Living with inflammatory arthritis

 

Dear Bloggers,

I probably have told you in earlier stories about my stiffness in joints and on a rainy and cold day it is harder to get out of bed and go on the move. No, I am not a complainer somehow there is a feeling that people around don’t know a lot about the condition and that there is a lot of pain involved. (One of the reasons that I only write once a month instead of every week.) I have used quite some pain relievers during the last fifteen years. As I stopped last year with the medication on advice of the rheumatologist. The inflammations took a flight. From sour joints until inflammatory bursitis in my hip and being treated with a nerve Intercostal Block on my rib.

Inflammatory arthritis is a condition many people endure for a lifetime. Thanks to advances in treatment, however, innovative medications can delay and even halt the progression of the disease, and non-drug approaches have can help relieve symptoms so you can live a full and productive life.

What is inflammatory arthritis?

Inflammatory arthritis describes a group of diseases caused by an overactive immune system. The most common symptoms are joint pain and stiffness. Affected joints may feel warm, swollen, and tender. But inflammatory arthritis can also affect other tissues in the body, including the lungs, heart, eyes, skin, and other organs. Left untreated, it can cause irreversible damage. Early treatment is the best way to relieve symptoms and limit the effects of inflammatory arthritis on the body.

While it’s not known what causes inflammatory arthritis in every patient, what is known is that the immune system does not know when to put on the brakes. Normally when we are exposed to bacteria, viruses, or fungi, the immune system produces white blood cells called lymphocytes as well as immune proteins to mount an attack against these invaders. Lymphocytes and immune proteins cause inflammation, which under typical circumstances is limited and resolves once the foreign substance is defeated.

But in someone with inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking your own tissues instead of the foreign substance and causes continued inflammation. For this reason, inflammatory arthritis is known as an "autoimmune disease" − auto meaning "self" and “immune” because the immune system loses its ability to distinguish self from foreign.

How are inflammatory arthritis and osteoarthritis different?

Although they share some common symptoms, inflammatory arthritis and osteoarthritis are quite different diseases. Osteoarthritis is a common condition causing wear-and-tear of the cartilage of the joints due to age and/or prior injury. Here are some other differences:

Inflammatory Arthritis - A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skin. Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on blood tests. Autoimmune disease related to body-wide inflammation.

Osteoarthritis - Symptoms are limited to the joints. Blood tests for biomarkers are negative. Mechanical wear-and-tear on joints due to age or injury.

 

What are the different types of inflammatory arthritis?

If you are experiencing symptoms that suggest inflammatory arthritis, your doctor will perform a number of tests, including a physical exam, blood tests, and imaging exams (such as X-rays, joint ultrasound, and/or MRI or CT scans). Sometimes the physician takes a sample of fluid from an affected joint for analysis − a procedure called joint aspiration. 

Based on the results of these exams, your physician will determine if you have inflammatory arthritis and if so, which type:

Rheumatoid Arthritis (RA) is the most common form of inflammatory arthritis. It tends to involve more than one of the small joints of the hands and feet. In particular, the lining of the joint or tendons (the synovium) is inflamed, causing warmth, pain, and stiffness. In 30% to 60% of people with RA, blood tests confirm the presence of proteins called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies. It is very important to control inflammation in the synovium to stop joint destruction and to treat RA to minimize damage to the heart, lungs, and eyes.

Psoriatic Arthritis is a type of arthritis called a "spondyloarthropathy" that is a combination of psoriasis (red, scaly patches on the skin, especially the knees, elbows, and scalp) as well as pain and swelling in the large and small joints and sometimes the spine. It can cause complete swelling of a finger or toe − a condition called "dactylitis."

 

 

Juvenile Idiopathic Arthritis (JIA) affects young people under age 16, causing inflammation in the joints and sometimes in the spine and ligaments (tissues that connect bone to bone) that lasts for more than six weeks. Swelling or mobility problems, including a limp if the legs are affected, may be the only signs of JIA. Some types of JIA cause eye inflammation that can occur without symptoms, so prompt diagnosis, treatment, and monitoring of JIA are vital to prevent permanent damage. Children and teens with JIA are best treated by a pediatric rheumatologist.

