Last year I told an acquaintance that at the age of 46, I had taken up running. The reply was, “Oh, that’s awfully hard on your knees.” At first I was taken aback. Yes, I knew if I didn’t stretch, warm-up or wear properly fitted shoes, I might experience pain or an injury. But the person telling me this was overweight, had borderline high blood pressure, and never worked out. I wondered if this friend realized by living a sedentary lifestyle, the odds of developing heart disease, osteoporosis, diabetes and some cancers had substantially increased. Not to mention that being overweight actually placed this person at a higher risk than me for developing knee pain from osteoarthritis and heel pain as a result of plantar fasciitis.

I’m no spring chicken and sometimes my running resembles a dawdling old hen. But I do know it’s necessary to take precautions at any age to guard against injury when participating in physical activity such as running. Because the truth is, sometimes pain happens. When it does, you can either use pain as an excuse or you can use it as a diagnostic tool to help improve and go forward with your performance.

There are three classifications of pain. In simple terms, these can be described as the following:

Nociceptive Pain: felt after an injury to body tissues such as cuts, sprains, broken bones, bruising, surgery, and sometimes cancer. Most pain is of this type.

Neuropathic Pain: resulting from an injury to nerves, the spinal cord or the brain, examples being Phantom Limb Pain and shingles ? which affects nerve tissue.

Psychogenic Pain: is related to a psychological disorder where the type, intensity or proportion of pain experienced is greater than the injury. Some chronic ailments may be related to this type of pain.

Pain can also be defined as acute (an immediate response to an injury) or chronic (a pain lasting more than six weeks). The majority of injuries from physical activity fall into the category of acute nociceptive pain. Although some overuse injuries such as Plantar Fasciitis or Runner’s Knee can become chronic if not properly treated or allowed enough time to heal. Most injuries to body tissues are minor and can be treated with nonsteroidal antiinflammatory drugs (NSAID), such as ibuprofen, and ice therapy or R.I.C.E. (rest, ice, compression and elevation) to decrease pain.

Cuts, bruises, strains, sprains, swelling and inflammation can generally be treated in this way. Severe acute injuries, such as fractured bones and ruptured tendons, should always be treated by a medical professional, as is the case with injuries resulting in chronic, neuropathic and psychogenic pain. If you experience minor pain or inflammation during an activity, this is a good time to evaluate what your body is saying and respond in a positive, strengthening manner. Try asking the following questions:

When you ask what arthritis is, professinals will tell you it’s inflammation of one or more joints. But you know it better as pain, swelling, stiffness, deformity, and/or a diminished range of motion of those joints! It’s estimated that over 50 million Americans suffer from osteoarthritis, rheumatoid arthritis and other related conditions.

Osteoarthritis is the most common form of arthritis. Osteo arthritis seems to come with the wear and tear of aging and affects nearly three-quarters of those over 50. The onset of arthritis is marked by morning stiffness, crackling joints, and perhaps some pain. As it progresses it causes discomfort, more pain, and some disability. It also causes an enormous consumption of painkillers and anti-inflammatory drugs that can have undesirable long-term effects.

If left untreated, osteo and rheumatoid arthritis, along with other forms of rheumatoid disease, can become progressively worse… painful crippling can result. This is particularly true of rheumatoid arthritis, which can destroy joints, unless effective treatment is administered in time.

Modern medicine doesn’t have much to offer for these chronic conditions… offering only symptomatic temporary relief. True, painkillers along with the so-called NSAIDs, non steroidal anti-inflammatory drugs, are effective in reducing symptoms quickly. However,these often cause serious side effects such as ulcers and gastrointestinal bleeding, and they don’t stop the progression of the disease. In the long run they have actually proven to worsen the condition by accelerating joint destruction.

Coping with the chronic pain of arthritis can be frustrating. You get the feeling you’re all alone facing the daily challenges caused by your arthritis symptoms. And, the traditional treatments leave a lot to be desired. It doesn’t have to be this bad!

The last few years of research on arthritis have brought some hope to this dismal picture. Old herbal remedies such as ginger, nettle, and willow bark, as well as fish oils and the already well-known cartilage constituents glucosamine sulfate and chondroitin sulfate, are about to revolutionize the treatment of arthritis. These substances not only give symptomatic relief, but, actually intervene at the root of the arthritis problem and help the body to rebuild functioning joints.

