Written by Dr. Currey
There are many different causes of joint pain ranging from reactions stemming from our own immune systems to lasting damage from past injuries to chronic wear and tear due to repetitive movements or poor body mechanics. The cause of the joint pain is quite important in designing an effective treatment plan that will improve function and decrease future damage. Simply popping a few Naproxen or other NSAID pills through the day is not a solution to the problem although it will temporarily decrease your pain.
As someone who lives with chronic joint pain, I am a human barometer. Perhaps some of you know what this means intimately as well. We can tell when the weather is going to change, and our walk or our grip might show it.
Autoimmune Causes of Arthritis:
- Rheumatoid Arthritis (RA): this is an arthritis that attacks the spaces in the joints, specifically the linings of those spaces causing swelling of the joints and pain. Patients who live with RA usually notice symptoms that are symmetric (the same joints affected on both sides of the body) and can have symptoms outside of the joint system. Some of these other symptoms can include eye problems, rubbery nodules under the skin, and problems in other organs such as the kidneys or lungs. Treatments for RA have come a long way in recent years and vary from oral to injectable therapies.
- Psoriatic Arthritis (PsA): this arthritis can present quite similarly to RA, but we see more of the disease process in the areas where muscle tendons meet your bones in joint spaces (enthuses). Often (but not always) patients will also experience skin lesions or changes in their nails along with the joint pain. PsA can be symmetric or asymmetric and also involves the spine whereas RA usually skips this area. Treatments here are similar to RA treatments.
- Ankylosing Spondylitis (AS): this arthritis affects more men than women and is focused in the spine. It has a genetic component like the other immune causes of arthritis and a genetic marker (HLAB27) is a good screen to see if you are predisposed; however, just because you don’t have the gene doesn’t mean you can’t get AS. Again treatments have come a long way. To reduce the severity of symptoms, patients with AS are encouraged to abstain from tobacco use and establish a regular exercise regimen designed to maintain spinal health and function.
- Lupus: if you have ever watched House MD, you know how varied the presentation of the autoimmune disease can be. Joint pain, kidney disease, neurological issues, you name it, this disease seems to be able to produce it. If you notice a new onset of joint pain accompanied by a rash on your face that looks like a butterfly is on your nose or new sensitivity to the sunlight, be sure to tell your doctor. An autoimmune blood panel is a good place to start.
Infectious Causes of Arthritis:
- Reactive Arthritis: this syndrome formerly known as Reiter’s Syndrome is characterized by joint and eye pain following an infection (the most common suspects are Chlamydia or Gonorrhea). This can cause rapidly progressing joint swelling and damage and is usually isolated to a single joint. It is important to seek immediate health care if you suspect you have this condition.
- Infectious Arthritis: this is an infection in the joint space itself and can cause rapid erosion of the bone and increases your risk for a blood infection – a medical emergency! Most often this results from a trauma where pathogens (germs) make their way into the joint space. Seek urgent health care if you think this is the cause of your joint pain – again this is usually a single joint.
- Lyme Disease (or other tick borne illnesses): a hallmark of Lyme Disease is wandering joint pain. This is exactly what it sounds like, one day your knees may hurt, and the next it’s your elbow or wrist. The pains come and go from the joints. If you have been bitten by a tick, always report this so that prophylactic (preventative) antibiotics can be prescribed. It is much easier to prevent a full blown infection with lyme than to eradicate it once it has set up shop.
Non-infections/Non-autoimmune Causes of Arthritis:
- Gout: the disease of kings. This arthritis results in the collection of uric acid crystals in joint spaces. The classic presentation is having extreme pain, redness, and swelling in a big toe (gravity pulls those crystals down). Uric acid is a breakdown product of proteins and alcohol. Thus a diet high in meats and alcohol is a risk factor to developing gout. There are many treatments both natural and pharmaceutical for prevention and resolution of attacks.
- Osteoarthritis (OA): this is the most common cause of joint pain and can result from past injury, repetitive strain injuries, or poor body mechanics. When you think of joint pain associated with increased age, OA is usually what you are thinking of. Evidence from looking at the joints of patients with OA is starting to show us that there is an immune response in the joint space as well – this may lead to OA being recategorized as an autoimmune condition in the future.
We have covered several causes of joint pain, and there are many others we haven’t touched on. At Bridges Family Wellness, we aim to find the balance between conventional and alternative medicine, and each treatment is personalized for your specific needs.
Non-Medical Treatments for Joint Pain:
- Physical Therapy: learning how to get your body into balance and how to use your body in a way that will reduce joint pain and lower your risk for continued damage.
- Alternating hot and cold therapies: this can help reduce swelling and pain in an area. Never use this with an infection as you can spread it to the surrounding tissues.
- Balneotherapy (water therapy): water with salt (epsom or dead sea are my favorites) is very therapeutic and can greatly reduce pain. A 20 minute soak in warm (not hot) water a few days a week is one of my favorite ways to reduce pain and stress.
- Exercise: I like to tell my patients (and myself) to keep moving so that you don’t rust. For this reason, we offer free Yoga at Bridges Family Wellness to incorporate frequent gentle movements, increase flexibility and body awareness, and reduce stress. Check the events page for days and times.
- Topical agents: if you are a patient here, you have most likely heard me praise castor oil as a topical to reduce pain and inflammation. Capsaicin cream is another great topical to reduce pain as it interferes with pain signals being sent by the nerves in the area.
- Diet: many people with arthritis notice very large changes in their symptoms once they identify and remove food triggers from their diets. Individual triggers vary and may include: nightshade plants (tomatoes, peppers, eggplant, ashwagandha, etc.), eggs, dairy, sugar, animal fats, soy, nuts, or others. Working with a nutritionist or ND trained in elimination diets is by far the best way to identify one’s triggers.
- Stress reduction: pain = stress and stress = pain. Pain is perceived as more severe when a person is experiencing more stress, and for many stress is a trigger for their condition. Practicing some form of mindfulness daily is important to any chronic pain condition. Meditation, yoga, journaling, prayer, coloring (yep), singing, knitting, and so many other options exist. Find what helps you feel relaxed and balanced and be sure to practice this regularly.
- Acupuncture: I could sing the praises of this therapy all day long, but you really need to experience it to know what it can do. If you have a bad experience with acupuncture, try a different practitioner and give it at least 3 sessions before you decide. If you need a recommendation for a practitioner, we have several in our area who are amazing.
As you can see, there is a lot to know about joint pain, and there are so many options to help your pain. We haven’t even discussed nutrients, herbs, homeopathy, or pharmaceuticals. If you want to learn more, be sure to schedule an appointment with us so we can tailor build a plan to your situation and needs.