Joey Wahler (Host): They're often unknown to people. So, we're discussing the hidden causes of joint pain. Our guest is Elyse Blackston. She's a Rheumatology nurse practitioner with Memorial Health System, Ohio.

This is Memorial Health Radio from Memorial Health System, Ohio. Thanks so much for joining us. I am Joey Wahler. Hi there, Elyse. Welcome.

Elyse Blackston: Hi!

Host: So first, not all joint pain is just arthritis, as some may believe, and it can actually be caused by various conditions. So, what are some of those?

Elyse Blackston: We see a wide range of different types of inflammatory arthritises here that can affect people of all ages. Some sorts of inflammatory arthritis even affect children. There are things like juvenile arthritis, which is a form of rheumatoid arthritis and seen in children. There are things like psoriatic arthritis. There are reactive arthritises where people have joint pain because of other health conditions like Crohn's or ulcerative colitis. We also see people who get joint pain related to Lyme's disease or a post-infectious arthritis.

Host: How about the fact that conditions related to joint pain, like you mentioned, inflammatory arthritis, for instance, don't only affect the older population. You mentioned children. How young can this start?

Elyse Blackston: I mean, there are very young children, two, three years old that end up with juvenile arthritis. And then, of course, we see psoriatic arthritis and things like that often can start even in your teenage years.

Host: Now, some of these conditions we're talking about are autoimmune diseases where the body is essentially attacking itself. So for the lay person like yours truly, what does that mean exactly?

Elyse Blackston: Well, that means that your body has kind of an overactive immune system, and it's attacking tissues that are good tissues that you don't want your body to attack. Your body's made to attack foreign invaders in your body, like viruses and bacteria, but sometimes it will recognize your own body as a foreign object. So, we use a lot of different medications to stop that process. And then once you stop that process, joint pain resolves.

Host: Now, this, again, is something that by no means affects only older people, as is the common misconception. It can start even in adolescence, right?

Elyse Blackston: Correct, correct. And we see a lot of people who will just blame it on their activity or they blame it on their weight and things like that. And that's not always the case. If you're having joints that are swelling up and joint pain that's present all the time, it definitely could be something else going on and is worth getting checked out.

Host: Now, when you mention that, I guess part of the problem there sometimes is that people don't realize they have such a condition because often those ailments have minimal symptoms other than that joint pain. It's kind of ironic in a way, right?

Elyse Blackston: Right. I've seen a lot of people come in who have lots of complaints of joint pain and swelling. And you start asking them simple questions, like do you have a lot of diarrhea? And they've had loose bowels their whole life, so they don't think it's anything abnormal for them. And the symptoms from like things like inflammatory bowel, and psoriatic arthritis can present sometimes with joint pain before they've had a diagnosis of psoriasis. They might not have any skin lesions yet. Or like I said, they think the diarrhea is normal for them because they've always been that way, so they don't realize that they have an underlying inflammatory bowel issue like Crohn's or ulcerative colitis.

Host: So, it's interesting because already you've pointed out that joint pain can mean something much more in terms of the underlying, right?

Elyse Blackston: Right.

Host: Plus the fact that this doesn't always affect older people by any means. So, it's also a scenario joint pain in the related conditions where much of the public is unaware of the causes behind this and whether they have it in the first place. And so, that's got to be a challenge for you and yours in trying to nip this in the bud in a timely fashion, right?

Elyse Blackston: It can be. It's a little bit of investigative work for sure, because not everybody with the same condition presents the same way. Some people who have rheumatoid arthritis come in with lots of pain and swelling in their hands. Other people have it in their wrist. Some people with fibromyalgia have no joint swelling at all, but they'll have the joint pain and muscle aching. And then, you have other people with psoriatic arthritis who have more issues with tendonitis or inflammation of their tendons and their tendon swelling or even affecting their eyes, where they get a condition called uveitis where their eye swells and becomes very red and hot, and they have to get steroid eyedrops and things like that to get it to be relieved. And those things can be going on without necessarily joint swelling, but you could still have joint pain with these other symptoms. And it be from things like psoriatic arthritis or even a pretty uncommon one a lot of people haven't heard of is ankylosing spondylitis, which is an inflammatory back condition, and it can kind of mimic psoriatic arthritis without psoriasis present.

Host: Gotcha. Now, you mentioned autoimmune disease earlier. Fevers and rashes are often a sign of that with symptoms that can come and go. They're not necessarily. always there. And again, as you touched on or even seen sometimes in children, so what should people be aware of there with fevers and rashes?

Elyse Blackston: With fevers and rashes, if those are things that are occurring on a regular basis and a lot of times they'll have joint pain too, but not always, and joint swelling sometimes, but those can be things like Stills disease, which is often seen in it's the way a child would present with juvenile arthritis, but in an adult. And then, you also can see things like lupus and Sjogren's syndrome, which can cause a lot of issues with fevers and rashes, sometimes sores in the mouth. So, you get a lot of mixed symptoms in those patients as well.

And another thing I think people don't realize is you can have things like lupus that only affects the skin. You don't always have systemic lupus that's affecting the entire body. It can just affect the skin. So if you're getting odd rashes, Dermatology of course is the best place to start out. But a lot of times, those people end up coming to Rheumatology if it is diagnosed as being just a skin lupus.

Host: And remind us, please again, what is lupus exactly?

Elyse Blackston: Lupus is another autoimmune disease where the body's attacking itself and it can attack many, many parts of the body. Some people get a thing called lupus nephritis where it's attacking the kidneys. You can get a lupus anticoagulation disorder that causes you to have blood clots, first trimester pregnancy losses. And then, of course, you can get it where it affects the skin, but you can also get it where it attacks the entire body.

