Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part II

As discussed in “Understanding Rheumatoid Arthritis – Dealing With Chronic Pain Associated With RA Part I,” rheumatoid arthritis or RA is a disease affecting millions of individuals around the world every year. RA leads to a constellation of symptoms including but not limited to small joint pain, neck pain, back pain, hip pain, knee pain, and leg pain, also known as sciatica. Approximately one per cent of the world’s population, one in ten thousand individuals, are affected by rheumatoid arthritis. There appears to be a significant, gender-based difference, with three to five times as many women as men presenting with symptoms. Significantly, Native Americans present with as high as six percent of the population affected with the disorder. This author found RA present in high numbers in skeletal samples of pre-Columbian, Native American populations at the William S. Webb Museum of Anthropology, University of Kentucky, Lexington. It is this author’s experience, based on extensive research, that this condition dates back to pre-historic times, yet an explanation for the high prevalence in Native Americans remains elusive. The greater incidence among smokers was also discussed and is noted once again. Although the link between smokers and RA appears robust, causality remains problematic.

Rheumatoid arthritis remains something of a conundrum with more questions unanswered than answered. One thing is certain, chronic pain associated with RA is very real and often leads to total disability, particularly as the disease progresses. Additionally, as areas beyond the smaller joints become involved, and neck pain, back pain, hip and knee pain, and even sciatica advance, the quality of life can and often does suffer, particularly in the latter stages of RA. As noted in Part I, RA is characterized by small joint involvement, usually involving the hands and feet in early stages, becoming widespread and affecting the larger joints and other organ systems as the disease progresses. RA is an inflammatory disease both chronic and systemic (widespread) in nature. The disease may express with a myriad of symptoms, and they may range from mild stiffness and discomfort, to chronic, systemic and even acute pain. It is not unusual in the latter stages of the disease for RA patients to be completely disabled.

As noted above and previously, rheumatoid arthritis is systemic and is a form of auto-immunity. RA is characterized by an inflammatory process affecting the synovial membrane, known as synovitis. The synovial membrane lubricates the joints and makes it possible for the cartilaginous surface of one bone to “glide” across the surface of another. Synovial fluid is the medium responsible for the effortlessness of this function, reducing friction as it lubricates the joint. Imagine placing a penny on your kitchen counter and sliding it with a little push; it would slide until friction slowed and eventually stopped it. Now, with synovial fluid present the penny would continue on and on as friction is reduced to almost zero. Synovial fluid is truly one of the body’s miracles, allowing joints to function in a virtually frictionless environment. However, when RA is present, the synovial fluid and consequently the synovial membrane becomes inflamed, causing friction. The friction leads to joint erosion, and the joint erosion leads to a breakdown of the joint capsule, leading to chronic pain, and deformity. The breakdown in the joint capsule, and the joint itself, exacerbates the deformity compounding the pain; and, thus we have a feedback look, constantly feeding upon itself as the pain grows more intense with each progression over time.

Rheumatoid arthritis may present with symptoms to include inflamed and swollen joints, slight fever and pain affected areas warm to the touch, stiffness, particularly upon arising in the morning, and soreness, stiffness, and pain after long periods of inactivity. I will repeat the latter portion of that last sentence because it is worth repeating:
“…stiffness, particularly upon arising in the morning, and soreness, stiffness, and pain after long periods of inactivity.”
Why would I repeat that sentence? Prolonged inactivity of any kind, whether extended periods of bed rest, self-imposed inactivity, or inactivity as habit, the result of a sedentary lifestyle, will only lead to heightened stiffness, soreness, and chronic pain, particularly as they relate to pain in the hands and feet, neck and shoulders, back, hips and leg pain, and sciatica. With inactivity, whether as the result of a sedentary lifestyle or as an adaptive and protective mechanism due to acute and chronic pain, deformity, further erosion, loss of function, and finally disability often result.

Stiffness in the morning or after periods of moderate to prolonged inactivity is a telling characteristic of RA, distinguishing it from osteoarthritis. Morning stiffness may last as long as one to two hours in advanced cases. Failure to integrate a proper stretching and exercise program, particularly when stiff, may result in heightened stiffness, soreness, and chronic pain. Small joint pain, particularly in the neck, hands and feet, can be dealt with by engaging in a simple but effective stretching and exercise program. Stiffness and soreness in the larger joints, those of the shoulders, back, hips, and knees, can and should be attended to through a comprehensive stretching and exercise program, preferably one designed by someone knowledgeable when it comes to RA. Of course an individualized, medically-supervised program is always best. Additionally, ice is always indicated when soreness, swelling, and stiffness is present and/or ongoing. When pain is acute, whether hand, neck, shoulder, back, hip, knee, or leg pain (sciatica), ice should always be the first step in any inflammation pain reduction strategy, not heat!

Ultimately, while we understand quite a bit about RA, there is no cure. However, as noted above, there are methods to alleviate the inflammation, stiffness and soreness, chronic pain, and many of the other symptoms associated with the disorder. The primary treatment strategy should be a two-pronged treatment approach designed to alleviate chronic joint pain symptoms, to include neck pain, back pain, hip and leg pain, and sciatica, and to offset, as much as possible, and prevent any further deterioration of the joints. The strategy must include medication, prescribed my your RA specialist, usually a specific anti-rheumatic medicine or medicines combined with anti-inflammatories, weight loss, podiatry for the feet, physiotherapy or physical therapy, various injections, again as prescribed, fish oil and certain natural bone and joint medications, ice, and exercise.

While statistics are not encouraging, particularly as they relate to treatment and prognosis, the debilitating and disabling effects of RA may be delayed and, in many instances alleviated, through an intelligent, holistic treatment strategy including medication, alternative medicine treatment methods, lifestyle changes, to include weight loss and diet considerations, and, above all, exercise. The concert of treatment strategies, with its holistic approach, will aid in alleviating and in some cases eliminating, at least short-term, the debilitating impact of RA. Rheumatoid arthritis, with its chronic, inflammatory, and systemic pain expressions, to include neck pain, back pain, hip pain, and sciatica, is not the disabling diagnosis it once was, provided a holistic, individually-designed treatment strategy is engaged early on and followed conscientiously. In Part III we will explore deeper into the various aspects of rheumatoid arthritis, including some of the specific treatment strategies available for individuals suffering from this debilitating and disabling condition.