Pain Conditions
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      2. Pain Conditions

      Arthritis

      Brief Overview: Arthritis is a broad term for conditions that cause joint inflammation, pain, stiffness, and decreased mobility. There are more than 100 types, but the most common in adults 60+ are osteoarthritis (OA)—a “wear-and-tear” condition of cartilage breakdown—and rheumatoid arthritis (RA)—an autoimmune condition that attacks joints. Arthritis is a leading cause of disability in older adults.

      Prevalence:

      • Over 54 million U.S. adults have some form of arthritis.
      • Prevalence increases with age: nearly 50% of adults 65+ report diagnosed arthritis.
      • Women are more commonly affected than men.
      • Osteoarthritis is the most prevalent type.

      Etiology:

      • Osteoarthritis: Degeneration of joint cartilage and underlying bone due to aging, overuse, or injury.
      • Rheumatoid Arthritis: Autoimmune reaction where the immune system attacks joint lining.
      • Other forms: Gout (uric acid crystal deposits), psoriatic arthritis, lupus-related arthritis.

      Risk Factors:

      • Age (risk increases significantly after 50).
      • Female sex (higher prevalence of RA and OA in women).
      • Family history/genetics.
      • Joint injury or overuse.
      • Obesity (increases joint load, especially knees and hips).
      • Autoimmune diseases (RA, lupus).

      Commonly Associated Conditions:

      • Chronic pain syndromes.
      • Depression/anxiety (due to chronic pain and disability).
      • Metabolic syndrome and obesity.

      Common Medications:

      • For osteoarthritis:
        • Acetaminophen (mild pain).
        • NSAIDs (ibuprofen, naproxen, topical diclofenac).
        • Corticosteroid injections.
      • For RA and autoimmune types:
        • DMARDs (methotrexate, sulfasalazine).
        • Biologics (adalimumab, etanercept).
        • Corticosteroids (short-term use).
      • Adjuncts: Topical analgesics, antidepressants for neuropathic pain, muscle relaxants.

      Common Labs, Imaging, and Tests:

      • Labs (especially for RA): Rheumatoid factor (RF), anti-CCP antibodies, ESR, CRP.
      • Imaging:
        • X-rays (joint space narrowing, osteophytes).
        • MRI (cartilage, ligaments, early inflammation).
        • Ultrasound (synovitis, joint fluid).
      • Joint aspiration (for gout or infection evaluation).

      Common Symptoms:

      • Joint pain and tenderness.
      • Stiffness, especially in the morning or after rest.
      • Swelling around joints.
      • Reduced range of motion.
      • Crepitus (grating sound with joint movement).
      • In RA: symmetrical joint involvement, fatigue, low-grade fever.

      Common Treatments:

      • Conservative: Physical therapy, exercise, weight management, assistive devices.
      • Medications (see above)
      • Injections: Corticosteroids, hyaluronic acid (OA).
      • Surgical options: Joint replacement (hip, knee), arthroscopy in select cases.

      Physical Findings:

      • Tender or swollen joints.
      • Limited range of motion.
      • Bony enlargements (e.g., Heberden’s nodes in OA).
      • Warmth and redness (in inflammatory arthritis).
      • Joint deformities (e.g., ulnar deviation in RA).

       

      Potential Complications and Contraindications:

      • Progressive joint damage and disability.
      • Loss of independence in daily activities.
      • Increased fall risk due to stiffness and weakness.
      • Medication side effects: GI bleeding (NSAIDs), liver/lung toxicity (methotrexate), infection risk (biologics).
      • Cardiovascular disease risk in RA.

      General Health and Lifestyle Guidance:

      • Maintain healthy weight to reduce stress on joints.
      • Stay physically active with low-impact exercise (walking, swimming, tai chi). Ask your healthcare provider what exercises are recommended for you.
      • Practice range-of-motion and strengthening exercises.
      • Use assistive devices (canes, braces, shoe inserts) as needed.
      • Apply heat or cold packs for symptom relief.
      • Balanced diet: anti-inflammatory foods (fish, fruits, vegetables, whole grains). Ask your healthcare provider if any specific dietary modifications are recommended for you.
      • Avoid smoking and excess alcohol (worsen inflammation and medication side effects).

      Suggested Questions to Ask Patients:

      • Which joints are most affected, and how long have you had symptoms?
      • Do you experience stiffness in the morning, and how long does it last?
      • How does pain impact your ability to perform daily activities?
      • Have you tried medications or therapy, and how effective were they?
      • Have you noticed fatigue, fever, or weight changes (suggesting systemic arthritis)?
      • Have you had any falls or balance issues related to joint pain?
      • What coping strategies or support systems do you use?

      Suggested Talking Points:

      • Arthritis is very common as we age, but there are many treatment options to manage pain and maintain function.
      • Staying active—even with gentle movement—helps keep joints flexible and reduces stiffness.
      • Weight management can significantly reduce stress on your joints, especially the knees and hips.
      • For autoimmune types like rheumatoid arthritis, early treatment with the right medications can help try to prevent long-term damage.
      • Let your healthcare provider know if you have side effects from medications, or if your pain changes suddenly.
      • You are not alone—support groups and community programs are available to help you manage arthritis.

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.