May 15, 2013
Joint pain can be associated with more than 50 kinds of arthritis— but it also can be caused by conditions that are not arthritis at all. So when a joint aches, how do you know whether you have arthritis or something else? And if you have arthritis, how do you know which kind you have?
Getting the right diagnosis is critical. Treatment for joint pain differs widely, depending on the cause. The right diagnosis and early treatment can arrest joint damage and return you to your previous level of activity. The wrong treatment—or avoiding treatment—may mean joint deterioration, poor function and compromised mobility.
Arthritis, or joint inflammation, causes painful, limited movement of joints. The three most common types of arthritis are osteoarthritis, rheumatoid arthritis and gout.
The causes, symptoms and risk factors for each of these forms of arthritis may differ. You may suffer from more than one type of arthritis—for example, gout and osteoarthritis. Arthritis sufferers may also have associated medical conditions, such as cardiovascular disease with rheumatoid arthritis.
Fortunately, there is hope. With proper, early medical treatment, the pain and limitation of movement of arthritis can be improved.
About the Speaker
Qingping Yao, MD, is a board-certified rheumatologist at Cleveland Clinic in the Orthopaedic & Rheumatologic Institute. He specializes in arthritis, lupus, and autoinflammatory disorders.
Dr. Yao completed his fellowship in rheumatology at University of California Los Angeles Medical Center, after his residency and internship in internal medicine Capital Health System – Fuld Campus, in Trenton, NJ. He received his doctorate at Peking Union Medical College, in Beijing, China. He graduated from medical school at the Inner Mongolia Medical College, in China.
Let’s Chat About Ask the Arthritis Expert
Moderator: Welcome to our ‘Ask the Arthritis Expert’ online health chat with Qingping Yao, MD. We are very excited to have him here today!
Arthritis Signs and Symptoms
enjoylife: What are the signs and symptoms of arthritis? Is there a cure or is it managed? Are there pain management techniques that truly work?
Qingping_Yao,_MD,_PhD: Do you mean rheumatoid arthritis or osteoarthritis? I ask because the treatment is different.
GroKenHaMMer: Is all arthritis pain in the joint or can it be in the bone?
Qingping_Yao,_MD,_PhD: It could cause adjacent bone pain. It is really dependent on the type of arthritis you are referring to. The page linked here explains many of the different types of arthritis.
ernest: What are the major diagnostic indicators you use when determining the specific type of inflammatory arthritis a person has? How important is that information to treatment? For example, does it help to know whether you are dealing with psoriatic arthritis rather than a generic inflammatory arthritis?
Qingping_Yao,_MD,_PhD: Arthritis has different kinds of forms. There are blood markers available to help us differentiate between them. The markers could be used to differentiate between psoriatic arthritis and other inflammatory arthritis, such as rheumatoid arthritis and lupus-related arthritis.
Association of Rheumatoid Arthritis and Osteoarthritis
Nellie: I know I have osteoarthritis beginning in my thumb joints and will eventually need surgery. But is it possible to also end up with rheumatoid arthritis? And is rheumatoid arthritis ever just confined to one area, or does it affect the entire body?
Qingping_Yao,_MD,_PhD: Osteoarthritis or degenerative changes do not evolve into rheumatoid arthritis. However, advanced rheumatoid arthritis can cause degenerative changes or osteoarthritis. Rheumatoid arthritis usually affects small joints in a symmetrical way. Certainly any joints could be affected, including large joints such as the knee.
kellwill: I know that I have osteoarthritis, but at the age of 76 years old, I am unable to tell whether my pains are attributable to that or something else. I have pains at night that wake me. They are not joint pains nor muscle cramps as far as I can tell. They occur in the thigh and calf and respond well to massage, but I do not know what causes them. Are these symptoms common with arthritis? If not, what should I consider?
Qingping_Yao,_MD,_PhD: Your pain in the thighs and calves could represent soft-tissue rheumatism other than a joint condition. Aquatic therapy and massage might be helpful.
Hashimoto Thyroid Disease and Rheumatoid Arthritis Diagnosis
Jaenin: My joints have been swelling at night. I have Hashimoto thyroid disease. What sort of tests would I need to have done to diagnose whether it is rheumatoid arthritis or perhaps systemic lupus erythematosus?
