Maybe you remember your grandmother talking about how stiff and uncomfortable her hands would feel before it rained. Perhaps you've felt pain in your joints yourself after sitting for a long time or being overly active. Arthritis is so common that most of us either know someone who has it or we have it ourselves.
What you may not know is that arthritic changes start when you’re in your twenties and progress until the end of life. More importantly, arthritis correlates poorly with pain! People with little arthritis have a lot of pain while some with severe arthritis have no pain at all. Although arthritis in the low back worsens as we get older, the prevalence of low back pain actually decreases after the age of 60.
What in the world is going on here? What causes arthritis and the joint pain that so many of us experience? Is it hereditary? Does the weather impact it? Is it a disease that only old people get?
Many questions, assumptions, and myths surround arthritis. Researchers and doctors are constantly learning more and more about it. Some of what we thought was true might, in fact, not be.
This article will delve into what we think we know about arthritis. It will uncover and challenge common misconceptions about the condition. If we wish to reduce our arthritic symptoms or overcome the pain in our joints, we need to know as much as we can about arthritis.
A Quick Overview
Arthritis doesn't discriminate. We now know it’s simply a normal part of aging. People of all ages, nationalities, and genders can and do get it. In fact, nearly a quarter of all American adults (over 54 million people) struggle with joint pain (1), and it is a leading cause of disability in the U.S. (2). While children and teens can have arthritis, it's typically associated with the elderly and aging. Women are also more prone to getting arthritis than men. Arthritis has been often described as having “wrinkles on the inside”. If you recognize that wrinkles and other normal signs of aging like grey hair don’t hurt, this may start to change the way you think about arthritis.
We hear our friends, family, and doctors talk about arthritis all the time, and most of us assume that it always creates joint pain and stiffness. While arthritis can hurt, the correlation between arthritis and pain is quite weak. For those who do have pain, other symptoms can include swelling, redness, and a decreased range of movement of the joint(s), as well as bone spurs (bone that forms around joints). Some of these changes are a result of moving less or being scared to move, which leads to de-conditioning.
Regardless of type or severity, arthritis presents only mild or moderate symptoms for some, while others experience severe and/or chronic pain. A person’s pain experience depends on many factors beyond the state of the joints. Beliefs, thoughts, feelings, stress, and things we hear, see, do, and don’t do all have an impact. In other words, arthritis is context-dependent and is poorly related to pain severity. Further complicating things, new research indicates that our psychology and social realities are actually more predictive of pain than what’s happening in the joint (3).
There are many kinds of arthritis (over 100 types!), the most common being rheumatoid arthritis and osteoarthritis. In the case of rheumatoid arthritis, a person's immune system attacks their joints, which leads to changes in the tissues including the cartilage (sliding surface that covers the bone), and the bone itself. In the case of osteoarthritis, similar changes happen to the joint’s tissues. The cartilage breaks down, thins, and can get rough, which leads to less protection for the bones. The various types of arthritis are broadly classified into the following categories: degenerative, infectious, inflammatory, and metabolic.
Tackling Some Misconceptions
Since arthritis is not just one disease but many, many different beliefs and assumptions swirl around it. Let's go through some common misconceptions about the condition, starting with:
Arthritis is NOT Caused by Cold and Wet Weather
You've probably heard someone say it before: they could tell it was going to rain because their arthritis had kicked up. Or that their joints hurt more in the winter than in the summer. So, is it true? Is joint pain affected by the weather?
Because all pain is controlled by the brain (not the joint), and because the brain’s job is to keep us safe by learning and predicting what’s dangerous, it will start to pair all kinds of things together through our lived experience. This is called “predictive coding.” The brain will pair pain with food, drinks, people, situations, movement, shoes, and, of course, weather. The truth is that while heat can help soothe sore and aching joints, and a sunny, warm environment makes us all feel better than a gray, cold one, the climate neither causes nor fixes arthritis (4).
If you struggle with osteoarthritis pain, in particular, that is due to severe structural damage and other changes in the joint, you will likely continue to feel this no matter the type of weather outside. Pain due to severe structural joint damage won’t come and go. However, pain that comes and goes due to predictive coding is not due to structural damage in the joint.
