Is that arthritis?						

This is a question I get asked several times each day.  I see patients who are experiencing various aches and pains and want to know if they have arthritis. The short answer is that not all aches and pains are caused by "arthritis".  Alternatively, even if arthritis is present, it is not always what is causing the pain.  It is very simple to get an X-ray, see arthritis, and say that it is causing the pain.  However, discomfort can be related to many different factors, including but not limited to: referred pain, structures other than the joints, perception of pain, mood, chronicity of pain, and inflammation.
 
The term arthritis truly means joint inflammation and it is this inflammation that causes pain.  Inflammation implies that the immune system is activated, causing swelling and discomfort.  There can also be joint discomfort without inflammation such as wear-and-tear arthritis or osteoarthritis.  Other causes of discomfort include bursitis, which is inflammation of a bursa, and tendinitis, which is inflammation of a tendon, and enthesitis which is inflammation and irritation where a tendon attaches to a bone.  Pain can also come from structural changes such as degeneration of a disc in the back or the formation of bone spurs.  Discomfort can also come from the muscular reaction to some of these changes, which causes muscle spasms or strains.  As you can see, the question "Do I have arthritis?” can be very difficult to answer.
 
When helping a patient who is experiencing pain, medical history is very important.  History and time give me more information than anything else.  Where is the pain, how long has the pain been present, what makes it worse, what makes it better, what time of day does it seem to be more bothersome, is it bilateral, is it improved or worsened with activity, is there morning stiffness, and is there is swelling? These are just some of the questions I ask in order to determine the cause of discomfort and develop a proper treatment plan. Blood work and testing are important in determining a diagnosis. However, I find that the most important information comes from the extended time I spend with my patients and their answers to these questions. 

Now let’s discuss some other causes of aches and pains other than "arthritis".  Bursitis is inflammation of a bursa.  A bursa is a sac of fluid that overlies a bony prominence that allows a tendon or ligament move smoothly over that area.  The places that we most commonly see bursitis are the hip, elbow, and shoulder. It can also be seen in the knee and ankle.  One of the most common types of bursitis is trochanteric bursitis, which is caused by inflammation at the outer point of the hip, known as the greater trochanter. Typically patients have pain with lying on their side and when they first get up from a low seated position like a car or a sofa.  Treatment of this discomfort typically involves injection of cortisone.  This is effective because it allows the medication to directly reach the affected area and is one of the most common procedures we do in the office.

Another cause of discomfort is tendinitis.  Tendons are strong bands of tissue that link muscle to bone and transfer the contraction of the muscle to movement of the fingers, toes, feet, ankles, etc.  Tendinitis often occurs in the hand and shoulder.  One of the most common types of tendinitis is trigger finger.  Trigger finger is flexor tendinitis which causes painful popping or snapping as the patient flexes and extends the finger. It can also cause the finger to lock in a particular position, most often flexion. It is common for a patient to awake with this problem which may require gentle, passive manipulation to unlock the finger. Again, an injection of cortisone directly into the finger completely alleviates this problem in approximately 70% of cases.

Enthesitis is inflammation of a tendon or ligament where it inserts into the bone.  Common sites where enthesitis occurs include the heel, elbow, toes, fingers, and pelvis.  When this occurs at the heel or bottom of the foot, it is called plantar fasciitis.  Patients often state that the discomfort is worse when they first wake up, and can continue to be bothersome throughout the day.  It is sometimes associated with a bone spur, although not always.  This again shows the variability of aches and pain and how they are very individual.  This problem is treated through the use of anti-inflammatories, heat, stretching, and adaptive devices.  Physical therapy can be very beneficial to patients experiencing enthesitis. 

Although the same structures and organs can be found in every person, each body responds uniquely.  We all have joints, muscles, tendons, ligaments, and an immune system; but how these parts interact and cause problems can create great differences between individuals.  What I enjoy most about this profession is spending time talking with patients and working on their aches and pains to develop a solution that works for them.

Because arthritis and pain is something that affects individuals on a daily basis, there are many statistics and standard practices used to treat patients. However, I view each patient and the pain they are experiencing individually, because how people experience pain is very subjective and individualized.  Accordingly, I evaluate each patient individually and develop a unique treatment plan to reduce pain and improve quality of life.  This is the mission of Cape Fear Arthritis Care, a different approach to aches and pains.  It is true that aches and pains are more common as we get older but they are not caused by getting older.  The bottom line is that if there is something causing discomfort on a daily basis that is interfering with your life, then it should be evaluated.  If pain is affecting the quality of your life and you want to see if there is something that can be done about it, give us a call (910) 679-3212.