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9 Best Exercises for Rheumatoid Arthritis Pain

in Arthritis

Article featured on MedicalNewsToday

For people with rheumatoid arthritis (RA), exercise can be hugely beneficial for relieving pain and joint stiffness.

People with RA who exercise may find that they have less pain than those who do not. Exercise can reduce painful symptoms, improve joint function and flexibility, increase range of motion, and boost mood.

It is best to seek medical advice before starting any exercise program and work with a doctor and a physical therapist to develop a tailored exercise plan.

Treatment for Rheumatoid Arthritis

Explore our comprehensive information on FDA-approved medications for rheumatoid arthritis. Learn about side effects, dosage, interactions, and more.

Best exercises for RA pain

The following types of exercise may help relieve the pain, joint stiffness, and other symptoms that RA can cause:

  1. Stretching

Stretching can help improve flexibility, reduce stiffness, and increase range of motion. Stretching daily is important for relieving RA symptoms.

The ideal stretching routine will be different for each person and depend on which joints are affected and what symptoms occur. However, stretches often involve slowly and gently moving the joints of the knees, hands, and elbows.

A typical stretching routine may consist of:

  • warming up by walking in place or pumping the arms while sitting or standing for 3–5 minutes.
  • holding each stretch for 20–30 seconds before releasing it.
  • repeating each stretch 2–3 times. Using a yoga strap may help people maintain proper form while stretching. If someone does not have a yoga strap, they could use an alternative such as a dog leash.

Some people may find it beneficial to work with a physical therapist who understands RA to learn the correct way to perform the stretches that meet their personal needs.

  1. Walking

Walking is a low-impact form of exercise that can help with aerobic conditioning, heart and joint health, and mood.

It is essential to wear proper shoes and stay hydrated, even if the walking is not strenuous. It is often sensible to walk slowly initially and then increase the pace when possible.

A person may want to start a walking routine on flat, even surfaces before progressing to uphill, downhill, or uneven surfaces.

  1. Flowing movements, such as tai chi and yoga

Both tai chi and yoga combine deep breathing, flowing movements, gentle poses, and meditation. They increase flexibility, balance, and range of motion while also reducing stress.

A 2013 study of participants with RA who had done group tai chi suggested that tai chi could reduce anxiety and depression while increasing self-motivation and self-esteem.

The participants did tai chi twice a week for 12 weeks.

A 2013 study of women with RA who did Iyengar yoga suggests that this exercise had mood, fatigue, and pain disability benefits. The participants did yoga twice a week for six weeks.

It is possible to find free online videos or apps like Gaia for tai chi or yoga workouts, including some yoga workouts specifically for people with RA. A person should always talk to their doctor before starting a yoga or tai chi practice.

  1. Pilates

Pilates is a low-impact activity that can increase flexibility for enhanced joint health.

It can be helpful to do Pilates poses that activate the core muscles and emphasize movements that help with stability. Pilates can be good for overall movement patterns, similar to tai chi and yoga.

People new to Pilates should begin slowly and seek guidance from a certified trainer if possible.

  1. Water exercises

Water helps support body weight by minimizing gravity, which means that water exercises do not impact heavily on the joints.

Swimming, water aerobics, and other gentle water exercises can increase flexibility, range of motion, strength, and aerobic conditioning. They can also reduce joint stress and stiffness.

More studies on the benefits of water exercises on RA are needed.

  1. Cycling

As RA increases the risk of cardiovascular disease, it is vital to keep the heart as healthy as possible. Cycling can help improve cardiovascular function.

Riding a stationary bike can be a safe way to get the joints moving and improve cardiovascular fitness. A benefit of a stationary bike is that a person can be supervised while riding. A person can also ride their bike outdoors to get fresh air.

In addition to improving aerobic conditioning, cycling can reduce stiffness, increase range of motion and leg strength, and build endurance.

  1. Strength training

Strengthening the muscles around the affected joints can help increase strength while reducing pain and other RA symptoms.

Using a resistance band is a way to challenge the body and build muscle over time. A physical therapist who works with people with RA should be able to offer guidance on suitable exercises.