Ankylosing Spondylitis (AS) affects primarily the spin and hip joints, breastbone, and large joints in the body. Over time, AS can result in noticeably reduced motion in the spine. Up to half of people with AS have a gene called HLA-B27, the presence of which can help confirm the diagnosis of this condition when it is found in combination with AS symptoms.

Gout & Pseudogout (calcium pyrophosphate dehydrate deposition disease or CPDD) are forms of arthritis caused by elevated levels of certain crystals in the body. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones. CPPD occurs when calcium salts form in the joints and are engulfed by white blood cells, provoking inflammation − most commonly in the wrists and knees.

Other autoimmune diseases can cause inflammatory arthritis as a symptom. Examples include Sjogren’s syndrome and lupus.

You and your rheumatologist: A lifetime partnership

If you have inflammatory arthritis, it is imperative that you see a rheumatologist on a regular basis to monitor your health and customize your treatment. Rheumatologists are medical doctors with special training in the care of people with joint diseases and autoimmune diseases. They are different from orthopedists, who are trained in surgery and who may also be involved in the care of people with inflammatory arthritis when medical treatments are not enough.

How do you know whether to start with a rheumatologist or orthopedist? If you have ongoing joint discomfort without chronic swelling or other symptoms, such as fatigue, you may be able to see an orthopedist first. But if your joint pain is accompanied by warmth, swelling, other signs of inflammation, fatigue or discomfort in other parts of your body, a visit to a rheumatologist may be in order. Your primary care physician can guide you.

Because inflammatory arthritis is an autoimmune disease that can affect multiple parts of your body, you may need to see other specialists, too, to keep your symptoms in check and maintain the best quality of life possible.

To prepare for your visit with a rheumatologist:

·     Bring in a full list of your medications, including vitamins and supplements.

·     If you are already taking medications for inflammatory arthritis, make any notes about reactions or side effects you may be experiencing.

·     Provide a list of all health conditions you have had, prior surgeries, and symptoms you may be experiencing.

·     Prepare a list of questions you may have for your doctor.

Your rheumatologist may choose from a variety of treatment options for inflammatory arthritis, depending on the type and severity of your disease, such as:

·     Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

·     Steroid medications (corticosteroids) such as prednisone, which are typically used for shorter periods of time because of their side effects.

·     Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine, sulfasalazine, minocycline, and leflunomide.

·     Biologic DMARDs, which target the proteins driving inflammation, such as infliximab, etanercept, abatacept, adalimumab and rituximab. These medications have revolutionized the care of people with inflammatory arthritis, sparing many from surgery.

·     Surgery may be indicated for specific joints with damage that can no longer be controlled by medications.

 

A diagnosis of inflammatory arthritis can initially feel overwhelming. It can take weeks or even months to come to terms with and understand what having this disease can mean in your life. By developing a close working relationship with your rheumatologist and other caregivers, however, there is much you can do to control inflammatory arthritis and maintain an independent and active lifestyle.

The Old Sailor,

Living with chronic pain, nothing to be sad about it

 

Dear Bloggers,

 

As a seemingly healthy person in my mid-50s, most people don’t suspect that I am living with chronic pain. When I tell people about my condition, it feels like many still doubt that I’m serious or assume I’m exaggerating. But truthfully, like many with invisible conditions, I’m probably more likely to downplay the severity of my discomfort on the rare occasion that I do mention it. It’s the kind of thing that seems to make people uneasy: pain that’s frequent or constant, with no means to alleviate, even though I always wish the Paracetamol in my medicine cabinet would magically do the trick. 

How things came into my life?

My chronic pain started in my late teens and has been worsening for years. It’s localized most intensely in my joints hands, knees, feet and neck. Along with it are daily pain on some of my ribs and monthly inflammations of bursae. The cause of it all is the weight of my body, working on it, but the progress is not very fast if you cannot work out fully anymore as I ripped a couple of muscles through the years of existence and this is worsening my pain. 