Host: Fibromyalgia. I want to ask you about that, Elyse. Because I guess there's yet another misconception at times that this is "in a person's head", but nothing could be further from the truth, right? Because this is a real often debilitating condition, isn't it?

Elyse Blackston: Correct. Fibromyalgia is something that we see a lot of. It can be very difficult to treat, but we have a lot of tricks up our sleeves, but it is not technically an autoimmune disorder like a lot of our other problems that we have. But fibromyalgia can be by itself, but you can also have it as a result of other underlying conditions that you have going on that have kind of triggered you to have the fibromyalgia as well.

So with fibromyalgia, you have a lot of muscle and joint pain, fatigue, tenderness to touch. And we kind of make sure we're ruling out other things that could be causing it first because at this time there's not currently any one test that we can say is available to say for sure that's what it is. It's basically you're ruling out other things that could be causing it, kind of going by your assessment on the person. And then, fibromyalgia is a lot of times triggered by some sort of traumatic event. It can be physical or sexual or verbal abuse as an adult or a child. It can also be things like just any type of traumatic event that really bothered you. You know, that's kind of different for everybody. Death of a close loved one, a bad car accident.

And then, another thing that can trigger it is other underlying health problems that are going on that are causing you pain, like an inflammatory arthritis that has went untreated for many years and your body just kind of gets used to having all this pain and gets really tense. So there's a lot of options out there for that. And we see fibromyalgia ranging from adolescents to 70, 80, 90-year-olds.

Host: Very interesting indeed. Couple of other things. Speaking of treatment, self-treating ourselves for these types symptoms you've discussed with an ibuprofen-type med, that may give some pain relief, but how about the fact that their long-term use can cause kidney failure, stomach ulcers? It's really something you don't want to overdo.

Elyse Blackston: Correct. And a lot of people, anyone who's been on blood thinners and things like that also should be avoiding any type of NSAIDs and they can be helpful in relieving your pain. But long-term use, if you're taking that a couple times a day every day. You know, you can end up on dialysis because it can kill your kidneys. You can end up with bleeding ulcers. It can make acid reflux worse. Blood pressure can go up. They can be very dangerous.

So, we do use those medications here in Rheumatology as well. But we do as many things as we can to try to limit the use of the NSAIDs and use other medications to control the pain and help the patient feel better, which in many cases if it is an inflammatory arthritis, NSAIDs and things like that, they might help take the edge off, but they're not going to make the problem go away.

Usually, we have to start with things like anti-inflammatory things like steroids to bring the actual swelling and inflammation down while other medications have time to take effect. And then, in other cases with patients like fibromyalgia, we actually use a lot of a medication called Cymbalta, which is technically a antidepressant, but it does help treat chronic pain. So, that can help lower the NSAID use as well. We actually use Cymbalta with just patients who have severe osteoarthritis and are trying to avoid a lot of NSAID use as well.

Host: So, that was going to be my next question. What are the latest treatments, the right ones for joint pain-related conditions? And it sounds like anti-inflammatories, perhaps steroids, but all obviously under the supervision of a professional, right?

Elyse Blackston: Correct, correct. And for inflammatory conditions like rheumatoid arthritis and Crohn's, we use a lot of medications called DMARDs. One of which Plaquenil was of course on the news there for a long time about it, possibly helping with COVID. So, that's one we use a lot for things like lupus, rheumatoid arthritis, Sjogren's syndrome.

We use things like methotrexate, which is also another DMARD. There's multiple DMARDs we use, but those all have to be monitored very closely with lab work to make sure that they're not causing any problems with like your liver and kidneys as well. Most of the time, people tolerate them very well.

And then, we also use a lot of biologic medications, which are things like Humira and Enbrel, Rinvoq. A lot of these are on TV, Skyrizi, Cosentyx. And they work by helping to lower the immune system so the body's not attacking itself. So, people on those medications are more at risk for infection, so they do have to be monitored closely.

Host: And so, finally, elyse, in summary here, what permanent damage can result from some of these conditions going untreated? To let those joining us know the importance of early prevention and getting this checked out if in fact they think there might be a problem, even though hopefully there might not be.

Elyse Blackston: Right. So, I'm sure a lot of us have seen people in our lives that have hands that have deformities and things where their fingers are kind of turned to the sides. And that can be a result from untreated rheumatoid arthritis. And in some cases, psoriatic arthritis and inflammatory bowel conditions can also cause a lot of joint destruction. And even if you wait too long, what happens is that destruction's permanent. Now, we can stop the condition and get the inflammation and the swelling down, and that helps with the pain. But if there's already a degree of damage to the joint where the joint itself has been eroded and eaten away by the inflammatory arthritis, that part is left. We cannot reverse that. It is then chronic osteoarthritis, which is just damage already done. I kind of explain to people it's kind of like rust on a car. Once it's there, it's not going anywhere. And the only way to fix it is to replace the joint at that point. So then, you're looking at surgery, you're looking at chronic pain from the damage done that won't be relieved by the medications that we can give you.

Host: So hopefully, those joining us do indeed heed those words. Folks, we trust you are now more familiar absolutely with joint pain's hidden causes. Elyse Blackston, valuable information. Keep up the great work, and thanks so much again.

Elyse Blackston: Thank you for having me.

Host: Sure. And for more information or to connect with a provider, please visit mhsystem.org/rheumatology. Please remember to subscribe, rate, and review this podcast and all the other Memorial Health System podcast as well. If you found this one helpful, please do share it on your social media. I am Joey Wahler. And thanks again for being part of Memorial Health Radio from Memorial Health System Ohio.