Qingping_Yao,_MD,_PhD: Inflammatory arthritis can be associated with Hashimoto thyroid disease. There are blood tests which can be used to differentiate between systemic lupus erythematosus and rheumatoid arthritis. I would recommend you to see a rheumatologist to find out.
Jaenin: Is there any way to head off things like rheumatoid arthritis and lupus? It is possibly too late as I am starting to get swelling of my joints as I sleep?
Qingping_Yao,_MD,_PhD: Sometime arthritis can be seen in people with Hashimoto thyroiditis. There are ways to tell whether you have rheumatoid arthritis or lupus. Your complaint of the symptoms might point to other forms of arthritis such as osteoarthritis. I would recommend that you see a rheumatologist.
Systemic Lupus Erythematosus Diagnosis
ernest: I hear conflicting things about lupus, especially when it comes to its diagnosis. How difficult is it to definitively diagnose systemic lupus erythematosus (SLE)? Is a positive ANA (antinuclear antibodies) at a specific dilution level required?
Qingping_Yao,_MD,_PhD: There is no difficulty making a diagnosis of lupus generally speaking. A positive ANA can be an adjunct in the diagnosis of lupus, but it can also be seen in normal healthy people. I would recommend you to see a rheumatologist.
Moderator: To register for an upcoming chat about lupus, please go to this link: http://chat.clevelandclinic.org/chatpage.aspx?chatid=1464
Arthritis and Infections
Ellen: Are people with arthritis more susceptible to common diseases like the flu?
Qingping_Yao,_MD,_PhD: Arthritis has different forms. If people have inflammatory arthritis, they could be susceptible to infections, including flu-like symptoms, either from the disease itself or from the medications the patient might take.
enjoylife: Will arthritis progressively worsen as we age?
Qingping_Yao,_MD,_PhD: Arthritis has different kind of forms. If you had osteoarthritis, then the joints could become worse with age. However, if you do physical exercises to improve the functionality of joints, your joints might be stable.
Genetic Testing for Rheumatoid Arthritis
Chris04: Is there a genetic test for rheumatoid arthritis?
Qingping_Yao,_MD,_PhD: Genetic testing has been done for research purposes, but it is not clinically useful.
Over-the-counter Medications for Arthritis
cliff: I was told to take Tylenol® (acetaminophen) as needed on a daily basis. Couldn’t this be harmful to the kidneys?
Qingping_Yao,_MD,_PhD: Tylenol is generally safe for kidneys, but it could be a harmful to the liver if people take over 4 grams per day.
Retired Dan: What new treatments are there in arthritis in the joints of fingers?
Qingping_Yao,_MD,_PhD: Arthritis is a general term and includes many different forms of joint conditions. The treatment is dependent on the condition.
Knee and Ankle Arthritis Treatment
sinaihospital: I have very bad arthritis in my right knee and also in right ankle. I have tried shots, therapy and braces provided by my foot and bone and joint doctors, but it did not help me. Can surgery help me in this case?
Qingping_Yao,_MD,_PhD: What is the diagnosis of the joint condition? Did you have trauma or injuries to the joints before? I would recommend you to see an orthopedic surgeon.
Rheumatoid Arthritis Maintenance Therapy
bav_patient: Last September, I was diagnosed with rheumatoid arthritis, and started taking a DMARD (disease-modifying antirheumatic drug) of sulfasalazine (Azulfidine®) 2 grams daily. In February this year, I achieved remission with almost no pain, and no longer take NSAIDs often. About two month ago, my doctor reduced the dose of sulfasalazine to 1 gram a day. So far, the reduced dose did not lead to re-emergence of my symptoms. My blood tests for inflammation (ESR [erythrocyte sedimentation rate] and CRP [C-reactive protein]) also returned to normal. Is it possible to completely stop taking sulfasalazine some time in the future, or does sulfasalazine have to be continuously taken at some maintenance dosage? Based on your experience, how common it is to have a rebound of arthritic pain after the DMARD therapy achieves the remission of rheumatic pain?
