Archive for category: Arthritis

Why are arthritis symptoms worse at night?

Article featured on Medical News Today

Many people notice that their arthritis symptoms get worse at night. When this occurs, it can be hard for people to sleep, leaving them exhausted in the morning and potentially contributing to daytime pain or fatigue.

It is common for pain to get worse at night. A 2020 study found that online searches for information about pain management peaked between 11:00 p.m. and 4:00 a.m.

Doctors do not fully understand why arthritis pain often worsens at night, but possible causes involve changes in the levels of hormones and cytokines, which are cell-signaling proteins, in the body. Daytime arthritis medication, which some people take during the morning, may also wear off by the evening.

In this article, we examine why arthritis pain gets worse at night and how it disrupts sleep. We also provide tips on ways to improve sleep.

Why arthritis symptoms get worse at night

Researchers have several theories to explain why many people with arthritis experience worse pain at night.

One theory is that the body’s circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.

Other processes may also intensify RA pain, including the nighttime release of pro-inflammatory cytokines, an increased number of cells traveling to inflamed tissue, and changes in the body’s immune response.

Additionally, the body releases higher levels of melatonin and prolactin at night, both of which can cause an increase in inflammatory cytokines.

A person’s arthritis inflammation and pain may worsen if:

  • they are already in pain when they go to bed
  • their mattress or pillow puts pressure on their joints and irritates their arthritis
  • they have other risk factors for insomnia, such as high stress levels or drinking caffeine before bed

How arthritis disrupts sleep

Many studies show a link between arthritis and sleep deprivation. People with arthritis may have trouble falling asleep and staying asleep. They may also report lower quality sleep due to the pain that the condition causes.

A 2021 study involving 133 people with arthritis and 76 matched controls found that 54.1% of people with arthritis reported poor sleep quality. The issues included:

  • greater difficulty falling asleep
  • shorter periods of sleep
  • poor sleep quality
  • more daytime problems related to poor quality sleep

A 2018 study reached a similar conclusion. The researchers compared 178 people with arthritis — 120 with RA and 58 with osteoarthritis (OA) — with 51 people with no arthritis. The rate of insomnia was comparable between the OA and control groups, at 32% and 33%, respectively. However, insomnia was significantly more prevalent among the RA group, affecting 71% of these participants.

Both studies also found a link between arthritis and mental health. People with arthritis were more likely to report marital problems and experience depression, suggesting that insomnia may be a reaction not only to arthritis but also to stress.

The link between arthritis pain and sleep goes in both directions. For example, arthritis can make it difficult to sleep, but sleep deprivation can also worsen arthritis pain. A 2018 study found that pain intensified as sleep worsened. In addition, a 2017 study found that people with knee OA who had poor quality sleep were more likely to ruminate on their pain.

Tips to get better sleep with arthritis

As insomnia can make pain worse, it is important that people with arthritis take steps to improve their sleep, as well as treating their pain.

Practice better sleep hygiene

Tossing and turning at night when unable to sleep may cause a person to notice and fixate on their pain. Good sleep hygiene may help a person fall asleep faster and remain asleep longer. People can try the following:

  • going to bed at the same time each night and establishing a bedtime ritual, such as taking a bath, meditating, or doing another calming activity
  • avoiding daytime naps
  • exercising during the day to ease arthritis symptoms and support better health, but avoiding exercise for 4 hours before bed
  • avoiding stimulants such as caffeine and nicotine, especially in the afternoon and evening
  • refraining from drinking alcohol or only drinking it in moderation
  • developing strategies for managing daytime stress to prevent negative thoughts from keeping a person awake or triggering joint pain
  • eating a balanced meal a few hours before bed and trying a light snack just before bed if nighttime hunger is a problem
  • using the bed only for sleeping and sex and not for watching television or doing work
  • keeping the bedroom cool and dark, potentially by using blackout curtains
  • investing in a comfortable, supportive mattress and quality pillows
  • trying different pillow positioning, such as putting a pillow between the knees or under the hips, to ease joint pain

While they are working on improving their sleep hygiene, a person may find it helpful to get back up if they cannot fall asleep. Doing this helps the association between bed and sleep remain strong.

