Suspect you could have axial spondyloarthritis or ankylosing spondylitis? Learn more here about symptoms, getting diagnosed, and more.

Chronic back pain is a hallmark of axial spondyloarthritis (axSpA), a degenerative inflammatory disorder that primarily impacts the lower spine. The catch is that back pain has a long list of other possible causes (sitting too much, stress, injuries, etc.), so determining if your back pain is the result of axSpA can be challenging. Most causes of back pain are mechanical (due to an injury or disc issue, say) rather than from inflammation from an overactive immune system, which is the culprit in axial spondyloarthritis.

But while inflammatory back pain has some unique traits and symptoms that can help accelerate being diagnosed with it, many people with back pain don’t know about inflammatory back pain or how it’s different from mechanical back pain and are unfamiliar with axial spondyloarthritis, which makes it hard to discuss this with your doctor as a potential reason for your symptoms.

It’s no wonder that it typically takes six to nine years from the onset of symptoms before a patient gets correctly diagnosed with axSpA, according to the American Journal of Accountable Care. This diagnostic delay is a problem not only because of patients’ pain — which can be very debilitating — but because the disease can continue to progress when it is not properly treated. This can lead to permanent damage and affect long-term function and mobility.

So, how can the health care system get people with axSpA diagnosed and treated sooner? This is a question many have been trying to answer for some time. But a recent study from Toronto-based researchers suggests bringing specially trained physiotherapists into the mix may help.

For the study, which was published in the journal Arthritis Care & Research, researchers analyzed data from a group of 405 adults with chronic lower back pain who underwent a primary and secondary screening for their pain. All patients were first seen by a primary care physician, but those who were younger than 50 and had had back pain for more than three months were also screened by a physiotherapist with advanced rheumatology training.

The physiotherapist screened each patient and determined whether they were no, low, medium, or high risk for axSpA. Those who received a second screening were also assessed by a rheumatologist to make sure that both the physiotherapist and rheumatologist would reach a similar conclusion in terms of likely diagnosis and next steps.

“Patients deemed by the rheumatologist to require further investigations underwent MRI and then received final diagnosis by the rheumatologist,” say study coauthors Laura Passalent, MHSc, and Y. Raja Rampersaud, MD. “The goal going forward would be that only patients who have a moderate or high risk of axSpA would go on to see the rheumatologist in an expedited manner.”

Of the patients who were screened, 15.6 percent received a final diagnosis of axSpA.

Those who were diagnosed with non-radiographic axSpA received the diagnosis within two years of symptom onset, while those who diagnosed with radiographic axSpA received the diagnosis within seven years — two years less than the average diagnosis time with traditional screening approaches.

This study shows that a collaborative screening model might reduce the time to diagnosis by several years.

“The sooner patients with inflammatory back pain can been evaluated by knowledgeable health care providers, the sooner they can receive appropriate treatment interventions,” say the study authors. “This study demonstrates the positive impact of a collaborative shared care approach to patients with symptoms suggestive of inflammatory back pain by expediting the gap between primary and specialty care.”

Not Sure What’s Causing Your Back Pain?

Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.

If you’re vaccinated and eager for a change of scenery after more than a year of staying home during the COVID-19 pandemic, you may be itching to travel outside of your town. Naturally, a road trip is top of mind for many — especially for those who are still hesitant to fly or who want a more local, convenient vacation. That said, “convenient” and “arthritis” often don’t go together. As anyone with joint pain and stiffness knows, there are challenges in taking road trips with arthritis that can hamper the fun or dissuade you from going altogether.

“It’s hard for me,” says Tami M., a CreakyJoints community member. “[Though] my husband is great about making a ‘stretch your legs’ stop every two hours […] It can be lots of fun if you care for yourself along the way.”

Taking care of yourself is especially important considering you may encounter upticks in traffic this year. In a May 2021 survey of more than 1,000 people from tire manufacturing company Bridgestone, more than half of respondents said they will vacation only by car this summer. Four in five said they feel safer in a car than on a plane right now.

The good news is there are plenty of ways to make road trips with arthritis more pleasant that are recommended by rheumatologists and occupational therapists as well as members of the CreakyJoints community.

Here are 12 tips for make a road trip less painful when you have arthritis so you can actually enjoy your vacation.

Bring cushions and pillows

A little extra padding will help you get comfortable and stay aligned in the car, whether you’re the passenger or driver. “You can bring a lumbar cushion and/or neck pillow to support your spine while driving,” says Lisa Zhu, MD, a rheumatologist at Ronald Reagan UCLA Medical Center.

This is also a favorite go-to tip of our members.

“I use a pillow for my neck that wraps around my headrest, a seat cushion and a lumbar cushion — these never leave my car,” says Kristina H.

Take plenty of breaks

You may think it’s best to drive straight to your destination, but taking the extra time to stop is well worth it — and can even make your trip more enjoyable.