  1. Hand exercises

RA can sometimes lead to limited use of the hands. A person with RA may lose their grip strength or find that they are dropping things.

Bending the wrists up and down, slowly curling the fingers, spreading the fingers wide on a table, and squeezing a stress ball can all help increase strength and flexibility in the hands.

  1. Gardening

Light gardening can be a beneficial exercise for a person with RA.

People should be gentle with their body, work slowly, and avoid overstraining the muscles and joints.

A person can avoid overstraining by avoiding bending and twisting in ways that can aggravate the lower back. A gardener should make sure to properly hinge at the hips when working in the garden.

Tips for exercising with RA

The tips below may improve safety and comfort when exercising with RA:

Be consistent

People need to exercise consistently to achieve meaningful results. It is important to keep at it and practice regularly. A person with RA will benefit from consistent and lifelong aerobic and muscle strengthening exercises. Some days may be less comfortable than others, but it is possible to adjust the intensity accordingly.

Accessorize for comfort and protection

The following methods can help people exercise more comfortably with less risk of injury and falls:

  • choosing proper shoes that provide the right protection and balance
  • using a slip-resistant yoga mat
  • wearing comfortable clothes that wick sweat away quickly

Seek variety

RA symptoms can vary daily, and they tend to come in waves. People often experience flares and periods of remission.

Doing a variety of exercises and mixing up the daily routine can help people avoid overworking one set of muscles or particular joints.

For example, a person doing morning stretches each day may choose to add strength training twice a week, a water workout once a week, and yoga or tai chi twice a week, symptoms permitting.

This variety should prevent any overuse injuries, which can aggravate symptoms and counter the benefits of the exercise.

Adjust exercises according to symptoms

People can reduce the intensity of an exercise on days when symptoms are more severe. For example, they could place a resistance band around the forearms instead of holding it in the hands.

Alternatively, they can try a different type of exercise or exercise for a shorter time.

On days when cycling or swimming seems too much, switching this type of activity to a leisurely stroll or some stretching will still be beneficial.

Listen to the body

It is important for people with RA to remain as physically active as possible. However, it is equally crucial to avoid discomfort or injuries.

It is vital to choose the right pace and listen to the body. If exercise causes discomfort or a flare, it is best to reduce the session. For example, do 10 minutes instead of 30. People should also take time off when necessary.

Pay attention to small things

Most exercises focus on large muscle groups. It is essential to make time for smaller parts of the body, such as the hands and fingers. It is also important to do small exercises with the toes and feet. Exercises that help with balance, such as yoga, are important also.

Creating a daily routine for these exercises can help.

Work with a physical therapist

Working with a physical therapist who specializes in RA can be helpful in developing a safe and appropriate exercise routine. This collaboration can be particularly beneficial for people with a new RA diagnosis or those who are experiencing a severe flare.

Exercises to avoid

People with RA should avoid strenuous exercise or any exercises that cause pain. These may include high-impact exercises that put excessive strain on the joints.

However, there are no specific exercises that everyone with RA should avoid. Each person is different, and an activity that causes pain for one person may not have the same effect on another person.

What is suitable for someone will depend on their situation and health condition. However, everyone is likely to benefit from paying close attention to their body and working with a doctor or physical therapist for guidance, if possible.

Summary

Exercise is usually helpful for people with RA. It offers a range of benefits, which include relieving symptoms, improving joint function, building strength, increasing flexibility, helping daily functioning, improving aerobic fitness, and boosting mood. It can reduce RA flares and make the symptoms of this condition easier to manage.

A person should work with a doctor and physical therapist, if possible, to develop a personalized exercise program for the best possible results.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2022/06/Blog-header-image-9-best-exercises-for-rheumatoid-arthritis-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2022-06-09 12:00:482022-05-31 13:06:089 Best Exercises for Rheumatoid Arthritis Pain

What is Degenerative Arthritis?

in 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.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2022/03/Blog-header-image-what-is-degenerative-arthritis-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2022-03-15 12:00:282022-03-15 12:00:28What is Degenerative Arthritis?