Develop an arthritis pain management strategy

A person can work with a doctor to develop a plan for managing arthritis pain.

Where possible, it is important to avoid going to bed in pain. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:

  • nighttime release arthritis drugs
  • drugs that work for 24 hours
  • an evening dose of pain medication

Identifying and managing arthritis triggers can also be helpful. A person can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.

Consider psychotherapy

Being in pain night after night can affect a person’s emotional well-being and cause them to experience more pain. A 2017 study of people with knee OA found that people with sleep issues tend to catastrophize and focus on their pain, intensifying both pain and insomnia.

Therapy can help a person better cope with their pain and deal with daytime stressors that undermine sleep. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based intervention that assists a person with learning new skills for sleeping better.

Summary

Nighttime arthritis pain is common. However, having arthritis does not mean that a person has to live with chronic sleep deprivation. The right combination of medications, sleep hygiene practices, and lifestyle adjustments may help a person sleep better and for longer.

People with arthritis should be aware that while pain can make sleep worse, low quality sleep can also intensify pain and increase stress. This can create a vicious cycle that arthritis medication alone may not be sufficient to break.

The best path to complete relief is to treat both insomnia and arthritis. A person can work with their doctor to create a treatment plan that addresses the two conditions.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

How to Live with Arthritis

Article from Orthogate

Arthritis pain is not something pleasant for anyone to live with. Although it is often thought as a side effect of aging, many younger people are affected by inflammatory arthritis. With that in mind, there is a large part of the workforce constantly suffering from arthritis pains. Odds are, you are either one of them, or you know someone who is. The first thing you should do if you suspect that you have arthritis is go see your primary care physician and follow their treatment plan. However, even with meds and treatments, you most likely will still feel pain. Luckily, there are plenty of home remedies that can help you live with them.

Diets and Home Treatments 

While there are several different kinds of arthritis, there are certain home treatments that can benefit each one. One of the major treatments that even the most home-treatment cynical doctors will advise is a change in diet. If you are over a certain weight, your weight may be causing you more pain by causing pressure on your joints. Your doctor may suggest to eat more low carb foods and avoid sugars and red meat. However, the best diet you can follow to lessen your arthritis pain is an anti-inflammatory diet. While it’s not strictly a “diet”, it does help you learn what foods to avoid and what foods you should add to your routine.

Sleep and Pain 

If you are suffering from arthritis pain, you might also be having trouble getting a good night’s rest. Even if you don’t have trouble falling asleep or staying asleep, pain can interfere with your REM sleep, causing you to wake up still feeling tired. This article on “Creaky Joints” talks more about the research behind these concerns. Even if your pain doesn’t interfere with your sleep, studies show that your lack of sleep affects your pain levels.

Physical Activity and Arthritis 

Another important part of living with arthritis is staying active. While it may feel like the last thing you want to do, light exercise can help you to stay healthy, no matter what kind of arthritis you have. It is important that you only practice low contact exercises, especially if you have inflammatory arthritis. Exercises that are safe to practice without hurting your joints are swimming, yoga, and cycling. It’s also good to take walks on days that you aren’t up to a workout.

On the other hand, you must learn when to say no and listen to your body. In order to not worsen the progression in your joints, you don’t want to push yourself too far. A walk in the park might be healthy, but you might want to talk to your doctor before agreeing to an all-day hike up a mountain. A lot of people with arthritis pains often feel these pains in full force during and after especially active vacations, so looking into activities that allow for solid exercise without overexertion is crucial for keeping the pain at bay. Doing safe activities for your joints while on a family getaway,  for example, allows for a quality vacation without negative effects and overdoing it.

When you are active or you over-do it, you might find yourself suffering a lot of pain in your joints. When this happens, you can take over-the-counter pain medication or practice some home remedies that might ease the pain. Hot and cold compresses are great for making the swelling go down in auto-immune arthritis reactions, but they are also a good pain relief for osteoarthritis. An old fashioned warm bath could also be the perfect solution to getting some relief. When you push yourself too far, take it as easy as life allows and rest. Your joints will only feel worse if you keep pushing them.

