Back Clinic Arthropathies Chiropractic and Physical Therapy Team. Charcot’s is degeneration of a weight-bearing joint and arthrogryposis which means, “curving of joints.” this is a general term that describes any disease of the joints. A group of disorders can afflict the joints, such as sacroiliitis, which causes inflammation in the sacroiliac joint. Doctors use arthropathy interchangeably with arthritis, which means “joint inflammation.”The forms that are distinct from arthritis are Neuropathic arthropathy, nerve damage from diabetes, or other nerve conditions resulting in slow damage to joints.
In diabetic people, arthropathy usually affects the foot and ankle. Hypertrophic pulmonary osteoarthropathy is where the bone ends of the ankles, knees, wrists, and elbows start to grow abnormally and painfully. Fingertips start to become rounded, called “clubbing.” This form of arthropathy usually happens to people with lung cancer. And Hemarthrosis is when blood leaks into a joint like the knee. This occurs after injuries or medical procedures and is a problem in people with hemophilia.
Can individuals managing facet arthropathy treat the condition with over-the-counter pain relievers, prescription muscle relaxers, exercise, and chiropractic spinal manipulation?
Facet Arthropathy
Facet arthropathy, or facet osteoarthritis, is arthritis that affects the facet joints in the spine. It causes pain and stiffness due to cartilage degeneration within these joints, often resulting from wear and tear associated with aging. Essentially, it occurs when the small joints in the back of the spine become arthritic and rub against each other painfully.
It affects the bony protrusions, called facet joints, that connect the spine’s bones.
Symptoms include neck and back pain that can worsen with standing, bending, or twisting.
Facet arthropathy is diagnosed using X-rays and other imaging studies.
Severe cases may require surgery.
Facet Joints
Twenty-four vertebrae form the spine, with two facet joints between each. Facet joints are small joints located at the back of each vertebra in the spine. They allow movement and stability, help maintain the alignment of the spinal bones/vertebrae, and limit excessive motion. The joints and the cushioning intervertebral disc form a three-joint complex between each vertebra.
The three-joint complex allows the spine to move, including bending, rotating, and extending.
Synovial fluid lubricates the joints so they can move.
The intervertebral disc provides flexibility and dissipates compressive loads.
The facet joints stabilize the spine by constraining rotation and bending.
Symptoms
Arthropathy refers to any disease affecting a joint, including arthritis. Osteoarthritis, also known as arthrosis, is a specific type of arthropathy. It is a non-inflammatory, degenerative arthritis. Pain is the main symptom that is typically worse in the morning when awakening, and in the evening, the pain can also get worse when twisting or bending backward. The symptoms can vary based on the part of the affected spine. Low back pain is the most common, a condition referred to as lumbar facet arthropathy because it affects the lumbar spine of the lower back. (Perolat R. et al., 2018) Common Symptoms include:
Muscle spasms or cramps.
Pain that may come in periodic flare-ups
Pain that worsens with standing or inactivity.
Dull pain on both sides of the spine.
Aching pain on both sides of the spine.
Pain in the lower back, buttocks, shoulders, or back of the skull
Radiating pain to the buttocks and legs.
Pain that improves with sitting, leaning forward, or changing positions.
Pins-and-needles sensations in the hands or feet.
Clicking sounds when moving the spine.
Catching sensations when moving the spine.
Muscle weakness.
Causes
Facet arthropathy causes progressive damage to the spine. Spinal osteoarthritis, aka spondylosis, is the most common cause, but it can also occur with a severe form of spinal arthritis known as ankylosing spondylitis. It is primarily due to age-related wear and tear, but injuries or repetitive stress on the spine can also cause it. Arthritis in the facet joints can develop due to:
Aging-related wear and tear
Disc problems
A previous back injury
Torn ligaments
Spinal fractures
Deterioration of facet joints can also cause bony overgrowths called osteophytes or bone spurs, which can cause radiating pain and restrict the spine’s range of motion.
Degeneration
The facet joints and intervertebral discs degenerate due to age-related wear and tear.
The cartilage in the facet joints can dry out, crack, and wear down.
The joint capsule and synovial membrane can inflame or tear, affecting synovial fluid production.
The loss of cartilage can lead to hypermobility, and the joint can stiffen over time.
Diagnosis
Imaging studies are important to the diagnosis. Several types confirm the diagnosis and also characterize the nature and severity of the condition:
X-rays provide a plain, black-and-white image of the spinal column.
CT scan composites multiple X-rays to create a three-dimensional image of the spinal column.
MRI uses magnetic and radio waves to generate images of soft tissues like ligaments and cartilage.
To confirm the diagnosis, a diagnostic block, which is a small amount of local anesthetic, is injected into a facet joint. The needle placement is directed either with an ultrasound or a CT scan. Facet arthroplasty is confirmed if the injection provides immediate relief (American Academy of Orthopaedic Surgeons, 2022). The healthcare provider will want to exclude other possible causes as part of the differential diagnosis. Conditions that mimic facet arthropathy include:
Herniated disc
Psoriatic arthritis
Reactive arthritis
Spinal gout
Spinal compression fracture
Treatment
The treatment varies depending on the location and severity of the condition. Generally, conservative treatments are used before more invasive procedures are considered.
