Types, Pain, and Effective Treatments for Osteoarthritis.
July is National Juvenile Arthritis Awareness Month, a time dedicated to shedding light on the realities faced by children and teens living with arthritis, as well as raising general arthritis awareness. 1, 2, 3 This observance highlights the importance of early diagnosis and effective treatment of juvenile arthritis, a condition affecting nearly 300,000 kids in the United States. Can you imagine that 1 in 250 kids could develop juvenile idiopathic arthritis (JIA)? This condition affects their ability to jump, play, and run, impacting not just the children but their parents as well. Imagine if both parents and children had arthritis!
In this blog post, we will explore the different types of arthritis, both juvenile and adult, and discuss what the pain feels like for each type. We’ll also examine how arthritis affects one of the most commonly impacted areas: the hip. Additionally, we’ll highlight the importance of effective treatments and explain why Integrated Health Solutions (IHS) in Indianapolis is an excellent resource for addressing the root causes of stress-induced osteoarthritis.
Different Types of Arthritis
Believe it or not, all arthritis is not the same! Sometimes when we hear it we think there is only one type. There are many different types of arthritis. Some have estimated there to be over 100 different types, and many of them have big differences in presentation, causes, and treatments. 6 Here is a summary of the most common:
1.Juvenile Idiopathic Arthritis (JIA) is the most prevalent form of arthritis in children. JIA has several subtypes, including oligoarthritis, polyarthritis, and systemic arthritis. Each subtype varies in symptoms, severity, and treatment responses. Associations for Rheumatology (ILAR) has defined JIA as “arthritis of unknown etiology persisting for ≥6 weeks with an onset at <16 years of age, after excluding other causes of joint inflammation”.
7, 8 It is believed, however, to be caused by an immunogenic mechanism involving both hereditary and environmental factors. What these hereditary and environmental factors are seems to be unclear. It has been observed that the condition is more common in Western children, and as it can affect many joints in the body, the common ones are wrists, knees, and ankles.
2. Osteoarthritis (OA) is the most common type of arthritis in adults but can also affect young people. It is estimated that nearly 32 million people in the US and 240 million worldwide suffer from this condition. 14 People who are more at risk of developing this problem are females, people with joint development abnormalities, previous joint injuries, obesity, and family history of OA. It is characterized by the breakdown and abnormal buildup of the joint cartilage and or bone. The build-up of bone is called bone spurs. The spurs are a result of the body following what is called Wolff’s Law: our bones become thicker and stronger over time to resist forces placed upon them and thinner and weaker if there are no forces to act against. This makes sense that older people develop it more than younger because it takes time. The problem is that the body lays down bone in places that don’t need more bone with OA which is around the joint surfaces. This causes the joints to be stiff and less mobile and sadly more easily irritated when they are moved resulting in pain. So naturally a method to combat OA is to find ways to decrease the forces on the joints.
3. Rheumatoid Arthritis (RA) is an autoimmune disease where the body’s immune system mistakenly attacks the joints, causing inflammation, pain, and eventually joint damage. RA can occur at any age but is more common in adults. It is estimated that it affects 15 million people worldwide and also is more common in women than men.
16 It is characterized by manifestations of nodules on the outside of joints along with vasculitis and the presence of other systemic conditions like heart and lung conditions. An interesting point is these nodes are found on the metacarpal phalangeal (MCP), and proximal phalangeal (PIP) joints (classically known as the knuckle and first finger joint) and it doesn’t affect the distal phalangeal joints (DIP) or the finger joints that are closest to the fingernails.
15 In fact, the early stages of the disease is where you notice these nodules on the hands and feet.
Another interesting finding and common in other autoimmune diseases is the presence of mental disorders, particularly depression and anxiety. It makes sense really that if you have a condition where your body is attacking itself causing pain, and no one knows why. That would be depressing.
4. Psoriatic Arthritis (PsA) is grouped in a sub-group of arthritis that is associated with chronic continuous inflammation. This means they have inflammation and immunological mechanisms. It may sound like similar other inflammatory arthritis, but one of the biggest differences is the person usually is also suffering from psoriasis. It is characterized by well‐demarcated, erythematous plaques covered by silvery‐white scales, typically occurring in a symmetrical distribution involving the elbows, knees, trunk, and scalp.
