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.”
You’ve been experiencing pain in your wrists. At first you might chalk it up sleeping funny, or an overuse injury from your yoga class. But if the pain endures, and depending on the specific mix of your symptoms, you may be wondering whether it could it be carpal tunnel, a form of arthritis, or something else.
For some people, however, it’s often not an either-or situation. Having arthritis raises your risk of developing carpal tunnel, so you could have both conditions at the same time.
In this article, we’ll explain why arthritis may be a cause of carpal tunnel and share information about carpal tunnel symptoms, diagnosis, and treatment.
While both arthritis and carpal tunnel can affect the wrists, hands, and fingers, the causes for the symptoms differ.
Rheumatoid arthritis is an autoimmune disease, which means your body’s own immune system attacks the joints, causing inflammation, pain, and swelling. Here are other common symptoms of rheumatoid arthritis.
Osteoarthritisis the “wear-and-tear” type that occurs when cartilage that cushions joints wears away. Here are other common osteoarthritis symptoms.
Carpal tunnel syndromeoccurs 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.
The floor and sides of this inch-wide tunnel are formed by small wrist bones called carpal bones, which are linked together by a ligament that overlies the top of the carpal tunnel. (The word carpal comes from the Latin “carpus,” which means wrist.)
Repetitive hand motions, such as those that occur when someone works on an assembly line, often contribute to carpal tunnel syndrome. With excessive motion, the tendons of the fingers can get swollen or inflamed and squeeze the median nerve. Despite common thinking that typing causes CTS, even heavy computer use did not make people more likely to develop it, according to one study.
A number of health problems can also cause swelling of this area. Arthritis is one, but diabetes and thyroid issues are also associated with carpal tunnel syndrome, as are hormonal changes that occur during pregnancy. Injuries, such as a wrist fracture, can contribute to the onset of carpal tunnel syndrome.
“It’s very common to have carpal tunnel syndrome when you have rheumatoid arthritis, especially if you have rheumatoid arthritis of the wrist,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor for CreakyJoints.
If you have rheumatoid arthritis, chances are it does affect your wrists — research shows they’re the most common site for RA in the upper body and that 75 percent of people with RA have wrist involvement.
Though its impact isn’t usually as great as RA, even osteoarthritis (OA), the wear-and-tear type of arthritis, increases the risk of carpal tunnel too. OA in the wrist can cause swelling and bony changes that crowd the carpal tunnel.
“The wrist is a very small area and if it gets inflamed for any reason, it can cause pressure on the nerve that leads to carpal tunnel syndrome,” says Robert Gotlin, DO, a sports and spine physician in New York City and an associate professor of rehabilitation medicine and orthopedics at the Icahn School of Medicine at Mount Sinai.
Interestingly, carpal tunnel, like rheumatoid arthritis, is three times more likely to affect women than men, possibly because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain.
Like OA, carpal tunnel is more likely to occur with age; more than three-quarters of people develop symptoms between the ages of 40 and 70.
Luckily, despite some similarities in symptoms between carpal tunnel syndrome and arthritis, doctors usually don’t have much trouble telling the two conditions apart. Even better, there’s some overlap between treatments for both conditions.
When carpal tunnel develops, it has a typical pattern, says Dr. Gotlin. Some key signs, which can help differentiate carpal tunnel from different kinds of arthritis, include:
The median nerve provides sensation to these fingers, as well as to half of the ring finger (the pinky typically isn’t affected). It also provides strength to some of the muscles at the base of the thumb. Initially, numbness and tingling symptoms come and go, but as the condition worsens, they may become chronic.
This may cause you to drop things or leave you unable to perform everyday tasks. “The thumb side of the hand provides precision grip, which is important when you want to do things like use a screwdriver or hold something carefully,” Dr. Gotlin explains. As carpal tunnel progresses, people may say their fingers feel useless or swollen, even though there’s no swelling. In the most severe cases, the muscles at the base of the thumb experience “gross atrophy,” which means they shrink in size.
Carpal tunnel tends to be especially painful at night. Blood pools because your hand isn’t moving, which creates swelling in the wrist. Many people also sleep with their wrists bent, which can also cause more pain at night.
Another tipoff it’s carpal tunnel is that in the early stages, people are usually able to relieve symptoms by shaking their hands rapidly (the “flick sign” in medicalese). “This gets the blood flowing again and reduces swelling, so the pain goes away,” says Dr. Gotlin.
