If you have ankylosing spondylitis or psoriatic arthritis, you may be familiar with the pain of enthesitis, an inflammation where tendons and ligaments attach to the bone — even if you aren’t aware it has a name. “I didn’t know what it was called!” Monica D. told us on Facebook. “I have pain all the time. Makes it difficult to walk very far.”
“Enthesitis is inflammation of the ‘enthesis,’ which is where a tendon or ligament attaches to bone,” says Joan Appleyard, MD, a rheumatologist at Baylor College of Medicine in Houston, Texas. “Symptoms are pain sometimes accompanied by swelling.”
There’s a reason the enthesis is susceptible to this problem. “The enthesis has a lot of blood flow and [thus] is subject to both infection and inflammation,” says Theodore R. Fields, MD, a professor of clinical medicine at Weill Cornell Medical College and an attending rheumatologist at Hospital for Special Surgery in New York City. “Two of the most common entheses are the area where the Achilles’ tendon inserts on the back of the heel, which causes Achilles’ tendonitis, and where the sheet of connective tissue, or fascia, inserts on the bottom of the heel, which causes plantar fasciitis.”
If you have rheumatoid arthritis or osteoarthritis, chances are you won’t experience enthesitis, because it generally only occurs with certain types of arthritis called spondyloarthropathies (SpA), which include non-radiographic axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis (a type that occurs in people with inflammatory bowel disease), and reactive arthritis (which can occur after infection, formerly called Reiter’s syndrome).
Enthesitis is actually one of the hallmark traits of SpA. “It is not a feature of rheumatoid arthritis — this is one of the ways in which SpA differs from RA,” Dr. Appleyard says.
Doctors aren’t exactly sure why SpA targets the enthesis, but it may be that a specific inflammatory response occurs in areas under biomechanical stress (stress on the joint from movement).
“About half of people with psoriatic arthritis and ankylosing spondylitis have enthesitis,” says Dr. Fields. “In both psoriatic arthritis and ankylosing spondylitis, the back and under portions of the heel are common sites of enthesitis.”
There are many other areas where enthesitis can occur, he says, including the inner and outer sides of the elbows, the area where the ribs meet the breastbone, the back of the head where it meets the neck, and in the spine in the area closest to the skin.
The main symptom of enthesis is pain, which Chronicwoman patients described as “horrible” or “burning.”
“Quite a bit of my PsA pain is due to enthesitis,” Ruth O. shared on Facebook. “It moves around from ball of my foot, to left shoulder, hands, wrists and left hip.”
Marcia G. told us, “I have [enthesitis] in my right ankle and heel mostly. My feet hurt randomly and the right toes and top of foot swell up.” Although many patients noted that enthesitis occurs in their feet, Kelly C. says it hurts “especially around my rib cage.”
Enthesitis might not mean your disease is progressing. “Enthesitis can be part of both severe and relatively mild cases of psoriatic arthritis or ankylosing spondylitis,” Dr. Fields says. It may indicate active disease, but not necessarily worsening disease, says Dr. Appleyard.
Your doctor will diagnose enthesitis based on a physical exam, in which they’ll note the location of pain, tenderness, or swelling. “Ultrasound can also be helpful in diagnosing enthesitis, and at times MRI can also be used,” Dr. Fields says.
“Managing enthesitis is important since it can cause a lot of discomforts,” Dr. Fields says. Some specific biologic therapies used to treat SpA seem to improve symptoms of enthesitis. “Treating the underlying disease with anti-TNF agents [a type of biologic] often helps with enthesitis, but traditional DMARDs such as sulfasalazine don’t treat enthesitis,” Dr. Appleyard says. Non-steroidal anti-inflammatory agents (NSAIDs) can be used for mild cases.
When deciding on a treatment regimen for SpA, Dr. Fields says it’s important to take into account all the affected areas. “In patients where enthesitis is the major issue, and more severe than the arthritis, we may skip the non-biologic agents and go directly to biologic therapies, since they tend to be more effective for enthesitis,” he says.
In addition to TNF blockers, other biologic options include blockers of the proteins IL-17, IL-12, or IL-23. “One exception is the non-biologic agent apremilast, which does not appear to cause infection and can be used in psoriatic arthritis, and which has been shown to have effectiveness in some people with enthesitis,” says Dr. Fields.
In addition, “local injection of corticosteroids can be used in enthesitis at times, but needs to be used carefully to avoid weakening of the surrounding tendons and ligaments,” Dr. Fields says.
Talk to your doctor about which medications are right for your individual case. (Here’s what one study found about picking the right treatment for enthesitis in PsA.)
A physical therapist can give you gentle stretches to do at home to help relieve the pain of enthesitis, Dr. Fields says. In addition, the doctors and patients we talked to suggested:
Apply heat or ice to affected areas
Maintain a healthy weight. “Weight loss can take pressure off the involved areas,” Dr. Fields says.
Rest and elevate the affected foot. “I try to keep the swelling down by icing it, and keeping my leg and foot elevated,” Lesley P. told us on Facebook.
Wear special shoes. “People with plantar fasciitis can benefit from shoe inserts to cushion the heel and may be helped by a consultation with a podiatrist,” Dr. Fields says.
Wear compression socks, braces, wraps, or even a medical boot.
Watch salt intake to control swelling. “Salt intake does make a difference,” Ruth says.
Over-the-counter remedies (check with your doctor first). “I love using Biofreeze on the bone in my foot — it helps!” Caroline P. told us on Facebook. Other Chronicwoman members recommended Epsom salt soaks, diclofenac gel, magnesium, or CBD products.
Fibromyalgia and multiple sclerosis are both chronic diseases with no cure. Fibromyalgia and multiple sclerosis can both cause some of the same symptoms. They can both take a long time to get the right diagnosis. They’re both more common in women. But fibromyalgia — often called “fibro” — and multiple sclerosis (MS) are two very distinct health conditions with very different causes and treatments, despite having some features in common. Read on to find out the differences and similarities of fibromyalgia vs. MS.
Fibromyalgia and MS may have some more vague symptoms in common, such as problems with focus and concentration, fatigue, and depression. If you’re Googling potential causes of these symptoms, you may find yourself researching both diseases to see if your symptoms match up. But despite some similarities, “for the most part, there is no mistaking symptoms of MS with fibromyalgia,” says Philip Cohen, MD, a rheumatologist, professor of medicine and professor of microbiology and immunology at the Lewis Katz School of Medicine at Temple University in Philadelphia.
This is especially true once you see a health care provider and start the process of seeking a diagnosis. Fibromyalgia is often diagnosed and managed by a rheumatologist, which is an internal medicine doctor who has specialized training in joint and musculoskeletal diseases. Multiple sclerosis is diagnosed and managed by a neurologist, which is a doctor who specializes in treating disorders of the brain and nervous system.
Read more to learn about the different symptoms of fibromyalgia vs. multiple sclerosis, how fibromyalgia and multiple sclerosis are each diagnosed, and how treatments for fibromyalgia and multiple sclerosis differ.
The Centers for Disease Control and Prevention estimates that about 4 million American adults have fibromyalgia. While doctors don’t know what causes fibromyalgia, it is a disorder in which people often experience widespread chronic pain and sensitivity to touch, in addition to many other symptoms (more on this below).
“Fibromyalgia is poorly understood,” says Dr. Cohen. “But it’s thought by many to be a disorder of pain perception, perhaps due to abnormalities in parts of the brain.”
Unlike MS, fibromyalgia is not an autoimmune disease, which occurs when then body’s immune system mistakenly attacks your own cells and tissues. Fibromyalgia is not related to inflammation, nor is it a joint or muscle disorder caused by physical injury.
People at higher risk of fibromyalgia include women, the middle-aged, and those with certain diseases, including different types of arthritis, or a family history of fibro. While fibro can impair your quality of life, it doesn’t damage your tissues and organs, or cause medical problems like heart disease and cancer. It is not life-threatening.
Though someone with fibro may experience a range of symptoms, the condition’s hallmark symptom is persistent pain in soft tissues and muscles all over the body. “Fibromyalgia pain is diffuse [all over], with particular involvement of what are called ‘tender points,’ or areas of tenderness elicited by pressing in specific parts of the neck, trunk, and extremities,” says Dr. Cohen. Frequently described as a deep ache, the pain may move around, persist for long periods, and disappear.
