Martin Weiss, MD
We all have general aches and pains, but when do they escalate from something normal to a reason to seek medical treatment? If you experience pain in your joints, muscles, or bones, the pain is severe, or pain lasts more than three to four days, it needs to be diagnosed and treated by your primary health care provider. This could be arthritis or another form of rheumatic disease that affects millions of people in the United States.
Rheumatic diseases are more than normal aches and pains and include many different disorders that can affect one’s bones, joints, muscles, and connective tissues. Rheumatic disease is an umbrella term that refers to arthritis and several other medical conditions. Types of rheumatic diseases include rheumatoid arthritis, psoriatic arthritis, lupus, gout, and fibromyalgia. These diseases can impact a person’s health and ability to complete daily activities.
Common symptoms of rheumatic diseases include swelling and pain in one or more joints including the wrist, elbow, knee, or one or more of the smaller joints in the hands and feet. The pain may come and go, or hurt all the time, and the joints can be inflamed and look red or feel warm to the touch. Other symptoms include stiffness in the joints lasting for 30 minutes or more when getting up in the morning, or feeling tenderness in the joints. Talk with your primary health care provider if you notice any of these symptoms. If your case is a challenge to diagnose or treat, your provider may refer you to a specialist called a rheumatologist. A rheumatologist is a doctor with special training in how to diagnose and treat rheumatic diseases.
The most common cause of arthritis in the older population is osteoarthritis, also called degenerative arthritis. It can affect any joint and is often attributed to “wear and tear,” but the real cause is unknown. Drugs like Ibuprofen can give symptomatic relief, but long-term use can cause stomach ulcers and other side effects. Steroid injections, especially into the knees, can give relief lasting for up to several months and can be performed by many primary health care providers, or by a rheumatologist. If needed, hip, knee, and shoulder replacements can be performed by an orthopedic surgeon.
The disease most commonly associated with rheumatologists is rheumatoid arthritis – an inflammatory arthritis caused by an underlying autoimmune disease. An autoimmune disease occurs when the body’s immune system starts to attack itself, mistaking healthy tissue as an enemy. In the past, this was a crippling disease which led to severe deformities. In 1954, the Nobel Prize was awarded for the discovery of cortisone, the first drug to help treat the symptoms of rheumatoid arthritis, but the long-term side effects of the drug outweighed the benefits. The introduction of the medication methotrexate in the 1980s showed control of the disease is possible, and with biologic drugs now available including TNF inhibitors and others, rheumatoid arthritis can typically be stopped. Biologic drugs are medications targeting specific parts of the immune system to treat disease.
Lupus is another rheumatic disease, found disproportionately in African American women. This disease may have many different symptoms, including a rash on the cheeks following sun exposure, fatigue, arthritis, hair loss, and brain fog. Lupus can involve any part of the body and can cause kidney failure and seizures if left untreated. There are several medications now available to help treat and control lupus.
Fibromyalgia is a rheumatologic disorder affecting the connective tissues, including the muscles, ligaments, and tendons. It’s a chronic condition that causes widespread muscle pain. Patients may also experience fatigue, poor sleep, headaches, and mood disturbances such as depression and anxiety. Medications such as Lyrica and duloxetine can help, and moderate exercise can be very beneficial.
Medications are typically the standard treatment for rheumatic diseases, and lifestyle changes such as diet and physical activity can help.
While there is ongoing research into the role of diet in rheumatic diseases, the Mediterranean diet is often recommended for its anti-inflammatory properties. This eating plan focuses on incorporating plant foods that contain vitamins, minerals, fiber, and other plant substances called phytonutrients to help decrease inflammation and damage to cells. Here are some highlighted foods included in the plan with benefits and recommendations:
Fruits and Vegetables – Eating a variety of fruits and vegetables is associated with overall health and less inflammation. For example, cherries, and berries in general, contain anthocyanins, and citrus fruits such as oranges and lemons contain carotenoids; both have an anti-inflammatory effect. Research also suggests vegetables like broccoli, spinach, lettuce, kale, and cabbage reduce inflammatory markers in the blood. Aim to include fruits and/or vegetables at each meal and snack.
Beans and Peas – Anti-inflammatory nutrients called polyphenols are found in beans and peas such as kidney, pinto, black, and garbanzo beans as well as black eye, crowder, and field peas. Eat beans and peas several times a week to help reduce inflammation and season with olive oil or broth instead of animal fat.
Nuts and Seeds – These foods contain antioxidants including tocopherols and the mineral magnesium, and both can help reduce inflammation and promote longevity. Aim to consume one handful a day (about 1-1 ½ ounces of nuts or seeds). Great options include unsalted walnuts, pine nuts, pistachios, almonds, pumpkin seeds, and sunflower seeds.
Fish and Seafood – Cold-water fish such as salmon, mackerel, anchovies, sardines, and herring are rich in omega-3s, a type of fat that can help control inflammation. It is recommended that you eat cold-water fish at least twice a week.
Extra Virgin Olive Oil – Extra virgin olive oil is loaded with oleocanthal, a compound with pharmacological actions similar to ibuprofen. Consume one to two tablespoons daily of olive oil in cooking or in salad dressings for its anti-inflammatory properties.
Diet, physical activity as able, and taking medications as prescribed are all important in managing a rheumatic disease. Early diagnosis and treatment can lead to more positive outcomes with less risk of long-term damage to joints and organs. Early treatment can also increase the chance of remission.
Consider requesting a referral to a rheumatologist from your primary health care provider if you have unexplained joint pain and swelling that is not resolved or repeated episodes of joint pain, swelling, fever, skin rash, or fatigue.