Get more information here about how symptoms of arthritis affect the hands.
Your health care provider can diagnose carpal tunnel by taking a medical history and conducting a physical exam. He or she may tap the inside of your wrist to see if you feel pain or a shocking sensation (the Tinel test) or ask you to bend your wrist down for a minute to see if it causes symptoms (the Phalen test).
Lab tests and X-rays may be used to reveal problems like arthritis, diabetes, and fractures. Your doctor may also employ electromyography (EMG), a test that measures electrical activity of the nerve, to help confirm the carpal tunnel diagnosis.
In most people, carpal tunnel gets worse over time, so early treatment is important. Ignoring symptoms can lead to permanent damage to the nerve and muscles, which can lead to loss of feeling, hand strength, and even the ability to distinguish hot and cold. It may also increase the need for surgery. Luckily, many people get better after first-step treatments, which include:
Immobilization: Wearing a wrist splint provides support and braces your wrist in a straight, neutral position that takes pressure off the median nerve. A splint can be worn just at night or 24 hours a day.
Rest: For people with mild carpal tunnel, avoiding activities or taking frequent breaks from repetitive-motion tasks that provoke symptoms may be all you need. If your wrist is red, warm, and swollen, applying cool packs can help.
Over–the–counter drugs: Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen may provide short-term relief by calming swelling, but they haven’t been shown to treat CTS itself.
Prescription medication: In more severe cases, steroid injections are given to relieve pressure on the median nerve. Steroid injections usually aren’t effective in the long term, but research suggests improvement lasts 10 weeks to more than a year. Caution: If you have diabetes, be aware that long-term corticosteroid use can make it hard to regulate insulin levels.
Alternative therapies: Yoga poses that emphasize opening, stretching, and strengthening the joints of the upper body were shown in one preliminary study to reduce pain and improve grip strength in those with CTS. People in one study who got acupuncture reported improvement in symptoms and functionality. Chiropractic manipulation has also been shown to be beneficial. Be sure to talk with your doctor before trying any of these treatments to be sure they’re appropriate for you.
If you’re diagnosed with both carpal tunnel syndrome and arthritis, the two conditions can be treated at the same time — and sometimes the treatment is even the same. For instance, NSAIDs can help relieve the pain of RA and OA as well as carpal tunnel. The same is true for corticosteroids. In addition to immobilizing the wrist to relieve symptoms of CTS, wearing a splint can provide rest and support for arthritis in the wrist, hand, and fingers.
When carpal tunnel symptoms are severe and/or don’t respond to these conservative measures, surgery may be required. It’s a very common surgery, performed more than 400,000 times each year.
The outpatient procedure, known as carpal tunnel release surgery, involves making one or more small incisions in the wrist or palm and cutting (“releasing”) the ligament that’s compressing the carpal tunnel to enlarge the area. “It’s no longer a tunnel, but more like a convertible car — the roof is gone,” explains Dr. Gotlin.
Following surgery, the ligaments usually grow back together and allow more space than before. Symptoms are usually relieved immediately after surgery, but full recovery can take up to a year. Recurrence of carpal tunnel following surgery is rare, though, according to Dr. Domingues, it’s more common in people with active rheumatoid arthritis. Be aware that fewer than half of people report that their hand(s) ever feel completely normal post-op. Some residual numbness or weakness is common. Still, it’s comforting to know that the surgery has a high success rate, providing a lasting, good outcome in up to 90 percent of cases in one study.
When you have arthritis, buttoning a shirt or fastening a clasp can be a pain in the butt. So is folding laundry with achy joints, blow drying your hair, or even signing paperwork. But then there’s actual pain that can occur in your buttocks — and it may actually be caused by arthritis.
The buttock is a large area, with many different structures within it, explains Claudette Lajam, MD, orthopedic surgeon with NYU Langone in New York City. The giant muscle at the surface of the buttocks is called the gluteus maximus. It overlies other layers of muscle and two major joints: the hip joint and sacroiliac (SI) joint, which is situated on each side of your spine, and connects the sacrum (base of your spine) to the ilium (top part of your pelvis).
Buttock pain may indicate a problem in either of the sacroiliac joints, the lumbar spine (lower back), muscles of the pelvis or any of those other layers, says Dr. Lajam, who also serves as spokesperson for the American Academy of Orthopaedic Surgeons.