More than nine in 10 fibromyalgia patients experience unrelenting exhaustion. The sleep problems that often accompany fibro, including light sleep and repeated awakenings, can contribute to fatigue, but treating fatigue in fibromyalgia isn’t just about getting more sleep.
“Fibromyalgia patients often have headaches, irritable bowel symptoms, and depression,” adds Dr. Cohen. “Although these problems may occur in MS, they are less commonly seen.”
About 1 million Americans are thought to have multiple sclerosis. Unlike fibro, MS is considered an autoimmune disease in which the immune system is attacking part of the central nervous system. Specifically, MS affects the protective sheath (myelin) that covers nerve fibers throughout your body, which can cause a wide range of symptoms depending on which nerves are affected. Over time, multiple sclerosis can permanently damage your brain and spinal cord.
Doctors don’t know what causes MS but believe that it’s due to a combination of genes and environmental factors. Women, Caucasians, people between the ages of 20 and 50, and those who live farther from the Equator have a higher risk of developing MS.
There are four main kinds of MS; symptoms and disease progression depend on what type you have. While many people with MS develop relatively mild issues (especially with newer treatments that can help prevent MS flares and disease progression), those with severe illness can lose mobility and speech and experience other complications.
MS symptoms vary among patients, depending on which parts of the nervous system are affected. The most common type of MS — called relapsing-remitting MS, which is what 85 percent of patients are first diagnosed with — is characterized by attacks, or flares, of new symptoms followed by periods of remission. Among the more common symptoms of MS are:
Numbness and tingling in the limbs often occur with MS, as do muscle spasms. Frequently, someone with MS will feel an electric impulse sensation when they move their neck a particular way; this is called the Lhermitte sign.
Dizziness and weakness can contribute to balance and coordination troubles. People with MS often complain of feeling suddenly clumsy or report tripping, stumbling, or falling more than usual.
When MS affects the optic nerve in your eye, it can cause eye problems such as blurry eyesight, double vision, and vision loss, and may involve eye pain and unexpected movement of the eye. You may find yourself partially color blind and have issues such as picking out clothes that don’t match.
People with MS may experience eye pain or pain elsewhere in the body. It can be acute or mild, and may be related to neurological issues or musculoskeletal problems. Occasionally, some MS patients do not develop pain. For fibro patients, pain is a defining aspect of the disease. Without its presence, you cannot get a fibromyalgia diagnosis.
Constant weariness is widespread in both MS and fibro. The vast majority of people with either condition often feel physically exhausted, and may find it interrupts their lives at home, school and work.
“Fibro fog” is common in fibromyalgia. About half of MS patients report brain fog-like symptoms as well.
When considering your symptoms, it is important to keep in mind that people with multiple sclerosis may experience a wide variety of other issues not common to people with fibromyalgia, such as mobility problems and speech troubles. What’s more, many unusual symptoms may be caused by a condition unrelated to either disease. As a result, it’s crucial to get an an accurate diagnosis.
If you suspect you might have either fibromyalgia or MS, says Dr. Cohen, “begin with [your] internist or general practitioner.” They can assess your symptoms and medical history and refer you to the right specialist for further testing.
Both fibromyalgia and multiple sclerosis can be difficult to diagnose. There’s no single test that confirms you have either disease, and doctors must rule out other conditions that can have similar symptoms. Read more about diseases that can mimic fibromyalgia.
When diagnosing fibromyalgia vs MS, providers must eliminate the possibility of those other illnesses, which include rheumatoid arthritis, lupus, spondyloarthritis, thyroid disorders, and others. To do this, they’ll typically use a combination of patient history, physical exam, and laboratory tests to narrow the field. At the same time, they can look for three diagnostic criteria:
Diagnosing MS is different from diagnosing fibromyalgia since clinicians can rely on certain tests in addition to symptoms, medical history, and a physical exam. Magnetic resonance imaging (MRI), for example, takes pictures of your brain and helps detect damaged nerves. Other tests may include spinal taps, optical coherence tomography — which scans your eyes for symptoms of MS — and evoked response tests, which look at how your nerves respond to certain stimulation.
According to the National MS Society, an official MS diagnosis requires the following:
The discovery of damage in two or more separate parts of the central nervous system
While neither illness has a cure, medication can be used to relieve fibromyalgia or MS symptoms. In the case of MS, drugs can also greatly modify the course of the disease. That’s why — though taking medication as prescribed is often key to the treatment of any chronic illness — medication adherence is especially crucial for MS patients.
For fibro patients:Some drugs commonly used to treat depression, called antidepressants, may ease pain and fatigue; these include duloxetine (Cymbalta) and milnacipran (Savella). Anti-seizure medications, frequently prescribed to people with epilepsy, can also help manage pain in fibromyalgia. Among these, the FDA has specifically approved pregabalin (Lyrica) for the treatment of fibro.
For MS patients:There’s been a lot of innovation in recent years to develop different kinds of medications that can help limit damage to the nervous system, reduce relapses, and slow disease progression. These include oral medications as well as medications that are injected or infused. Each medication works differently, but they generally affect immune system activity to prevent it from attacking the nervous system.
People with MS may need additional medication to treat flares, such as corticosteroids, as well as medications to target specific MS symptoms, such as drugs for bladder issues, sexual dysfunction, and muscle stiffness and spasms.
Patients with MS and fibro can also benefit from healthy lifestyle practices, too, including:
Exercise: Regular physical activity can help manage symptoms of fibro or mild MS, and may improve mood, fitness and function. Swimming, walking, tai chi, and yoga are smart options. Consult a health care provider or physical therapist about a new exercise regimen, so it can be adapted to individual needs.
Diet: Though there is no specific diet recommended for MS or fibro, a healthy eating plan may boost your immune system, help manage co-existing conditions, and promote overall good health.
Sleep: Getting adequate rest is vital for both conditions. It’s recommended that adults between ages 18 and 64 should aim for seven to nine hours nightly.
Complementary practices: Some patients report that activities like meditation, acupuncture, deep breathing and massage help them relax and ease symptoms.
Keeping a consistent daily routine is often suggested for both fibro and MS, as is leaning on family, friends, and professionals for emotional support. “If there is depression or anxiety, referral to a psychiatrist or counselor is often helpful,” says Dr. Cohen.
While MS and fibro may have some symptoms in common, they are ultimately distinct conditions with very different causes and treatments. Visiting a health care provider can help you get to the bottom of your symptoms quickly and begin the correct therapies. The faster you start, the faster you can start feeling better.
When you think of arthritis, you might think of creaky knees or painful, swollen fingers. But if your wrist is feeling swollen and stiff, this wrist pain may be caused by arthritis too.
The wrist is a complex joint that connects the hand to the forearm. It is formed by the two bones of the forearm — the radius and the ulna — and eight small carpal bones that sit between your fingers and your arm. The carpal bones are arranged in two rows at the base of the hand, with four bones in each row. The joint surface of each bone is covered with articular cartilage, which is a slippery substance that protects and cushions the bones as you move your hand and wrist.
Arthritis in the wrist is often the cause of wrist pain. According to one estimate, one in seven people, or 13.6 percent, in the United States has wrist arthritis. But the kind of arthritis that affects your wrist might not be so obvious. Two of the most common forms of arthritis — osteoarthritis (OA, or degenerative arthritis caused by wear and tear on the joints) and rheumatoid arthritis (RA, an inflammatory type of arthritis caused by inflammation in the joint) — share many symptoms in common. Plus, other, less common forms of inflammatory arthritis affect the wrist that your doctor will need to consider as well.
“Besides pain, loss of flexibility in the wrist may affect your ability to use your hands to dress, eat, and do many work tasks,” says Steven Eyanson, MD, a retired rheumatologist who was in private practice at Physicians Clinic of Iowa in Cedar Rapids and a clinical assistant professor at the University of Iowa in Iowa City.
Learn more about what causes arthritis in the wrist and how arthritis in the wrist is treated.
Not everyone with arthritis in the wrist will experience symptoms. When symptoms do occur, the severity can vary greatly from person to person. For some patients, wrist arthritis symptoms aren’t constant, but may come and go depending on their level of activity and other factors. You may have done something to the wrist — such as repeated overuse, lifting, carrying, or bending — that aggravates it and causes a flare. Then it returns to its baseline.
