Not only are there many different types of arthritis but arthritis can arise in all areas of the body. There are over 100 different forms of arthritis and arthritis related diseases. The most common are osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA). We have discussed these before, so now we are going to discuss other types of arthritis and connected diseases, such as fibromyalgia, gout and lupus.
Fibromyalgia is considered a central pain syndrome, meaning that the brain and spinal cord process pain signals differently. Fibromyalgia is a specific kind of chronic, widespread pain, that is often accompanied by tenderness. A touch or movement that doesn’t cause pain in the average person may feel painful to someone that suffers from fibromyalgia (this is called allodynia). Something that is mildly painful to the average person may be very painful to someone with fibromyalgia (this is called hyperalgesia). Fibromyalgia is characterized as widespread pain, and it may come and go or be constant.
Other than pain, fibromyalgia is associated with fatigue, sleep problems, inability to concentrate and mood swings. Fibromyalgia can be made worse by stress and physical activity.
Symptoms of fibromyalgia may include deep muscle pain and soreness, morning stiffness in the joints, radiating pain and sensitivity to touch. This condition can affect both men and women. It is estimated that 5 million people in the U.S. have fibromyalgia and that 1 million of those are men.
Gout is a form of inflammatory arthritis, but it does not cause widespread inflammation like RA or PsA. With gout, uric acid crystals are the problem. When your body produces too much uric acid or you cannot remove the excess uric acid fast enough, it can build up in the blood (hyperuricemia). Excess uric acid can form crystals in the joints that can result in extremely painful joint inflammation. Gout usually strikes in the joint of the big toe, but may affect other joints as well.
With a gout flare-up you may go to bed feeling fine and wake up in excruciating pain. Certain foods can set off a gout flare-up; these foods include fish, alcohol, caffeine, fried foods, red meats, soda, shellfish and raisins. Certain vegetables including spinach, cauliflower, asparagus, mushrooms, peas, beans and lentils may also trigger a flare-up. They increase the likelihood of a gout flare-up because they are high in purine content. Keep in mind that vegetable purines can be eliminated from the body much easier than purines from animal products.
Lupus is an autoimmune inflammatory disease in which the immune system mistakenly attacks various parts of the body, including the joints, kidneys, skin, blood, brain and other organs. It occurs when the immune system creates antibodies that attack and destroy healthy tissue. It can cause symptoms such as joint pain, fatigue (that doesn’t subside with rest), light sensitivity, fever (over 100 degrees Fahrenheit), rash or skin sores (which may appear in a butterfly-shaped pattern across the cheeks and nose), nose or mouth sores (usually painless) and kidney problems.
Lupus is a complicated and unpredictable disease, so you never know when the symptoms will appear or how long a flare-up will last. Over time lupus can lead to organ damage. Women of color are two times more likely to develop lupus than any other gender or race.
Back pain can be a symptom from several forms of arthritis and other associated conditions, including ankylosing spondylitis, psoriatic arthritis and fibromyalgia. In most cases however, back pain is the result of some sort of injury, such as lifting or bending incorrectly or from an automobile accident.
Osteoarthritis is another common cause of back pain, and it is known as a degenerative joint disease. It is a condition in which the protective cartilage that cushions the tops of the bones degrades, or wears down. This can cause swelling and pain in the joints. It may develop into bone spurs over time. Osteoarthritis of the spine may cause stiffness or pain in the neck or back, but it may also cause weakness or numbness in the legs or arms if it is severe enough to impinge the spinal nerves or spinal cord itself. In most cases lying down can help relieve the pain. Everyone reacts differently to back pain; for some people it is debilitating while others can live their lives normally.
Osteoarthritis is most common in older people because with age the cartilage wears down naturally. Usually if it occurs in someone younger it is due to injury. In people younger than 45, osteoarthritis is more common in men but after age 45 it is more common in women. Osteoarthritis is more prevalent in people who are overweight, due to the extra pressure on their joints; it also occurs more frequently in those who have jobs that put repetitive stress on the joints.
Other Musculoskeletal Pain
Soft-tissue rheumatic conditions can also cause pain. With these conditions muscles and connective tissues such as tendons, ligaments, or bursae become inflamed and painful. Two of these conditions are bursitis and tendinitis which are known as soft tissue rheumatic syndromes.