As they quickly sooth your pain, these powerful creams help repair, restore and regenerate cartilage, tendons, muscle and ligaments. Fast acting, these creams increase mobility and optimal repair of joint structures as they help reinforce the body’s protective linings and lubricating fluids by recovering cell stability and function to stop further damage. Really powerful stuff. You can learn more about this non-traditional arthritis treatment at our website.

RA is a condition that forces half of patients to become disabled from the work force within five to ten years? and reduces life expectancy by as much as 18 years. RA affects about one per cent of the world’s adult population, most commonly women between the ages of 30 and 50.

The good news is that a tremendous amount of progress has been made within the last ten years in identifying patients earlier and treating the disease more aggressively. Patients with RA, if treated appropriately, can lead a relatively normal life. This is in stark contrast to the wheel-chair bound existence common as recently as 20 years ago!

Experts in the field consider early rheumatoid arthritis to be a medical emergency with mortality and morbidity equal to that for diabetes, asthma, heart disease, and other life-threatening conditions.

Rheumatoid arthritis attacks the joints in a symmetric fashion (both sides of the body affected equally) with the most common areas being the hands, wrists, ankles, knees, and feet. In addition to the swelling and pain, patients with RA often have profound fatigue and stiffness.

Rheumatoid arthritis is an autoimmune disease that attacks not only joints, but internal organs such as the blood vessels, lungs, heart, and eyes. Patients with RA are at increased risk for heart attack, stroke, and lymphoma.

Since many other types of arthritis such as gout, lupus, and osteoarthritis can look like RA a careful diagnostic approach is needed.

Laboratory testing has its pitfalls. The rheumatoid factor, a blood test found to be positive in about 80 per cent of individuals with RA, may also be positive in other disease conditions. Couple that with the fact that 20 per cent of patients with RA will be rheumatoid factor negative, then it becomes clear a diagnosis should not hinge on the results of blood tests alone.

Imaging procedures can also be misleading. Conventional x-rays often miss the erosions found with early disease. Newer imaging technologies such as magnetic resonance imaging (MRI) and ultrasound are much more sensitive.

After the diagnosis is made, there is even more hope for a patient today. In the past, non steroidal anti-inflammatory drugs (NSAIDS) used to be considered a cornerstone of therapy. That is no longer true.

Disease-modifying anti-rheumatic drugs (DMARDS) are being used earlier. Among the DMARDS currently being used are methotrexate, leflunomide (Arava), azathioprine (Imuran), sulfasalazine (Azulfidine), cyclosporine, and hydroxychloroquine (Plaquenil). These drugs attack the immune cells responsible for chronic inflammation. While DMARDS alone in combination are effective, they are relatively non-specific. Often, combinations of DMARDS are required.

Biologic Response Modifiers (BRMS) can target the disease more specifically than DMARDS. RA is a disease that is dependent on the signaling that occurs between immune cells. The signaling takes place through the use of special chemical messengers called cytokines. BRMS act at both the cytokine (chemical messenger) as well as the cellular level allowing the disease to be better controlled and in some instances put into remission.

Biologic response modifiers, which include drugs that suppress tumor necrosis factor (TNF), appear to be particularly effective.

Tumor necrosis factor is a protein that is produced by the immune cells. TNF is the major culprit responsible for inflammation-inducing damage. By block the effects of TNF, better control of RA can be achieved.

Three anti-TNF drugs are currently available: etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). Another biologic drug, anakinra (Kineret) blocks interleukin, a different cytokine.

These drugs allow patients to have their disease controlled to such an extent that most are able to enjoy a normal work and leisure existence.

On the horizon are other biologic drugs that work at different points in the immune system- on different cytokines and on different pathways- to allow even greater as well as more specific control of disease. Since rheumatoid arthritis is a disease with many different cytokine and cellular mechanisms responsible for damage, attacking the disease at different points makes sense. In the future it may be possible to identify patients through specific tissue signals (called “biomarkers”). These biomarkers will allow physicians to type patients and give patients the specific therapy that will work best for them. Once that is achieved, the possibility of a cure becomes a reality.