“The number one symptom of wrist arthritis is pain,” says Chadwick Hampton, MD, an orthopedic surgeon at Palm Beach Gardens Medical Center in Palm Beach Gardens, Florida. The pain may be sharp, depending on the motion, says Dr. Eyanson. Or it may be dull and deep if it’s an inflammatory type of arthritis like rheumatoid arthritis.
The other main symptom of wrist arthritis is a change in your grip strength, such as an inability to open jars, use keys, or turn doorknobs.
About 30 million Americans have osteoarthritis, which makes it the most common type of arthritis. It’s more common with older age, but it can occur in younger people too, depending on such factors as injuries and genetic risk. In osteoarthritis of the wrist, the smooth, slippery articular cartilage that covers the ends of the bones gradually wears away over time. Since cartilage has little to no blood supply, it has little ability to heal or regenerate when it gets injured or worn down.
Osteoarthritis in the wrist can also develop from a condition called Kienböck’s disease. Here, the blood supply to one of the carpal bones — the lunate — is disrupted. That causes the bone to deteriorate. Over time, this can lead to structural changes and arthritis in the joints around the lunate.
Post-traumatic arthritis is a common form of osteoarthritis that happens as a result of physical injury to a joint such as from sports, a car accident, a fall, or other trauma. Injuries can damage the bone and/or cartilage, which changes the joint mechanics and makes it wear out more quickly. Post-traumatic arthritis symptoms in the wrist may appear within a few years, or it can take decades for joint damage from an injury to cause pain.
About 1.5 million people in the U.S. have rheumatoid arthritis (RA). RA is a chronic inflammatory disease that causes pain, stiffness, swelling, and loss of function in joints throughout the body.
Rheumatoid arthritis is caused by autoimmunity, which is a malfunction in your immune system. Normally, your immune system reacts to any external threats (such as viruses, bacteria, or parasites that could cause disease) by releasing antibodies, white blood cells of various types, and other defense systems. But in autoimmune diseases like RA, your body’s immune system is confused for some reason. It attacks your own healthy tissue when there’s no reason to.
RA often starts in smaller joints, such as those found in the fingers and wrist. RA is often symmetrical, which means it affects the same joint on both sides of the body. OA, for example, might affect only your right wrist, but RA is more likely to affect both your wrists.
As RA progresses, it can affect the range of motion and flexibility of the wrist joints. Because RA causes widespread inflammation in your body, it’s not common that wrist pain would be your only symptom. You’re also likely to experience pain in other joints, especially your fingers or toes, as well as fatigue, low-grade fever, and these other rheumatoid arthritis symptoms.
Psoriatic arthritis (PsA) is another kind of inflammatory arthritis linked to psoriasis (a disease that causes red, scaly rashes on the skin). Psoriatic arthritis in the wrist might cause similar symptoms to those of RA — pain, stiffness, swelling, and loss of function — but there may be additional PsA symptoms that occur that are more unique to PsA. People with PsA are likely to have problems with their nails, such as pitting and crumbling, as well as swollen fingers and toes, a condition called dactylitis that makes them appear sausage-like. PsA joint pain is also less likely to be symmetrical than that of RA.
Carpal tunnel occurs when a major nerve in the hand — the median nerve — becomes compressed in the carpal tunnel, a narrow passageway on the palm side of your wrist that also houses the tendons that bend the fingers. Interestingly, having arthritis raises your risk of developing carpal tunnel, so you could have both conditions at the same time. The nature of the pain in carpal tunnel usually sets it apart from arthritis, though: It often causes numbness and tingling in the first three fingers (thumb, index, and middle finger), as well as these other carpal tunnel symptoms.
Tendons are thick cords that join your muscles to your bones. When tendons become irritated or inflamed, that’s called tendinitis. Tendinitis causes acute pain and tenderness that makes it difficult to move the affected joint. Any tendon can develop tendonitis, but you’re more likely to develop it in your shoulder, knee, elbow, heel, or wrist. The most common cause of tendonitis is a repetitive action. You may develop tendinitis if you make the same motion frequently while playing sports, for example.
First, your doctor will ask about your symptoms and medical history and perform a physical exam. During your physical exam, your doctor will examine your wrist for swelling and pain.
Next, your doctor will examine the range of motion of the wrist itself. Your doctor may have you twist and flex both wrists in every direction to assess your range of motion. They will manipulate your wrist and thumb joints and ask if you feel pain in your wrists and thumbs. This exam can show how mild or severe the arthritis is, or if another condition is causing symptoms, such as carpal tunnel syndrome or tendinitis.
If your doctor suspects inflammatory arthritis, they will order blood tests to detect the presence of certain antibodies, such as rheumatoid factor or anti-CCP, which help identify RA and other types of inflammatory arthritis. They may also order blood tests that look for levels of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Your doctor may order imaging tests, such as X-rays or MRIs, to assess whether you have joint damage in the wrist.
Nonsteroidal anti-inflammatory medications (NSAIDs) like aspirin, naproxen, and ibuprofen (all available over the counter) can help relieve pain and inflammation. They’re commonly used to treat pain and stiffness in OA and inflammatory arthritis. NSAIDS don’t slow the progression of arthritis. But they do help treat acute symptoms like pain and inflammation. NSAIDs are also available by prescription at stronger doses for shorter-term use. All NSAIDs, both OTC and prescription, can have significant side effects, including gastrointestinal complications and an increased risk of heart disease, so talk to your doctor about the right dosage and duration for you. Your doctor might also prescribe a topical gel NSAID, which can be helpful if oral medications aren’t helping with the pain. A common one is diclofenac (Voltaren), says Dr. Hampton.
If you have an inflammatory arthritis like rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are used as a first-line therapy to help reduce the immune system activity that triggers inflammation and pain. DMARDs are not used for osteoarthritis.
Corticosteroids like prednisone are powerful anti-inflammatory agents that can quickly relieve pain and swelling. “This type of therapy is often employed as a temporary or ‘bridge’ therapy [for inflammatory arthritis] while patients wait for DMARDs to take effect,” says Brian Golden, MD, a rheumatologist and clinical associate professor in the department of medicine at NYU Langone Health in New York City. It’s best to use corticosteroids in the lowest possible does for short periods of time, as they can cause a range of serious side effects, including bone thinning and high blood sugar.
An occasional steroid shot in the wrist can offer temporary pain relief and reduce inflammation. Shots shouldn’t be done repeatedly, as frequent injections can damage cartilage. Many doctors limit cortisone injections in a joint to no more than three or four times a year.
Biologics are a newer class of DMARD that targets specific immune system pathways to reduce immune system activity that is causing inflammation and pain. They’re used to treat inflammatory types of arthritis, such as rheumatoid arthritis and psoriatic arthritis, and are typically offered after patients haven’t responded to “conventional” DMARDs like methotrexate.
It’s important to exercise your wrist joints to promote range of motion, improve flexibility, and prevent additional damage. Your doctor will likely send you for physical therapy so you can do these exercises under supervision and then repeat them at home. Your physical therapist can develop a program that’s right for you. “The stronger the muscles are around the joint, the better you’ll feel,” says Dr. Hampton. Here are some range-of-motion exercises, including some for your wrist, which you can try at home.
In addition to physical therapy, it’s a good idea to do regular cardiovascular and strength training exercises that don’t put too much pressure on your wrist joints. Swimming and water exercises, for example, places less pressure on the joints since water helps supports the body. Tai chi and yoga involve gentle, flowing movements. (Be sure to ask your yoga teacher for modifications that don’t stress your wrist.) Walking is low-impact exercise that’s well-suited to people with arthritis. Avoid any exercises with a pushing movement or that put weight on the wrist (such as a handstand or a bench press) as that could exacerbate your wrist pain, says Dr. Hampton. “You want to stay active,” he says. “Keep the muscles and tendons around the joint strong. That will help with pain.”
Support braces can help support wrist movements and ease physical stress. They can’t prevent severe injuries, but they can help you do daily activities with less discomfort. You can get a custom-made or over-the-counter splint to cover your wrist or forearm. Dr. Hampton suggests to his patients that they wear the splint at night while they sleep. He says its compression offers pain relief.