Qingping_Yao,_MD,_PhD: It is possible to completely stop sulfasalazine, but patients with rheumatoid arthritis could be at a risk of recurrence. I would continue sulfasalazine 1 gram per day (a very small dose) for at least a couple more years.
About 15 percent of patients with rheumatoid arthritis could go clinically into remission completely without recurrence, but the remaining patients have an intermittent disease course. Therefore, the majority of people with rheumatoid arthritis may have a recurrence sooner or later after stopping the medications. Therefore, it is reasonable to continue maintenance therapy.
Thumb Nodules Treatment
GroKenHaMMer: Is it possible to shatter a nodule on a thumb joint in the same manner as a spur on a heel?
Qingping_Yao,_MD,_PhD: If the nodule bothered the functionality of the thumb too much, a surgery could be done. If it was mild, I would just treat the pain and improve the function.
Osteoarthritis and Joint Replacement
jello: If you have had a deep venous thrombosis (DVT), should you still consider knee replacement? What if your osteoarthritis is very painful? Basically, what are the real deciding factors to consider for knee joint replacement?
Qingping_Yao,_MD,_PhD: Regarding knee replacement, people with knee osteoarthritis or other forms of arthritis have refractory pain and difficulty functioning. Therefore, to ease refractory pain and improve functionality, the knee joint replacement would be needed. For acute DVT, treatment with blood thinner such as Coumadin® (warfarin) is necessary. During this period of time, it would be ideal to avoid surgery.
little b: I had a knee replacement, and the knee replacement was recalled. I have pain 75 percent of the time. Would I still feel pain from arthritis in that knee?
Qingping_Yao,_MD,_PhD: People with knee replacement could feel pain for a short period of time, such as several months. If the knee pain continues after six months, then the knee should be assessed by an orthopedic surgeon for possible mechanical issue or loosening.
kit and kaboodle: I’ve heard you can’t kneel after surgery. Is this permanent or short-term?
Qingping_Yao,_MD,_PhD: Did you mean knee replacement surgery? Physical therapy to recover the knee after knee replacement would be required for at least three months. Physical therapy will be guided by a physical therapist. Inappropriate kneeling would not be helpful in the recovery.
Arthritis and Lifestyle
SeaWolf: Arthritis seems to be a fairly common problem for people in their 70s and older. Do you have any suggestions for lifestyle activities that help to limit the worsening of the arthritis symptoms, such as diet and exercise? For instance, I participate in an aerobic exercise class in a warm water pool and that reduces the pain from my arthritis. What else can I do?
Qingping_Yao,_MD,_PhD: Physical exercise is helpful in the relief of osteoarthritis-related pain. Each individual joint would require individual exercise. For example, for knee osteoarthritis, quadriceps strengthening exercise is advised. Supplements such as glucosamine and chondroitin might be helpful in some cases. I would urge you to continue to do the warm water pool therapy.
Jaenin: I do a lot of lifting of buckets since I care for farm animals, and I go up and down stairs often. Should I cut back on my manual labor if I am diagnosed with rheumatoid arthritis or systemic lupus erythematosus (SLE)?
Qingping_Yao,_MD,_PhD: People with rheumatoid arthritis or SLE can do physical activities or labor work, depending on his or her symptoms. The exercise will be tailored to each individual and the degree of the exercises should be based upon an individual’s tolerability.
Katie: Can cracking knuckles cause arthritis?
Qingping_Yao,_MD,_PhD: Trauma or injury can cause traumatic osteoarthritis.
Lindsey: Are there any exercises recommended for improving arthritis pain?
Qingping_Yao,_MD,_PhD: Yes, there are. For example, for knee osteoarthritis, quadriceps strengthening exercise is advised. The exercise could relieve pain and increase endurance or stamina.
savtaro: I am a 73-year-old woman and I believe I have osteoarthritis. The pain in my knees is my worst symptom lately, but it started years ago with an inability to stand for long periods of time without pain. I am now finding stairs very difficult—whereas I used to go up and down easily and effortlessly. I am also very stiff on rising, especially from a sitting position. A few months ago I tripped and broke my shoulder. So, all of the focus of physical therapy and orthopedics has been on the shoulder, but the leg symptoms are actually more troublesome. What can be done?