A syndrome is a group of signs and symptoms that occur together and indicate a particular problem. This type of syndrome produces pain, swelling, or inflammation in the tissues and structures around the joint. Since the structures affected by soft tissue rheumatic syndromes are near the joints, it can often be mistaken for arthritis. The difference between arthritis versus bursitis and tendinitis is the source of inflammation. Arthritis is inflammation in the joint itself, whereas bursitis, tendinitis and other soft tissue rheumatic syndromes involve inflammation in the tissues and structures around a joint.
Soft tissue rheumatic syndromes may affect the areas around the joints of the shoulders, elbows, wrists, fingers, hips, back, knees, ankles, and feet. Pain is the main symptom. Because the structures affected are located near the joint, moving the joint can become extremely painful and difficult. Some conditions may cause redness, warmth, or swelling in the affected area. Specific symptoms and causes can depend on what area is affected. In most cases these conditions occur suddenly, may last days, weeks, or longer and then just go away. They may reoccur in the same place or show up in other areas of the body. Often these syndromes go away in their own time.
Anyone can develop a soft tissue rheumatic syndrome because the causes are so common. They often appear in people who are otherwise healthy. Bursitis, tendinitis and other soft tissue rheumatic syndromes typically result from one or more of the following: play or work activities that may overuse or cause injury to the joint, incorrect posture, stress on the soft tissue from an abnormal or poorly positioned joint or bone (such as difference in leg length or arthritis in a joint), other diseases or conditions, (rheumatoid arthritis, gout, psoriasis, thyroid disease, or an unusual drug reaction), or an infection.
Types of Bursitis
Bursitis is inflammation or irritation of a bursa, the small sac located between a bone and muscle, skin, or tendon. The bursa allows smooth gliding between these structures. There are specific types of bursitis depending on where in the body the syndrome occurs.
The subacromial bursa lies just above the rotator cuff. Bursitis often develops due to injury, impingement, or overuse of the shoulder, or calcium deposits. Symptoms include pain in the upper shoulder, or upper third of the arm, and severe pain with movement.
The trochanteric bursa is located over the prominent bone on the side of the hip. Women and middle-aged to older people are more often affected by this form of bursitis. It may occur spontaneously without any specific injury. It may also be caused by an abnormality in your gait due to arthritis or pain in your hip, knee, ankle, foot or back. Symptoms include pain that gradually spreads over the side of the hip and may sometimes travel down the thigh, pain when sleeping on the affected side, rising from a seated position whether in a deep seated chair or car, climbing stairs and occasionally, pain when walking.
The ischial bursa is located below the bone in your buttock called the ischium. Inflammation may occur here as a result of injury or prolonged sitting on a hard surface. Symptoms may include pain when sitting or lying down on the back and pain that travels to the back of the thigh. Ischial bursitis is also known as “weaver’s bottom” or “tailor’s seat.”
Swelling of the small sac at the tip of the elbow is caused by injury, gout, rheumatoid arthritis, infection or prolonged leaning on the elbows. Symptoms of olecranon bursitis may include painful swelling and redness on the tip of the elbow.
The prepatellar bursa is located beneath the skin and in front of the kneecap. It can become inflamed as a result of infection, injury, gout, or repeated irritation from kneeling. Symptoms include swelling in the front of the knee that may be painful. Redness or warmth may occur with infection or gout.
Infrapatellar bursitis is a similar condition that affects the infrapatellar bursa which is located just below the kneecap. Pes Anserinus bursitis is also associated with the knee. This bursa is located just beneath the knee on the inner part of the leg. This is often irritated in people who run, have “knock-knees” or in people who are overweight. Symptoms can include pain on the inner knee, pain while sleeping on the affected side if the knees are touching, pain when climbing stairs, and pain that travels to the inside and back of the thigh.
These are just some of the most common types of arthritis, including fibromyalgia, lupus, gout and some of the different types of bursitis. We will continue to discuss some other types of bursitis and tendinitis in another post! Stay tuned!
About the Authors
William Goolsbee has spent his career in Life Sciences including leading roles in drug development in immunology and genetic medicine. Recent senior positions include Chairman of the Board at Sarepta Therapeutics and Founder and CEO at Metrodora Therapeutics.
Dr. Gil Price
Gil Price M.D. is the Chief Medical Officer at the Propharma Group, where he provides medical supervision for all clinical trials. He previously served as the Chief Executive Officer of Drug Safety Solutions, where he oversaw safety monitoring for drugs in clinical development. Dr. Price also served as the Director of Clinical Development at Medimmune Oncology and Director of Medical Affairs at Glaxo.