Archive for category: Arthritis

Rheumatoid Arthritis: Can Knowing Your Risk Prompt Better Health Habits?

Article featured on Brigham Health Hub

If someone in your family has rheumatoid arthritis (RA), you may already know that you are more susceptible to developing the disease. Could understanding personal risk factors encourage you to change health habits, to possibly decrease your chances of developing RA?

Doctors at Brigham and Women’s Hospital are finding that people who learn their risks – based on genetics, blood markers, personal behaviors, and environmental exposures – are more likely to change behaviors to make them potentially less vulnerable to the disease.

“There are modifiable environmental factors that might have an impact on disease,” says Jeffrey A. Sparks, MD, MMSc a rheumatologist and assistant professor of medicine in the Division of Rheumatology, Immunology and Allergy at the Brigham. “Once you know what the risk factors are and how you can do something about it, you can act on that.”

What Causes Rheumatoid Arthritis?

Rheumatoid arthritis, the most common type of chronic arthritis, is caused by a dysregulated immune system. Symptoms include pain and stiffness in the joints (typically worse in the morning), as well as decreased energy, slight fever, appetite loss, and development of hard bumps beneath the skin near joints.

Progression varies from one person to the next. But when advanced, RA eventually can destroy both cartilage and bone, causing increased pain, swelling, deformities, and loss of mobility. Rheumatoid arthritis is more common among women and often begins between ages 40 – 60 years.

Genes probably don’t cause rheumatoid arthritis by themselves. But genetics may make a person more vulnerable to disease triggers, such as smoking and infections. In RA, the disease occurs in the “synovium” (the lining layer of the joints) when the immune system stops protecting the joints and instead damages bone and cartilage. Researchers at the Brigham and elsewhere are helping to understand the genes, health habits, and environmental factors that may increase a person’s risk of RA. They also are studying how to decrease that risk – including by changing some health behaviors such as smoking, obesity, low fish consumption, and poor dental health. These health behaviors likely affect RA risk by either increasing or decreasing the amount of inflammation in the body.

With these risk factors in mind, Brigham researchers including Dr. Sparks and Elizabeth Karlson, MD, MS are seeking ways to encourage prevention strategies for people at risk.

New Studies Suggest Knowledge Motivates Changes

Knowledge of risks is the first step to changing behavior. But what is an effective way for people to learn about their risks?

As part of the recent PRE-RA Family Study, Brigham researchers found that first-degree relatives of RA patients were familiar with the disease and symptoms. But they were relatively less aware of how their own health habits (including dental hygiene, smoking, overweight/obesity, and diet) could contribute to their risk of developing RA. In the study, those who received an interactive, web-based RA education tool that visually depicted their own personal risks showed greater increases in their knowledge of RA risk factors than those who received education that was not personalized to their own risks.

More importantly, the PRE-RA Family Study also showed that people would act on this new knowledge. Relatives who learned about their own personal risk of RA — based on genetics, autoantibody results from the blood, and their own behaviors — showed increased motivation to improve RA risk-related behaviors. The education included an interactive, visual presentation of their own risks, personalized for each participant, along with specific behavior changes (such as “eat more fish”) that might reduce those risks. Six months later, people who received personalized risk assessment and education, compared to those who received non-personalized information and education, were more likely to have increased fish intake, quit smoking, and brush and floss their teeth more frequently.

What You Can Do Right Now

For relatives of people with RA, but who themselves do not have RA symptoms, knowing and tracking your own personal health history is a good first step. The next is to be aware of how behaviors can affect your risk. Then pick actionable, attainable goals to reduce that risk, such as improved dental hygiene, quitting smoking, and maintaining a healthy weight.


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

Common Types of Arthritis Explained

Arthritis is a painful rheumatic condition that causes joint inflammation. There are many different types of arthritis that can affect the joints and other areas of the body and cause similar symptoms, such as pain, swelling, and stiffness.

There are more than 100 different types of arthritis. Some common types of arthritis include osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA).

Below, we explore these conditions, as well as other diseases that can present with arthritis. We also discuss potential treatment and when to seek medical guidance.

OA

According to the Centers for Disease Control and Prevention (CDC). OA affects over 32.5 million adults in the United States.

Symptoms

Symptoms of OA include:

  • pain and swelling in the joints
  • joint stiffness
  • limited range of motion

People often experience OA symptoms in the hips, hands, and knees.