Some people have found that their symptoms improve when wearing special arthritis gloves. They’re tight, often fingerless, gloves that may improve symptoms.
Cold therapy can provide relief for inflamed joints in the wrist. Cold constricts the blood vessels in the muscles, which decreases blood flow to the joint area to help reduce swelling and inflammation. Heat therapy warms the skin and the joints, which causes blood vessels to dilate, and sends more oxygen and nutrients to the joints and muscles. Try both and see which makes you feel best.
Surgery isn’t often needed to treat arthritis in the wrist. But surgery is considered when other treatments don’t relieve pain, wrist arthritis symptoms are severe, or when you can’t use your wrist or hand well. Surgical procedures include the following.
This is the least invasive of the three kinds of wrist surgery, says Dr. Hampton. The arthritic bones of the wrist joint are removed, which diminishes pain. Motion is preserved because there is no fusion. Proximal row carpectomy is only an option for some types of wrist arthritis. “Not everybody is a candidate,” says Dr. Hampton. It depends on where the arthritis is located. You have two rows of four bones in the wrist. If your arthritis is in the proximal row (the one closer to your arm), then you’re a candidate. If it’s in your distal row (the one closer to your hand), then you’re not a candidate. If your arthritis is in both the distal and proximal rows, then you’ll need a wrist fusion. This surgery can provide pain relief while preserving motion.
This procedure eliminates all movement at the wrist joint. Wrist fusion secures the bones of the forearm to the bones in the wrist and hand. “You’re trying to fuse all the bones together so they don’t move anymore,” says Dr. Hampton. “Fusions heal, but you lose movement in the wrist. If you’re at the point of getting this surgery, you’re in debilitating pain and you have no other choice. Either you keep living like this or you get rid of the pain and lose your motion.” The surgery provides pain relief, but the loss of motion can prevent you from doing some daily activities like lifting and manual work that involves your hands like carpentry, says David Geier, MD, an orthopedic surgeon, sports medicine specialist, and author of That’s Gotta Hurt: The Injuries That Changed Sports Forever.
This is the most invasive of the three surgeries, says Dr. Hampton. Here, damaged bone is removed and replaced with a metal and plastic implant. Dr. Hampton says this surgery isn’t done often as the implant in the wrist joint hasn’t been perfected like it has been in hip or knee joint replacements. It was done more in the past and not found to always be successful. “The rare circumstances where this procedure is performed involves older, less active patients who are in excruciating pain that’s not relieved by less invasive treatments,” says Dr. Geier.
Say study authors: ‘Patient–reported joint assessment may aid in capturing flares between routine clinical visits.’
No one knows how you’re feeling better than you, but do your symptoms actually correlate to objective measures of disease activity? A new study points to yes.
In the study, which was published in the journal Rheumatology, researchers followed 80 rheumatoid arthritis (RA) patients for one year. At the beginning of the study, all participants were either in remission or had low levels of disease activity (DAS28-CRP <3.2). Throughout the year, 36 percent of patients reported a hand flare — and clinical exams and ultrasounds confirmed that what the patients were sensing was accurately reflecting what was happening inside their bodies.
“Self-reported flares were associated with increased disease activity as determined by clinical examination and [ultrasound],” the authors wrote. “Patient-reported joint assessment may aid in capturing flares between routine clinical visits.”
Doctors and patients need to be on the lookout for these additional symptoms.
Axial spondyloarthritis (axSpA) is often described as an inflammatory form of arthritis that causes low back pain. While chronic back pain is usually the major feature of axSpA, this condition may cause symptoms in other areas of the body as well. In fact, many patients end up developing arthritis in one or more peripheral joints, according to a new study published in the journal Arthritis Research & Therapy.
Researchers recruited 708 patients from a group of French arthritis patients who had been diagnosed with early inflammatory back pain that suggested they probably had axSpA and followed them for five years. During that time, 36 percent of patients developed arthritis in at least one peripheral joint — most often in the lower limbs.
Peripheral arthritis appeared to strike more often in axSpA patients who were older (at least 33 years old), non-smokers, and negative for HLA-B27 antigen (a protein that’s sometimes associated with axSpA).
Those who developed peripheral arthritis were also more likely to develop an inflamed toe or finger and enthesitis (an inflammation of the spot where tendons or ligaments attach to bone).
While non-steroidal anti-inflammatory drugs (NSAIDs) are considered the first-line treatment for axSpA, patients who went on to develop peripheral arthritis were more apt than those who did not to require stronger medications, such as TNF inhibitor biologics. Not surprisingly, they also missed more work and reported worse quality of life.
The authors suggested that rheumatologists should be routinely monitoring axSpA patients for peripheral arthritis so they can treat those who develop it accordingly.
The connection between arthritis and jaw pain might not be immediately apparent because we often associate arthritis with pain and stiffness in the hands, elbows, or knees. But if you’ve been noticing pain on the sides of your face, arthritis could be the reason.
“By jaw pain, we mean pain in front of the ear, up as far as the top of the ear, as low as the back part of the jaw and even into the cheek,” says Vivian P. Bykerk, BSc, MD, FRCPC, a rheumatologist at Hospital for Special Surgery in New York City. “It can feel like tooth pain and you might even think that is what it is.”
You may also find it hard to open and close your mouth, or that it hurts to eat. “It wants to lock,” Carrie G. told us on Facebook about her jaw pain. “It makes it hard to chew or even get food in.”
Another arthritis patient, Anne M., has also experienced jaw pain. “I’ve had that once upon a flare — it lasted a good while too, like two weeks or so,” she told us on Facebook. “The worst was in the morning; I remember I dreaded ‘opening’ it first thing.”
Although jaw pain from arthritis can affect your quality of life — not to mention your enjoyment of food — there are some things you can do to minimize the impact of jaw pain from arthritis.
The joint responsible for jaw pain is the temporal mandibular joint (TMJ). “This is where the lower jaw hinges at the level of the ear,” Dr. Bykerk says. Responsible for talking as well as eating, the TMJ is the most frequently used joint in the body. This frequency of use also makes the jaw susceptible to different kinds of arthritis.
“Like other joints, the TMJ is at risk for osteoarthritis, along with other types of arthritis such as rheumatoid arthritis,” says Lauren Levi, DMD, dentist at The Mount Sinai Hospital in New York City. “Osteoarthritis is the most common type of arthritis that affects the TMJ.”
Some people may be more at risk for arthritis in the jaw than others. “Macro or microtrauma, through grinding or clenching, along with decreased lubrication in the joint may increase the risk for developing arthritis,” Dr. Levi says.
Stress and chronic pain in the body, such as may occur with arthritis elsewhere, can cause clenching; so in a vicious cycle, jaw pain and arthritis may become a “chicken or the egg” scenario, Dr. Bykerk says.
“People will clench if they have pain, if they are stressed, or pain can result if they clench too much or grind their teeth, called bruxism,” she says. “If bruxism and clenching go on too long the TMJ can wear out, the cartilage in the joint can break down and degenerative arthritis occurs.”
Pain conditions including autoimmune or inflammatory diseases like rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis are consistently associated with TMJ disorders.
You can also feel pain in the jaw from causes that are not related to arthritis. “Pain most commonly results due to muscular and soft tissue tension, such as problems with the myofascial tissue around the jaw,” Dr. Bykerk says. Poor teeth alignment or poor posture, which can put the head in an awkward position, can also put pressure on the jaw, causing pain. In addition, injury, infection, or past surgery may be the reason for experiencing jaw pain.
The joint itself can also ache without actual damage to the bone or cartilage. “Arthralgia, which is an extremely common condition that affects the TMJ, is characterized by a painful joint without any osseous [bone] changes,” Dr. Levi says. “Arthritis, by contrast, accompanies osseous changes that can be visualized on imaging.”
The underlying causes for jaw pain can be hard for doctors to suss out, as the TMJ is a very complex joint with multiple factors affecting it. Your rheumatologist or dentist may recommend a specialist who deals with TMJ disorders, called an oral and maxillofacial surgeon. “A thorough comprehensive evaluation and history taking is crucial to accurately diagnosing the etiology [cause] of jaw pain,” Dr. Levi says.