Plan Ahead to Prevent Pain 

Finally, you can prevent arthritis pain by thinking ahead. If you’re going to have a long day, plan times that you can take a break or rest. If mobility aids take some pressure off of your lower joints, think about walking with one. Buy clothes that don’t have as many difficult buttons and zippers and don’t be afraid to ask for help when you need it.

It’s not easy to live with the pain of arthritis, but with the right preparations and support system, you can be ready for anything your body throws at you.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Why are my RA symptoms getting worse?

From WebMD, medically reviewed on October 8, 2020

Getting control of you moderate to severe rheumatoid arthritis can be difficult, here are some common reasons why.

You’re Having a Flare

Red, warm, swollen joints are inflamed. A flare is when inflammation in your body spikes. Your symptoms can get worse. You might also have a mild fever, fatigue, and feel sick all over. To treat a flare, your doctor might adjust your medicine to lower the inflammation. To feel better, get more rest and apply hot or cold packs to sore, swollen joints.

You’re Under Pressure

Stress, anxiety, and even depression are common with RA. It’s more than just a bad mood. Depression can make it hard for you to manage your symptoms. Stress tells your body to release cortisol, an anti-inflammatory hormone. But ongoing stress triggers too much cortisol. This makes pain feel worse. Find ways to relax, like yoga, bubble baths, or exercise.

Your Sleep Cycle Is Off

RA pain and sleep trouble are a vicious cycle. If you’re in pain, you can’t sleep well. If you don’t get enough rest, your symptoms get worse. Good habits can help you get the downtime you need. Use guided imagery to distract you from the pain. Take pain meds before bedtime so you can nod off more easily. Switch off your phone and bedside clock. Their lights can disturb your slumber.

Your Meds No Longer Help

Even if what you’re taking has kept your RA under control for a while, things can change. If your body starts to resist current treatments, your symptoms may get worse. Talk to your doctor. You may be able to change to a new treatment. If you’re on a biologic, they might add other rheumatoid arthritis drugs to get your symptoms under control.

You Have Another Disease, Too

As if RA isn’t enough to handle, you can get related conditions that cause similar symptoms. People with RA are more likely to get fibromyalgia, too. It causes chronic pain, fatigue, and tender points that mimic RA. Your doctor can diagnose fibro to be sure it’s the cause of your problems and suggest treatment.

You’re Out of Remission

The goal of RA treatment is to make disease activity stop or slow down greatly so you have few or no symptoms. Doctors call this remission. But it doesn’t always last. RA might return and get worse. Over the years, your symptoms can come and go. See your doctor to adjust your medications.

You Don’t Exercise Enough

RA joint pain and stiffness can make you want to stay on the couch. But if you don’t move your joints, your symptoms will get worse. Exercise actually helps ease RA pain and fatigue. Try to get some activity every day. Walk, bike, or swim to rev up your heart. Do range-of-motion stretches to keep your joints limber. Work your muscles so they stay strong.

You Just Had a Baby

RA symptoms often ease up when you’re pregnant. But this can end soon after delivery. It’s hard to care for a baby when you have severe joint pain and fatigue, too. Your doctor can prescribe treatments that control your symptoms but are also safe for your baby if you plan to breastfeed.

You’re Carrying Extra Pounds

Added weight puts more stress on inflamed joints, which leads to more pain. Too much fat in your body can release hormones that worsen RA inflammation.  Your treatments may not work as well if you’re overweight. Exercise daily, and get help from a nutritionist if you struggle to stay at a healthy weight.

You Smoke

If you have RA and smoke, you should quit! Smokers with RA who quit often see symptoms improve. Smoking raises the odds that you’ll get RA in the first place. It can also affect the way your RA drugs work. They may not control your symptoms like they should. And it can zap your energy so you don’t exercise, which could ease your joint pain. Quit smoking or get help to kick the habit.