Lifestyle Changes
Initially, a healthcare provider may recommend rest and avoiding aggravating movements, including any activity that involves bending or twisting.
Activities that take the weight off the facet joint, such as sitting, leaning forward, or changing positions, may help ease the pain.
Patients may also be advised to adjust their sleep positions to take the pressure off facet joints.
Options included curling up on your side or lying on your back with the knees supported with pillows.
Medications
If a diagnostic block is used, a patient may not need medications immediately. However, as the anesthetic starts to wear off, the patient may be prescribed over-the-counter or prescription pain relievers based on the severity of the pain. These can include:
Analgesics like Tylenol
Nonsteroidal anti-inflammatory drugs like Advil or Aleve
Muscle relaxants like Lloresal for acute back pain
Antidepressants like Cymbalta for chronic back pain
Physical Therapy
Physical therapy is a major part of the treatment of lower back pain. The treatment plan will include personalized exercises to strengthen the core muscles and avoid stress on the spine. Examples include:
Knee-to-chest stretches, hugging your knees for 30 to 60 seconds.
Walking 10 to 20 minutes per day.
Aquatic therapy to alleviate pressure on the spine.
Surgery
If conservative measures don’t work or provide sufficient relief, a healthcare provider may recommend specialist procedures or surgeries that include:
Lumbar intra-articular injections deliver an anesthetic or corticosteroid into the spine for longer-lasting pain relief.
Sinuvertebral nerve ablation destroys spinal nerves with a strong electrical current.
Extracorporeal shockwave therapy ESWT delivers low- or high-energy electrical pulses to help ease pain.
Spinal fusion surgery involves fusing two or more vertebrae to eliminate movement and pain in the facet joints.
Facet rhizotomy is a surgical procedure used to sever one of the nerves supplying the facet joint.
Stem cell regeneration is an experimental procedure in which stem cells are harvested and injected into damaged joints to restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Facet Syndrome Pain Treatment
References
Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. doi.org/10.1007/s13244-018-0638-x
Can individuals with arthritis incorporate various natural remedies to reduce joint pain in their extremities and restore mobility?
Introduction
Regarding the body, joints allow the upper and lower extremities to be mobile. This allows the host to move, bend, flex, and rotate without feelings of pain and discomfort. However, as many people age, so do the body and joints, as wear and tear can cause limited movement and stiffen the body. When this happens, it can lead to inflammatory effects and joint disorders. When the joints develop limited mobility and have overlapping risk profiles, it can come in the form of arthritis. When it comes to arthritis can come into two forms: osteo and rheumatoid, and both forms can cause two different inflammatory effects on the joints, causing pain and discomfort to the individual. Luckily, there are natural ways to manage the overlapping pain profiles caused by arthritis. In today’s article, we will look at the difference between the two forms of arthritis and how various natural remedies can help reduce pain-like symptoms caused by arthritis. We associate with certified medical providers who inform our patients of how arthritis can affect the joints and cause pain-like symptoms to their extremities. While asking important questions to our associated medical providers, we advise patients to incorporate various natural remedies to reduce pain-like symptoms related to arthritis and restore joint health. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.
Osteoarthritis Vs. Rheumatoid Arthritis
How often do you experience pain in your upper and lower extremities in the cold and feel better with the heat? Do you experience your fingers locking up constantly, making it difficult to grasp objects? Or do you notice swelling or redness in your joints, causing a decreased range of motion? When it comes to the joints dealing with these pain-like issues, it could be due to inflammation, causing the surrounding muscles, tissues, and tendons to become swollen. When it is not being treated, it can lead to the development of arthritis. Arthritis can come in two forms: osteoarthritis and rheumatoid arthritis. These two forms can affect the joints differently, confusing many individuals. Rheumatoid arthritis is a common autoimmune joint disease that causes hyperplasia of the joint tissue and synovial inflammation, which causes cortical bone loss and marginal bone erosion. (Liu et al., 2021) Osteoarthritis can develop when the cartilage between the bones wears down, and it causes the pain associated with inflammation that sensitizes the joint capsule. (Knights et al., 2023) At the same time, osteoarthritis is a well-known degenerative joint disease that is the main cause of disability in a person’s daily living. It has a multifactorial etiology affecting the joint structures. (Yunus et al., 2020) When dealing with either of these forms of arthritis, many people have found natural remedies to help manage the symptoms and reduce the pain.
