Ask the Doctors June 2006 Issue

Ask the Doctors: 06/06

My arthritis seems to flare based on my moods, particularly during a period of emotional distress. Has there been any research on the relationship between mood and arthritis symptoms?

Although there has been some limited research on the relationship between emotions and arthritis, the findings have not shown emotions to be a cause of flare-ups—however, they can make symptoms worse. One study, for example, found that depression caused people with knee osteoarthritis to feel more pain than others with the same disease and symptoms but who were not depressed. When overwhelmed with emotional pain, such as anger, frustration, or sadness, you are less able to cope with physical pain. When you’re in a bad mood, for example, you might focus on symptoms that are normally ignored during a good mood.

Living and coping with any chronic disease is difficult. Some studies have shown that patients who understand their condition and participate actively in their own treatment report less pain. Take time to rest and relax. Don't give up your everyday activities, but do set realistic and flexible goals. Participate in activities that you can enjoy with family and friends. Recognize that your emotional state is a factor in how severe your symptoms seem to be and how well you’re able to cope with them.

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I have rheumatoid arthritis. Although I'm fine when I go to bed, I always wake up extremely stiff. In fact, unless I go through a stretching routine for several minutes, I find I can hardly walk. What causes morning stiffness?

Morning stiffness is characteristic of patients with rheumatoid arthritis (RA). Some patients can be stiff for hours, even all day. The physiology of the stiffness is not entirely clear, but it is related to inflammation in the body’s soft tissues and joints, which may cause swelling and a feeling of tightness. If you have morning stiffness that persists for more than 30 minutes, it is usually a sign of joint inflammation (synovitis), especially when there is also swelling. The treatment is to use drugs that are commonly prescribed for RA. These include nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter drugs such as Aleve and Advil, or prescription forms such as plaquenil, methotrexate, sulfasalazine, azathioprine, and leflunomide. For patients with persistent synovitis after these medications, and especially with X-ray evidence of joint damage, biologics (Enbrel, Humira, Remicade, Orencia) are recommended. These drugs all have side effects, so their use should be carefully monitored.

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I have end-stage osteoarthritis in my right knee and am facing the prospects of a total knee replacement. I’m not anxious to undergo surgery. How long can I postpone the operation without compromising its success?

Total knee replacement is elective surgery. With few exceptions, it is not urgent and can be scheduled around important life events. Occasionally, excessive delays can result in the loss of bone and tendon tissue, which can compromise the quality of the surgery and its result.

Some studies have shown that patients with the worst function and pain at the time of surgery had comparatively worse function two years after surgery, and that performing knee replacement earlier in the course of functional decline may be associated with a more positive outcome.

Better overall physical fitness will allow quicker recuperation and return to activity after surgery. Patients typically have the procedure when pain prevents them from taking part in activities that they used to enjoy. When the basic activities of daily life—walking, shopping, or reasonable recreational pastimes—are inhibited by the knee pain, it may be time to consider surgery.