5. Ankylosing Spondylitis (AS) is an interesting type of arthritis that primarily affects the spine and pelvis, leading to severe, chronic pain and discomfort. It can come from auto-immune issues or chronic inflammatory ones.
21 It usually starts between the ages of 20-30 and has some evidence of being genetically transmitted. The advanced stages can cause fusion of the spine as seen on x-rays as a “railroad sign”.
What Does Arthritis Pain Feel Like?
Types of arthritis pain can vary significantly depending on the type and severity of the condition. To make
this discussion easier, let’s categorize the different types of pain that some can feel when specific types of
tissue are irritated:
- Muscle Pain: Feels deep, dull, achy, pulsing, throbbing, or stinging.
- Fascial Pain: Often feels like heat and sharpness. The fascia is the tissue that surrounds muscles and other organs, holding them in place.
- Nerve Pain: Feels like burning, pins and needles, or numbness.
- Bone Pain: This is more complex. For instance, a bone fracture can cause pain in the surrounding tissues as well, leading to a combination of the above sensations. It is sometimes characterized as very sharp, and pounding. It is also usually located around a specific area often over a bone.
Juvenile Idiopathic Arthritis (JIA)
Children with JIA often describe their pain as a dull ache or soreness in the joints, particularly in the knees, ankles, and wrists. The pain is usually worse in the morning or after periods of inactivity, a symptom known as morning stiffness. It often affects the tissue surrounding the tendon-to-bone connection called the enthesis. Some studies have also estimated that 65% of cases will also complain of muscular pain involved with JIA. This makes sense as muscle irritation can feel dull and achy.
Osteoarthritis (OA)
As OA primarily deals with increased forces overtime on joint tissues, what it feels like could include irritations in the tissues causing those forces like the muscles and tendons along with damaged joint surfaces. So you can feel dull achy, pulsing/throbbing, and stinging pain, but it usually is accompanied by increased movement. Particularly movement that happens after a joint has been stationary and is relieved with the opposite–when the joint gets rest. The joint may also feel stiff and swollen, particularly in the morning or after sitting for a long time. Also, keep in mind that these types of pain usually also accompany the other related characteristics of OA previously mentioned such as age, repetitive trauma,
etc. I wouldn’t suspect OA in a 15-year-old complaining of deep dull achy pain with motion. That just doesn’t fit the characteristics.
Given the multiple types of tissue involved with OA, one may question whether the pain they are feeling is coming from the build-up of irritated bone, the degenerative cartilage, or the increased strain on the muscles causing the force on the bone. The answer is–well it could be all of those!
Rheumatoid Arthritis (RA)
RA pain is typically described as a persistent, throbbing pain in the joints, accompanied by swelling, redness, and warmth. The pain and stiffness usually present in the morning particularly in the hands and feet and will last longer than 30 minutes to hours. The pain and swelling often come and go, with periods of increased inflammation (flares) followed by periods of relative improvement. During flare-ups, patients may also experience flu-like symptoms, such as muscle aches and fatigue.
Psoriatic Arthritis (PsA)
PsA pain can affect multiple joints and is often associated with swelling and a feeling of warmth. The skin can, especially the silvery white plaque areas. Patients might also experience stiffness, especially in the morning, pain in the fingers and toes, and swelling. Some cases of PsA can develop back (sacroiliitis) and eye pain (Uveitis). Sounds familiar doesn’t it. It is one of the hard ones to determine, but the skin symptoms are usually a good giveaway.
Ankylosing Spondylitis (AS)
Lastly is Ankylosing Spondylitis (AS). Pain for AS is often felt in the lower back and hips, characterized by a constant, dull ache or sharp pain. The pain and stiffness are usually worse in the morning and improve with physical activity.
When is Hip Pain Arthritis?
Since most arthritis cases are osteoarthritis (OA), the rest of this article will focus on OA. When you see the word “arthritis,” think “osteoarthritis.”