Everything, though, starts with early accurate diagnosis. If damage is allowed to occur the chances for remission drop dramatically!

According to Dr. Nathan Wei, “The hand and wrist are the mirrors of disease.” While the cause of hand pain can be a localized problem, hand pain can also be the presenting sign for other diseases.

The wrist and hand are capable of power and precision. As a result, pain and swelling are often accompanied by weakness of grip in hand disorders. A careful history and a complete physical examination are important. The presence of symptoms elsewhere in the body is important to establish.

Two serious hand problems are:
? Reflex sympathetic dystrophy (RSD). This is caused by a disorder of the sympathetic nervous system. Typically, it is described as a burning pain. The precipitating factor may be trauma Color changes including purplish discoloration of the fingers may occur. The treatment involves a special procedure called stellate ganglion block. Usually performed by an anesthesiologist, this procedure is often very effective.
? Hypertrophic osteoarthropathy. The hand becomes swollen and painful. This picture occasionally occurs in patients with underlying cancers.

Other hand problems that point to other diseases:
? Psoriasis may also cause pitting or lifting up (onycholysis) of the fingernails.
? Abnormal blood vessel patterns near the fingernails may signify auto-immune diseases like lupus.
? Raynaud’s phenomenon… When fingers blanch (turn white) this may be a sign of an underlying autoimmune problem such as systemic lupus erythematosus or scleroderma.
? Bumps, called “nodules” can develop as a result of osteoarthritis, gout, and rheumatoid arthritis.
? Depuytren’s contracture is a problem where the skin in the palm may become thickened and shortened. A cord of tissue develops and causes fingers to bend into the palm. Treatment for this problem may be steroid injection, splinting, and physical therapy. Surgery is often needed. This condition occurs with other medical diseases.
Virtually all types of arthritis can affect the wrist and hand.
Arthritis when untreated or poorly treated will lead to deformity. Tendonitis is another common problem in the wrist and hand. In the wrist, tendonitis usually causes pain and localized swelling. Tendonitis can be confused with arthritis.

Tendonitis in the hand is most common in the palm. This causes locking or triggering of the fingers. Steroid injection and physical therapy are usually effective treatments. Treatment consists of anti-inflammatory medication, steroid injection, splinting, and occasionally physical therapy.

Tips to make your hand pain better…
? Wear splints if you’re going to be doing a lot of repetitive motions
? Use your whole arm instead of just your hand and wrist
? Enlarge the handles on your tools. You can get kitchen utensils and writing implements with enlarges handles. They’re worth it.
? Make sure to take rest breaks.
? Avoid repetitive movements when possible.
? Carry objects with the palms open and flat. This will take the pressure off your wrists and fingers.
A common cause of hand pain is carpal tunnel syndrome
… pinching of the median nerve in the wrist. Carpal tunnel syndrome is a symptom- much like fever… it is not a disease! It is the most common cause of tingling in the hands. Besides tingling, burning pain may also occur. Patients often have discomfort at night that is relieved by hanging the affected hand over the side of the bed or vigorously shaking the hands. The discomfort of carpal tunnel syndrome can also be brought on by holding up the newspaper while reading, or by driving. Causes of carpal tunnel syndrome include arthritis, endocrine problems, pregnancy, trauma, infection, tumors, and overuse. Treatment of carpal tunnel syndrome depends on the severity. Mild to moderate carpal tunnel syndrome is treated with splinting, sometimes steroid injection, and avoidance of overuse. For patients with carpal tunnel syndrome that doesn’t respond to conservative measures or where the carpal tunnel syndrome is severe, surgery is indicated.
Radial nerve damage leads to wrist drop. Radial nerve pressure in the wrist can occur as a result of repetitive motion, tight pressure (handcuffs, watchbands, bracelets), diabetes, and trauma. Ulnar nerve damage and compression in the wrist can cause a “claw hand.” Treatment consists of anti-inflammatory medication, rest, splinting, injection, and sometimes surgery.

Treatment of hand disorders is entirely dependent on making an accurate and specific diagnosis.

Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians.