If you're having joint pain, tell your family doctor. Early treatment can help prevent or reduce lifelong disability.
Shweta Akhouri, MD, is an assistant professor in the Department of Family and Geriatric Medicine at the University of Louisville School of Medicine in Kentucky. In addition to teaching family medicine residents, she focuses on both inpatient and outpatient medicine. Her areas of interest include women's health, antibiotic stewardship, and geriatric medicine. Dr. Akhouri completed her family medicine residency at the University of Louisville in 2018.
Linda (not her real name) is a 60-year-old woman who came to see me as a new patient. She said that her main health concern was "terrible arthritis" in her knees and ankles. It had slowly gotten worse over time to the point that she often had to use a wheelchair.
There are many kinds of arthritis. When people talk about arthritis, they usually mean osteoarthritis (also called degenerative or "wear and tear" arthritis). It's the most common kind. It causes the cushion layer between your bones (called the cartilage) to wear away over time.
I gave Linda a physical exam and asked more detailed questions about her condition. She described the following symptoms:
- Joint pain in both knees, both ankles, and the fingers in both hands
- Joint stiffness that is worse right after she wakes up but slowly gets better during the day
- Joint swelling with finger deformities in both hands
She also told me that her symptoms didn't improve when she took an over-the-counter (OTC) pain reliever.
I looked at the X-ray images of Linda's knees that she had brought with her to the visit. She had been told that her arthritis was probably caused by aging. But her X-rays only showed mild age-related changes in her knees. These images did not explain the severe symptoms she described. I suspected that she might have a condition called rheumatoid arthritis. I ordered some blood tests and asked Linda to follow up with me in a week.
Rheumatoid arthritis (also called RA) is a kind of arthritis and a type of autoimmune disease. It happens when the body's immune system attacks its own joint tissue. This causes inflammation (swelling) in the lining of the joints. RA is 2 to 3 times more common in women than in men. Symptoms of RA often develop in adults who are in their 60s.
I suspect a diagnosis of RA when a patient has pain in joints on both sides of the body (for example, both hands or both knees). This is different from osteoarthritis. It usually only affects one set of joints. Another difference is that joint stiffness from RA is worse in the morning and slowly improves as the day goes on. Joint pain from osteoarthritis gets worse with activity and better with rest.
When Linda came back to my office for a follow-up visit a week later, I explained her new diagnosis of rheumatoid arthritis. I told her that RA is a lifelong condition. There is no cure for RA. But there are treatment options to relieve symptoms, reduce pain, prevent future damage, and improve quality of life. I scheduled a visit for Linda to see a rheumatologist. A rheumatologist is a doctor who specializes in treating problems with joints and soft tissues.
Because I work in a small town, it's not always easy for my patients to see a subspecialist right away. In Linda's case, the earliest available appointment with the rheumatologist was in 3 months. Linda's care was in my hands until then. Fortunately, as a family doctor, I'm trained in all areas of medicine for children and adults.
I started treatment with prescription medicines right away. It's important to start treatment for RA immediately after diagnosis. This prevents more joint damage and loss of movement. I also recommended lifestyle changes to help ease Linda's symptoms. For example, I suggested some gentle exercises she could try. (Learn more about RA risk factors, symptoms, and treatment options, including medicines and lifestyle changes.)
As Linda's family doctor, I continue to work closely with the rheumatologist to provide the best care for Linda. I also treat any other health problems that she has. Her RA symptoms began to improve shortly after she started treatment. Nine months after her first visit to my office, Linda was able to walk with very little assistance.
Quick Tip
It isn't easy to hear that you have a chronic (long-term) condition like rheumatoid arthritis. You may feel unsure about how managing it will affect your life. If you're having a hard time dealing with a new diagnosis, talk to your family doctor. He or she can answer your questions, provide useful resources, and help you find the support you need.
