Pain facet arthritis rain

Use-related joint pain, often described as a diffuse, intermittent "aching" pain starting within seconds or minutes of joint use, is often the earliest and, undoubtedly, the most important symptom of osteoarthritis (OA). It is frequently accompanied by tenderness and is exacerbated by "knocking" or "bumping" the joint against an object. 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 are no scientific data, it has been suggested that joint pain increases concurrently with a simultaneous fall in barometric pressure and rise in humidity, (e.g., rain). Therefore, in individuals who feel that weather influences their arthritis, the effect is probably real but the cause may be unknown.

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 the "gelling" phenomenon, 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 the occurrence of 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 periarticular muscles.


Locking of the joint during motion is most likely a result of loose cartilage fragments floating within the joint capsule. Joint instability can be observed with joint motion and it may be associated with the loss of strength and function of the periarticular muscles. Periarticular muscle atrophy develops from infrequent use of a painful joint. Other muscles may be used more to compensate, which may cause pain to the unaffected side of the body. An example of this is in the case of a limp, in which the good leg is overused to spare a painful joint on the opposite side. These symptoms may result in progressive loss of joint function and eventual disability.

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 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.
Just as there is heterogeneity in the effects and manifestations of OA at one joint, there is variation in the pattern of joint OA distribution in different individuals. There is a particular predilection for OA at the DIP joints of the hand, base of the thumb, knee, hip, and intervertebral facet joints.

OA of the spine occurs in the areas where there is the most motion, such as the lower 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 on the facet joints that join the vertebral bones together may impinge upon the spinal column, causing a condition called spinal stenosis. The typical patient with this problem complains about back and leg pain that is exacerbated with walking and relieved with rest.

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