Risk factors

The following increase the likelihood of developing OA:

  • joint overuse, which can happen due to aging
  • joint injury
  • being female
  • obesity
  • a family history of OA

RA

RA is an autoimmune condition that causes painful swelling and inflammation in the joints. It typically affects the hands, wrists, and feet.

Symptoms

RA does not only affect joints. It can also cause problems in other organs of the body, including the heart, lungs, and eyes.

While some people experience a sustained progression of the disease, the intensity of symptoms usually comes and goes. Symptoms may include:

  • pain, stiffness, and swelling in several joints at once
  • fatigue
  • unexplained weight loss
  • fever

Another characteristic of RA is symmetrical involvement. This means pain and signs of inflammation occur on both sides of the body and in the same joints.

Complications

RA can cause lasting tissue damage, which can lead to:

  • recurring pain
  • destruction of joints
  • deformity or incorrect alignment of joints
  • limited joint mobility

Some people who have RA may also need assistance walking.

Risk factors

Some RA risk factors include:

  • being older
  • being female
  • having specific genes
  • smoking or being exposed to cigarette smoke early in life
  • having never given birth
  • having obesity

PsA

PsA is an autoimmune condition.

Symptoms

Symptoms of PsA include:

  • swelling, pain, and stiffness in the joints
  • extreme fatigue
  • nail changes

PsA joint involvement is asymmetric, affecting different joints on either side of the body.

This type of arthritis can develop in people with a skin condition called psoriasis, which causes scaly, flushed, or silvery patches of skin. These patches can look different depending on a person’s skin color.

Risk factors

Researchers still do not fully understand what causes this form of arthritis. However, having a family history of PsA may increase a person’s risk of developing this condition.

Gout

Gout is a type of arthritis that causes painful swelling, often in a single joint at a time.

Symptoms

Symptoms of gout can flare up and go away quickly. They include:

  • pain and swelling
  • flushed skin
  • a joint that feels hot to the touch

Swelling is common in the big toe. Often, it also affects the knee or ankle joint.

Risk factors

A person may be at higher risk of developing gout if they:

  • are male
  • have overweight or obesity
  • take certain medications, such as diuretics or beta-blockers
  • drink alcohol
  • follow a diet rich in purines or fructose

Health conditions that may lead to gout include:

  • heart failure
  • high blood pressure
  • diabetes
  • kidney disease

Gout may also occur due to metabolic syndrome, which is not a condition in itself. It refers to a number of characteristics, diseases, or habits that can make a person more likely to experience other health conditions, such as heart disease, stroke, or diabetes.

Lupus

This chronic illness is an autoimmune condition that commonly affects females aged 15–44 years.

Lupus is not a type of arthritis in itself. However, arthritis is one of the most common symptoms of this condition.

Symptoms

One symptom of lupus is the characteristic butterfly rash that can develop on the face. Other rashes can also develop on the arms, hands, and face. Rashes can worsen after sun exposure.

While symptoms may differ from person to person, they generally include:

  • joint and muscle pain
  • fever during flare-ups
  • hair loss
  • chest pain
  • kidney issues
  • sores in the mouth and nose
  • chronic fatigue
  • problems with memory
  • anemia
  • eye irritation, dryness, and inflammation
  • cold sensitivity with color changes of the hands and feet

Juvenile arthritis

Juvenile arthritis, also known as childhood arthritis, affects children or even infants.

Symptoms

Symptoms of juvenile arthritis include:

  • joint pain and swelling
  • joint stiffness
  • a rash
  • fever
  • fatigue
  • eye inflammation
  • loss of appetite
  • difficulty carrying out daily activities

Cause

There is no known cause of childhood arthritis. It appears to affect children regardless of race, age, or background.

Diagnosis

Reaching a definitive diagnosis may take time, because many types of arthritis are similar or resemble other conditions.

Typically, a doctor will first check a person’s medical and family history. They will also ask about symptoms and perform a physical exam. They may run tests such as:

  • imaging tests, including X-rays, MRI scans, or ultrasound scans
  • nerve tests
  • blood tests
  • joint fluid tests
  • skin or muscle biopsies
Treatment

Arthritis management depends on the type of arthritis. There are different forms of treatment available.

Medications

Medical treatment for arthritis may involve:

  • over-the-counter nonsteroidal anti-inflammatory drugs for relief of pain and swelling caused by inflammation
  • corticosteroid injections administered by a physician
  • topical pain relief creams and gel
  • disease-modifying antirheumatic drugs
  • biologics

Surgery

Surgery may not be necessary for everyone with arthritis. However, it can benefit certain complications of arthritis that result in malalignment of joints and functional limitations due to damaged joints. It can also help with intractable pain, which is when a person experiences pain that is difficult to treat or manage.