You’ve Been Too Active

Exercise is good for your RA, but you can overdo it. If you’ve been active all day, take time to relax. Rest can cool inflamed joints and help you bounce back from fatigue. Take breaks so you don’t get hurt. A physical therapist can teach you how to protect your joints, prevent painful muscle spasms, and exercise safely.

You’re Low on Vitamin D

People with RA often have low levels of vitamin D in their bodies. If you don’t have enough, your RA could become more active. That can lead to painful inflammation and even bone loss over time. Low vitamin D can worsen pain and fatigue. Your doctor can test your blood to measure your levels. More time in the sun (with sunscreen) and supplements might give you what you need.

You Have an Infection

RA and the treatments you take for it make you more likely to get an infection. Your immune system is overworked already, so it’s hard for it to fight off common bugs. Even seasonal flu can trigger RA symptoms. It also puts you at risk for septic arthritis, which causes severe pain in your knees, hips, or shoulders. Get the vaccines that your doctor suggests, such as a yearly flu shot.

You Stopped Taking Your Meds

Maybe they’re too expensive. Or perhaps you felt better so you thought it was OK to ditch your meds. But symptoms may flare up if you stop your medications. Talk to your doctor. You might be able to switch to a drug that doesn’t have as many side effects, or take a lower dose.

You Were Diagnosed Late

Your RA symptoms may be worse if you had the disease for years before you knew it. If it isn’t spotted and treated early, inflammation can lead to joint pain, damage, and deformity that won’t get better. Physical therapy may help you move better and ease your pain. Surgery can also replace your damaged joint with a new one.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

12 Tips for Walking When You Have Sensitive Knees

From VeryWellFit

Sensitive knees can be a challenge for walking, but it is a recommended way to maintain your function and reduce your symptoms. If you have knee pain due to osteoarthritis or other causes, you don’t have to let that keep you from starting a walking program.

A regular program of walking can reduce stiffness and inflammation and it won’t make most chronic knee conditions worse. Walking is the preferred exercise by people with arthritis, and can help you improve your arthritis symptoms, walking speed, and quality of life, according to the CDC.

Walking is part of a healthy lifestyle to keep your heart and bones strong and your joints functioning. Here are tips for walking when you have sensitive knees.

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Arthritis of the Hand

Article Featured on Bidneeham.org

Arthritis, the medical term for joint inflammation, is an extremely common problem for older adults. Arthritis in the hands can make it difficult to perform everyday tasks. While the condition can be managed with proper medical care, first you must recognize its common warning signs.
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5 Ways to Help Prevent Arthritis

Article Featured on Michigan Hand & Wrist

While it may not be possible to completely get rid of your risk of developing arthritis, there are some things you can do to reduce your risk and delay the onset. Arthritis happens when cartilage wears away, causing your bones to rub against and damage each other, which is why you feel pain. There are some tips you can follow that may help arthritis from developing, which include:

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A Patient’s Guide to Rheumatoid Arthritis

Article Featured on US News

The human body is an incredibly complex machine. Most of the time, all the parts work correctly, with various gears and components clicking in harmony. But occasionally, something gets out of whack. When this happens, the guardian of the machine – the immune system – can get turned around and begin attacking the body it usually protects. This is what happens in an autoimmune disease like rheumatoid arthritis, an inflammatory disease that affects the joints.

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Osteoarthritis of the Hip

Article Featured on AAOS

Sometimes called “wear-and-tear” arthritis, osteoarthritis is a common condition that many people develop during middle age or older. In 2011, more than 28 million people in the United States were estimated to have osteoarthritis. It can occur in any joint in the body, but most often develops in weight-bearing joints, such as the hip. Read more

Arthritis of the Wrist

Having painful arthritis in your wrist can make it hard to do many everyday activities. Although there is no cure for arthritis, there are several treatment options available to help relieve your painful symptoms and stay active.

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How To Treat MP Joint Arthritis

Description

Hand bones are called metacarpals. The finger bones are called phalanges. The metacarpophalangeal joint (MP joint), or knuckle, is where the finger bones meet the hand bones. At the MP joints, the fingers can move in multiple directions. They can bend, straighten, spread apart and move together. MP joints are important for both pinching and gripping.

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