Rheumatoid Arthritis within Foot and Ankle

in Ankle Pain, Arthritis, Foot Pain

Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.
As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.
The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.
Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.
Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.
Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:
X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.
Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.
Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

To Top

Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.
Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.
Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.
Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/
For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

To Top

Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.
Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.
During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.
Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.
Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.
Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.
Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.
Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.
If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.
There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.
Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.
If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.
If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.
Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.
There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.
This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.
This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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Options for Treating Arthritis in the Knee

in Arthritis

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.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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Jog on: Exercise Won’t Raise Your Odds for Arthritic Knees

in Arthritis, Knee, Running

Article featured on MedicineNet
Dr. Kim Huffman, an avid runner, gets a fair amount of guff from friends about the impact that her favorite exercise has on her body.
“People all the time tell me, ‘Oh, you wait until you’re 60. Your knees are going to hate you for it’,” Huffman said. “And I’m like, ‘That’s ridiculous’.”
Next time the topic comes up, Huffman is well-armed: An extensive British analysis of prior study data has found no link between a person’s amount of exercise and their risk for knee arthritis.
The research team combined the results of six clinical trials conducted at different places around the globe, creating a pool of more than 5,000 people who were followed for 5 to 12 years for signs of knee arthritis.
In each clinical trial, researchers tracked participants’ daily activities and estimated the amount of energy they expended in physical exertion.
Neither the amount of energy burned during exercise nor the amount of time spent in physical activity had anything to do with knee pain or arthritis symptoms, the researchers concluded.
“This helps dispel a myth that I’ve been trying to dispel for quite a while,” said Huffman, an associate professor at the Duke University Medical Center’s division of rheumatology.
“If you add up the amounts of activity that people do and also the duration of activity, neither of those is associated with knee arthritis,” added Huffman, who wasn’t involved in the analysis.
Dr. Bert Mandelbaum is chief medical officer of the Los Angeles Galaxy soccer club and team physician for the U.S. Soccer Men’s National Team.
He agreed the study “further corroborates the fact that levels of exercise in one’s personal life do not increase the risk, the onset or progression of osteoarthritis.”

So where did this misconception come from?

Huffman thinks it’s because people mistake exercise-related injuries for the effect that exercise itself has on your joints.
“Right now, the clear risks for knee arthritis are genetics, injuries and female sex,” Huffman said. “People who exercise more may be more likely to injure their knee. That’s where I think the myth comes from.”
In fact, exercise can help ward off knee arthritis in several ways, Huffman said:

  • Flexing and extending the knee during exercise promotes the diffusion of fluid into the joint, promoting better nutrition.
  • An elevated metabolism created by exercise helps control inflammation in the knee joint.
  • Weight loss reduces the amount of load placed on the knee.
  • Exercise strengthens the muscles surrounding the knee, stabilizing it and reducing the risk of injury.

“I don’t think we’re finding that simple overuse or using your joint is a problem. It’s more an association with injuries and perhaps in the setting of obesity or high genetic risk,” Huffman said.
Your best bet is to choose an exercise that poses the least risk of a knee injury, Huffman said.
“If you want to go snow skiing, I don’t think that’s a huge problem but you’re probably going to be more likely to injure yourself downhill skiing than, say, walking in your neighborhood or training for a marathon,” Huffman said. “It’s not soccer or football or skiing itself. It’s just the risk for injury during those activities.”
On the other hand, exercise provides benefits that go far beyond healthy joints, said Mandelbaum, co-chair of medical affairs at Cedars-Sinai Kerlan-Jobe Institute at Santa Monica, Calif. He played no role in the research review.
“Physical activity is essential to optimize both physical and mental health and plays a central role in facilitating life’s quality and quantity,” Mandelbaum said. “The list of benefits includes decreased anxiety, better mood, decreased levels of coronary disease, hypertension, diabetes and obesity, and therefore a longer life.”


