Why does osteoarthritis pain wax and wane?

Factual Questions
1

I’m posting this in GQ, hoping to get responses other than anecdotal.

I have pretty severe arthritis in one hip. It varies from completely asymptomatic, to quite painful - causing a pronounced limp and feeling of instability. What confuses me is that I have been unable to identify any cause(s) for the exacerbations. Looking on-line, it is said that that weather and activity can cause exacerbations, but I have been unable to identify any such correlation. Maybe it could be something like barometric pressure, that I am not readily aware of, as opposed to temperature, precip, etc. Other sites list factors such as stress, but my personal situation has not really changed significantly over the past 4-5 years, and certainly does not change day-to-day correlating to the waxing and waning of symptoms.

It can be asymptomatic (or nearly so) for several days, and then one time that I stand from a chair, or on one particular step while walking the dog, it suddenly becomes painful. I bike and golf pretty regularly. I live in the Chicago area, so over the past 4-5 years I have tried to correlate my symptoms through a wide range of weather.

Given the mechanics of hip osteoarthritis, what exactly gets inflamed such that pain occurs/worsens? I’ve read articles such as this: Peripheral pain mechanisms in osteoarthritis - PMC

but am not sure how to apply it to my personal situation.

2

Have you tracked your diet at all during flare ups? Too much sugar or fat can cause inflammation.

3

Haven’t tracked it, but my diet is pretty constant. In general, we eat a pretty - uh - unadventuresome, pretty low meat diet. Sometimes we go a tad heavy on the ice cream, but that’s about it.

4

Well, it’s something to think about. Maybe the next time it flares, consider what you’d eaten the day before? Also consider your level of hydration that day too.

5

Sleep and rest is important with OA. Track your sleep patterns.

6

Yeah - I guess I could track sleep, diet, and food intake.

-But I RARELY eat out. What we cook at home really doesn’t vary too much week to week. Sure, maybe one day we’ll have burgers, but then it will be several days of rice and beans or lentil soup. Not a lot of crazy rich food.

-I tend to drink a TON of water. So much that I pee terribly frequently.

-I sleep pretty well, and get a good 8-9 hrs just about every night.

Even today, this morning it hurt really bad, so I popped 2 aspirin - which I infrequently do. Then, about 6 hrs later, we were going to walk the dog and it hurt pretty badly. I did not take any meds, and it went away and I walked the dog without difficulty. Now I’m completely symptom-free.

I just sorta feel it is a fool’s errand to try to chart every possible factor or combination of factors that makes it hurt when I get out of my chair at 10:30 am, when it didn’t hurt at 8:30 am or 12:30 pm. - and all I did since 6:30 am was sit in that chair and work (besides eating/drinking, bathroom, dog in/out, etc. Not sitting there motionless like a lump.)

7

Such is the nature of the evil mistress Arthritis.

So sorry you’re suffering.

Sudden onset pain I found the lidocaine patches work well. JFYI

8

If you did want to track that, the NWS website makes it easy to get your local baro oressure hour by hour.

The general anecdotal belief is that falling pressure, rather than absolute pressure high or low, is correlated w increasing arthritic pain.

So not too hard to, whenever you notice sudden onset pain, check the pressure trajectory of the last e.g. 12 hours.

9

Thank you. Solid information I can use. Explains a lot.

10

What I read is that the muscles attached to the joint will pull on the damaged joint bc they are conserving warmth or reacting to the weather in some way, and so you get a painful joint. Also there can be referred pain from that event. IANAMP, so take it with a grain of salt. I do not have a cite for this, either, but I am sure someone will weigh in with better info.

11

It took me years to pinpoint it, but gluten is the variable contributor to pain in my arthritic knees. The list of foods and other things that cause inflammation is long and not consistent between individuals.

12

A long past injury could be flaring up?
Sleep on your side that acts up most nights?
And then there’s gout, I hope not. Seems your diet wouldn’t activate it but a uric acid blood test would rule that out or put it in play.

13

Falling barometric pressure is fairly well correlated to my sinus headaches which is an inflammation thing similar to arthritis. My then wife noticed that I had the worst morning headaches when there was a clear night followed by a gloomy morning.

14

Thank you for this thread! I have wondered the same things. I have had access to 2 medical people who were tasked with treating this issue – one was a PA (Physician’s Assistant) who did not care to commit to anything, even though I said I was fine with educated speculation; the other was my physical therapist who has a doctorate in that discipline. His solutions were all about strengthening the muscles (not always the ones you would think) that support the hip and thigh. He also worked on increasing the space inside the joint. These all helped me (anecdotal). But since I stopped seeing him, I also stopped doing the exercises, and my general level of pain has stabilized somewhat, possibly as I have gotten used to it. I use Tylenol occasionally for pain, the effectiveness of which is variable, and I have a prescription NSAID that I take even more rarely.

I am fortunate to live in San Francisco, where the weather is very mild in all seasons. We do get barometric pressure changes, I’m sure, but I’ve never paid attention to them, so I will be interested to hear if anyone finds a correlation there. Of course, there’s nothing one can do about things like weather, and I find that anticipation can just make the results worse.

15

I’ve had osteoarthritis since my late teens - so close to 50 years.
A long time ago I had the waxing and waning phenomenon but the last 20 or more years have been purely waxing unless I manage to get medications for relief.
Right now I’ve had severe pain for about a month. I have a doctor appointment on November 4th and hope I will get some prednisone for temporary relief.
I’ve been taking upwards of 10/12 ibuprofen daily to keep it down a notch. Not supposed to take it at all because I am on blood thinners but one has to do what can to survive.

16

I have arthritis in one of my finger joints. Yes, just one, the rest are fine. And I don’t know what kind of arthritis, as I’ve never had an diagnosis by a doctor.

I bicycle a lot and I noticed I never get any pain in that finger while cycling. It feels normal, which is totally the opposite of what I expected. I finally figured out that the amount of bending in the joint is critical. If I keep the finger straight for a while (for example, while sleeping), it’s painful and difficult to bend. Keeping it curved and it feels normal. While bicycling, the finger is bent around the handlebar, so that’s why no pain.

I’ve apparently learned subconsciously to keep the finger bent while sleeping, because I rarely have pain anymore. I don’t know if this will help you, but perhaps your position while sleeping might be contributing.

17

Stress is a bigger deal than you’d think, and I learned this when I had to have emergency surgery for a volvulus (twisted gut-- something common in dogs and horses, but rare in humans).

Two days after the surgery, I started experiencing pain in all kinds of places-- every place that had been injured recently, and every place I often had arthritis flare-ups. My left leg, which had been very painful a couple of years earlier due to an infection-- so painful that I was on crutches for several days, became painful again, and the side of my neck, where I’d experienced whip-lash when the ball joint on my car failed, hurt very badly, and even my left shoulder hurt right where it had hurt after my COVID vaccine.

The doctor said the cause was a “cortisol rush.” It was a stress reaction to a particularly invasive surgery, that was also emotionally stressful, as it happened after admission through emergency-- I had surgery on a Saturday morning when, Friday afternoon, I’d had no idea that would be my weekend.

Most people experience short cortisol rushes when they get up in the morning, or when they experience the fight/flight response, but I was having an extreme and prolonged one.

The reason certain places hurt was that both extended pain experiences, as well as extreme ones, left neural “pathways” so pain communicated with the brain more easily. Neural pathways from old injuries that had resolved a long time ago, were brief, or just not very bad, had dissipated. I’m not sure if these are literal chains of neurons, or just the word the doctor used to explain the process to me.

Part of the reason it started when it did was that after a day, I had voluntarily gone off the fentanyl drip with the button I could control (narcotics give me migraines after a few days), and was just on Tylenol for the surgical pain, which was not all that bad, ironically. The doctor put me on Percocet, or Vicodin, or something for a day, and that made things a lot better, and after another day, the cortisol-induced pains were mostly gone, and I was back on just Tylenol.

This was several years ago, and the entire hospital stay was six days.

I’ve got arthritis in both knees, in my neck (probably partly due to the whip-lash), and in an ankle that was broken once. I rarely get pain Tylenol doesn’t work on, but sometimes I do. I also have pain sometimes in the foot of the leg that was infected.

I know that when stress, either physical or mental is coming, there’s probably going to be extra pain. I have prescriptions for gabapentin and tramadol, and I know to carry some with me on those days.

You could ask your doctor about this.