Common surgeries for arthritis include:

  • foot, ankle, hand, or wrist surgery
  • hip or knee replacement surgery

Physical therapy

Physical therapy can be a great option for people with arthritis. It can help ease pain or increase activity.

Behavioral changes that can help with arthritis may include:

  • getting regular exercise
  • quitting smoking, if applicable
  • reaching or maintaining a moderate weight
  • eating a healthful diet

Home remedies

Some people find certain home remedies helpful in relieving pain and swelling from certain types of arthritis. These may include:

  • hot and cold therapy
  • mindfulness strategies, such as meditation
  • massage

To discover more evidence-based information and resources for arthritis, visit our dedicated hub.

When to contact a doctor

If a person has experienced joint symptoms that last more than 3 days, they should seek treatment from a healthcare professional.

Similarly, if a person has joint symptoms at different times within a month, they should also contact a doctor.

Living with arthritis

Medications and other treatments can help a person manage chronic symptoms, such as pain and swelling.

Pain will come and go with many types of arthritis. However, even if the pain resolves, a person should still seek treatment.

It is important to treat arthritis early. If left untreated, some types of arthritis may worsen over time and cause permanent disability.

Summary

Arthritis is a painful condition that causes joint inflammation.

Different types of arthritis can cause similar symptoms. It is vital to get the correct diagnosis, as it can help determine most effective treatment options.

The right treatment may also prevent future complications and help a person live a more active life.


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

Use Heat And Cold To Ease Arthritic Joints

Article featured on Summit Ortho

When arthritic joints become stiff or painful, we explain how and when to use the application of heat and cold for arthritis for simple, effective relief.

Arthritis is the number one cause of disability in our country. More than 50 million Americans are affected by this disease. This number represents one out of every five adults and approximately 300,000 children. People of all ages and races are vulnerable to this joint-disabling condition. It is most common among women, and our chance of developing arthritis increases as we age.

Because there is currently no cure for arthritis, many people are under the impression that there is nothing they can do to manage their symptoms. In fact, medicine offers many helpful treatments for arthritis. Some therapies help with pain, and others improve the function of affected joints. In some cases, early treatments can actually slow the progress of the disease. Below we demonstrate how best to use heat and cold for arthritis.

One simple, inexpensive, and effective way for patients to treat painful joints at home is the application of heat or cold.

The trick is to know when to reach for a heating pad and when to use a towel-wrapped bag of ice or frozen peas to ease arthritic pain. We explain how temperature works to soothe a joint, and we distinguish between the type of pain that responds to heat versus the type of pain that responds to cold therapy.

Use heat to treat chronic stiffness in arthritic joints.

Heat encourages blood vessels near the surface of the skin to expand, increasing blood flow and relaxing muscles. When you wake up with sore joints, or if you feel stiff after a period of inactivity, a heating pad or a hot shower or bath will stimulate blood flow to your joints and help to make them feel more limber. A heat treatment is also a great way to prepare arthritic joints for exercise or activity.

Use cold to treat the acute pain caused by inflammation and swelling.

Pain following activity or a period of exercise is the result of soft tissue injury; broken capillaries leak blood and serum into adjacent tissues and cause localized swelling and inflammation. When a long walk or an afternoon in the garden leaves your joints feeling thick and painful, use cold. Cold applications cause the blood vessels to constrict, preventing further leakage and additional swelling, and relieving pain by numbing the sore joint. Use a bag of ice, a bag of frozen peas, or a gel-filled cold pack wrapped in a towel to protect your skin. Apply cold for 10 to 20 minutes. Remove for at least 20 to 40 minutes, and then repeat if necessary.

Generally, heat applications work best early in the day.

Use this as a jump-start for stiff joints. Icing is used at the end of the day to minimize any inflammation sparked by your day’s activities. If you have any questions about hot and cold treatments, talk with your doctor. At Summit, our teams of physicians and healthcare professionals can manage symptoms through a variety of conservative treatments designed to restore mobility, reduce pain, and protect the lifestyle you love.


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

Options for Treating Arthritis in the Knee

Article featured on The Noyes Knee Institute

Knee osteoarthritis can occur when the cartilage around the knee wears down. Without the protection of cartilage, bones in the joint grind together, causing inflammation and pain. In severe cases, a knee surgeon might recommend knee replacement or arthroscopic surgery. Fortunately, many non-invasive options help relieve the pain of arthritis in the knee.