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2021/11/Blog-header-image-jog-on-exercise-wont-raise-your-odds-for-arthritic-knees-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2021-11-15 12:00:432021-11-15 12:00:43Jog on: Exercise Won’t Raise Your Odds for Arthritic Knees

Everything You Need to Know About Osteoarthritis

in Arthritis, Osteoarthritis

Article featured on Medical News Today

Osteoarthritis (OA) causes inflammation in the joints and the breakdown and gradual loss of joint cartilage. As the cartilage wears down, a person experiences pain and difficulty with movement.

OA is a common joint disorder. It develops in the hand, for example, in 1 in 12 people over the age of 60, according to the Arthritis Foundation.
OA is a progressive disease, which means that symptoms worsen over time.
There is no cure, but treatment can help manage pain and swelling and keep a person mobile and active.

Symptoms

OA leads to pain and stiffness in the joints.
In the early stages, a person may have no symptoms. Symptoms may occur in one or more joints, and they tend to appear gradually.
When symptoms develop, they can include:

  • pain and stiffness that worsen after not moving the joint for a while
  • swelling
  • difficulty moving the affected joint
  • warmth and tenderness in the joints
  • a loss of muscle bulk
  • a grating or crackling sound in the joint, known as crepitus

The progression of OA involves:

  • synovitis — mild inflammation of the tissues around the joints
  • damage and loss of cartilage
  • bony growths that form around the edges of joints

Effects

Cartilage is a protective substance that cushions the ends of the bones in the joints and allows the joints to move smoothly and easily. In people with OA, the smooth surface of the cartilage becomes rough and starts to wear away. As a result, the unprotected bones start to rub together, causing damage and pain. Eventually, bony lumps form on the joint. The medical names for these are bone spurs or osteophytes, and they can lend a knobbly appearance to the joint. As the bones change shape, the joints become stiffer, less mobile, and painful. Fluid may also accumulate in the joint, resulting in swelling.
While OA can develop in any joint, it commonly affects the knees, hips, hands, lower back, and neck.

The knees

OA usually occurs in both knees, unless it results from an injury or another condition.
A person with the condition may notice that:

  • There is pain when walking, especially uphill or upstairs.
  • The knees lock into position, making it harder to straighten the leg.
  • There is a soft, grating sound when they bend or flex the knee.

The hips

A person with OA in the hips may find that any movement of the hip joint, such as standing up or sitting down, can cause difficulty or discomfort.
Pain in the hips is a common feature of the condition. OA in the hips can also cause pain in the knee or in the thighs and buttocks.
A person may experience this pain while resting as well as while walking, for example.

The hands

In the hands, OA can develop in:

  • the base of the thumb
  • the top joint of the other fingers, closest to the nail
  • the middle joint of the other fingers

A person with the condition may notice:

  • pain, stiffness, and swelling in the fingers
  • bumps that develop on the finger joints
  • a slight bend sideways at the affected joints
  • fluid-filled lumps or cysts on the backs of the fingers, which may be painful
  • a bump that develops where the thumb joins the wrist, which can make it difficult to write or turn a key

For some people, the finger pain decreases and eventually goes away, though the swelling and bumps remain.
Anyone who experiences joint stiffness and swelling for more than 2 weeks should see a doctor.

Causes

Doctors do not know the exact cause of OA, but it seems to develop when the body is unable to repair joint tissue in the usual way.
It often affects older people, but it can occur at any age.

Genetic factors

Some genetic features increase the risk of developing OA. When these features are present, the condition can occur in people as young as 20 years old.

Trauma and overuse

A traumatic injury, surgery, or overuse of a joint can undermine the body’s ability to carry out routine repairs and may trigger OA, eventually leading to symptoms.
It can take several years for OA symptoms to appear after an injury.
Reasons for overuse or repeated injury include jobs and sports that involve repetitive movement.

Risk factors

A number of risk factors increase the chances of developing OA.

  • Sex: OA is more common among females than males, especially after the age of 50.
  • Age: Symptoms are more likely to appear after the age of 40, though OA can develop in younger people after an injury — especially to the knee — or as a result of another joint condition.
  • Obesity: Excess weight can put strain on weight-bearing joints, increasing the risk of damage.
  • Occupation: Jobs that involve repetitive movements in a particular joint increase the risk.
  • Genetic and hereditary factors: These can increase the risk in some people.

