Ask the Doctors November 2012 Issue

Ask The Doctors: November 2012

Mood and Pain...Imaging Joint Damage...Identifying Arthritis Symptoms...

Q. 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?

A. 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. 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. 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.

Q. How do you evaluate an arthritic joint to determine if joint damage is getting worse? I know X-rays show some kinds of damage, but do they show soft-tissue damage as well?

A. X-rays can show changes indicative of disease progression, such as joint-space narrowing, bone cysts, and bone spurs. They can help determine if symptoms of arthritis—swelling, tenderness, loss of motion, instability—are related to the bones or the soft tissues, and the appearance of joints on X-rays is often distinctive for various forms of arthritis.

Magnetic resonance imaging (MRI) is a sensitive indicator of early rheumatoid joint destruction, but it is very expensive. Although it is not routinely used in patients with arthritis, MRI is useful when other problems—such as meniscal tears or ligament injuries—exist because it permits the simultaneous imaging of all joint components with excellent contrast between different tissues.

Computed tomography (CT) is helpful in detecting the fine details of bone, but it also is a relatively expensive test and does not give as clear a picture of the soft tissues as does evaluation by MRI.

Ultrasonography is an attractive method of imaging because of its low cost, absence of radiation, and speed of imaging. Recent advances in ultrasound technology have allowed for the development of equipment for imaging inflamed joints in patients with rheumatoid arthritis.

X-rays, however remain the least expensive and best method for monitoring progression of osteoarthritis and rheumatoid arthritis.  

Q. I have pain and stiffness in my elbows and hip if a I sit for a long period of time. However, there’s no swelling or redness, which I thought were symptoms of arthritis.

A. The primary symptoms in almost all forms of arthritis are pain and stiffness. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the most common types. Morning stiffness is common in OA and subsides after a few minutes of activity. In RA, however, morning stiffness may not begin to improve for an hour or longer. People with OA often notice more stiffness during the day after resting for an hour or so.

Pain and stiffness that develop gradually and intermittently over several months or years suggest OA. Pain, stiffness, and fatigue that worsen over several weeks could be caused by RA or another form of inflammatory arthritis. Swelling, warmth, and redness over the joint are most common with RA or other types of inflammatory arthritis.