Osteoarthritis and Rheumatoid Arthritis: What’s the Difference?

Knee osteoarthritis is a progressive condition in which the subchondral bone suffers damage as the cartilage slowly wears away. This type of arthritis is common in middle-aged and elderly patients and happens more frequently in females than males.

Rheumatoid arthritis (RA) is a disorder of the autoimmune system which leads to chronic inflammation. RA usually presents in both knees at the same time. Other joints, including fingers, toes, ankles, and wrists may also be affected.

Both types of arthritis respond to the conservative treatments listed below. However, as an auto-immune disorder, RA also requires specific medical care.

Treatments for Arthritis in the Knees

Weight Loss

For every pound of weight lost, you relieve four to six pounds of pressure from the knee. Carrying a significant amount of extra weight puts extra strain on knee joints which aggravates arthritis symptoms. However, even if you are not obese, losing just five to ten pounds could significantly relieve arthritis pain.

Avoid Aggravating Activities

While it’s important to continue exercising and moving your knees, overdoing it can make problems worse. Avoid the following activities if you notice pain or swelling up to 24 hours after participation:

  • High-impact exercise/sports
  • Kneeling/squatting
  • Walking for periods longer than 60-90 minutes without a rest break
  • Using stairs (inclining or declining)
  • Sitting in one position for more than 30 minutes without a break (such as during a long drive)
  • Standing for periods longer than 30-60 minutes

It may not be practical to avoid all of these activities every day, but reducing them as much as possible should help alleviate arthritis knee pain.

Anti-Inflammatory Medications

NSAIDs can be extremely helpful in easing arthritis pain. However, it’s important to use prescription or over-the-counter anti-inflammatory medications only as recommended by your physician. Overuse can cause serious side effects.

Knee Injections

Steroid or synthetic lubricant injections such as Synvisc may be recommended when diet and other lifestyle changes are ineffective.

Physical Therapy

Physical therapy and “knee-friendly” exercises are often recommended to help regain strength and flexibility in the knee joint.

Knee Surgery

When conservative methods fail, it may be time to consider knee surgery. Many people automatically think of total knee replacement when they think of surgery for treating knee arthritis, but there are several other surgical options to consider:

  • Arthroscopic debridement, abrasion arthroplasty
  • Autologous chondrocyte implantation
  • Femoral osteotomy
  • High tibial osteotomy
  • Meniscus transplantation
  • Osteochondral autograft transfer
  • Partial knee replacement

You and your knee surgeon will determine the surgical option that’s best for your situation. If you have sustained additional knee injuries, other procedures may be performed simultaneously as surgery to correct arthritis.

Should I see a Knee Surgeon?

If you have tried conservative therapies, but your arthritis pain continues to get worse, it may be time to consider surgery.


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

3 Types of Exercises to Fight Arthritis

Article featured on Penn Medicine

Exercise is crucial for everyone, especially those suffering from arthritis.

“Sometimes, my patients think that the only way to relieve pain is to stop all physical activity,” said Craig Israelite, MD, orthopaedic surgeon and Co-director of the Knee Service at Penn Medicine. “Keeping active is actually very good for individuals suffering from joint pain or arthritis. Exercises that work the muscles and tendons provide stability and strength around the joint.”

You don’t need to run a marathon or lift weights for hours to increase strength, improve flexibility and reduce joint pain. There are many non-weight-bearing activities you can do to keep in shape, including:

Range-of-Motion Exercises

These exercises (also known as stretching or flexibility exercises) help to relieve stiffness and increase joint mobility. The goal is to get your joints moving in their normal range of movement. Examples include raising your arms over your head or rolling your shoulders back and forth. It is recommended that these exercises be done daily or at least every other day.

  • Yoga
  • Pilates
  • T’ai chi

Strengthening Exercises

Strong muscles help support and protect joints. A workout program that includes weight or resistance training can help to maintain current muscle strength or increase it. These type of exercises should be done every other day, but allow an extra day in between if joints become painful or swollen. Discontinue any exercise that continues to bring on discomfort.

  • Wrist curls
  • Overhead arm raises
  • Seated rows
  • Leg raises and dips

Aerobic or Endurance Exercises

These types of activities can improve your cardiovascular health, give you more energy and help to maintain or reduce weight. Having control of your weight reduces the pressure on affected joints. Try to include 20-30 minutes of aerobic exercise three times a week.