Other conditions

Some diseases and conditions make it more likely that a person will develop OA.

  • inflammatory arthritis, such as gout or rheumatoid arthritis
  • Paget’s disease of the bone
  • septic arthritis
  • poor alignment of the knee, hip, and ankle
  • having legs of different lengths
  • some joint and cartilage abnormalities that are present from birth

Diagnosis

A doctor will ask about symptoms and perform a physical examination.
No definitive test can diagnose OA, but tests can show whether damage has occurred and help rule out other causes.
Tests may include:
X-rays and MRI: These can reveal bone spurs around a joint or a narrowing within a joint, suggesting that cartilage is breaking down.
Joint fluid analysis: A doctor will use a sterile needle to withdraw fluid from an inflamed joint for analysis. This can rule out gout or an infection.
Blood tests: These can help rule out other conditions, such as rheumatoid arthritis.

Treatment

While no treatment can reverse the damage of OA, some can help relieve symptoms and maintain mobility in the affected joints.
Interventions include exercise, manual therapy, lifestyle modification, and medication.

Medication

Medication can help reduce pain.
Acetaminophen (Tylenol)
This can relieve pain in people with mild to moderate symptoms. Follow the doctor’s instructions, as overuse can lead to side effects and cause interactions with other medications.
Nonsteroidal anti-inflammatory drugs
If acetaminophen does not help, the doctor may recommend a stronger pain reliever, which may include ibuprofen, aspirin, or diclofenac.
A person can take these orally or topically, applying the medication directly to the skin.
Capsaicin cream
This is a topical medication that contains the active compound in chilies. It creates a sensation of heat that can reduce levels of substance P, a chemical that acts as a pain messenger.
Pain relief can take 2 weeks to a month to fully take effect.
Do not use the cream on broken or inflamed skin, and avoid touching the eyes, face, and genitals after using it.
Intra-articular cortisone injections
Corticosteroid injections in the joint can help manage severe pain, swelling, and inflammation. These are effective, but frequent use can lead to adverse effects, including joint damage and a higher risk of osteoporosis.
Duloxetine (Cymbalta) is an oral drug that can help treat chronic musculoskeletal pain.

Physical therapy

Various types of physical therapy may help, including:
Transcutaneous electrical nerve stimulation (TENS): A TENS unit attaches to the skin with electrodes. Electrical currents then pass from the unit through the skin and overwhelm the nervous system, reducing its ability to transmit pain signals.
Thermotherapy: Heat and cold may help reduce pain and stiffness in the joints. A person could try wrapping a hot water bottle or an ice pack in a towel and placing it on the affected joint.
Manual therapy: This involves a physical therapist using hands-on techniques to help keep the joints flexible and supple.

Assistive devices

Various tools can provide physical support for a person with OA.
Special footwear or insoles can help, if OA affects the knees, hips, or feet, by distributing body weight more evenly. Some shock-absorbing insoles can also reduce the pressure on the joints.
A stick or cane can help take the weight off of the affected joints and may reduce the risk of a fall. A person should use it on side of the body opposite to the areas with OA.
Splints, leg braces, and supportive dressings can help with resting a painful joint. A splint is a piece of rigid material that provides joint or bone support.
Do not use a splint all the time, however, as the muscles can weaken without use.

Surgery

Some people may need surgery if OA severely affects the hips, knees, joints, or the base of the thumbs.
A doctor will usually only recommend surgery if other therapies have not helped or if there is severe damage in a joint.
Some helpful procedures include:
Arthroplasty
This involves a surgeon removing the damaged areas and inserting an artificial joint, made of metal and plastic. Some refer to this procedure as a total joint replacement.
The joints that most often require replacing are the hip and knee joints, but implants can also replace the joints in the shoulder, finger, ankle, and elbow.
Most people can use their new joint actively and painlessly. However, there is a small risk of infection and bleeding. An artificial joint may also come loose or wear down and eventually need replacing.
Arthrodesis
This involves a surgeon realigning, stabilizing, or surgically fixing the joint to encourage the bones to fuse. Increased stability can reduce pain.
A person with a fused ankle joint will be able to put their weight on it painlessly, but they will not be able to flex it.
Osteotomy
This involves a surgeon removing a small section of bone, either above or below the knee joint. It can realign the leg so that the person’s weight no longer bears down as heavily on the damaged part of the joint.
This can help relieve symptoms, but the person may need knee replacement surgery later on.

