Pain facet arthritis rain
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.
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Pain associated with OA usually increases with activity and is relieved with rest. However, it may continue for hours after the joint is allowed to rest. About half of all patients with OA complain of joint pain at rest and 30% experience night pain.
Many people believe that weather conditions affect their joint pain. Although there is conflicting data, it has been suggested that joint pain increases concurrently with a simultaneous fall in barometric pressure and rise in humidity, (e.g., rain).
In addition to pain, most OA patients report a sensation of "stiffness." Although stiffness may be severe, it usually lasts only a few seconds or minutes (rarely longer than 30 minutes). The most characteristic feature of this stiffness is known as "gelling", which is manifested by difficulty initiating joint movement after a period of inactivity. Joint stiffness can result in difficulty moving the joint through its full range of motion or experiencing pain on movement.
Other common symptoms of OA include a reduction in the range of motion of the affected joint, "locking" of the joint, or the sensation that the joint has become unstable and is likely to "give way." Limitation of motion is usually associated with the following:
• formation of osteophytes
• severe loss of cartilage, leading to malalignment or contractures of the joint
• spasms of the muscles around joints
The presence of osteophytes, the loss of normal joint structure, and the development of joint instability can all result in abnormal forces on the surrounding ligaments, capsule, and other innervated structures, resulting in pain. The pain may be localized to the affected joint or it may be referred to another area of the body. For example, a patient with OA of the hip may complain of referred pain down the thigh, running into the knee, sometimes mistakenly thought to be due to arthritis of the knee.
Because pain is the most common and important symptom in OA and articular cartilage has no nerve endings, what is the source(s) of arthritic pain?
The source(s) of pain in OA must come from other areas within the joint.
• subchondral bone: increased vascularity and activity leads to sclerosis and cysts; increased intraosseous pressure leads to pain
• joint margin: thickening of the capsule and osteophytes irritating the capsule may cause pain
• capsule and synovium: increased thickness and mild inflammation may cause pain
• tendons and bursae: periarticular tendinitis and bursitis cause pain, resulting in decreased joint motion, leading to muscle wasting and weakness.
OA of the spine occurs in the areas where there is the most motion, such as the neck and low back. Pain associated with OA of the back increases with walking and may, therefore, limit walking, exercise, and recreational activities. OA of the back may need to be distinguished from a herniated disc, if there is an acute onset of the back pain. Severe osteophyte formation in the facet joints may impinge upon the spinal cord, causing a condition called spinal stenosis.
Whether this type of pain can be aggravated by weather change is difficult to say. Many patients will swear that rainy or cold weather makes their arthritis pain worse. Who is it to argue with them?
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