  • Walking
  • Bike-riding
  • Swimming

Have additional questions about how an exercise plan could help you fight arthritis? Or, are you interested in exploring other pain management options?

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

Chronic Inflammation and Your Joints

Article featured on Harvard Health Publishing

Why the immune system is sometimes the culprit in joint pain.

When you suffer a joint injury — maybe a banged-up knee or a twisted ankle — a little inflammation is part of the healing process. Puffy, red, tender joints may indicate that your immune system is working to remove damage and promote the growth of new tissue, a healthy kind of inflammation. But sometimes the immune system launches unhealthy, chronic inflammation in the joints, for no apparent reason. This leads to pain, stiffness, and joint damage known as inflammatory arthritis.

The attack on joints

It’s often unknown what triggers the immune system to unleash an assault on the joints, but we do know what the cells are up to once they’re in action.

“In a common type of inflammatory arthritis like rheumatoid arthritis, a variety of immune cells can be found in the lining and fluid of the joint. These cells attract other immune cells and together lead to thickening of the joint lining, new blood vessel formation, and — ultimately — joint damage,” says rheumatologist Dr. Robert Shmerling, medical editor of the Harvard Special Health Report Fighting Inflammation (/ui).

Chronic inflammation in the joints can damage cartilage, bones, tendons (which attach muscle to bones), or ligaments (which hold joints together); irritate nerves; and produce a long list of symptoms, including pain, swelling, and stiffness. The joint damage may be progressive and irreversible.

Types

There are many types of inflammatory arthritis. Common ones include these:

  • Rheumatoid arthritis (RA): RA occurs when the immune system attacks the lining of the joints, especially in the hands, wrists, and feet. RA may also affect the heart, lungs, and eyes.
  • Gout: Gout is characterized by a buildup of uric acid, which can form crystals in the joints — especially in the big toe, and sometimes in the hands, wrists, or knees. The crystals activate a temporary inflammatory response that can become chronic.
  • Calcium pyrophosphate deposition disease (CPPD, or pseudogout): In CPPD, calcium crystals settle in the joints, especially the knee, wrist, shoulder, ankle, or elbow. Like the uric acid crystals in gout, the calcium crystals in CPPD prompt the body to respond with inflammation; over time, this may become chronic.
  • Psoriatic arthritis: About 30% of people with psoriasis (an autoimmune condition that causes raised patches of scaly skin) develop psoriatic arthritis, which can affect the knees, ankles, wrists, or fingers.

What about osteoarthritis?

Osteoarthritis, a wearing away of the smooth cartilage lining joints, has long been considered a noninflammatory form of arthritis. “But we now recognize that some inflammatory cells are present in osteoarthritis, although the inflammation is usually much less dramatic than in rheumatoid arthritis or other types of inflammatory arthritis,” Dr. Shmerling says.

The finding of mild chronic inflammation in osteoarthritis has been significant enough for researchers to begin investigating whether the condition can be treated with some of the same types of medications used to treat inflammatory arthritis.

Treatment

Many types of drugs are used to treat inflammatory arthritis. They include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce levels of prostaglandins — chemicals that promote inflammation
  • oral or injected steroids, which reduce inflammation and suppress the immune system
  • injections or intravenous infusions of nonbiologic disease-modifying antirheumatic drugs (DMARDs), which suppress the immune system
  • injections or infusions of biologic DMARDs, that suppress the immune system in a more targeted way than nonbiologic DMARDs
  • Janus kinase inhibitors, which interrupt inflammatory signals
  • drugs that lower uric acid levels (for gout).

Results with drug treatment are often good. “Medications to lower uric acid can essentially eliminate gout. And the development of newer drugs for rheumatoid arthritis, including biologics and Janus kinase inhibitors, makes it possible for far more people than in the past to experience remission and protection from ongoing joint damage,” Dr. Shmerling says.

Other ways to live with arthritis

Other ways to help reduce pain and inflammation include exercising, avoiding processed foods (which promote inflammation), reducing stress, not smoking, and getting enough sleep. Wearing a splint or brace on affected joints and seeking physical therapy may also ease your pain and keep you mobile and active.


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

What Is Degenerative Arthritis?

Article featured on MedicalNewsToday

Arthritis is an umbrella term for diseases that affect a person’s joints. Degenerative arthritis, also known as osteoarthritis, is a form of arthritis that develops due to aging or overuse.