The hip is a ball-and-socket joint. The “ball” is the top of your thigh bone, and it sits in a “socket” that’s formed by part of your pelvic bone. Slippery tissue called cartilage covers the bone surface and helps cushion the joint. Osteoarthritis (OA) occurs when the protective cartilage gradually wears down, which over time leads to pain and stiffness. The most common symptom of hip osteoarthritis is pain around the hip joint. As hip OA disease progresses, low-grade inflammation can set in, explains physical therapist Colleen Louw, PT, spokesperson for the American Physical Therapy Association (APTA). That results in increased sensitivity of the surrounding nerves, which can cause pain in and around the low back and buttocks.
The bones in your spine (vertebra) are separated by spongy discs, which act as shock absorbers. With age, these discs can wear or shrink, which narrows the space between the spinal joints, or “facet” joints. “The facet joints are a series of small joints in the lower back that contain the same type of cartilage that is found in your knees,” explains Louw. Disc changes can lead to more strain on the joints, which can cause the cartilage to wear down and the facet joints in the vertebrae to rub against one another, leading to the pain and stiffness of OA. “It is not uncommon for these joints to refer pain into the buttocks, especially with prolonged standing or even walking,” says Louw.
Ankylosing spondylitis is a form of arthritis that causes inflammation in the joints in your spine. Most commonly, it affects the vertebra in your lower back and the SI joints. Over time, inflammation can cause some of the vertebrae to fuse, which makes your spine less flexible and leads to chronic pain and discomfort. Early symptoms of AS are frequent pain and stiffness in the lower back and buttocks, which comes on gradually over the course of a few weeks or months. Some people even use the phrase “alternating buttock pain” to describe their AS symptoms.
With rheumatoid and other forms of inflammatory arthritis, the immune system mistakenly attacks a protective lining in your joint called the synovium, and destroys cartilage. Though RA tends to affect smaller joints first (such as those in your hands and feet), symptoms can spread to both your hips as the disease progresses. Inflammatory arthritis in your hip will feel painful and stiff. You may also experience a dull or aching pain in the buttocks that’s worse in the morning, and gradually improves with activity.
“Unless there is a direct trauma that occurs to the buttock itself, like falling on an object or getting kicked, buttock pain is usually referred from somewhere else,” says Louw. Here are other reasons aside from arthritis that your butt may be in pain.
Your buttocks are made up of three muscles: the gluteus maximus, the gluteus medius, and the gluteus minimus. You can strain one of these or other overlapping muscles in the area, which can cause pain, says Dr. Lajam. “The hamstrings attach right at the bottom of the pubic bone,” she says; “injury or tears of the hamstrings can cause deep buttock pain. Sprains or strains of the abductor muscles [the side muscles of the hip] can cause buttock pain.”
Your buttocks may develop a painful bruise (or black-and-blue mark) if you get hurt, such as falling off your bike or kicked by your kiddo during an overly aggressive wrestling match. You may notice swelling, discoloration, and tenderness to the touch.
This painful condition occurs when the small, fluid-filled sacs — called the bursae — that cushion the bones, tendons, and muscles near your joints become inflamed. The most common causes are repetitive motions or positions that put pressure on the bursae around a joint. Bursitis most often affects the shoulder, elbow, and hip. “Bursitis of the hip can lead to buttock pain,” says Dr. Lajam.
You also have bursae in your buttocks called ischial bursa, which can become inflamed and cause ischial or ischiogluteal bursitis. This can result from sitting for a long time on a hard surface, direct trauma, or injury to the hamstring muscle or tendon from activities like running or bicycling.
This is inflammation of the SI joints, which can cause pain in your buttocks, and well as your lower back, hips, or groin. Some forms of inflammatory arthritis, such as ankylosing spondylitis and psoriatic arthritis, as well as osteoarthritis, can cause sacroiliitis, so might an injury, pregnancy, and infection. Learn more about sacroiliitis.
Pain that radiates from your lower back to your buttock and down the back of your leg is the hallmark symptom of sciatica. It most commonly occurs when a herniated disk, bone spur on the spine, or narrowing of the spine (spinal stenosis) compresses part of the nerve. Injuries or overuse of the piriformis muscle, which is located in the buttocks near the top of the hip joint, can contribute to sciatica too. This causes inflammation, pain, and often some numbness in the affected leg. The pain can range from mild ache to a sharp, burning, or excruciating pain. Usually only one side of your body is affected.