“Osteoarthritis is often diagnosed based on symptoms and imaging, and is commonly is associated with joint sounds, known as crepitus,” Dr. Levi says. “Osteoarthritis is also often associated with morning stiffness, jaw tightness, and decreased range of motion of the jaw.”
Jaw bone and cartilage changes due to arthritis may be seen on imaging tests such as an X-ray, CT scan, or MRI. “Changes that can be visualized on imaging include condylar beaking or flattening [damage to the rounded end part of the bone], and decreased joint space,” Dr. Levi says.
“Other forms of arthritis, such as rheumatoidarthritis, may be diagnosed with help from blood tests,” Dr. Levi says. With inflammatory or autoimmune diseases, you will have elevated inflammatory markers like c-reactive protein or erythrocyte sedimentation rate; many rheumatoid arthritis patients also test positive for antibodies such as rheumatoid factor and anti-CCP.
But if you have inflammatory arthritis, chances are jaw pain won’t be your first symptom; and if you’ve already been diagnosed, your doctor will have an indication that jaw pain may be due to your condition.
Luckily, you may find relief with non-invasive measures to resolve the jaw pain. “Almost always conservative treatment will be tried first,” Dr. Bykerk says. This may include:
Physical therapy to provide gentle exercises to help loosen your jaw and strengthen the muscles around the joint.
A mouth guard fitted by a dentist to help with teeth grinding and clenching overnight. “I have been wearing a night guard for years,” Karin D. told us on Facebook.
Relaxation techniques to manage chronic pain and reduce stress and tension in the joint.
Your doctor may also give some relief with steroid shots, which Karin also says she’s had. “If the TMJ is inflamed it can be injected with cortisone,” Dr. Bykerk says. In addition, your doctor may advise over-the-counter medications. “NSAIDs are often prescribed to decrease inflammation and thus help decrease pain,” Dr. Levi says.
Making sure inflammatory arthritis is well-managed can improve jaw pain due to the condition. “For rheumatoid, psoriatic arthritis, and other forms of systemic arthritis, it is important to control the underlying disease,” Dr. Levi says.
In very severe cases, surgery to the jaw may be recommended, but this is a “last resort” option.
When you think of arthritis, you might think of creaky knees or painful, swollen fingers. But if your neck is feeling stiff or you have pain when you turn your head, this neck pain may be caused by arthritis too.
Like the rest of the body, the disks and joints in the neck degenerate due wear and tear. Osteoarthritis of the neck includes these changes that happen over time or because of an injury. Most people 60 years old and older will have a degenerative type of neck arthritis, says Rajat Bhatt, MD, a rheumatologist with Prime Rheumatology in Houston, Texas. Inflammatory types of arthritis that occur because of an overactive immune system can affect your neck as well.
Learn more about what causes neck arthritis and how arthritis of the neck is treated.
While arthritis in the neck is common, symptoms of neck arthritis vary, says Neel P. Shah, MD, an orthopedic spine surgeon at Montefiore Medical Center in the Bronx, New York.
For most people, arthritis in the neck causes no symptoms. When neck arthritis symptoms do occur, it’s typically pain and stiffness in the neck that ranges from mild to severe. It may be worsened by looking up or down for a long time, or by activities where the neck is held in the same position for a long time like driving or reading a book. Neck pain usually subsides with rest or lying down.
Two other types of symptoms that are common in people with arthritis in the neck are radiculopathy and myelopathy.
Radiculopathyaffects the spinal nerve root, the part of the nerve that branches off from the main spinal cord. Usually, some form of pressure on the spinal nerve root causes symptoms such as pain, weakness, numbness, and/or electrical sensations down an extremity.
Myelopathyis a disease process that affects the spinal cord that comes on slowly over time. Symptoms include compressed spinal nerve roots, radiculopathy, pain, weakness, numbness, and/or electrical sensations in an extremity.
“Neck arthritis can become debilitating, especially if there is compression of the spinal cord, which can lead to loss of strength, coordination, and balance,” says Dr. Shah.
Neck pain can have numerous possible causes. Still, many people with sore, stiff necks that don’t improve over time are diagnosed with a type of arthritis.
Osteoarthritis in the neck is the degeneration of joints, vertebrae, and discs in the cervical portion of the spine. With less padding between them, vertebrae may rub against each other. That can cause tiny bone fragments to break off and float in the synovial fluid (a thick liquid that lubricates your joints and helps them move smoothly).
Sometimes this process stimulates the growth of bony projections along the edges called bone spurs, or osteophytes. Since the padding is now thinner, the vertebrae become closer to each other. That leaves less room for the spine nerves that stick out from the spinal cord.
Symptoms of neck osteoarthritis range from none to pain, stiffness, and inflammation. Osteoarthritis in the neck pain tends to worsen after activity. Complications such as loss of coordination can happen if the spinal cord becomes pinched.
Rheumatoid arthritis is a chronic inflammatory disease where the body’s immune system mistakenly attacks the lining of the joints. It often starts in the smaller joints of your hands and feet and can spread to other parts of the body like the neck as the disease progresses. This typically doesn’t happen until years after the onset of arthritis symptoms.
Neck pain is the primary symptom of rheumatoid arthritis in the neck, with the severity varying from person to person. You may feel a dull or throbbing ache in the back of your neck around the base of the skull. Joint swelling and stiffness can make it hard to move from side to side.
The difference between rheumatoid arthritis neck pain and a neck injury is that stiffness and pain from an injury can gradually improve over days or weeks. Rheumatoid arthritis in the neck may not get better; it can worsen if left untreated. Even if symptoms improve, inflammation, swelling, and stiffness can return with rheumatoid arthritis in the neck.
Other types of neck arthritis include psoriatic arthritis and ankylosing spondylitis, which are both considered a type of arthritis called spondyloarthritis. It’s an umbrella term for inflammatory diseases that involve both the joints and entheses, the places where ligaments and tendons attach to the bones.
Psoriatic arthritis is a form of arthritis often accompanied by psoriasis, an inflammatory skin disease. For some people who have psoriatic arthritis, the condition involves the spine, which impacts the neck. Pain happens when inflammation strikes the joints between the vertebrae. This pain can occur on just one side of the body, the neck, and the lower and upper back. Read more about psoriatic arthritis symptoms.
Ankylosing spondylitis is a form of arthritis that strikes the bones in your spine and pelvis as well as peripheral joints. Early signs and symptoms might include pain and stiffness in your lower back and hips, especially in the morning and after inactivity. Fatigue and neck pain are common. AS symptoms might worsen, improve, or stop at irregular intervals.
Your doctor will start by taking a history and doing a physical exam. They’ll check the range of motion in your neck and test your strength, sensation, and reflexes to find out if there is pressure on your nerves or spinal cord. They’ll ask when your symptoms started, when the pain happens, and what makes the pain better and worse.
Your doctor may order an X-ray to assess alignment and look for arthritic changes, says Dr. Shah. If there is a concern of compression of spinal nerves or the spinal cord, you may need an MRI to look at the neutral structure and discs, says Dr. Shah.
A CT scan may be ordered to look at the bone more closely, especially to see if any bony outgrowths are causing compression. However, X-rays and MRIs are the tests that are usually ordered, says Dr. Shah. A CT scan with a myelogram (where dye is injected into the spinal canal to see the neural structures) may be used if an MRI can’t be done.
Electromyography, or EMG, may be ordered to assess for nerve compression, says Dr. Shah. An EMG tests the electrical conduction of the nerves in the arms. This test would be helpful if you have multiple nerves being compressed or compression of nerves at the neck and in the arm, he says.
Your doctor may order blood tests to see if you have any antibodies or systemic inflammation that would reveal inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
Over-the-counter medications can be used to help address pain, inflammation, and swelling. NSAIDs like aspirin, naproxen, and ibuprofen can help relieve pain and reduce inflammation. Analgesics (such as acetaminophen) can help with mild to moderate pain. Your doctor can prescribe a stronger anti-inflammatory if OTC medications don’t provide relief.
Even though many commonly used NSAIDs are available over the counter, it’s important to talk to your doctor about side effects and drug interactions. NSAIDs can have significant side effects, including gastrointestinal complications, and are associated with an increased risk of heart disease.
