Arthritis is a common condition that causes pain and inflammation in the joints. There are over 100 different types of arthritis, and the severity of pain can vary greatly between different forms of the disease. Some types of arthritis are relatively mild, while others can be extremely painful and debilitating. So which types of arthritis tend to be the most painful?
Most Painful Types of Arthritis
Here are some of the arthritis types that are generally considered to be the most painful:
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease where the immune system attacks the joints, causing inflammation and joint damage. Of all the common types of arthritis, rheumatoid arthritis is often ranked as the most painful.
People with rheumatoid arthritis typically experience pain, swelling, and stiffness in multiple joints on both sides of the body. The joints most often affected include the hands, wrists, elbows, shoulders, knees, ankles, and feet. However, any joint can be impacted by RA.
The pain of rheumatoid arthritis is often described as a burning, throbbing, or stabbing sensation. The level of pain can range from mild to severe, and pain levels can fluctuate on a daily basis. During RA flare-ups, the pain intensifies. RA pain is often worse in the morning and after periods of inactivity.
In addition to joint pain, people with rheumatoid arthritis may experience debilitating fatigue, fever, appetite loss, and firm lumps called rheumatoid nodules under the skin. The chronic inflammation caused by RA can eventually lead to bone erosion and joint deformity if the disease remains uncontrolled.
Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis, affecting over 30 million adults in the United States. It occurs when the protective cartilage on the ends of bones gradually wears away over time, causing pain, swelling, and stiffness in the joints.
While osteoarthritis can affect any joint, it most commonly impacts the knees, hips, hands, lower back, and neck. The pain of osteoarthritis tends to worsen with activity and improve with rest. Pain is often described as a dull ache or soreness in the affected joints. However, in severe cases, the pain can become sharp and stabbing.
Many people with advanced osteoarthritis describe the pain as debilitating and intense, especially when getting up from a seated position or during weightbearing activities. Factors like excess weight and joint injuries can accelerate the degeneration of cartilage and increase OA pain.
Psoriatic Arthritis
Psoriatic arthritis is a type of inflammatory arthritis associated with the skin condition psoriasis. With psoriatic arthritis, people experience joint pain, swelling, and stiffness along with psoriasis symptoms like red, scaly skin patches.
Psoriatic arthritis can range from mild to severely disabling. The most common joint symptoms involve the fingers, toes, knees, ankles, and lower back. The pain and inflammation tend to come and go in episodic flares.
In a study published in Rheumatology, 47% of people with psoriatic arthritis reported their pain as moderate to severe. Some describe the pain as burning, stinging sensations in the hands and feet.
Gout
Gout is a form of inflammatory arthritis caused by high levels of uric acid in the blood. This condition leads to the development of urate crystals that deposit in the joints and soft tissues, triggering intense joint inflammation and pain.
The big toe joint is the most common site of gout pain due to its cooler temperature compared to other areas of the body. Gout causes the joint to become severely inflamed, red, and exquisitely tender to touch.
Gout attacks often strike suddenly, flaring up overnight with throbbing, pulsing toe pain levels reaching as high as a 10 on a scale of 1 to 10. Even the slightest touch or pressure on the affected joint can feel agonizing.
Septic Arthritis
Septic arthritis, also called infectious arthritis, is joint inflammation caused by bacteria, viruses, or fungi entering the joint space. It develops rapidly and causes severe arthritis joint pain.
Any joint can be affected by septic arthritis, but the knee is the most common site. Symptoms include intense, escalating joint pain along with swelling, redness, warmth, and an inability to use the joint.
Septic arthritis requires urgent medical treatment with antibiotics to fight the infection before it destroys the joint cartilage. Prompt treatment is key because septic arthritis joint damage can occur quickly, sometimes in a matter of days.
Assessing Arthritis Joint Pain
The level of arthritis pain someone experiences can be influenced by multiple factors, including:
- The specific type of arthritis present
- The joint(s) affected
- The severity of inflammation
- Amount of joint damage accumulated
- Pain threshold and coping mechanisms
- Effectiveness of treatment
Doctors often assess and measure arthritis pain using a variety of scales and questionnaires. Some examples include:
Numeric Rating Scale (NRS)
The NRS asks patients to rate their arthritis pain on a scale of 0 to 10, with 0 representing no pain and 10 representing worst possible pain. The higher the rating, the greater the pain severity.
Wong-Baker FACES Pain Rating Scale
This scale uses illustrations of facial expressions representing different pain levels. Patients select the face that best matches how they feel. The facial expressions range from smiling (no hurt) to crying (hurts worst).
Australian/Canadian Osteoarthritis Hand Index (AUSCAN)
The AUSCAN is a survey that assesses hand pain and physical function in osteoarthritis. It uses a scale system to measure the degree of hand pain, stiffness, and difficulty gripping and performing daily tasks.
Health Assessment Questionnaire (HAQ)
The HAQ measures a patient’s level of functional ability and includes questions about activities of daily living and arthritis symptoms like pain and fatigue. Functional ability scores range from 0 (no disability) to 3 (completely disabled).
By using validated arthritis pain scales, doctors can better evaluate a patient’s symptoms, monitor their progression over time, and assess how well treatments are working.
Treatment Options for Arthritis Pain Relief
While there is currently no cure for most forms of arthritis, a range of treatment options exist to help manage pain and other symptoms. Common medications and therapies used to treat arthritis pain include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex) can help relieve mild to moderate arthritis pain. They work by reducing inflammation.
Analgesics
Pain relievers like acetaminophen (Tylenol) and opioids (codeine, morphine, oxycodone) may be used for severe arthritis pain. These help alleviate pain but have no effect on inflammation.
Corticosteroids
Steroid medications like prednisone work potently to reduce arthritis inflammation and pain. They can be taken orally or injected directly into arthritic joints.
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs like methotrexate, hydroxychloroquine, and sulfasalazine slow the progression of inflammatory forms of arthritis. They help minimize joint damage that can worsen pain.
Biologic agents
Biologics like adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) target overactive immune system activity responsible for inflammation. They can significantly improve arthritis pain.
Joint injections
Corticosteroid joint injections can provide rapid relief for swollen, inflamed joints by reducing inflammation. Hyaluronic acid injections may also help replace lost joint fluid and improve painful osteoarthritis.
Physical therapy
Gentle exercises, stretching, hot/cold therapy, electrostimulation, and massage provided by physical therapists can strengthen muscles, improve joint mobility, and decrease arthritis pain.
Surgery
For severe, debilitating joint damage that hasn’t responded to other treatments, surgical procedures like joint replacement, tendon repair, and joint fusion may help alleviate intractable arthritis pain.
Doctors work with patients to tailor the right pain relief plan based on the type of arthritis present, the joints involved, symptom severity, treatment tolerance/safety, and level of pain reduction needed to improve daily function.
Conclusion
Rheumatoid arthritis, osteoarthritis, psoriatic arthritis, gout, and septic arthritis are generally considered to be the most painful types of arthritis. Rheumatoid arthritis in particular tends to produce high levels of joint inflammation and destruction that result in significant pain. Determining the arthritis diagnosis and using validated pain scales allows doctors to better evaluate a patient’s pain levels and target appropriate therapies. While arthritis cannot be cured, the variety of available treatment options can often successfully manage pain and other symptoms to improve quality of life.