If you’re experiencing buttock pain and you’re not sure why, your primary care doctor is a good place to start. They may refer you to a rheumatologist or orthopedic doctor depending on your symptoms and circumstances.
If you’re already diagnosed with arthritis and are experiencing buttock pain that’s new or different, it’s important to let your doctor know. You might have an additional kind of arthritis or injury alongside your current diagnosis. (For example, buttock pain could be a sign that you have osteoarthritis in your spine in addition to rheumatoid arthritis.)
Step one for buttock pain treatment is following your arthritis treatment plan, says Dr. Lajam. Taking your medication as prescribed and maintaining a healthy weight can help relieve buttock pain caused by arthritis. Your doctor may recommend steroid injections in affected joints to help relieve the related buttock pain.
Most types of arthritis cause swelling, but the swelling of dactylitis is something else all together. “My fingers feel like they are going to burst,” psoriatic arthritis (PsA) patient Emily Terbrock told us on Facebook. This incredibly painful, red, and hot swelling can cause fingers to look like sausages, giving dactylitis the nickname “sausage fingers.”
Dactylitis, though, can be distinguished from regular joint swelling. “Dactylitis is the swelling of an entire digit — finger or toe — rather than just a knuckle within the finger or toe,” says rheumatologist Arthur M. Mandelin II, MD, PhD, associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “Usually, the affected digit is most swollen in the middle and less swollen at the ends, taking on a cigar-shaped appearance.”
Dactylitis is associated with spondyloarthritis, which is an umbrella category of arthritis that notably causes symptoms in the spine, as well as other joints.
“Dactylitis can be associated with all of the spondyloarthropathies, including IBD-related inflammatory polyarthritis and reactive arthritis, but it’s most commonly with psoriatic arthritis,” says Mona Indrees, MD, a rheumatologist at AnMed Health in South Carolina. “Dactylitis can also be seen in other conditions such as sickle cell disease, gout, sarcoidosis, TB, and syphilis.”
These conditions can be differentiated by other clinical features and laboratory tests, says rheumatologist and researcher Dafna Gladman, MD, professor of medicine at the University of Toronto.
Because of the close connection between dactylitis and psoriatic arthritis, its presence can be used to diagnose psoriatic arthritis and distinguish it from other forms of arthritis.
“I have PsA and my first symptom was pain in my finger, which was misdiagnosed as tendinitis for months. It got to the point where my finger couldn’t bend at all, swelled twice its size, and was extremely hot,” Erin Jean Wheller told us on Facebook. “My rheumatologist took one look at me and immediately knew it was [psoriatic] arthritis.”
Other patients also told us dactylitis was one of their first PsA symptoms as well; its presence can be helpful in leading to a quick and accurate diagnosis.
“Dactylitis is caused by uncontrolled inflammation that results from spondyloarthropathies, and can be associated with flaring of the underlying joint disease,” Dr. Idrees says. “The swelling is diffuse and continuous throughout the tissue, affecting tendons, ligaments, synovium — the space that contains the joints and joint capsule — and adjacent soft tissue.” (Here’s more information about synovitis.)
In terms of why there’s such a strong association between dactylitis and psoriatic arthritis, there’s still no definitive answer, but Dr. Mandelin has some ideas. “It isn’t clear why dactylitis happens, but it is likely that its origin is related to the fact that patients with psoriatic arthritis have a tendency to develop inflammation of tendons and the surrounding tendon sheaths in addition to inflammation of the actual joints,” he says.
Dr. Idrees says the condition is often painful and can also severely limit functionality. The patients we heard from bore this out, describing incredible pain from their hands touching anything at all; a heavy, hot feeling; and not being able to bend or use their fingers.
“When it happens it starts out as a tightness, and eventually gets to the point where the skin is stretched so tight that it becomes itchy,” Lyin Despres described on Facebook. “Each movement of the affected finger is excruciating. It feels as though the nerves are being compressed by the swelling and if you move you will be tortured. You can’t get dressed or undressed, eat, use the bathroom, or do much of anything unassisted when this happens to both hands at the same time.”