Unlock The Secrets of Inflammation- Video
Natural Remedies For Arthritis
When it comes to reducing pain-like symptoms that are caused by arthritis and managing their associated symptoms, many people start to make small changes in their daily routine. Many people start changing their eating habits by incorporating anti-inflammatory and antioxidant foods to reduce inflammatory cytokines and help reduce the progression of arthritis. (Gioia et al., 2020) At the same time, changing dietary habits are a small part of creating healthy habits. Therapeutic exercises and braces for the joints can also help reduce the pain and progression of arthritis. (Siddiq et al., 2024) When people commit to a healthy diet full of antioxidants and anti-inflammatory properties and exercise, it can help reduce not only arthritis but also the co-morbidities associated with arthritis, like chronic musculoskeletal pain. (Sakamoto et al., 2023)
Turmeric & Magnesium
Another natural remedy that many people can incorporate to reduce arthritis affecting their joints is taking turmeric and magnesium supplements. Turmeric is part of the curcumin plant, a powerful antioxidant that can help reduce pain affecting the joints by decreasing the inflammatory status of arthritis. (Calderon-Perez et al., 2021) This is because turmeric and curcumin are natural oxygen scavengers and active nitrogen providers that effectively treat pain from arthritic joints. (Zeng et al., 2021) At the same time, magnesium supplements can help relieve pain and arthritic joints by achieving a holistic analgesic effect on the individual. (Zhu et al., 2024) By incorporating these supplements as part of a holistic treatment plan for individuals with arthritis in their joints, they can manage their symptoms and reduce pain.
References
Calderon-Perez, L., Llaurado, E., Companys, J., Pla-Paga, L., Boque, N., Puiggros, F., Valls, R. M., Pedret, A., Llabres, J. M., Arola, L., & Sola, R. (2021). Acute Effects of Turmeric Extracts on Knee Joint Pain: A Pilot, Randomized Controlled Trial. J Med Food, 24(4), 436-440. doi.org/10.1089/jmf.2020.0074
Gioia, C., Lucchino, B., Tarsitano, M. G., Iannuccelli, C., & Di Franco, M. (2020). Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients, 12(5). doi.org/10.3390/nu12051456
Knights, A. J., Redding, S. J., & Maerz, T. (2023). Inflammation in osteoarthritis: the latest progress and ongoing challenges. Curr Opin Rheumatol, 35(2), 128-134. doi.org/10.1097/BOR.0000000000000923
Liu, Y. Q., Liu, Y., Chen, Z. Y., Li, H., & Xiao, T. (2021). Rheumatoid arthritis and osteoporosis: a bi-directional Mendelian randomization study. Aging (Albany NY), 13(10), 14109-14130. doi.org/10.18632/aging.203029
Sakamoto, J., Miyahara, S., Motokawa, S., Takahashi, A., Sasaki, R., Honda, Y., & Okita, M. (2023). Regular walking exercise prior to knee osteoarthritis reduces joint pain in an animal model. PLOS ONE, 18(8), e0289765. doi.org/10.1371/journal.pone.0289765
Siddiq, M. A. B., Oo, W. M., & Hunter, D. J. (2024). New therapeutic strategies in osteoarthritis. Joint Bone Spine, 91(6), 105739. doi.org/10.1016/j.jbspin.2024.105739
Yunus, M. H. M., Nordin, A., & Kamal, H. (2020). Pathophysiological Perspective of Osteoarthritis. Medicina (Kaunas, Lithuania), 56(11). doi.org/10.3390/medicina56110614
Zeng, L., Yu, G., Hao, W., Yang, K., & Chen, H. (2021). The efficacy and safety of Curcuma longa extract and curcumin supplements on osteoarthritis: a systematic review and meta-analysis. Biosci Rep, 41(6). doi.org/10.1042/BSR20210817
Zhu, Y., Shen, S., Cui, L., Wu, L., & Zhang, B. (2024). Magnesium sulphate and sodium bicarbonate as additives for periarticular local infiltration analgesia improve pain management after unicompartmental knee arthroplasty: a prospective, double-blind, randomized controlled trial. J Orthop Surg Res, 19(1), 764. doi.org/10.1186/s13018-024-05233-6
Getting a good night’s sleep can be difficult for individuals suffering from arthritis. Can finding a mattress that fits an individual’s needs help relieve aches and pains and provide restful sleep?
Mattress For Arthritis
Quality sleep can be difficult for those managing arthritis. Joint pain, stiffness, and tenderness can make falling and staying asleep feel impossible. A mattress for arthritis should be firm, provide comfortable support, and relieve joint pressure. (Sleep Foundation, 2024)
How Mattresses Affect Arthritis?
Not adequate support or cushioning can exacerbate arthritis pain and stiffness.
Individuals not sleeping well at night can experience significant physical and mental fatigue, increase the risk of injury, and perceive a higher level of pain.
Zoned mattresses provide targeted pressure relief to areas of arthritis pain, like the neck and lower back.
Mattresses that don’t support the body are more likely to disrupt sleep and exacerbate nighttime and daytime pain symptoms.
The body needs time to recover and repair during sleep, so the right mattress for arthritis will allow sound rest throughout the night.
A joint-supporting mattress can alleviate pain and stiffness.
