An EMS Guide to Chronic Pain
Sarcoidosis Directory
Sarcoidosis is an inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands. In people with sarcoidosis, abnormal masses or nodules (called granulomas) consisting of inflamed tissues form in certain organs. These granulomas may alter the structure and function of the affected organ(s). The symptoms of sarcoidosis can vary greatly, depending on which organs are involved. Most patients initially complain of a persistent dry cough, fatigue, and shortness of breath. The exact cause of sarcoidosis is not known. The disease is associated with an abnormal immune response, but what triggers this response is uncertain. There is no cure for sarcoidosis, but the disease may get better on its own over time. Follow the links below to find WebMD's comprehensive coverage about how sarcoidosis is contracted, what it looks like, how to treat it, and much more.
Medical Reference View AllSlideshows & ImagesWebMD's Lungs Anatomy Page provides a detailed image and definition of the lungs. Learn about lung function, problems, location in the body, and more.
Erythema nodosum. Red, tender, subcutaneous nodules on the extensor aspects of the legs between knees and ankles are a common condition of many causes, some clear, some likely, and many obscure. The most important conditions that are heralded or attended by erythema nodosum are such infections as streptococcal upper-respiratory infections, ulcerative colitis, histoplasmosis, coccidioidomycosis, tuberculosis, syphilis, and leprosy. Another condition that is sometimes revealed by investigation of erythema nodosum is sarcoidosis. Drugs, including oral contraceptives, appear to be the cause of particular cases of erythema nodosum. In many cases, however, no clear cause can be found.
Early Signs And Symptoms Of Arthritis
When people hear the term "arthritis," they typically think of osteoarthritis (OA)—likely because it's the most common form of arthritis, affecting 80% of U.S. Adults over the age of 65 . According to Dr. Graham, OA is considered a degenerative disorder caused by trauma or age-related wear and tear on joints over time. "OA is most likely to affect weight-bearing joints, such as the knee, hip, lower spine or big toe, but it can also cause pain and stiffness in the thumb or finger joints."
Osteoarthritis can affect anyone at any age, but it most commonly appears in older adults. This particular type of arthritis affects the cartilaginous portion of the bone (the smooth surface at the end of a bone where it articulates with another bone and forms a joint). The degree of degeneration that occurs at a joint depends on many factors, including lifestyle, weight, medical history and activity level. OA affects people's bodies asymmetrically and usually at specific joints based on a person's lifestyle, profession, sports activities, hobbies and injuries.
Most notably marked by joint pain, inflammation and swelling, OA can have varying presentations and may even be asymptomatic for some people. People often discover they have arthritis incidentally after their health care provider requests medical imaging for another issue. Unfortunately, the effects of this disease can lead to moderate to severe disability, significantly affecting a person's life and often incurring high medical costs.
Early Signs And Symptoms of OsteoarthritisEarly signs and symptoms of OA can vary, but according to Dr. Graham, the earliest signs usually include joint pain or ache, as well as joint tenderness, swelling or stiffness that feels worse in the morning. Untreated pain or stiffness can lead to a limitation in mobility and overall function. While it's estimated that 80% of U.S. Adults ages 65 and older have radiographic evidence of OA somewhere in their bodies, only 60% of those with OA present with symptoms, according to Creighton University researchers Rouhin Sen and John Hurley .
Why Are Arthritis Symptoms Worse At Night?
Many people notice that their arthritis symptoms get worse at night. While doctors do not fully understand why it worsens at night, this likely occurs due to changes in hormone and cytokine levels.
It is common for pain to get worse at night. A 2020 study found that online searches for information about pain management peaked between 11:00 p.M. And 4:00 a.M.
Doctors do not fully understand why arthritis pain often worsens at night, but possible causes involve changes in the levels of hormones and cytokines, which are cell-signaling proteins, in the body. Daytime arthritis medication, which some people take during the morning, may also wear off by the evening.
In this article, we examine why arthritis pain gets worse at night and how it disrupts sleep. We also provide tips on ways to improve sleep.
Researchers have several theories to explain why many people with arthritis experience worse pain at night.
One theory is that the body's circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.
Other processes may also intensify RA pain, including the nighttime release of pro-inflammatory cytokines, an increased number of cells traveling to inflamed tissue, and changes in the body's immune response.
Additionally, the body releases higher levels of melatonin and prolactin at night, both of which can cause an increase in inflammatory cytokines.
A person's arthritis inflammation and pain may worsen if:
Many studies show a link between arthritis and sleep deprivation. People with arthritis may have trouble falling asleep and staying asleep. They may also report lower quality sleep due to the pain that the condition causes.
A 2021 study involving 133 people with arthritis and 76 matched controls found that 54.1% of people with arthritis reported poor sleep quality. The issues included:
A 2018 study reached a similar conclusion. The researchers compared 178 people with arthritis — 120 with RA and 58 with osteoarthritis (OA) — with 51 people with no arthritis. The rate of insomnia was comparable between the OA and control groups, at 32% and 33%, respectively. However, insomnia was significantly more prevalent among the RA group, affecting 71% of these participants.
Both studies also found a link between arthritis and mental health. People with arthritis were more likely to report marital problems and experience depression, suggesting that insomnia may be a reaction not only to arthritis but also to stress.
The link between arthritis pain and sleep goes in both directions. For example, arthritis can make it difficult to sleep, but sleep deprivation can also worsen arthritis pain. A 2018 study found that pain intensified as sleep worsened. In addition, a 2017 study found that people with knee OA who had poor quality sleep were more likely to ruminate on their pain.
As insomnia can make pain worse, it is important that people with arthritis take steps to improve their sleep, as well as treating their pain.
Practice better sleep hygieneTossing and turning at night when unable to sleep may cause a person to notice and fixate on their pain. Good sleep hygiene may help a person fall asleep faster and remain asleep longer. People can try the following:
While they are working on improving their sleep hygiene, a person may find it helpful to get back up if they cannot fall asleep. Doing this helps the association between bed and sleep remain strong.
Develop an arthritis pain management strategyA person can work with a doctor to develop a plan for managing arthritis pain.
Where possible, it is important to avoid going to bed in pain. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:
Identifying and managing arthritis triggers can also be helpful. A person can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.
Consider psychotherapyBeing in pain night after night can affect a person's emotional well-being and cause them to experience more pain. A 2017 study of people with knee OA found that people with sleep issues tend to catastrophize and focus on their pain, intensifying both pain and insomnia.
Therapy can help a person better cope with their pain and deal with daytime stressors that undermine sleep. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based intervention that assists a person with learning new skills for sleeping better.
Nighttime arthritis pain is common. However, having arthritis does not mean that a person has to live with chronic sleep deprivation. The right combination of medications, sleep hygiene practices, and lifestyle adjustments may help a person sleep better and for longer.
People with arthritis should be aware that while pain can make sleep worse, low quality sleep can also intensify pain and increase stress. This can create a vicious cycle that arthritis medication alone may not be sufficient to break.
The best path to complete relief is to treat both insomnia and arthritis. A person can work with their doctor to create a treatment plan that addresses the two conditions.
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