“Try to enjoy the journey by planning out stops to stretch for a picnic or wander through some local gardens or attractions to avoid prolonged stiffness from sitting too long,” says Lynn Ludmer, MD, Medical Director of Rheumatology at Mercy Medical Center in Baltimore.

And while you’re taking breaks, consider switching up who is driving and who is serving as the co-pilot. Jo J. uses two-hour playlists to make sure that happens, without having to keep a close eye on the clock. “When the music stops, [you] must get out and move,” they say.

In addition to getting out of the car every few hours, Laura T. recommends using your time in the passenger seat wisely. “Try to do some seated exercises, like shoulder rolls [and] ankle circles.”

If the route is new to you, it’s also a good idea to research it beforehand to get a sense of driving time and good places to rest. “The maps don’t always tell the entire story,” says Dr. Ludmer.

Remember, the idea is to take a break before you need to. “Be proactive about taking breaks and try not to wait until after your pain starts or worsens to take a break,” says Dr. Zhu.

Stretch when you take breaks

Make the most out of your breaks by gently stretching to avoid stiffness and pain. A few physical therapist-recommended stretches include:

• Shoulder Shrugs: Raise your shoulders up to your ears, then shrug back down. Next, bring your shoulder blades together by inching them backward. Do this 10 to 15 times.
• Car Cat/Cow: Put your arms on top of your steering wheel. Arch your back and then curve it forward. Do this 10 to 15 times.
• Calf Stretch: Place your hands against your car and lean forward with one foot about 12 inches in front of the other. Shift your weight into the front foot and keep the back heel against the ground (and both feet pointed forward). Next, slightly bend your back knee to stretch your lower calf and hold for 30 to 60 seconds. Do twice and then switch sides.

Here are more gentle stretches to relieve stiffness from driving with arthritis.

Keep your medication close

The last thing you want to do is dig through the Tetris of suitcases in the trunk when you need your medication — and are in pain.

“Organize your medications in a way that is easily accessible, like in a pill box that is within arm’s reach while you are sitting in the car,” says Dr. Zhu. “Also, bring enough medication to last the duration of your trip and then some, in case your trip takes longer than expected or if medications get spilled.”

Protect yourself from the sun

It’s easy to underestimate the amount of sun exposure you get on the road. But it exists and can lead to a sunburn or even a flare-up, depending on your condition.

“Some people with arthritis, especially those with lupus and similar autoimmune conditions, can get disease flares triggered by UV exposure,” says Dr. Zhu. “If this applies to you, make sure to bring and apply sunscreen, ideally SPF 50 or higher, and/or wear long sleeves and pants throughout your trip.”

Do your research on rental cars

If you’re renting a car, explore your options before picking it up to make sure it can accommodate your needs.

“It should be easy for you to get in and out of and it should be large enough for you to sit inside comfortably and store all of your belongings, plus any assistive devices that you need,” says Dr. Zhu. “Make sure to adjust the mirrors and seat to minimize straining and maintain a good posture.”

Most newer cars have features that make traveling with arthritis easier, but it’s worth checking the technology, too. Older cars may make it more difficult for you to travel with arthritis.

“If you’re heat sensitive, make sure the car has air conditioning,” says Cheryl Crow, OTR/L, an occupational therapist at Arthritis Life and adjunct faculty member of the Lake Washington Institute of Technology’s Occupational Therapy Assistant program. “If manual windows are difficult for you, make sure it has electronic windows. And, depending on your hand function, you might find a button electronic lock easier than a physical key.”

Make your hands more comfortable while driving

“Many [people] with arthritis find that compression gloves can help with pain while using the hands for long periods of time,” says Crow. “Some might also find the models which have gripping material to be helpful.” Read more here about using compressions gloves for arthritis.

You can also find steering wheel covers that make it easier to grip while you drive.

“If you have hand arthritis, you can use a steering wheel cover, which requires less grip strength,” says Dr. Zhu. “There are versions made of rubber, silicone, and sheepskin.”

Bring your usual pain management tools

If you regularly use pain ointments, heating pads, ice packs, braces, splints, canes, or compression socks at home, be sure to bring them on your road trip, too.

Make use of heated seats

One of the most frequently recommended remedies from CreakyJoints community members: heated car seats (or a heating pad if your car doesn’t have heated seats).

“Heated seat pads are a must,” says Autie M.

Casey says, “a heated seat pad that plugs into cigarette lighter was the best $20 I ever spent.”

This makes sense, as heat therapy boosts your blood flow to a given area, helping blood vessels dilate. This draws in more oxygen and nutrients. Heat can be particularly helpful for soothing stiff joints, especially if you have morning stiffness from arthritis.

Stay hydrated and avoid hunger

Drinking enough water or other healthy beverages is good for your joint health overall. It can also help fight fatigue. And since you’ll need to get out regularly to stretch anyway, you shouldn’t worry too much about stopping for bathroom breaks. “Make it as easy to stay hydrated as possible,” says Crow. “Bring extra bottles and choose a water bottle that is lightweight and easy to grasp.”