What to Look For Mattress Types
Mattresses fall into three basic categories.
Foam or Latex
These mattresses are often recommended for individuals with chronic pain because they conform to the body and alleviate pressure points without being too firm that they aggravate existing injuries or inflammation.
Not all foam is the same; some mattresses are too soft to support someone with arthritis.
Latex is a more reliable material for support and durability, but it’s also more expensive than memory foam.
Innerspring
Innerspring mattresses are often long-lasting and provide firm support.
However, they are not recommended for individuals with arthritis because they can be hard on joints and pressure points.
The innerspring system doesn’t mold or conform to the body, so getting and staying comfortable can be difficult, if not impossible.
They’re not as heat-retaining as foam mattresses so that hot sleepers may prefer them.
Hybrid
A hybrid mattress typically consists of individually wrapped springs topped with one or more layers of memory foam.
Hybrid mattresses are often recommended for arthritis patients because they meet the expert-recommended balance between support and cushioning.
Firmness Levels
Mattress firmness is rated on a scale of 1 to 10, with firmer mattresses scoring higher, often 6 or 7 and above. However, no one firmness rating works for all individuals with arthritis. Finding the right firmness for arthritis symptoms is highly individualized. For some, a super firm sleep surface can aggravate symptoms. In determining what firmness number is needed, consider weight. For example, a person weighing 400 pounds will have a different experience on a soft mattress than a person weighing 150 pounds. Typically, larger bodies need a firmer mattress to avoid sinking too far into the mattress’s core. Petite individuals may be perfectly supported on a mattress rated 5 or 6 for firmness, but taller or heavier individuals should look for a mattress rated seven or eight.
Support and Pressure Relief
Individuals will want to look for a mattress that targets specific areas for relieving aches and pains, such as the shoulders, hips, and lower back. Foam helps relieve pressure points in the body without feeling too soft, which is helpful when managing joint pain. There is debate over whether latex or memory foam is better for relieving sensitive pressure points. A Journal of Chiropractic Medicine study suggests that latex foam may outperform traditional memory foam as it reduces body pressure and evenly distributes weight along pressure points. (Low F. Z. et al., 2017)
Motion Transfer
Motion transfer refers to a mattress’s ability to isolate body movement. It’s helpful to consider how much you and your partner are affected by each other’s movement throughout the night. This may not be necessary for individuals who don’t sleep with a partner. So, if you or a partner disrupt sleep throughout the night, a mattress with better motion absorption is recommended.
Sleep Position Can Affect Arthritis and Joint Pain
Mattress manufacturers often design mattresses to accommodate back, side, or stomach sleepers, as different sleeping positions usually require different types of support. One study suggests that sleeping-related pain can be reduced in those with lower back pain when they choose the right sleeping surface for their preferred sleep position. (Jacobson B. H. et al., 2010) Therefore, purchasing a mattress for the preferred position is important.
Durability
A mattress’s expected lifespan depends on the materials it’s made from. A mattress that immediately loses some of its features and benefits won’t last very long. This is why it is recommended to know how long the trial period is for the mattress and keep track of its performance. Count on at least six to seven years, but latex and hybrid mattresses can last longer.
Trial Period
Considering the trial period on the mattress is important when buying online. Determining if it’s right for your body can take a little while as it takes a while to break in a new mattress, so look for a longer trial period to see and feel if it is the right choice. (Mattress Firm, 2023) Most online mattress retailers offer at least a 100-day trial period, while some offer 365 days to send it back. However long the trial period, looking into the terms and conditions of any return policy is recommended. A company can say you can return it if it doesn’t meet expectations; however, restrictions or exclusions may apply to your purchase.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Low, F. Z., Chua, M. C., Lim, P. Y., & Yeow, C. H. (2017). Effects of Mattress Material on Body Pressure Profiles in Different Sleeping Postures. Journal of Chiropractic Medicine, 16(1), 1–9. doi.org/10.1016/j.jcm.2016.09.002
Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. doi.org/10.1016/j.apergo.2010.05.004
Can understanding what knee tests are used help a healthcare provider diagnose the cause of individuals experiencing knee pain?
Knee Pain Tests
A knee examination is the first step in determining the cause of knee pain. Different knee tests may be performed during the exam to help the healthcare provider find the cause and develop an optimal treatment plan. These tests evaluate knee function and range of motion and look for conditions and injuries such as arthritis, meniscus tears, ACL tears, other ligament injuries, and kneecap issues.
Checking If There is Fluid in the Knee
Many individuals know if their knee is swollen, as they can see or feel the swelling. However, if there is excess fluid in the knee joint, the healthcare provider may compress the joint to feel for excess fluid. Fluid is often visible above the kneecap and can be compressed in this area. Fluid may also be detected in the back of the knee, referred to as a Baker’s cyst if the fluid has collected into a cluster. (Frush T. J., & Noyes F. R. 2015)
Arthritis Tests
Certain characteristic findings can detect knee arthritis:
Crepitus
Crepitus is the sensation when rough cartilage or exposed bone is rubbing when the knee is bent. (Lo G. H. et al., 2018)
The examiner will feel and listen for grinding as the knee is bent back and forth.