Degenerative arthritis is the most common form of arthritis in the United States, where more than 32.5 million adults are living with the condition.

It is sometimes known as the “wear and tear” form of arthritis, as it often occurs due to the natural aging process. It can also develop as a result of an injury or the overuse of a particular joint.

In this article, we look at the causes, risk factors, symptoms, diagnosis, and treatment of degenerative arthritis.

Symptoms of degenerative arthritis

The symptoms of degenerative arthritis vary depending on where in the body a person develops the disease. They usually get worse over time rather than occurring suddenly, except in the case of injuries.

Regardless of which parts of the body the condition affects, common symptoms may include:

  • pain, often throbbing
  • dull aching
  • swelling
  • reduced flexibility
  • clicking or popping noises when a joint bends
  • stiffness
  • decreased range of motion

Typically, joint stiffness will present early in the morning or after periods of rest, and it will last for up to 30 minutes before loosening up again. The joint pain can either be predictable and low level, lasting for long periods, or take the form of intense unpredictable bursts of pain.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the parts of the body that OA most often affects include the:

  • fingers and thumbs
  • knees
  • hips
  • neck
  • lower back

As the condition progresses, people may find themselves unable to complete activities such as holding a coffee pot, going up steps, or walking long distances.

Causes of degenerative arthritis

People develop degenerative arthritis when the joint cartilage between bones becomes damaged or breaks down.

Often, the body activates a repair mechanism to attempt to remedy this damage. As part of this, bone spurs, or osteophytes, may grow within the joint at the end of the bone. These can then cause friction within the joint and lead to pain when the person uses it.

Risk factors

Certain factors may increase a person’s chance of developing degenerative arthritis. These include:

  • Age: Symptoms generally appear in adults over the age of 50 years, although they can occur earlier.
  • Sex: Females are more likely than males to develop OA.
  • Genetics: OA tends to run in families.
  • Weight: Having obesity can increase a person’s likelihood of developing OA, as the additional weight can place extra stress on the joints.
  • Overuse: Repetitively using the same joints, such as in sports or at work, can sometimes lead people to develop OA.

Some of these risk factors, such as weight, are modifiable, whereas a person cannot change others, such as age and genetics.

Diagnosis of degenerative arthritis

There is no single test to confirm the diagnosis of degenerative arthritis.

Instead, doctors will ask a series of questions about the person’s medical history, such as when the pain began and whether they have sustained any injuries to the affected joint or joints. They may also want to know when the pain occurs and what, if anything, makes it worse.

In addition, the doctor can use X-rays to check for bone spurs or other types of bone damage. They may also take samples of fluid from the joints to rule out infection or gout and run blood tests to exclude other possible causes.

Treatment for degenerative arthritis

Healthcare professionals may treat degenerative arthritis in various ways. Some people with the condition may receive a combination of treatments.

The main aims of treatment include:

  • reducing symptoms
  • improving joint function
  • preventing the condition from progressing further
  • maintaining or improving the person’s quality of life

Medications

Doctors prescribe medications to help reduce the pain and inflammation associated with degenerative arthritis.

Medications may include:

  • oral pain relievers, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • oral anti-inflammatory medications
  • corticosteroid injections to relieve inflammation and pain
  • topical products, such as creams, sprays, or rubs, to soothe sore joints

Physical therapy

Combining physical therapy with increased activity levels can help a person manage degenerative arthritis symptoms. People should ensure that they only participate in low impact activities to prevent further damage to the joints.

Maintaining an active lifestyle may help by:

  • reducing pain
  • improving function
  • increasing muscle and bone strength
  • improving mood
  • increasing quality of life
  • preventing falls by improving balance

It can also help a person maintain a moderate weight, which experts advise people with OA to try to do.

Surgery

Some people may need surgery if other treatments prove ineffective or the damage to the joint is extensive.

This surgery could be in the form of an osteotomy, during which a surgeon removes or reshapes part of the damaged bone.

Alternatively, a person may have a partial or total joint replacement, which involves a surgeon partially or entirely removing the joint and replacing it with a synthetic one.

Nonmedical options

Maintaining a moderate weight can help remove the added stress that excess body weight can put on the joints. People can do this by following a nutritious, well-balanced diet and engaging in regular, low impact physical activity.

Hot and cold therapies may also help relieve pain and stiffness in the joints. People should alternate the application of hot and cold compresses to the areas over the affected joints.

However, a person should always wrap an ice pack in a cloth first so that they are not applying it directly to their skin.


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

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