Neck pain due to inflammatory arthritis is typically treated with a disease-modifying antirheumatic drug (DMARD), such as methotrexate for RA. Other conventional DMARDs include leflunomide, hydroxychloroquine, and sulfasalazine. Biologics are a newer type of DMARD that target specific immune system pathways. DMARDs help to reduce the immune system activity that is triggering inflammation and pain.
Steroid-based injections and nerve blocks can offer pain relief for arthritis in the neck. Both can be good for pain that radiates from the neck, says Carlo Milani, MD, an assistant attending physiatrist at Hospital for Special Surgery in the Department of Physiatry in and assistant professor of clinical rehabilitation medicine at Weill Cornell Medical College in New York City.
An epidural steroid injection is where doctors inject medicine directly into the epidural space of the spinal canal surrounding the nerve roots. The medicine is a combination of corticosteroids and a local anesthetic, which together reduce inflammation and relieve pain.
A facet joint injection is an injection of local anesthesia and corticosteroids that is placed directly into the affected joint. Facet joints connect the bones of the spine, allowing the spine to bend and twist.
The anesthesia offers temporary pain relief and the corticosteroids reduce inflammation in the joint.
A nerve block is the injection of a local anesthetic close to a targeted nerve or group of nerves to block pain. Different types are used depending on where you’re in pain. You may get relief from one injection or need several nerve block treatments.
If you’re experiencing neck pain due to arthritis, your doctor may recommend physical therapy. Physical therapy for neck arthritis entails doing specific exercises to help strengthen and stretch weak or strained muscles. Physical therapy can improve range of motion. Sessions and programs vary in length and frequency and are tailored to your condition.
“The foundation of what we’re trying to do in physical therapy for the neck is often to help improve posture and the way people move,” says Dr. Milani. “Exercises in physical therapy tend to be focused on strengthening muscles of the back and neck, which puts less strain on structures of the cervical spine.”
You may feel like you don’t want to move when your neck hurts. But being inactive may increase stiffness, which can cause you to lose even more mobility. “Aches and pains tend to respond better to continued movement than rest,” says Dr. Milani. “Exercise is often the foundation of treatment.”
Exercises that involve stretching, strengthening, and improving range of motion can help reduce pain and keep your neck limber. You want to move gently and smoothly when doing neck exercises, not jerk your neck or make sudden movements. You may feel discomfort at first. Stop if any exercise increases your neck pain.
Light exercise can help improve strength and flexibility. Walking, swimming, water aerobics, or biking fit the bill. Or go for yoga or Pilates. “Avoid overhead movement exercise or positions that exacerbate your symptoms,” says Dr. Milani. He says, for example, on a stationary bike, avoid a position that aggravates neck pain. Find a comfortable position while you are riding.
The military chin tuck helps with posture. Hold your chin to the neck for 10 to 20 seconds. Do this 10 times a day, says Dr. Shah.
Don’t forget about your shoulders. Exercising them will help strengthen the muscles that support your neck. Basic shoulder rolls will keep your shoulder and neck joints fluid.
If medication, physical therapy, or other treatments don’t work, a procedure called radiofrequency ablation that numbs the joints of the neck might be indicated, says Dr. Milani. In the procedure, a heated needle tip heats up a small area of nerve tissue to stop it from sending pain signals. That can offer long-term, but usually not permanent, relief for six months to two years, he says.
While you can’t stop age-related joint degeneration from happening, you can try to slow its development or ease symptoms with simple lifestyle changes. Here are a few remedies you can try to manage neck arthritis pain.
Sleep with a pillow and bed that support your sleep preference, says Dr. Shah. If you like sleeping on your back, get a firm mattress and pillow. Side sleepers should get a medium mattress and pillow. Stomach sleepers should go for a soft mattress and pillow. Dr. Milani says you may find it helpful to sleep with a cylinder-like pillow that sits in the curve of your neck.
Quit smoking if you’re a smoker. Smoking decreases the effectiveness of some drugs used to treat arthritis. And smoking can make it harder for you to do activities that relieve arthritis symptoms, like exercise. “It can worsen arthritis and also increase pain sensitivity,” says Dr. Bhatt.
Support your back and neck while you sit at your computer. Keep your computer at eye level so you don’t have to change your neck position by looking up and down. “When using a computer and key board, have the monitor at eye level,” says Dr. Shah. “Use risers or an adjustable desk.” Your keyboard should be close to your body and your body should be close to your desk, says Dr. Milani. If your company offers it, an ergonomic assessment of your work station can help ensure that it’s set up properly, he says.
When talking on the phone, use a headset. That will help prevent you from straining your neck. Smartphones have even launched the term “text neck,” which is a repetitive strain thanks to people hunching over their devices. This stance aggravates muscle pain in the neck. Instead of tilting your chin down to read your smartphone, put the device at eye level. That way your head isn’t constantly dropping and forced to strain.
Changing your posture can help relieve neck pain from arthritis. Good posture, as it’s related to the neck, is when the ears are positioned directly above the shoulders with the chest open and shoulders back. Here, stress is minimized because the head’s weight is naturally balanced on the spine. “Correct posture is key,” says Dr. Shah. “With the use of computers and smartphones, we’re constantly being hunched forward. It’s demanding to the neck and applies harmful pressure to the structures of the neck.”
“Surgery is usually a last resort for neck arthritis,” says Dr. Milani. Your doctor may recommend it if you have severe pain that isn’t relieved with nonsurgical treatment or if you have signs of neurologic injury. “Surgery may be needed if the arthritis causes instability, or more importantly, impingement of nerves and/or the spinal cord,” says Dr. Shah.
When you think of arthritis, you tend to think of creaky knees, swollen fingers, or a stiff hip. Arthritis in the ankle doesn’t get as much attention. While arthritis doesn’t affect the ankle as commonly as other joints, it can take a significant toll on your mobility and quality of life. “Ankle arthritis can cause significant disability and affect daily living,” says Saira Bilal, MD, assistant professor of medicine at the George Washington University in Washington, D.C.
Arthritis in the ankle can lead to pain, swelling, deformity, and instability in the ankle joint. Ankle arthritis affects the tibiotalar joint, which forms between the shin bone (tibia) and ankle bone (talus).
“The incidence of ankle arthritis is five to 10 times less than arthritis of larger joints like the hip and knee,” says podiatrist Krista A. Archer, DPM, who is on staff at Lenox Hill Hospital in New York City. “When I see it in advanced stages, it usually occurs after someone has experienced a prior injury. Ankle arthritis causes pain and can lead to changes in your gait, or the way you walk.”
Learn more about what causes ankle arthritis and how arthritis of the ankle is treated.
If you have ankle pain, it’s important to understand the type of arthritis that might be causing it, because some types of arthritis have very specific medications and treatments. Here are some of the more common types of arthritis that strike in the ankle.
Osteoarthritis (OA) is a degenerative joint disease where the cartilage that cushions the ends of a joint wears away gradually. Osteoarthritis often occurs because of typical wear and tear on a joint that happens with age. But many cases of ankle osteoarthritis are related to a previous ankle injury. Injury can damage the cartilage directly or change how the ankle joint works, leading to cartilage deterioration over time.
This type of arthritis develops in the foot as a result of injury, even one that happened a long time ago. For example, a sprain, fracture, or dislocation in the ankle may damage cartilage. That can lead to premature deteriorating of the joint. Symptoms may appear within a few years, or it can take decades for joint damage from an injury to cause pain.
Rheumatoid arthritis (RA) is a chronic inflammatory disease, in which the body’s immune system attacks itself. The joints of the ankles can be affected by RA. Difficulty with ramps, inclines, and stairs are the early signs that the ankle is involved with RA. Standing and basic walking can become painful as the RA in the ankle advances.
Other types of inflammatory arthritis such as psoriatic arthritis and peripheral spondyloarthritis can also affect the ankle joint.
For many people, pain and swelling in the big toe is the first symptom of gout, which is a type of arthritis that occurs because of elevated levels of uric acid in the blood accumulate in and aggravate joints. Gout attacks can affect other joints aside from the big toe, including the ankles. Lumps of uric acid, called gout tophi, may form underneath the skin around the ankles after you’ve had gout for years.
This chronic form of arthritis happens after an infection of the urinary, genital, or gastrointestinal systems. The ankles, along with knees and joints of the feet, are often the first joints affected by reactive arthritis.