Deformity
As knee cartilage wears away, the knees can become progressively knock-kneed or bow-legged.
Limited Motion
If arthritis, bone spurs, and swelling prevent normal mobility, the knee’s range of motion often becomes limited.
Torn Meniscus Tests
Tests used to determine if there is a meniscus tear include:
Joint Line Tenderness
Joint line tenderness is a non-specific test in which the area of the meniscus is felt. It is considered a positive test when there is pain in this area.
McMurray’s test
This test is performed with the patient lying flat. The examiner bends the knee and rotates the shin bone.
This test is performed with the patient squatting.
The test is performed with the leg fully externally rotated or internally rotated, depending on whether the lateral or medial meniscus is being tested.
A click is heard or felt over the area of the tear.
ACL Tear Tests
These knee pain tests are for an anterior cruciate ligament (ACL) tear:
Lachman Test
The Lachman test is one of the most reliable to diagnose an ACL tear.
With the knee slightly bent, the examiner stabilizes the thigh while pulling the shin forward.
The shin shifts too far forward with a torn ACL.
Anterior Drawer Test
This test is performed with the patient lying flat.
The knee is bent 90 degrees, and then the shin is pulled forward to check the stability of the ACL.
Pivot Shift Test
The pivot shift test can be difficult, especially if the patient is experiencing discomfort and cannot relax the knee.
This test places stress on the knee joint and assesses the rotational stability of the ACL.
Other Ligament Injuries
For a suspected injury to other ligaments, including the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), the following tests may be used:
Posterior Drawer Test
The posterior drawer is performed similarly to the anterior drawer test, in which the patient lies flat.
The knee is bent 90 degrees; the shin is pushed backward to check stability and function and detect if the posterior cruciate ligament (PCL) has been injured.
Collateral Ligament Stability
Side-to-side stability of the knee detects problems with the MCL and LCL.
The shin is shifted to each side, with the patient lying flat and the knee slightly bent.
The LCL or MCL damage causes the knee to open up too much, a condition known as varus (LCL) or valgus (MCL) instability. (Ohori T. et al., 2017)
Kneecap Tests
Tests for kneecap issues include:
Patellar Grind
In this test, also called Clarke’s sign, the patient lies on their back with the leg extended.
The examiner pushes the kneecap down to reproduce the knee pain while the patient flexes the thigh muscles.
Damaged cartilage can cause a grinding sensation/crepitus.
Patellar Tenderness
The examiner can slightly lift the kneecap and place direct pressure on parts of the underside.
The examiner looks for regions of sensitivity or pain.
Patellar Apprehension
This test indicates an unstable kneecap.
The examiner places pressure on the kneecap in a certain direction, and the patient may feel like the kneecap is going to pop out.
Injury Medical Chiropractic and Functional Medicine Clinic
Knee pain tests typically check the range of motion, discomfort symptoms, and sounds that could indicate a specific type of knee injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Overcoming an ACL Injury
References
Frush, T. J., & Noyes, F. R. (2015). Baker’s Cyst: Diagnostic and Surgical Considerations. Sports health, 7(4), 359–365. doi.org/10.1177/1941738113520130
Lo, G. H., Strayhorn, M. T., Driban, J. B., Price, L. L., Eaton, C. B., & Mcalindon, T. E. (2018). Subjective Crepitus as a Risk Factor for Incident Symptomatic Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis care & research, 70(1), 53–60. doi.org/10.1002/acr.23246
Gupta, Y., Mahara, D., & Lamichhane, A. (2016). McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?. Ethiopian journal of health sciences, 26(6), 567–572. doi.org/10.4314/ejhs.v26i6.10
Ohori, T., Mae, T., Shino, K., Tachibana, Y., Fujie, H., Yoshikawa, H., & Nakata, K. (2017). Varus-valgus instability in the anterior cruciate ligament-deficient knee: effect of posterior tibial load. Journal of experimental orthopaedics, 4(1), 24. doi.org/10.1186/s40634-017-0087-3
Can individuals dealing with psoriatic arthritis find non-surgical treatments to reduce joint pain and improve skin health?
Introduction
The body is a complex machine with a communal relationship with the joints, organs, bones, muscles, and tissues, each of which has a specific function to ensure the host is alive. The brain is the main control system that gives each body’s systems, organs, muscles and joints a job. When environmental factors or pathogens enter the body, the immune system is the first one to defend the body and eliminate the pathogens to initiate the natural healing process. However, when the immune system is attacking the body constantly, over time, it can lead to autoimmunity and cause overlapping risk profiles in the body. This, in turn, can lead the development of chronic conditions and cause individuals pain and discomfort. In today’s article, we look at an autoimmune disorder known as psoriatic arthritis, its causes and symptoms, and how treatment can help reduce its pain like effects. We discuss with certified medical providers who inform our patients how psoriatic arthritis can affect the joints. While asking informed questions to our associated medical providers, we advise patients to incorporate various non-surgical treatments to reduce psoriatic arthritis symptoms and help manage joint pain that affects a person’s quality of life. Dr. Alex Jimenez, D.C., encompasses this information as an academic service. Disclaimer.