Arthritis is NOT an Old Person's Disease
While many of us picture an older person with knobby fingers when we think of arthritis, the fact is that this condition impacts all of us during our lives. While the elderly are more likely to have arthritic change due to their joints’ "wear and tear" over many years (5), young and middle-aged adults, and even children will have arthritis of varying degrees.
In the U.S., around 300,000 kids and teenagers have juvenile arthritis (6). While some juvenile arthritis can result in pain, it doesn’t always and doesn’t have to. Many young people have “growing pains” due to their tissues changing and other life stressors. This can create swelling in joints too; however, it’s benign and tends to resolve itself. This is different from structural arthritis pain. That said, many young people start to show normal joint changes in their teens.
Arthritis is an equal opportunist in regards to gender. While men are more apt to struggle with ankylosing spondylitis and gout, women are more frequently diagnosed with fibromyalgia, lupus, and rheumatoid arthritis. Psoriatic arthritis (7), meanwhile, seems to affect both sexes equally.
Arthritis is NOT Easily Diagnosed by X-Rays, Ultrasounds, and MRIs
In many cases, your doctor should be able to see your arthritis using an X-ray, ultrasound, or MRI (magnetic resonance imaging). X-rays can typically show the narrowing of the joint space, bone spurs, and low bone density, while ultrasounds can indicate inflammation, uric acid crystal deposits, and the erosion of joints from gout. MRIs, with their 3-D capability, can display soft tissue tears and bone marrow edema (fluid build-up).
However, many studies have concluded that there is no correlation between these types of images and the pain patients feel. One recent study that looked at people who had osteoarthritis in their shoulders, for instance, found the same frequency of abnormal MRI results whether the patient was experiencing pain or not (8). In other words, people who showed signs of arthritis in their X-ray or MRI results weren't necessarily feeling any pain from it. Similarly, another study concluded that X-rays weren't an accurate predictor of knee pain in patients even when their results showed signs of knee osteoarthritis (9).
Sometimes X-ray, ultrasound, and MRI results indicate someone has arthritis when they don’t feel any arthritic-related pain at all. This is because most arthritis is a normal part of aging and doesn’t need any intervention aside from making a habit of eating a healthy diet, exercising regularly, and sleeping well.
Arthritis is NOT 100% Hereditary
The jury is still out on whether or not arthritis is hereditary. The answer often depends on the type of arthritis. When it comes to osteoarthritis, a family history of the same type of arthritis is a known risk factor (10) that may increase one's chance of getting the disease. However, studies have been unable to pinpoint a single gene for osteoarthritis (11). Also, people who grew up with a parent or relative who had a lot of arthritis pain may be more likely to have pain themselves simply due to the fear and belief that they may end up like their parent or relative. So, while the pain may be inherited, it may have nothing to do with the health of the joint. Rheumatoid arthritis may also have a genetic component because specific genes have been identified that may increase the likelihood that someone gets this type of arthritis (12). But numerous other factors increase one's risk of getting the disease. These can include being overweight, a smoker, older, female, and someone who has never given birth before (13).
Genetics may play a part in other types of arthritis as well, but only in conjunction with many other factors. In many cases, it's assumed that a family history indicates whether or not you'll get arthritis, but environmental and other variables are contributing factors as well. Remember that pain is subjective, depends on context, and is strongly tied to our beliefs and psychology, including thoughts, feelings, and behaviors.
Most importantly, arthritis does not have to hurt!
While arthritis can become severe to the point where some need injections, braces, physical therapy, and arthroscopic or joint replacement surgery, it’s important to separate how the joint looks from a person’s pain experience. Surgery, including joint replacement, is a great option with exceptional outcomes. Many who have joint replacement surgery have a better quality of life afterward. Many wish they’d done it years earlier. We know the body is amazing at healing itself and medical interventions can be life-changing when needed. But knowing whether your pain is being caused by your joint health arthritis is of utmost importance. This process is simple and painless, and Lin can help.
A Final Word From Lin
While no one enjoys having painful and stiff joints, it may be a relief to know you aren't alone. Many other people - of all different ages, races, and genders - deal with the same symptoms regularly just like you do.
With so many different types of arthritis, it's important to familiarize yourself with the kind you have so you can learn about it and take steps to understand what's causing the pain you feel. Challenging the generalizations and assumptions you come across will ultimately benefit you and help you to free yourself from the pain.