If ankle arthritis is suspected, doctors will start with a medical history to determine a diagnosis. They’ll ask when you noticed your symptoms, where you feel pain, and how the symptoms affect your life. They’ll examine your ankle to check for signs of arthritis in the joints, such as swelling and tenderness.
Other tests can assess whether other types of arthritis may be responsible for the ankle pain, such as blood tests that measure inflammation and antibodies to rule out inflammatory arthritis, or testing of joint fluid for uric acid crystals if gout is suspected. Imaging tests such as X-rays can help confirm a diagnosis and determine the extent of the joint damage.
Ankle arthritis doesn’t have a cure. But many treatments are available that may help relieve pain and improve function.
“The goal with these treatments is to help patients function and do their daily activities with less pain,” says Narandra Bethina, MD, a rheumatologist at the University of Vermont Medical Center and assistant professor at the Robert Larner, MD College of Medicine at the University of Vermont in Burlington. “This can also result in better quality of life.”
Medications are an important part of treatment for arthritis in the ankle. They can help slow bone loss, relieve inflammation, and ease pain. Here are the types of medications used commonly in arthritis treatment.
Nonsteroidal anti-inflammatory drugs:Over-the-counter medications like ibuprofen (Advil) and naproxen (Alleve), as well as prescription NSAIDs, can help relieve pain and swelling in the joints. Even though many NSAIDs are available over the counter, they can have side effects (such as stomach ulcers and kidney dysfunction) especially when taken for the long term and/or in high doses.
Oral corticosteroids:These quick-acting drugs help stop inflammation and are often used to manage flares in rheumatoid arthritis and gout, says Rajat Bhatt, MD, a community rheumatologist with offices in Richmond, Pearland and Greater Heights, Texas. It’s best to use corticosteroids in the lowest possible dose for short periods of time, as they can cause a range of serious side effects, including bone thinning and high blood sugar.
Steroid injections:In certain cases, steroid injections into the ankle joint can help relieve inflammation. These shots shouldn’t be done repeatedly, though. “Frequent injections damage cartilage,” says Dr. Bhatt. “Also, we try avoiding tendon injections and tendon ligaments close to the joint.” An occasional shot, though, can offer temporary pain relief and reduce inflammation. “No more than three injections per year is the standard of care,” says Dr. Archer.
Analgesics:Analgesics such as acetaminophen (Tylenol) help with pain relief. That makes them good for people who can’t take NSAIDs if they’re allergic to them or have stomach issues. You can also combine analgesics and NSAIDs, Dr. Bhatt says.
Topical creams:Over-the-counter topical pain relievers (salves, rubs, or balms) are an alternative, says Dr. Bilal. They’re good if you can’t take oral medications or if medications aren’t helping with the pain. Examples include capsaicin cream (over the counter) and the prescription NSAID diclofenac (Pennsaid, Solaraze, Voltaren Gel), Dr. Bilal says.
Gout medications: Some gout medications help prevent future attacks of joint pain and inflammation. Others relieve an acute attack’s pain and inflammation. Some people take both types of gout medication.
DMARDs: Disease-modifying anti-rheumatic drugs include conventional immune-modifying drugs, such as methotrexate, as well as biologics, which are more targeted to certain immune system chemicals and pathways (these include such drugs as Humira and Enbrel) work slowly to change the course of inflammatory disease. They’re only used to treat inflammatory arthritis such as psoriatic arthritis and rheumatoid arthritis.
Lifestyle modifications are a big part of helping treat arthritis in the ankle. “The most important lifestyle change a patient can make is a commitment to healthy eating and exercise,” says Dr. Archer. “Unfortunately, pain from arthritis can force a patient to become more sedentary, which in turn can cause depression and overeating. Diet is 80 percent to 90 percent of the battle.”
Soothe with heat and ice: Stiff and sore ankles can be relaxed and soothed with heat therapy. Ice can help numb areas affected by joint pain and reduce inflammation. “Ice therapy is helpful for acute exacerbation of arthritis symptoms (swelling and redness), and heat is good for chronic pain symptoms,” says Dr. Archer.
Do ankle-friendly exercise: It’s important to control your weight with regular, low-impact aerobic exercise. “Keeping your weight close to your ideal BMI is the best thing you can do to control your pain and symptoms,” says Dr. Archer. As little as a 10-pound weight gain can increase stress on your ankle. This extra weight can weaken tendons and ligaments, which makes sprains and strains more likely.
Do gentle exercises that don’t stress the ankle joint, such as swimming or cycling. “Walking is one of the best exercises if done correctly with good shoes,” says Dr. Bhatt. Limit high-impact activities, such as running or tennis. Also stay away from soccer and kickboxing, says Dr. Bhatt.
Invest in your shoes: Cushioned shoe inserts can help create less pain in the ankle joint. A major cause of ankle arthritis is trauma. Reducing the amount of high-impact activity and providing cushion to the ankle joint helps prevent joint damage, says Dr. Bilal. “A rocker bottom added to the sole of your shoe can help decrease impact on your heel while standing or walking,” says Dr. Bilal. Here’s how to pick the right footwear when you have arthritis.
Go for physical therapy:Specific exercises can help your flexibility and range of motion and strengthen the muscles in your ankle. Your physical therapist can develop a program that’s right for you. Here are some range-of-motion exercises, including some for the ankle, you can try at home.
Get a supportive ankle brace: A brace called ankle-foot orthosis can help hold the ankle joint in position. It will support the joint, take pressure off the ankle, and prevent extra motion. It spans both the ankle and foot and looks like an ankle brace with a foot orthotic attached. Most people start with an over-the-counter brace, then if necessary, get a fitted one from a foot and ankle specialist or podiatrist. Most are worn inside the shoe though a new kind is worn outside the shoe.
“Custom-made orthotics are the best choice for ankle arthritis,” says Dr. Archer. “Usually ankle arthritis is asymmetrical. Prefabricated devices don’t provide as much relief. A custom device addresses all the issues specific to each foot.”
Eat a clean diet: As we shared above, maintaining a healthy weight helps reduce stress on the joints. Losing excess pounds leads to less pain and increased function. “Avoid processed foods and foods high in sugar, especially if you have gout,” says Dr. Bhatt. You especially want to eat healthfully since your exercise abilities may be limited, says Dr. Archer. “Diet becomes a huge factor in in weight control,” she says.
Use an assistive device: A cane or walker can help reduce stress on the affected joint and help improve mobility and stability, says Dr. Bilal. Holding a cane with the hand opposite the hurting ankle can help alleviate pressure off the affected ankle. However,Dr. Archer says a cane should be a last resort. “A cane can throw off gait and create hip problems,” she says. Learn more about using a cane with arthritis.
Your doctor may recommend surgery for your ankle arthritis if your pain causes disability and isn’t relieved with nonsurgical treatment. Your doctor may recommend more than one type of surgery. “Ankle surgery is complicated as it most commonly involves a fusion of the rearfoot or ankle joint or both,” says Dr. Archer. “If there is significant spurring of the ankle joint, the spurs can be resected via ankle arthroscopy first before fusion is attempted to try and restore ankle motion. However, all non-surgical measures should be attempted before surgery is planned.”
What’s right for you depends on the extent of your arthritis in the ankle. Here are some options.
Ankle arthroscopic repair: “Ankle arthroscopy is useful to clean up loose joint bodies, or small pieces of bone spurs in the joint that have broken off over time,” says Dr. Archer. It can lead to less pain and improved range of motion, says Dr. Bilal. Since the surgery can be done laparoscopically, your surgeon will make a few small incisions.
Ankle arthroscopic repair is helpful in the early stages of arthritis in the ankle and for those with limited ankle arthritis. It’s often ineffective in advanced ankle arthritis, says Dr. Bilal. That’s because when a significant amount of cartilage has worn away, the procedure won’t help the joint.
Ankle fusion surgery:This surgery, also called arthrodesis, is used in end-stage ankle arthritis. The procedure decreases movement of the worn-out portion of the joint/cartilage, which in turn decreases pain. The joint is then held in place with a rod or plates and screws, says Dr. Archer. The bones fuse together over time.