What Is Psoriatic Arthritis?
Do you experience swelling in your joints that causes pain and discomfort when moving? Do you feel your skin itchier and warmer than usual? Or have you noticed that everyday tasks are more difficult now than before? Many of these pain-like scenarios are associated with joint pain associated with an autoimmune or musculoskeletal condition. Since autoimmunity is developed when environmental factors cause the immune system to attack healthy cells, it can envoke pain and discomfort to the body. When a person is dealing with an autoimmune condition, it can impact not only the individual but also the rest of the body’s system. For instance, if a person is dealing with an autoimmune condition, they could be dealing with skin issues that can cause them to develop scaly, itchy, red skin patches known as psoriasis. If they have joint pain combined with psoriasis, it can develop into psoriatic arthritis. (Skornicki et al., 2021) Now psoriatic arthritis is a heterogeneous autoimmune condition with musculoskeletal involvement that can manifest various symptoms including inflammation and arthritis. (Hackett et al., 2022) This in turn causes many individuals to think they are dealing with rheumatoid factors.
Causes & Symptoms
As a multifactorial pathology, psoriatic arthritis causes care often influenced by a complex interplay of immunological, environmental, and genetic factors that cause its development. (Zalesak et al., 2024) When the immune system starts to attack the healthy cells in the body, the inflammatory cytokines can become haywire and attack the “problem,” causing the development of autoimmunity. Within this integration, some of the causes can include predisposing genetic backgrounds with the presence of environmental factors that can activate the innate immune system precipitate the onset of psoriatic arthritis. (Azuaga et al., 2023) Some of the symptoms can many individuals with psoriatic arthritis can include:
Tendon tenderness
Joint pain
Stiffness
Fatigue
Joint swelling
Skin rash
Musculoskeletal pain
However, there are ways to manage psoriatic arthritis, reduce joint pain from affecting a person, and help them manage the symptoms.
Arthritis Explained-Video
Treatments For Psoriatic Arthritis
When it comes to treating psoriatic arthritis, healthcare professionals need to develop therapeutic options to educate the individual and develop a treatment plan that can include conventional therapies and non-pharmacological therapies that are affordable and customized with the individual’s condition. (Ogdie et al., 2020) Since psoriatic arthritis is a complex inflammatory musculoskeletal condition and skin disease, individuals must try to find ways to reduce the inflammatory effects of causing more joint issues. Non-surgical treatments like chiropractic care, physical therapy, and diet changes can help mitigate the burden of psoriatic arthritis by reducing the complications and the socio-economic impact. (McGonagle et al., 2022)
Another way individuals can reduce the inflammatory effects of psoriatic arthritis is by consuming anti-inflammatory foods to dampen the inflammatory cytokines attacking the joints and going to physical therapy sessions like water aerobics to help stabilize the joints and help people be more mindful about their bodies. Since psoriatic arthritis can be managed through non-surgical therapy, low-weight bearing exercise regimes and incorporating anti-inflammatory foods to reduce inflammation can help people minimize psoriatic arthritis symptoms from impacting their health and wellness journey.
References
Azuaga, A. B., Ramirez, J., & Canete, J. D. (2023). Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci, 24(5). doi.org/10.3390/ijms24054901
Hackett, S., Ogdie, A., & Coates, L. C. (2022). Psoriatic arthritis: prospects for the future. Ther Adv Musculoskelet Dis, 14, 1759720X221086710. doi.org/10.1177/1759720X221086710
McGonagle, D. G., Zabotti, A., Watad, A., Bridgewood, C., De Marco, G., Kerschbaumer, A., & Aletaha, D. (2022). Intercepting psoriatic arthritis in patients with psoriasis: buy one get one free? Ann Rheum Dis, 81(1), 7-10. doi.org/10.1136/annrheumdis-2021-221255
Ogdie, A., Coates, L. C., & Gladman, D. D. (2020). Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford), 59(Suppl 1), i37-i46. doi.org/10.1093/rheumatology/kez383
Skornicki, M., Prince, P., Suruki, R., Lee, E., & Louder, A. (2021). Clinical Burden of Concomitant Joint Disease in Psoriasis: A US-Linked Claims and Electronic Health Records Database Analysis. Adv Ther, 38(5), 2458-2471. doi.org/10.1007/s12325-021-01698-7
Zalesak, M., Danisovic, L., & Harsanyi, S. (2024). Psoriasis and Psoriatic Arthritis-Associated Genes, Cytokines, and Human Leukocyte Antigens. Medicina (Kaunas, Lithuania), 60(5). doi.org/10.3390/medicina60050815
Back pain is one of the most common reasons for seeking health care. Individuals dealing with back pain but don’t know the cause may have some inflammatory joint disease or autoimmune condition. Can seeing a rheumatologist help?