Complications

Septic arthritis is joint inflammation caused by bacteria. Joint replacement surgery slightly increases the risk of this infection.
This is a medical emergency, and hospitalization is necessary. Treatment involves antibiotic medication and drainage of the infected fluid from the joint.

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

Lifestyle tips

A range of strategies can help ease the symptoms of OA. Ask the doctor for advice about suitable lifestyle adjustments. They may recommend:

Exercise and weight control.

Exercise is crucial for:

  • maintaining mobility and range of movement
  • improving strength and muscle tone
  • preventing weight gain
  • building up muscles
  • reducing stress
  • lowering the risk of other conditions, such as cardiovascular disease

Current guidelines recommend that everyone should do at least 150 minutes of moderate-intensity exercise each week.
A doctor or physical therapist can help develop an exercise program, and it is important to follow their instructions carefully to prevent further damage.
Choose activities that will not put additional strain on the joints. Swimming and other types of water-based exercise are a good way to keep fit without putting additional pressure on the joints.
Learn more here about suitable exercises for arthritis of the knee.

Assistive devices and adjustments

A loss of mobility due to OA can lead to further problems, such as:

  • an increased risk of falls
  • difficulty carrying out daily tasks
  • stress
  • isolation and depression
  • difficulty working

A physical or occupational therapist can help with these issues. They may recommend:
Assistive devices: Using a walker or cane can help prevent falls.
Adjustments to furniture and home fittings: Higher chairs and devices such as levers that make it easier to turn faucet knobs, for example, can help.
Talking to an employer: It may be possible to make adjustments to the workplace or arrange for more flexible hours.

Supplements

Some research has suggested that people with low vitamin D levels have a higher risk of OA. Also, in people with a low vitamin C intake, the disease may progress more rapidly.
Low levels of vitamin K and selenium may also contribute, but confirming these findings will require further research.
Some people use supplements for OA, including:

  • omega-3 fatty acids
  • calcium
  • vitamin D

The American College of Rheumatology note that there is not enough evidence to support the safety and effectiveness of these supplements for OA. They recommend asking a doctor before using them.

Outlook

OA is a common disease that causes joints to deteriorate, leading to pain and stiffness. It tends to appear during middle age or later.
There is currently no cure, but researchers are looking for ways to slow or reverse the damage. Lifestyle remedies and pain relief medications can help manage it.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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Why Are Arthritis Symptoms Worse at Night?

in Arthritis

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.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2021/10/Blog-header-image-why-are-my-arthritis-symptoms-worse-at-night-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2021-10-26 12:00:522021-10-26 12:00:52Why Are Arthritis Symptoms Worse at Night?

RA Symptoms You Shouldn’t Ignore

in Arthritis
Article featured on WebMD, Medically reviewed by Brunilda Nazario, MD
Rheumatoid arthritis can have many symptoms. The most common are stiff, painful joints and fatigue.
But this disease causes inflammation in many body parts, so you may have symptoms that you don’t realize are related to RA. Some are signs of serious complications that put your organs, or even your life, at risk.
If you have any of these symptoms, don’t try to deal with them on your own. Call your doctor right away.

Broken Bones

Both RA and medications to treat it, like steroids, cause your bones to become weaker. You’re more likely to break a bone if you fall. Exercise, especially weight-bearing activity like walking, helps to keep your bones strong.

Chest Pain

RA makes you more likely to get heart disease. Over time, plaque builds up in your arteries. Doctors call this atherosclerosis. This can lead to a heart attack. Chest pain is a common symptom.
RA is a possible cause of a painful heart problem called pericarditis. That’s when thin layers of tissue around your heart get inflamed. You may feel severe chest pain that’s easy to mistake for a heart attack.
Even though your chest pain may not be a heart attack, if you have it, call 911 or go to the emergency room right away.