Patients with hip pain often attribute it to their arthritis acting up. From our discussion, we know that OA is caused by chronic forces on joint structures over time, leading to irritation. For arthritis to flare up, there usually needs to be a change in those forces, often an increase. These changes can be due to factors like weather pressure changes, stress, anxiety, or immobility.
One of the force changes on the joint that oftentimes is dismissed initially is the overcompensation of one muscle group over another when performing hip motions and supporting the hip joint during hip motions.
An overcompensation could take place due to several things:
Repetitive or Past Injuries: Injuries from car accidents, sports, etc., often cause the joint to enter a protective mode. This causes the surrounding muscles to overcompensate, using larger muscles to stabilize and move the joint. This compensatory pattern remains even as the injury heals, increasing joint stress over time and leading to arthritic bone buildup.
Poor Mechanical Techniques: Poor posture or technique during daily activities, such as sitting or standing for long periods. It could be from repetitive motion daily activities or jobs like a painter working with their arms overhead for hours which strain the muscles.
Psychosocial Factors: Wearing high heels frequently due to societal expectations or other wardrobe choices can affect posture and muscle balance. To support these fashion choices the body must overcompensate to to meet the demands these changes inflict.
Muscle Imbalance: Imbalances or overcompensation in the muscles around the hip joint can generate problematic forces. These forces increase stress on the hip joint, leading to pain and potential injury..
The signs and symptoms of hip osteoarthritis (OA) can also stem from the muscles, tendons, and ligaments surrounding the hip. These symptoms might include deep, achy pain, stiffness (especially in the morning), decreased range of motion (ROM), and pain with activity. This complexity makes it challenging to attribute these symptoms solely to arthritis.
Treatments for OA
An interesting fact is that the hip joint consists of the femur connecting to the pelvis, with muscles extending from the pelvis into the back, as it connects to the spine. Often, what people perceive as hip “arthritis” pain is actually due to low back muscle or joint irritation/injury. The only definitive way to determine if the pain originates from hip arthritis (irritation of the bony changes in the joint itself) is through an MRI or CT scan. An X-ray will show bony joint changes (osteophytes/spurs, decreased joint space) indicative of arthritis, but it does not reveal active inflammation. In contrast, an MRI, ultrasound, or CT scan can show increased inflammation activity.
Treating hip OA, or any OA, can be challenging. CT and MRI are expensive procedures requiring specialized equipment. While these scans would be helpful in pinpointing the exact tissue causing irritation, it is not practical to perform them on everyone. Consequently, many medical providers opt for anti-inflammatory drugs as a broad approach to reduce inflammation. Although these treatments are effective in decreasing the consequences of increased joint forces that lead to inflammation, they do little to address the mechanical irritation causing the inflammation.
For a more effective approach to managing osteoarthritis (OA), combining anti-inflammatory medications with corrective functional therapy is key. This dual strategy helps reduce the inflammation and address the underlying causes of joint stress. By simultaneously lowering inflammation and correcting the forces on the arthritic joint, we can achieve longer-lasting relief and prevent future flare-ups.
One of the most important parts of corrective functional therapy is improving stability. This involves optimizing the body’s natural movement patterns to evenly distribute stress across all the tissues involved in any action. By enhancing stability, we can help the body move more efficiently and reduce strain on any single area.
At Integrated Health Solutions (IHS), we use a combined approach from multiple disciplines to treat our patients. We focus on reducing muscle stress on joints and improving muscle coordination for better stability and support in everyday activities. This not only decreases joint stress now but also helps prevent future issues by promoting healthy movement habits. This approach can reduce the need to rely solely on medications for managing osteoarthritis (OA) inflammation.
Arthritis is a diverse condition with many different types. While OA is the most common, it’s important to understand that OA is not always the main source of pain, particularly with hip pain. Recognizing this opens up more options for managing it and improving function and quality of life. It’s hard to see someone limit their daily activities because they believe they can’t do certain things due to arthritis—especially when arthritis might not be the cause at all.
If you would like to learn more about osteoarthritis and the integrated approach we take here at IHS to address its root causes, give us a call to set up an appointment with one of our doctors. See how you can improve your quality of life today. Call us at 317.220.2020.
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Prepared and writen by Dr. Andrew Sanders
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