Rheumatologist
Depending on what’s causing the back pain, individuals may need to see their primary doctor for a referral. Individuals are recommended to see a rheumatologist if they have back pain that doesn’t come from an injury that doesn’t go away after a few weeks, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. Rheumatologists treat severe or persistent back pain and are experts in autoimmune diseases, including lupus, Sjogren’s syndrome, rheumatoid arthritis, ankylosing spondylitis, axial spondylitis, Psoriatic arthritis, and other forms of inflammatory or autoimmune arthritis.
What Do They Do?
A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:
Inflammatory
Autoimmune
Related to painful joint disease
The doctors diagnose, treat, and manage these conditions long-term. Depending on diagnosis and care needs, they may also lead or be part of a team that includes other healthcare providers.
Symptoms
When muscles ache, pain presents, or joints hurt, and especially if there are signs of inflammation that don’t go away, seeing a healthcare provider is recommended. Symptoms of inflammation include:
Redness
Swelling
Pain
Stiffness
Loss of joint function
Usually, to see a rheumatologist, individuals need a referral from their primary care provider and may be referred when:
There is no evidence of a back injury.
At-home therapies like heat application, prescription medications, or physical therapy are unsuccessful.
There is uncertainty about what’s causing the back pain, but I suspect it’s rheumatological.
Blood tests for inflammatory markers or certain antibodies yield abnormal results.
There is a diagnosis of a rheumatic condition and recommend a specialist to manage it.
There is a family history of a rheumatic or autoimmune condition that may cause back pain.
Some types of arthritis can cause permanent, progressive joint damage.
Conditions
Conditions that can affect the spine and cause back pain and are treated by a rheumatologist include: (Johns Hopkins Medicine, 2024)
Rheumatoid arthritis (RA)
This often starts in smaller joints of the hands and feet and later moves to the neck and/or back.
It can also affect different body organs and have systemic symptoms.
Ankylosing Spondylitis (AS)
Primarily a disease of the spine, it may also impact the shoulders, hips, knees, and ankles.
Systemic symptoms, including fever and fatigue, can manifest.
Axial Spondylitis
This primarily affects the spine, chest, and pelvis.
It may also cause problems with the connective tissue, eyes, bowel, and skin.
Psoriatic Arthritis (PsA)
Pain in the lower back is common, especially in severe cases.
It can affect other joints and cause psoriasis.
Reactive Arthritis
This is a reaction to infection.
It is more common in the limbs, hands, and feet joints but can involve the spine.
Enteropathic Arthritis
This mainly affects the spine but can include other joints.
It is associated with inflammatory bowel disease.
Autoimmune diseases that don’t specifically target the spine but can also cause back pain include:
Lupus
Sjögren’s syndrome
Hashimoto’s thyroiditis
Finding a Doctor
Individuals may be fine with their primary healthcare provider’s choice regarding which rheumatologist to see. However, they may want to research other options to ensure the right rheumatologist is chosen. Things to look at include:
Search online medical directories.
Visit the websites of the doctors being considered to learn more about their training, approach, and specialties.
Check online reviews.
Check on health insurance coverage.
Ask members of the healthcare team, friends, and family for recommendations.
Contact rheumatologists’ offices to see if they are accepting new patients.
Once decided, pass along the information to the primary care doctor so they can make the referral.
Preparing For The Initial Visit
Before seeing a new rheumatologist, take a few minutes to prepare so you can make the most of the appointment. Individuals will want to have:
A list of back-related symptoms, including frequency and severity.
A list of what makes symptoms better or worse.
A copy of recent test results and records from other doctors.
Individuals can ask their provider/s to send their medical information to the rheumatologist’s office in advance.
A list of treatments that have been tried and how well they worked.
A list of all medications, over-the-counter and prescription, supplements, and herbal products taken.
A list of medication allergies.
Complete medical history and family history of potentially related diseases.
A list of any questions regarding conditions, treatment, etc.
If possible, fill out any paperwork for the new office beforehand to save time on the appointment day.
Injury Medical Chiropractic and Functional Medicine Clinic
Talking with a healthcare provider is important. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
For individuals with arthritis, can incorporating acupuncture with other therapies help manage pain and other symptoms?