Dryness

RA sometimes causes dry eyes. This makes you more likely to get an eye infection.
People with RA could get another autoimmune condition called Sjögren’s syndrome. It often leads to dry mouth, nose, eyes, vagina, or skin. Your lips or tongue may dry out, crack, and get infected.

Eye Problems

It’s rare, but RA can cause inflammation in the white part of your eye, called the sclera. The symptoms are mostly redness and eye pain. You might have blurry vision. If you notice these signs, see your doctor.

Work With Your Doctor to Prevent RA Complications

With RA, it’s important to treat more than just your joints. Talk to your doctor to tailor a plan.

Fever

It can be a sign of infection. RA medications like biologics and steroids slow down your immune system. While they ease joint pain and swelling, it’s harder for you to fight off bugs like the flu. RA makes you more likely to get an infection just because the disease wears down your immune system.
Mild fever is also one sign of an RA flare. That’s when inflammation gets out of control. If it gets too high, your doctor will check for infection.

Hearing Loss

There may be a slightly higher risk of hearing loss with RA.
Tinnitus, or ringing in your ears, can be a side effect of treatments like nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).

Mood Changes

RA is tied to depression, anxiety, and other mood problems. That’s because the disease causes pain, fatigue, and stiffness that make it harder to do the things you enjoy. Depression and anxiety could also come from inflammation.
Some people with RA get fibromyalgia. This illness causes muscle pain and often leads to depression and anxiety. Stress makes all of your symptoms worse.
If your mood changes seem to take over your life, talk to your doctor. Depression and anxiety can become serious if you don’t treat them.

Numbness or Tingling

RA sometimes affects the small nerves in your hands or feet. They might feel numb or like you’re being stuck with pins and needles.
If these tiny blood vessels in your hands or feet shut down, your fingers or toes may feel cold or numb. They could even change color when it’s cold outside and look white, red, or blue.
Rheumatoid vasculitis, which affects blood vessels, can also cause numbness, tingling, burning, or pain in your hands or feet due to damaged nerves. If your hands or feet are so numb that they drop or go limp when you try to raise them, see your doctor right away.
Numbness and tingling are side effects of biologics, too.

Stomach Pain or Indigestion

RA and medicines used to treat it are linked to mouth and stomach ulcers, stomach bleeding, acid reflux, diarrhea, and constipation. Painful diverticulitis (inflamed pouches in your GI tract) and colitis (an inflamed colon) are also possible if you have RA.
RA drugs like NSAIDs often cause ulcers or an upset stomach.
Belly pain is sometimes a sign of a rare RA complication called rheumatoid vasculitis — when inflammation spreads to your blood vessels. Weight loss and lack of appetite are other symptoms. Vasculitis is serious, so see a doctor right away.

Trouble Breathing

If you have a hard time getting your breath and can’t figure out why, maybe RA is to blame. Some people with the disease, especially men who smoke or used to smoke, are more likely to get serious lung problems.
When RA inflammation causes scar tissue to form in your lungs, you might notice chronic cough, shortness of breath, fatigue, and weakness.
RA may inflame the tissue that lines your lungs. That can lead to shortness of breath or pain or discomfort when you breathe.
See your doctor right away if you have unusual breathing problems or a cough that won’t go away.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2021/09/Blog-header-image-RA-symptoms-you-shouldnt-ignore-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2021-09-14 12:00:182021-09-14 12:00:18RA Symptoms You Shouldn’t Ignore

How to Live with Arthritis

in 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.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2021/05/LiveWithArthritis.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2021-06-02 12:00:392021-06-02 12:00:39How to Live with Arthritis

Why are my RA symptoms getting worse?

in Arthritis, Joint Pain, Pain Management
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.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2021/05/RAsymptoms.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2015/03/new-mexico-orthopaedics-web-logo-vs7.png nmortho2021-05-21 12:10:152021-05-21 12:10:15Why are my RA symptoms getting worse?
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