Joint pain is the price of walking upright. Pretty much everyone at some point in their lives is going to experience some form of joint pain. Death, taxes, and joint pain. But when does joint pain become more than just your typical, “I over did it” joint pain? When does it become, “I think there is something really wrong” type of joint pain?
I would say that 50% of the consultations I see on a daily basis come from people asking me this exact question. Is this joint pain caused by an autoimmune disease?
Here are a few typical scenarios.
Mr. B is a 65 year old man who presents to clinic with bilateral knee pain. He first noticed the pain a few years ago. He used to take some over-the-counter ibuprofen when it got real bad and that used to relieve the pain. Over the past few months he has noticed worsening. His left knee sometimes swells up. The ibuprofen isn’t really cutting it anymore. He tells me that the pain is worse after particularly active days. When he sits down he feels pretty good but when he stands up, he feels pretty stiff but generally loosens up after a few steps. He used to work construction and played football in college.
Mrs. M is a 53 year old woman who comes to the clinic for joint pain. About 3 months ago, she noticed that she was having a lot of difficulty removing her rings. She really didn’t pay much attention to it. She told herself, “I must be eating too much salt”. Over the course of the next few weeks she began developing pain and swelling involving her knuckles. The pain is particularly worse first thing in the morning and sometimes wakes her up in the middle of night at times. She also states, “My hands feel like a claw in the morning”. The stiffness last well over one hour in the morning and typically, by noon she’s as good as she is going to be for the rest of the day. She’s tried ibuprofen, naproxen, and acetaminophen but nothing seems to work. She also remarks that her hot flashes have gone completely out of control recently.
Inflammatory vs. Non-inflammatory joint pain
In scenario #1, we have a man presenting with non-inflammatory joint pain. This is your common wear and tear arthritis or osteoarthritis. It can involve pretty much any joint you can think of. What is important to note, is that it tends to progress slowly over time. The joint pain tends to worsen with increasing activity and it typically responds, although maybe not completely, to over-the-counter anti-inflammatory medications. Usually there is no joint swelling, but when it comes to the knees, swelling often does occur. A phenomenon called “gelling” can also occur with osteoarthritis. This occurs when the joint has been in a resting position for a while and then becomes active. The joint stiffens up or gels, but then loosens up pretty quickly.
In scenario #2, we have a woman presenting with joint pain that develops over the course of 3 months, or what we call a subacute presentation. She’s experiencing joint swelling involving small joints and it’s associated with prolonged morning stiffness. What I mean by prolonged is over one hour. Her symptoms also are worse in the morning. She also experiences constitutional symptoms, i.e., hot flashes. These are all hallmarks of inflammatory joint pain. There are MANY different autoimmune diseases that present with inflammatory joint pain and they all have their own particular flavor. Some like the knuckles, some like the ankles, some like the knees, some have a symmetrical distribution, and some are simply just random. But they all share these specific key characteristics.
Another important note about autoimmune joint pain. It doesn’t go away. This is very important. There are A LOT of different things that can cause a joint to swell, but most of them get better with time. When it doesn’t, then you have to start wondering.
Here’s a table summarizing what we just learned. I like tables 🙂
Why is this important?
So why should you care? Well, first of all, walking around with swollen joints isn’t exactly the most pleasant thing in the world. It turns out that it isn’t exactly healthy for your joints either. Autoimmune joint disease at times can cause permanent joint damage and it can happen over the course of 3 months. Don’t believe me? I dare you to do a quick Google image search. Type in “rheumatoid arthritis hands”. Rheumatoid arthritis is the prototypical autoimmune disease that affects the joints.
Early identification and prompt treatment is essential to prevent joint damage. I mean look at those hands!
So if you think that you or someone you know is suffering from autoimmune or inflammatory joint pain, give your local rheumatologist a buzz.
Rheumatology Secrets 3rd edition