Acupuncture For Arthritis
Acupuncture has been around for thousands of years and is a form of traditional Chinese medicine that utilizes needles inserted into various parts of the body to relieve pain and inflammation. The practice is based on the concept of life energy that flows throughout the body along pathways called meridians. When the energy flow becomes disrupted, blocked, or injured, pain or illness can present. (Arthritis Foundation. N.D.) Further research is needed to determine how the acupuncture therapeutic mechanisms work and the overall effectiveness. However, there is emerging evidence suggesting that acupuncture can provide symptom relief for individuals with joint pain, especially those with osteoarthritis and rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Benefits
The actual method that reduces the pain and inflammation is still unclear. Theories include that the needles suppress inflammatory responses, improve blood flow, and relax muscles. Although acupuncture cannot cure or reverse arthritis, it may be useful for managing pain and decreasing associated symptoms, especially in combination with other therapies. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Rheumatoid Arthritis
A systematic review of 43 studies, including humans and animals with rheumatoid arthritis, demonstrated varied results. Several studies showed improvement in symptoms and decreased biological markers of rheumatoid arthritis following one to three sessions of acupuncture for four weeks or more. (Sharon L. Kolasinski et al., 2020) Beneficial outcomes following acupuncture treatment for rheumatoid arthritis include:
Reduced pain
Reduced joint stiffness
Improved physical function
The results of the human and animal studies suggested that acupuncture has the potential to down-regulate:
Levels of interleukins
Levels of tumor necrosis factor
Specific cell signaling proteins/cytokines involved in the inflammatory response, which become elevated in autoimmune conditions like rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Most of the study subjects were also receiving other forms of treatment, especially medication. Therefore, it is difficult to conclude how beneficial acupuncture is alone or as a supplemental addition to other medical treatments. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Osteoarthritis
Acupuncture for osteoarthritis of the hand, hip, and knee is recommended, according to the American College of Rheumatology and Arthritis Foundation, meaning that it may be worth trying, although more research is needed to confirm its effectiveness. However, since the risk is relatively minor, acupuncture is generally considered a safe alternative treatment option for managing the symptoms. (Sharon L. Kolasinski et al., 2020)
Chronic Pain
As clinical trials suggest that acupuncture may be effective in providing pain relief, it may be a recommended option for individuals suffering from chronic pain. A recent systematic review of 20,827 patients and 39 trials concluded that acupuncture is effective for the treatment of chronic musculoskeletal pain, headache, and osteoarthritis pain. (Andrew J. Vickers et al., 2018)
Triggering the release of endorphins/hormones that help reduce pain.
Safety
Acupuncture is considered a safe procedure by a licensed and certified professional.
To practice acupuncture in the United States, an acupuncturist needs a minimum of a master’s degree from a program accredited by the American Academy of Acupuncture and Oriental Medicine and a license in the state where they received their acupuncture treatment.
Doctors with an MD or DO degree licensed in the United States to practice medicine can also be licensed by the American Academy of Medical Acupuncture after additional training.
Risks
Risks associated with acupuncture are bleeding and bruising, especially for individuals who have a bleeding disorder like hemophilia or take a blood thinning medication. Individuals are recommended to talk to their healthcare provider to determine if acupuncture is a safe option.
Side Effects
Most individuals do not experience any side effects, although possible reactions can include: (Shifen Xu et al., 2013)
Soreness
Bruising
Scarring
Needle shock: a vasovagal response that presents as feeling faint, clammy hands, chills, and slight nausea.
Acupuncture Session
During the initial treatment, individuals will discuss their medical history and what joints and areas of their bodies are presenting with symptoms.
After a physical exam, the individual will lie on a treatment table.
Individuals may be face up or down depending on what areas of the body the acupuncturist needs to access.
It is recommended to wear loose clothing that can be rolled up or moved out of the way to access different areas easily.
Depending on what areas need to be accessed, individuals may be asked to change into a medical gown.
The acupuncturist will use alcohol swabs to disinfect the area before inserting the needles.
The needles are made of stainless steel and are extremely thin.
Individuals may feel a slight pinch in sensitive areas like the hands and feet, but needle insertion should be comfortable and well-tolerated without significant discomfort.
For electroacupuncture, the acupuncturist will pass a mild electric current through the needles, typically 40 to 80 volts.
The needles stay in place for 20 to 30 minutes.
After the treatment is finished, the acupuncturist will remove the needles and dispose of them.
Frequency
The frequency of acupuncture sessions will vary depending on the severity of the symptoms and whether the visits are approved and reimbursed by the health insurance company.
Cost and Insurance
Costs for acupuncture can vary from $75 to $200 per session.
The first session, which involves an initial assessment and evaluation, usually costs more than follow-up visits.
Whether the health insurance will cover some or all of the costs of acupuncture sessions depends on the individual insurance company and the condition being treated.
Medicare currently covers acupuncture services up to 12 visits within a 90-day period for chronic low back pain only.
Medicare will not cover acupuncture for other conditions. (Medicare.gov. N.D.)
Acupuncture is not a cure for arthritis, but it may be a useful tool to help manage pain and other symptoms. Make sure to consult a healthcare provider if acupuncture is safe to try based on medical history.
Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain, 19(5), 455–474. doi.org/10.1016/j.jpain.2017.11.005
Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B., Shen, X., & Lao, L. (2013). Adverse events of acupuncture: a systematic review of case reports. Evidence-based complementary and alternative medicine : eCAM, 2013, 581203. doi.org/10.1155/2013/581203
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