Chronic joint pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Important presenting symptoms in joint disease are pain, stiffness or locking, swelling, weakness or difficulty moving, fatigue, and emotional lability such as anxiety or depression.4 When taking a history, particular attention should be given to the onset and subsequent temporal and spatial pattern of joint involvement as well as to the age and sex of the patient. Osteoarthritis is characterized by use-related pain, whereas inflammatory pain is most severe in the mornings and again towards the end of the day. Prolonged morning stiffness is usually present. However, it is not uncommon for symptoms to overlap and RA and osteoarthritis may be difficult to separate on symptoms alone.5 The diagnosis of gout is more straightforward with symptoms beginning acutely with a pricking sensation and progressing to an intolerable burning pain. More constant severe pain throughout the day and night may indicate the presence of sinister bone pathology, but can also indicate important psychosocial influences.
Arthritis 1
Len Sperry in Behavioral Health, 2013
Two of the most common forms are osteoarthritis and rheumatoid arthritis. Osteoarthritis affects approximately 65% of older adults, while rheumatoid arthritis affects only about 5% of the total population. Osteoarthritis alters the hyaline cartilage and causes loss of the articular cartilage of the joint as well as irregular growth to the connecting bone structures. This disease begins asymptomatically before age 40 and afterwards nearly everyone experiences some pathological changes in their weight bearing joints. While men and women are equally affected by it, the onset is sooner in men. Pain is the earliest reported symptom, which is increased by exercise and relieved by rest. Morning stiffness lasts 10 to 30 minutes and lessens with movement. As the disease progresses, joint motion decreases, and tenderness and grating sounds—called crepitus— appear. As articular cartilage is lost in the joint ligaments become lax. Ligaments which effectively supported the joint before the disease progressed now become lax or loosened resulting in the joint becoming less stable and increasing the risk of complications, such as fractures if the individual falls. Pain and tenderness are experienced that arise from the changes in the ligaments and tendons (National Center for Chronic Disease Prevention and Health Promotion. 2000).
Selected topics
Henry J. Woodford in Essential Geriatrics, 2022
PMR occurs in people over the age of 50, and 90% of cases present in those over 60 years. It is twice as common in women as men. It causes a slowly progressive pain and stiffness of the proximal muscles. Fever, malaise, night sweats, and weight loss are present in around a third of people. Morning stiffness lasting over 30 minutes is characteristic. A mild polyarthritis similar to rheumatoid arthritis may be seen. Diagnosis relies on the exclusion of other diseases. Inflammatory markers are elevated. The ESR is typically over 40 mm/hour, the serum C-reactive protein (CRP) is also likely to be elevated. Autoantibodies and CK are usually normal. There may be anaemia of chronic disease (two thirds of people) and abnormal liver enzymes (a third of people). Treatment is with steroids, typically prednisolone at a dose of 10–20 mg per day. The steroids can usually be slowly reduced and withdrawn over a period of several months. Bone protection should be considered for people on steroids (see Chapter 16).
Patient-reported outcomes and realistic clinical endpoints for JAK inhibitors in rheumatoid arthritis
Published in Expert Review of Clinical Immunology, 2022
When considering patient-reported outcomes (PROs), it is important to realize that the patient’s perspective of their daily burden of disease often differs from the physician’s perspective [1,2]. Health-Care Providers (HCPs) think of morning stiffness in RA and physical function, sleep disturbances, and pain at night. Patients experience the burden of disease throughout the day – which include fatigue and work impairment, depression and anxiety, limits in social functioning, and self-efficacy in coping and satisfaction/dissatisfaction with health and health care. Morning stiffness is important and may also occur later in the day. Pain can be a constant companion. Sleep disturbance and sexual satisfaction are often overlooked or not discussed. Since there exists a fair amount of discordance between what patients and physicians consider important in terms of defining disease activity and flares, it is important to assess PROs in clinical practice as well as trials.
Drug therapies for polymyalgia rheumatica: a pharmacotherapeutic update
Published in Expert Opinion on Pharmacotherapy, 2018
Miguel A. González-Gay, Trinitario Pina, Diana Prieto-Peña, Mónica Calderon-Goercke, Ricardo Blanco, Santos Castañeda
Polymyalgia rheumatica (PMR) is a common inflammatory disease in individuals older than 50 years from Western countries [1]. It is characterized by severe pain and stiffness involving bilaterally the shoulders and proximal aspects of the arms. These symptoms also affect the neck, the pelvic girdle and the proximal aspects of the thighs. Morning stiffness lasting more than 45 min, fatigue and malaise are common. Typically, patients with PMR have elevation of acute phase reactants, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) [2,3]. However, it is not exceptional to see patients with PMR who have small elevation of acute phase reactants at the time of disease diagnosis [4]. In this regard, in up to 20% of patients with PMR the ESR may be lower than 40 mm/1st hour [3,4].
Economic burden of fatigue or morning stiffness among patients with rheumatoid arthritis: a retrospective analysis from real-world data
Published in Current Medical Research and Opinion, 2020
Vibeke Strand, Ruchitbhai Shah, Chris Atzinger, Jifang Zhou, Jerry Clewell, Arijit Ganguli, Namita Tundia
The primary aim of the study was to compare HCRU and associated costs between newly diagnosed RA patients with new episodes of fatigue or morning stiffness and newly diagnosed RA patients without morning stiffness or fatigue. Morning stiffness and fatigue were analyzed in two separate cohorts and in one combined cohort (patients having both morning stiffness and fatigue). To minimize selection bias, cases were matched to controls using propensity-score matching. Baseline characteristics or covariates considered in the propensity model included but were not limited to age, gender, geographic region, health plan type, year of RA diagnosis, Charlson comorbidity index29, number of comorbid psychiatric conditions (generalized anxiety disorder, post-traumatic stress disorders, dementia, substance abuse disorder and personality disorder), medication use (including steroids, analgesics, nonsteroidal anti-inflammatory drugs, conventional synthetic and biologic DMARDs), the claims-based index for RA severity (CIRAS)30 and HCRU (hospital admissions and length of hospital stay, and ED, outpatient and rehabilitation visits).
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