most frequently related to tension, overuse, or muscle injury from exercise or physical work. In 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 the whole body, like some infections (such as the flu) and disorders that affect connective tissues throughout the body (such as lupus, polymyositis, polymyalgia rheumatica, vasculitis).
One common cause of muscle aches and pain is fibromyalgia, a condition that includes tenderness in the muscles and surrounding soft tissue, sleep difficulties, fatigue, and headaches.
The most common causes are:
• Tension or stress
• Overuse: using a muscle too much, too soon, too often
• Injury or trauma including sprains and strains
So... the list of conditions that cause muscle pain...
• Polymyalgia rheumatica
• Infections, including:
o Muscle abscess
o Trichinosis (roundworm)
o Influenza (the flu)
o Lyme disease
o Rocky Mountain spotted fever
o Electrolyte imbalances like too little potassium or calcium
• Drugs, including:
o Statins for lowering cholesterol (such as atorvastatin, simvastatin, and lovastatin)
o ACE inhibitors for lowering blood pressure (such as enalapril and captopril)
and, as mentioned above, hypothyroidism.
For muscle pain from overuse or injury, rest, anti-inflammatory drugs, and ice for the first 24 - 72 hours of an injury will reduce pain and inflammation. After that, heat can be used.
Muscle aches from overuse and fibromyalgia often respond well to massage. Gentle stretching exercises after a long rest period are also helpful.
Regular exercise can help restore proper muscle tone. Walking, cycling, and swimming are good aerobic activities to try. Begin exercise slowly with a warm up and stretching. Increase the workout gradually. Avoid high-impact aerobic activities and weight lifting when injured or if in pain.
Yoga and meditation are excellent ways to help with sleep and relaxation.
Seek medical attention if:
1. muscle pain persists beyond 3 days
2. there is severe, unexplained, persistent pain
3. there is any sign of infection, like swelling or redness around the tender muscle
4. there is inadequate circulation in the area where the muscles aches 5. there is a tick bite or a rash
6. the muscle pain has been associated with starting or changing doses of a medicine, such as a statin (atorvastatin, simvastatin, or lovastatin)
Diagnostic tests that may be performed including CBC, muscle enzymes (creatine kinase), blood chemistyries, thyroid panel, and possibly a test for Lyme disease or an autoimmune disorder.
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