RD: What About the “Little” Pains?
Last updated: August 2021
Yeah, those. The non-agonizing tweaks and twinges. The background knee-throb.
The sudden, sharp jab that takes your breath as you pick up a dish to put it in the dishwasher? Welp, there goes another piece of that dinnerware set.
Momentary RA aches and pains
You have rheumatoid disease (arthritis). Your diagnosis may have been just a few weeks ago, or it might have been 33 years ago, like me.
Whenever it was, you know this pain intimately. It’s the pain your rheumatologist shrugs and shakes her head over when you mention it in quiet desperation during your once-every-three-month, maybe-15-minute appointment.
This is the RD pain that doesn’t get much attention, medicine-wise, but it sure can focus your attention like a laser when it’s happening. And that can be either momentary — that sharp stab in the joint, there and gone again — or longer-lasting. Hours or days. Or … more.
Possible culprits of pain symptoms
Different things may cause this kind of pain, given RD’s mercurial nature.
Inflammation is often the first culprit. Autoimmune diseases cause the body’s infection fighters (antibodies) to attack its own tissues: in RD’s case, the synovial tissues that help cushion the joints and several vital organs are the targets.
This causes body-wide inflammation which, in turn, causes pains both large and small. It can, of course, also cause damage, destruction, and disability.
The next possible culprit is existing joint damage.
When the joint’s synovial tissues are damaged, the bones grow pitted and ragged, causing more inflammation. The synovium tries to repair itself, automatically producing a thick pannus that coats the damaged part of the joint and, over time, hardens.
It’s a nice try, but it can cause further pain as the bones grate and rub against one another, inflaming the tissues all around them.
Other factors that impact RA pain
The other reasons for RD pain on a lower level include — and the research isn’t quite in on this, even if most people with the disease are nodding their heads wildly — the weather, the foods we eat, and our weight and physical fitness.
My own joints tend to get persnickety when the barometric pressure is changing. My theory is that liquids expand when the pressure is low, and contract when it’s high.
The synovial fluid in that slim capsule between my joints is, really, a fluid, so it acts just the same as my eye drops and the amount of water that drips out of my coffeemaker. Some days, even though I always use the same amount of water, I get a little more or a little less coffee in the pot. Voila—barometric pressure!
So, within that tiny space between my joints, the fluid (already inflamed) is expanding one day, contracting the next. Ouch.
No, I have no scientific proof, but it makes as much sense as anything else about this danged disease. Next up:
Inflammatory responses to certain foods
Yep, we’ve heard it all. Plants from the nightshade family are bad news for RD. You know the ones: tomatoes, potatoes, and eggplants, oh my.
Or maybe it’s gluten, the inflammatory substance in wheat, that causes our joints to go sideways. Or sugar, another wildly inflammatory culprit. Or red meat. Or alcohol.
Ask the Internet and you’ll find hundreds of web pages that list foods you should avoid. But RD is famously capricious. The tomato that makes your knees groan makes my tastebuds smile aloud without causing me the least little twinge.
Same with all the other foods on the list. Mi gluten, tu gluten—or not. This is another of those RD-aggravating things that science hasn’t settled on, but that many of us will swear by.
Nutrition and a balanced diet
It’s well-known that the more weight our RD-joints bear, the more stressed they are and the more likely they are to hurt. So, it behooves us all to do our best to eat mindfully.
Stick to lean meats and fish. Eat plenty of fresh veggies and fruits. Cook with and eat healthy oils like olive and canola oil, and severely limit carbs like bread and pasta. And leave sugary, high-calorie sweets and alcohol for the occasional special moment, not an everyday indulgence.
Finally, most processed foods like chips and boxed meals are not our friends if losing weight or keeping it under control is the goal.
Gentle stretches and physical activity
As for exercise: yep, with RD, sometimes it’s just not happenin’. On those days, try gently stretching the joints and muscles that don’t hurt. Doing a gentle workout with light hand-weights is good for you; using weight machines (if you’re able) is excellent, too.
The idea is to work muscles that provide the most support for our joints, both those in the upper body and the lower body.
I walk. It covers that weight-bearing requirement for joints all over my body, but mostly in my hips, knees, ankles, and feet. It makes my heart work harder, which makes it stronger. And it’s good for my mind. I love walking outdoors, in particular (flowers! fresh air! birds!) but when the weather isn’t cooperating, a treadmill, a podcast, and earbuds work just fine.
What about treatment?
For those mild-to-moderate, grit-your-teeth, wish-it-would-just-stop pains, talk to your PCP or rheumatologist.
Some over-the-counter drugs can help, but be sure they won’t interfere with any of your prescribed meds.
Prescription NSAIDs can help control inflammation, and conventional DMARDs and biologic DMARDs can calm the active disease and slow it way down.
For more intractable pain, there are stronger pain medications. They’re out of favor these days, but don’t be afraid to ask your doctor about them if they're affecting your quality of life. You shouldn’t have to suffer in silence.
Did you know rheumatologist Dr. Donica Baker is answering community questions?
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