Am I the only one?

No, There are many people that are dealing with chronic pain and many of them know how to hide it from the outside world and some of them are living right through the pain. Others like me need some treatment in pain relief and go to a specialist for advice and treatment. In other words, many millions of people around the world are dealing with invisible and ongoing pain. I’m far from alone in my experience. 

Diagnosis

Arthritis and inflammation is an important cause of joints pain. I wake up off and on throughout the night with shooting pain in legs knees and hands, my finger lives a life of their own. Every morning, my joints and fingers are stiff and painful, sending shockwaves of pain through from my whole body. In the beginning, I believed that it was all in my head. Doing dishes or walking for a long distance but also sitting in the same position can kill my day and make life completely miserable. Some days, I know as soon as I get out of bed that the combination of feeling sour and pain means I just won’t be able to sit at my computer and write a blog story on this day.

A good healthcare provider can help you find the root cause of the pain while treating it. This is particularly critical for younger people. Because it’s less common for chronic pain to appear at a young age, a medical issue can usually be uncovered and providers don’t want lifelong chronic pain to be the diagnosis if it doesn’t have to be. Although you have to request for it when you explain that this might save them a lot of money, it might help. In my case, the healthcare providers were giving up pretty quickly and diagnosed me with Fibromyalgia and gave me medication (Diclofenac it stops inflammation and I had it for more than 15 years) to ease the pain. Nowadays, they tend to be “even more aggressive in looking for the causes of pain,” prioritizing things like MRIs, CAT scans, and blood work. Well the source of my pain was visually apparent and was diagnosable by a Rheumatologist and a physical therapist, the learned me to accept my pain and live with it without any other medication then Paracetamol. Every case is different, so go and see your physician and talk things through, as more elusive causes require tests like those mentioned above. 

With older patients, these diagnostic tests are also fairly routine options, particularly if pain is persistent despite treatment or does not have a clear cause. However, there is often some pain to be expected during the normal aging process, so it’s more typical to see older patients with chronic pain issues or for the cause to be clear, such as mine Arthritis.

 

Causes

"Oftentimes there was physical trauma, emotional trauma, or chemical trauma that initiated the [pain] process” for patients.

 Other common causes of chronic pain can be: Inflammation, for example caused by arthritis or an Infection, such as an ear infection and also an illness, such as cancer, muscular dysfunction like spasm. Chronic repetitive motion like a frozen shoulder or autoimmune diseases, such as fibromyalgia or rheumatoid arthritis.

However, this list does not cover every possible origin. There are a massive variety of causes, locations, and intensities of chronic pain conditions. This can make the nebulous condition hard to categorize or track. 

Treating it

The options for treating or reducing chronic pain are nearly as vast as the potential causes. This can often delay relief if the first treatment is ineffective. In my case, I was sent to physical therapy first and went for many months, but found no relief from this route other than a confirmation of cause, so I’m now exploring alternatives. Many physicians hesitate to prescribe opioid painkillers for chronic pain because of their addictive potential. However, non-opioid solutions can be effective.

Treatment options for chronic pain

Medication is far from the only possible solution. Other treatment options for chronic pain are Physical therapy, Acupuncture, Local electrical stimulation, Brain stimulation, Surgery, Chiropractic treatment in all of these cases you are the one that decides in the end.

The best cure for my personal situation is treatment with medication in the long run according to the Rheumatologist we should wait with it as long as we possibly can. As Meds can do more damage in some cases. I’ve tried some other pain-alleviating routes in the meantime (including physical therapy and some Zen course to get my life in balance.) and have been slowly investigating more options recently (like chiropractic treatment and acupuncture) but this is for the years to come. 

Ultimately, what works for each person may be one of these things, a combination of several, or something else altogether. Some people may get some relief from treatments like these, but need surgery or deeper medical intervention to fix the root condition causing the pain. 

For a lot of people, myself included, just being aware of the range of options for treatment, and the fact that so many other people are in a similar boat (be it one we can’t see), provides the first bit of relief.

Smile everyday it might give less negative feelings

 

The Old Sailor,