Over the years, a lot of people have come to see me about an aching knee, back, shoulder or other joint. The first thing I do with each patient is try to determine whether their arthritis is degenerative (less serious) or inflammatory (more serious).
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I start by asking three questions:
1. Does your pain get better or worse as the day goes on?
If your pain gets worse throughout the day, that suggests degenerative or mechanical (wear-and-tear) arthritis. If your pain gets better, that suggests an inflammatory arthritis.
Osteoarthritis and mechanical low back pain are degenerative forms of arthritis. Inflammatory forms of arthritis include:
2. Do you ever get stiff, and if so, for how long?
I always ask about stiffness, especially in the morning. Ten, 15 or 20 minutes of morning stiffness don’t bother me so much because they likely are caused by degenerative arthritis. But if you tell me, “Doc, it takes me 30 to 45 minutes to sort of get unglued,” that suggests an inflammatory arthritis.
Because we see stiffness in both types of arthritis, I may ask you about the “gelling” phenomenon. I’ll say, “If I give you a one-way, all-expenses-paid limo trip to Detroit for an Indians game, how will you feel after your ride?”
If not moving much for a few hours would make you feel stiff for a few minutes, I’d think mechanical arthritis. But if it takes you half an hour to feel right again, I’d think inflammatory arthritis.
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3. Are joints painful on one or both sides of your body?
If your arthritis is symmetrical — involving both shoulders, wrists or elbows, for example — I’d be more concerned about an inflammatory arthritis like RA.
But if you tell me, “Everything is fine, doc, except for my right knee,” or “My left shoulder is killing me,” I’d be less concerned because they suggest degenerative arthritis.
However, arthritis can develop on a spectrum. Sometimes one knee is the problem and then, a few weeks later, both knees become problems.
I will also ask about your family history. For certain people with arthritis, genetics can play a role. I’ll ask you about medications, too. Statins and other medications can cause aches and pains.
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The next steps: Exam and X-rays
A physical exam is critical. We can feel and see certain things that we can’t learn just by talking to you. For example, osteoarthritis may develop at the site of an old injury. Obesity may also cause joint degeneration.
Plain X-rays (not MRI scans) can be vital. They can tell us which joints are affected by either inflammatory or degenerative arthritis.
When lab tests are useful
People are often surprised to learn that positive lab results don’t always mean you do have arthritis, and negative lab results don’t always mean you don’t have arthritis.
Take the ANA (antinuclear antibody) screening test for RA. If we did blood work on every man, woman and child at a Browns game in the old Cleveland Municipal Stadium, nearly 5,000 of the 80,000 fans would have a positive ANA. But they’d be absolutely, completely normal.
That’s why, in rheumatology, we use lab tests to confirm — rather than make — a diagnosis.
How to start the process
Joint pain and stiffness, together with loss of range of motion, can mean early arthritis. If you’ve experienced sustained joint pain for two to four weeks, it’s a good idea to see your primary care physician.
Your doctor can decide if — and when — you need to see a rheumatologist like me.