Arthritis is so common that most of us either know someone with it or we have it ourselves. Maybe you remember your grandmother talking about how stiff and uncomfortable her hands felt before it rained. Perhaps you've felt your own joint pain after sitting for a long time or being overly active.
What you may not know is that arthritic changes start when you’re in your twenties and continually progress. More importantly, arthritis isn’t always connected to pain! People with little arthritis can feel a lot of pain while some with severe arthritis experience no pain at all. Take your lower back, for instance, one of the most common spots for chronic pain. Although arthritis in the lower back worsens as we age, complaints about lower back pain actually decrease after age 60. Given worsening arthritis, you’d think every senior would be crying out with back pain.
So what causes arthritis and the joint pain we almost all experience? Is it in our genes? Does the weather affect it? Is it something only older people get?
Many questions, assumptions, and myths surround arthritis, and researchers and doctors are constantly learning more about it. In fact, some of what we thought was true might not be.
So let’s talk about what we think we know about arthritis and challenge some of the common misconceptions out there. After all, in order to reduce arthritis symptoms or overcome joint pain, we need to know as much as we can.
Let's dig into the facts about arthritis.
A Quick Overview
Arthritis doesn't discriminate: nearly a quarter of all American adults (over 58 million people) struggle with joint pain, and it is a leading cause of disability in the U.S. People of all ages, nationalities, and genders can and do get it. And while it’s a normal part of aging, children and teens can have arthritis too. Arthritis has been described as having “wrinkles on the inside,” and if you think about how wrinkles, gray hair, and other normal signs of aging don’t hurt, you can change the way you think about arthritis.
There are over 100 types of arthritis, broadly classified as degenerative, infectious, inflammatory, and metabolic. The most common types are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is an autoimmune disease that causes a person's immune system to attack their joints, leading to changes in the tissues including cartilage (the sliding surface that covers the bone), and the bone itself. In the most common type of arthritis, osteoarthritis, similar changes occur. Cartilage breaks down, thins, and can get rough, which leads to less protection for the bones.
Because we hear friends, family, and doctors talk about arthritis a lot, most of us assume it always means constant or consistent pain and stiffness. While arthritis can indeed hurt, the correlation between arthritis and pain is actually quite weak. For those who do experience pain, they can also have symptoms including joint swelling, redness, and a decreased range of movement, as well as bone spurs (bone that forms around joints). Some of these symptoms are actually a result of moving less or being scared to move, which leads to de-conditioning (when your body adapts to less physical exertion).
Regardless of type or severity, for some people, arthritis presents only mild or moderate symptoms, while others experience severe and/or chronic pain. Your pain experience depends on more than just the state of your joints. Expectations of pain, anxious or depressed feelings, stress, and even things we hear, see, do—and don’t do—all have an impact. In other words, an arthritis diagnosis doesn’t necessarily mean severe pain; how arthritis affects us is context-dependent. In fact, new research indicates that our psychology and social realities are actually more predictive of pain than what’s happening in the joint.
Tackling Some Misconceptions
Since “arthritis” is a blanket name for several diseases, we believe and assume many different things about it, including some common misconceptions.
Arthritis is NOT Caused by Cold or Wet Weather
If your grandma didn’t say it, you've probably still heard someone say that they could tell it was going to rain because their arthritis had flared up. Or that their joints hurt more in the winter than summer.
Because all pain is controlled by the brain, not our joints, and because the brain’s job is to keep us safe by learning and predicting danger, it starts to pair all kinds of things together throughout our lives. This is called “predictive coding.” Our brains pair pain with food, drinks, people, situations, movement, shoes, and, of course, weather. So while heat can help soothe sore and aching joints, and a sunny, warm environment makes us all feel better than gray, cold ones, the climate neither causes nor fixes arthritis.
If you struggle with osteoarthritis pain, in particular, your pain is caused by structural damage and other changes in the joint, and you’ll likely feel it no matter the weather. Pain from severe structural joint damage doesn’t come and go. Only pain due to predictive coding and not structural joint damage comes and goes.
Arthritis is NOT an Old Person's Disease
While we may 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, young and middle-aged adults—and even children— can have arthritis of varying degrees.
In the U.S., around 300,000 kids and teenagers have juvenile arthritis. While some juvenile arthritis causes pain, it doesn’t always and it doesn’t have to. Many young people have “growing pains” due to changes to their tissues and other life stressors. Growing pains can create joint swelling too, but this swelling is benign and tends to resolve itself. It’s also common for teens to begin developing normal joint changes.
Arthritis is an equal opportunist in regards to gender. Men are more likely to struggle with ankylosing spondylitis and gout while women are more frequently diagnosed with fibromyalgia, lupus, and rheumatoid arthritis. Psoriatic arthritis, 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 arthritis using an X-ray, ultrasound, or MRI (magnetic resonance imaging). X-rays show the narrowing of the joint space, bone spurs, and low bone density, while ultrasounds show inflammation, uric acid crystal deposits, and the erosion of joints from gout. MRIs, with their 3-D capability, show any soft tissue tears and bone marrow edema (fluid build-up).
Studies show, however, that there’s no correlation between these types of images and the pain patients feel. Sometimes X-rays, ultrasounds, and MRIs indicate someone has arthritis when they don’t feel any arthritis-related pain at all. This is because most arthritis is normal with age and doesn’t need any intervention aside from making a habit of eating a healthy diet, exercising regularly, and sleeping well.
One recent study that looked at people who had osteoarthritis in their shoulders found the same frequency of abnormal MRI results whether the patient was experiencing pain or not. In other words, people with 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.
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 that can increase one's chance of developing the disease. But studies have been unable to pinpoint a single gene for osteoarthritis. Also, people who grew up with a parent or relative who experienced 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 their joint health.
Specific genes have been identified as possibly increasing the likelihood that someone develops rheumatoid arthritis. But numerous other factors increasethe chances, including being overweight, a smoker, older, female, and someone who’s never given birth.
Genetics may play a part in other types of arthritis as well, but only when many other factors are at play. So even if a parent suffered from bad arthritis pain, don’t assume you will too. Sure, family history often indicates whether you'll get arthritis, but your environment and other variables are contributing factors as well. Remember: pain is subjective, depends on context, and is strongly tied to our perceptions and psychology, including thoughts, feelings, and behaviors.
Most importantly, arthritis does NOT have to hurt!
While some arthritis pain can become severe enough to require injections, braces, physical therapy, or even surgery, most arthritis doesn’t come to that. It’s important to differentiate a joint’s deterioration from pain. Surgery, including joint replacement, is a great option with exceptional outcomes for people with serious joint damage due to arthritis. Many people who have joint replacement surgery have a better quality of life afterward and say they 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 coming from arthritis or not is important in knowing how to treat it to feel “back to normal”. Lin can help you figure that out, and help you live with less pain overall.
Lin Can Lead You to a Better Outcome
No one enjoys having painful, stiff joints, but you’re not alone in your experience. People of all ages, races, and genders around the world deal with the same symptoms you do.
With so many types of arthritis, it's important to know what kind you have so you can learn about it, understand what's causing your pain, and take steps toward healing. Challenging the generalizations and assumptions you encounter will remind you that arthritis pain isn’t set in stone, and can ultimately help free your from the pain.