The surgery is ideal for those with excessive bone loss, poor ligaments, poor bone quality, or previous infection. It’s the most common surgical treatment for end-stage ankle arthritis, says Dr. Bilal. “Younger, heavy, physically active males might be better candidates for ankle fusion,” says Rashmi Maganti, MD, a rheumatologist who practices at the Baylor Clinic in Houston and an assistant professor at Baylor College of Medicine.
Ankle fusion isn’t a good option for everyone. “Sometimes the bones don’t heal and join together,” says Dr. Bhatt. Plus, you can develop arthritis at the adjacent joints of the ankle and foot from increased stress on those joints after this surgery, says Dr. Bethina.
Dr. Archer says that you shouldn’t expect to walk as you once did. “But if the pain is bad enough, you may welcome the chance to walk slightly differently without pain.”
Total ankle replacement: In this procedure, damaged cartilage and bone are removed and replaced with new metal or plastic joint surfaces to restore the joint’s function. This procedure helps preserve joint motion, says Dr. Bilal. Ideal candidates have good bone quality and normal tendons and ligaments. “Patients with pre-existing arthritis in smaller joints in foot or hip or knee impairment that would be worsened by loss of ankle joint motion might be better candidates for ankle replacement,” says Dr. Maganti.
This surgery is controversial, though, and has mixed results. “Joint replacement comes with its risks, including implant failures,” says Dr. Bilal. “And it’s not an ideal procedure for people who have deformity or prior infections leading to joint damage.”
The ankle joint gets a lot of stress and implants aren’t as good as natural bone, Dr. Bhatt says. It does preserve movement in the ankle joint, but you have to be off your foot for a while. “Outcomes for replacement for a weight-bearing, poorly supported joint like the ankle need a lot of surgical expertise,” says Dr. Maganti.
You haven’t intentionally changed your diet or started a new exercise routine, yet your pants are getting looser and the number on the scale keeps going down. Should you celebrate — or start to worry?
While unexplained weight loss might seem like a welcome surprise (especially if you’re among the two out of three Americans who are overweight or obese), it’s often a red flag. Any number of conditions could turn out to be responsible for your unexplained weight loss: overactive thyroid, diabetes, cancer … the list goes on and on. And yes, rheumatoid arthritis (RA) is among the diseases that can cause weight loss.
To figure out what’s wrong, you and your doctor may need do some sleuthing, but weight loss probably won’t be your only clue. If RA is the culprit you’ll likely also have painful or swollen joints, fatigue, and trouble moving certain joints. Here are common symptoms of rheumatoid arthritis to be aware of.
RA probably isn’t the first disease that comes to mind when you think of unexplained weight loss, but there are a few reasons why RA sometimes causes people to lose weight.
“Early on, when the disease is active, there’s a lot of inflammation, and [weight loss] can be a side effect of inflammation,” says Joshua Baker, MD, assistant professor of rheumatology and epidemiology at the University of Pennsylvania and Philadelphia VA Medical Center.
More specifically, the same cytokines (inflammatory proteins that are part of your immune system) that wreak havoc on the joints of people with RA also impact metabolism and contribute to the breakdown of muscle. That could happen if you have RA but haven’t yet been diagnosed; if you’ve been newly diagnosed and treatment hasn’t had a chance to kick in; or if you’ve been living with RA for a while but your current treatment has stopped working.
Another reason rheumatoid arthritis can cause weight loss is that it can decrease your appetite, says Caroline A. Andrew, MD, a medical weight management specialist at the Hospital for Special Surgery in New York City. Aches and pains can be a factor as well: “If a person has significant joint pain and cannot move easily or exercise, there may be a loss of muscle mass, causing weight loss,” she says.
Generally speaking, a newly diagnosed RA patient who was losing weight will start regaining weight once they begin treatment because the medication will address the underlying inflammation that was responsible for the weight loss.
“If RA symptoms improve with treatment, a person can start to do physical therapy and exercise and start to regain muscle mass. Appetite may also improve,” says Dr. Andrews.
However, all drugs have side effects, including RA medications. Depending on what you take — and how your body reacts to it — you might experience weight gain or weight loss. According to one 2016 study, the drug leflunomide (Arava), one type of disease-modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis, is more apt to cause weight loss as a side effect than some other RA medications. It sometimes causes diarrhea, nausea, and upset stomach, all of which can exacerbate weight loss.
No matter which RA drug regimen you’re on, be sure to talk to your doctor if you start losing weight for no apparent reason. That change is reason enough for your doctor to order some tests and reassess your disease activity. If your RA is no longer being well controlled, it may be time for change in your treatment plan.
At the same time, Dr. Baker says your physician should screen you for other conditions that could be responsible for weight loss. “Are you having shortness of breath in addition to losing weight? If so, you might need a chest scan test for interstitial lung disease,” he says. This condition, in which scar tissue builds up in the lungs, is common among smokers, but Dr. Baker estimates that about 15 percent of RA patients also get it (including smokers and non-smokers). “We don’t fully understand why, but we think the same inflammation [that impacts the joints] is occurring in the lungs and causing damage,” he says. (Read more about how inflammatory arthritis affects the lungs.)
Whatever the reasons for your weight loss, it’s important to sort it out. RA patients who lose too much weight can become underweight and frail, which studies have shown increases the risk of early mortality.
Clearly, unexplained weight loss with rheumatoid arthritis can be dangerous, but so is being overweight.
“Fat tissue releases cytokines, which cause inflammation in the body,” says Dr. Andrew. “These cytokine levels are already elevated when someone has an inflammatory arthritis, so being overweight can exacerbate the already existing inflammation.”
The physical toll of being overweight is also problematic. “Carrying extra weight places increased pressure and stress on the joints, which can worsen the pain and stiffness associated with rheumatoid arthritis,” says Dr. Andrew. “Every pound of excess weight places about four pounds of extra pressure on the knees.
The result of all that physical pressure, adds Dr. Baker, is that many people with RA also end up with osteoarthritis (the “wear-and-tear” kind of arthritis). That combo adds up to higher rates of disability and higher pain scores — and drug therapies can only help so much.
“Studies have shown that some DMARDs may not be as effective in subjects who are overweight or obese. One study showed that regardless of the type of initial treatment, subjects with RA who were overweight or obese were significantly less likely to achieve sustained remission compared to subjects with a normal weight,” says Dr. Andrew.
Meanwhile, you’re more apt to experience drug side effects if you’re overweight because obesity often causes inflammation in the liver that interferes with your ability to process drugs, says Dr. Baker. (Read more about how arthritis affects the liver.)
The upshot is that if you’re overweight and you can manage to lose even a small amount of weight, your arthritis prognosis should improve dramatically. “It’s OK if you don’t get to a ‘normal,’ weight,” says Dr. Baker. “That might not be possible or realistic.” Shedding just 10 percent of your current weight — that’s 18 pounds if you currently weigh 180 — could make a big difference.
How well you can make a fist or squeeze someone else’s hands could reveal a lot about your own health.
If the joints in your hand have recently started aching, it’s natural to worry about why. Are they just over-taxed, or could you be developing progressive autoimmune condition like rheumatoid arthritis (RA)?
In 2017, the European League Against Rheumatism (EULAR) stated that seven factors can help doctors determine which patients with arthralgia — joint pain without other obvious arthritis symptoms — were most likely to progress to RA. Those factors include morning stiffness and family history of rheumatoid arthritis.
Difficulty making a fist is also on that list of early RA risk factors, but according to authors of a new Annals of the Rheumatic Diseasesresearch letter, there hasn’t been much scientific evidence proving that it’s a useful tool for predicting RA.
To find out whether one’s inability to completely make a fist can actually predict RA risk, the researchers reviewed previous studies, including one of more than 600 patients who had recently been diagnosed with small joint pain. At baseline participants were asked to try to close their fists all the way (with fingertips touching the palm).
Researchers also measured fist strength by having participants squeeze an assessor’s fingers. They then used MRIs to determine whether the inability to make a fist or weak fist strength was more common in people who had the kind of inflammation (tenosynovitis) in the hands and wrist that’s associated with RA. The found a strong correlation.
“Difficulties making a fist in recent-onset arthralgia… is considered a sign of imminent RA,” the authors wrote. “This is the first study providing scientific support for the predictive value of this sign.”