Qingping_Yao,_MD,_PhD: Your knee problem may likely represent osteoarthritis or degenerative changes. I would recommend trying knee quadriceps-strengthening exercises and knee braces with heel wedges. But these would be best assessed by a rheumatologist and instructed in person.
north town: I have severe arthritis, and I am in constant pain. Should I walk or exercise?
Qingping_Yao,_MD,_PhD: Arthritis has many different forms. Generally speaking, no physical exercise would be encouraged while people have active joint pain. However, physical exercise, including joint exercise, can ease pain for people with mild pain.
Preventative Treatment for Arthritis
Chris04: What preventative treatments do you recommend to help slow down or even prevent arthritis in general? What vitamin can I take? I am also wondering how menopause affects arthritis.
Qingping_Yao,_MD,_PhD: Arthritis is a general term and includes many different forms of joint conditions. For osteoarthritis or degenerative changes, physical exercise, glucosamine and chondroitin would be helpful in some cases. For rheumatoid arthritis, which is a type of inflammation, hormonal changes could affect the disease process.
lutsk: In your opinion, is it beneficial to take supplements for osteoporosis as an additional therapy for rheumatic arthritis, particularly at the remission stage?
Qingping_Yao,_MD,_PhD: Any supplements with vitamin D. and calcium components would be helpful.
Nutrition and Arthritis
robtoby: Are there any dietary changes one can make for an occasional—and I mean once every few years—gout flare-up? It is so painful (as you know) and I wind up on a Medrol® (methylprednisolone) dose pack to alleviate the pain. It is obviously not recurrent enough to go on any type of medication.
Qingping_Yao,_MD,_PhD: Diets are very important in the management of gout. I would recommend you avoid food such as mushrooms, fatty meat, internal organ meats and seafood. Certainly, alcohol reduction will be also helpful.
sallyp: What foods help arthritis? What are the advantages and disadvantages of a fish oil supplement?
Qingping_Yao,_MD,_PhD: Fish oil and a low-sugar diet might be helpful in some cases. Glucosamine and chondroitin might be helpful for osteoarthritis in some cases. I would avoid overtaking fish oil, too.
redwoodpec: For arthritis, are there certain foods that should be consumed or avoided? If so, what about mushrooms, for example?
Moderator: This question is best addressed by a nutritionist. At Cleveland Clinic, Mladen Golubic, MD, PhD referred to the anti-inflammatory diet in his web chat this past January.
Moderator: I'm sorry to say that our time with Cleveland Clinic expert Dr. Qingping Yao is now over. Thank you Dr. Yao for taking your time to answer our questions today about Arthritis.
Qingping_Yao,_MD,_PhD: Thank you so much for all of your questions today.
To make an appointment with Qingping Yao, MD or any of the other specialists in our Department of Rheumatic and Immunologic Diseases at Cleveland Clinic, please call toll-free at 866.275.7496. You can also visit us online at: clevelandclinic.org/rheum
For More Information
On Cleveland Clinic
The Orthopaedic & Rheumatologic Institute at Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for adults and children for bone, joint or connective tissue disorders. The Institute blends the strengths of Cleveland Clinic’s Orthopaedic and Rheumatologic Programs, both ranked first in Ohio and among the top three nationally by U.S.News & World Report.
Cleveland Clinic’s Arthritis & Musculoskeletal Center within the institute is a multidisciplinary clinic combining the expertise of nonoperative orthopaedists and rheumatologists in one location. Our evaluation and treatment center brings together experts so the cause of your joint pain can be quickly and appropriately diagnosed. Our team includes rheumatologists, nonoperative orthopaedic physicians, musculoskeletal radiologists, physical and occupational therapists, brace technicians and musculoskeletal patient educators.
Cleveland Clinic’s Department of Rheumatic & Immunological Diseases provides state-of-the-art diagnosis, treatment and rehabilitation for adults and children for diseases ran including rheumatoid arthritis, osteoarthritis, bursitis/tendonitis, osteoporosis, gout, pseudogout and multiple other forms of arthritis, systemic lupus, vasculitis, fibromyalgia and other diseases.
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