Unfortunately, the presence of dactylitis often denotes more severe disease, Dr. Gladman says. “Digits with dactylitis are more likely to have damage than those without dactylitis,” she says. Dr. Mandelin says it’s important to note, though, that this is just an increased risk, and not a guaranteed outcome. “The take-away message is that patients with dactylitis should probably be watched more closely and have their disease controlled more tightly in order to try to counteract this risk,” he says.
Many patients we heard from said once they were diagnosed and found the right medicines for them, their dactylitis subsided. “I have had dactylitis in my fingers and a toe,” Joan Wzontek Alba told us on Facebook. “Now I’m on biologics and haven’t had a sausage finger since I found one that works.”
All three doctors we talked with agreed that biologics are more effective in treating dactylitis than conventional disease-modifying antirheumatic drugs (DMARDs).
“Even if joint disease responds to traditional DMARDS, dactylitis can be resistant, and at that point we may add a biologic,” Dr. Idrees says. “Research so far shows the most effective control of dactylitis comes from the use of biologics, including TNF inhibitors and some of the newer agents like ustekinumab and secukinumab, but one has to weigh the risks versus benefits.”
In addition to biologics, Dr. Mandelin advises patients with dactylitis to strongly consider “the new small-molecule JAK inhibitor agents, as these are clearly more effective against dactylitis than traditional DMARDs such as methotrexate.”
Talk with your doctor to see which medication is right for your symptoms—and make sure you adhere to your medication regimen, Dr. Idrees says.
If you have psoriatic arthritis, Dr. Mandelin advises to make sure you’re seeing a rheumatologist and a dermatologist, as the disease is complicated and needs to be addressed from all sides. “Psoriatic arthritis is more complex than many other forms of arthritis, and can affect the body in several unusual ways that aren’t always a concern with other forms of arthritis — dactylitis is only one such example,” he says.
Let your doctor know right away if you experience dactylitis. “It is important to treat dactylitis immediately so that it does not become a chronic problem,” Dr. Gladman advises.
In addition to medical treatments, some patients we heard from had suggestions for treating dactylitis at home. Talk to your doctor before trying home remedies.
Use cold packs or soak hands in cold water.
Wear compression gloves, or finger sleeves like volleyball and basketball players use.
Try warm paraffin wax, icy hot, or other warming treatments.
Keep fingers moving with crochet or knitting, a stress ball, or even just flex and release.
Do regular range-of-motion exercises for fingers and toes.
Learn about how functional disability is often one of the early signs that you can have rheumatoid arthritis.
As rheumatoid arthritis (RA) progresses, it can take quite a toll on your quality of life. Joint pain, stiffness, and inflammation worsen, and, in turn, make the normal activities of everyday life — walking around your house, taking a shower, getting dressed in the morning — a lot more challenging. While that might come as no surprise to someone who has been living with RA for a while, a new study suggests that many RA patients struggle to perform daily activities one to two years before getting diagnosed.
According to the study, which was recently published in the journal Mayo Clinic Proceedings, so-called “functional disability” often occurs well before someone learns that they have RA. “This is a new finding and a finding that is quite intriguing,” lead author Elena Myasoedova, MD, PhD, told ScienceDaily. “It may reflect an accumulation of symptoms between the time of first onset and the time required for providers to actually diagnose patients.”
This kind of delay is problematic for a few reasons. Not only does it mean that people are experiencing debilitating symptoms during this pre-diagnosis period, but they may also be missing out on the opportunity to start treatment early in the disease process. If you have RA, starting a disease-modifying drug antirheumatic drug (DMARD) as soon as possible is usually the best way to achieve remission and avoid permanent joint damage and disability.
To conduct this study, researchers analyzed data from the Rochester Epidemiology Project which contained medical records and questionnaires from 586 RA patients and 531 healthy people. Not surprisingly, the authors found that people with RA had higher rates of functional disability compared to those without the condition. But they also reported that rates of functional disability were elevated in the one- to two-year period that pre-dated their official RA diagnosis.
Early RA symptoms often include joint pain, but unexplained fatigue and low-grade fevers are also common. Of course, many other conditions may cause similar symptoms, so it’s important to see a doctor so you can sort it out. If it does turn out to be RA, speeding up the diagnosis and starting treatment sooner should make it less likely that you’ll develop long-lasting damage and disability.