According to the National Academies of Sciences, Engineering, and Medicine, the adequate intake (AI) of water — which can come from beverages (like water and tea) and food (like fruits and vegetables) — for men ages 19 and older is 3.7 liters (about 16 cups) liters each day, with 3 liters (13 cups) coming from beverages. For women, the AI is 2.7 liters (about 11 cups) of water, with 2.2 liters (9 cups) coming from beverages.

It’s also important to drink the right fluids. Opt for water or tea instead of sugary sodas or energy drinks.

You should also bring health snacks, adds Dr. Zhu, as properly fueling yourself can help keep pain at bay. Consider packing some anti-inflammatory goodies, like a nut-based trail mix, a vegetable sampler, or a few pieces of fruit.

Sit correctly in the car

How you sit can have a big impact on your comfort level over the course of your trip.

“For basic ergonomics, try to ensure a ‘90-90-90’ angle where the angle between your thighs and trunk, trunk and shoulders, and elbows is all 90 degrees,” says Crow. “For head and neck positioning, this can be tricky as many head rests cannot be adjusted safely. However, if possible, try to avoid an excessive ‘head forward’ position.”

When you’re driving, rotate your upper and lower back when you check for blind spots or reverse the car rather than just moving your neck. (Remember not to rely only on blind spot mirrors or radar detection.) Try to park so you don’t need to back up when leaving, if possible.

You also want to think about how you get in and out of the car to avoid pain and injury. When you get into the car, face away from the seat — in other words, sit and then swivel in, per the Cleveland Clinic. When you get out, swivel to face away from the seat first and use the door frame to assist you. This can help you minimize pain and work with a limited range of motion.

Consider disabled parking placards

A disabled or handicap parking placard may allow you to park in more convenient designated areas, and many cities and states also offer free parking to accessibility permit holders.

“If you need a disabled parking placard, talk with your doctor about this well in advance of your trip, since this process usually takes weeks,” says Dr. Zhu.

Check your local DMV website for more information on getting a placard. Read more here about getting a disabled parking permit.

Be a More Proactive Patient with ArthritisPower

Join CreakyJoints’ patient-centered research registry to track your symptoms, disease activity, and medications — and share with your doctor. Join now.

Your hip or shoulder is achy, stiff, or feels inflamed. When you try to move it, the pain intensifies. You’re wondering what’s going on with your body. Well, it could be any number of problems, but arthritis and bursitis are among the most common contenders. Yet many people don’t understand the difference between arthritis and bursitis and, therefore, can’t begin to figure out which condition they may have.

Arthritis and bursitis both cause painful inflammation that can be perceived as coming from a joint, like your hip or shoulder. The key difference comes down to the specific structure within your body that has become inflamed, and you need to sort it out to get the right treatment.

If you’ve only recently started experiencing discomfort, it’s probably okay to start by resting the impacted area and taking over-the-counter pain relievers. If that doesn’t help — or if the pain is severe enough to interfere with everyday activities, including sleep — you’ll want to see a doctor.

For best results, you’ll want to seek out a rheumatologist (a doctor who specializes in disorders of the joints, muscles, bones, and connective tissue), an orthopedist ( doctor who focuses on bone problems), or a physical medicine and rehabilitation (PM&R) physician (aka a physiatrist, who treats all kinds of pain).

You won’t be able to diagnose yourself with arthritis vs. bursitis, but having some background knowledge of the two issues, including their symptoms and how they’re diagnosed and treated, can help you be more prepared to see a doctor.

Arthritis vs. Bursitis

Arthritis and bursitis can cause very similar symptoms, though the root causes are different. “Arth refers to joint and itis means inflammation,” explains rheumatologist Joseph E. Huffstutter, MD, a partner with Arthritis Associates in Hixson, Tennessee. “If you’re talking about pure arthritis, the problem is confined to the joints or one particular joint.”

There are more than 100 types of arthritis, but most fall into one of two main categories.

• Osteoarthritis (OA) is a “wear-and-tear” disorder that occurs when the cartilage that cushions joints wears down over the years.
• Inflammatory arthritis (IA), which includes rheumatoid arthritis (RA) and psoriatic arthritis (PsA), among others, occurs when the body’s immune system mistakenly attacks the joints.

Just as arthritis, by definition, means joint inflammation, bursitis means inflammation of the bursa. Bursa are tiny sacs that are found throughout the body, primarily around joints or tendons. Their job is to help lubricate joints and reduce friction as you move.

“Normally the sacs are empty, but when they become inflamed or irritated they get filled with fluid. When there’s fluid or inflammation, that’s bursitis,” says Dena Barsoum, MD, a physical medicine and rehabilitation physician with the Hospital for Special Surgery in New York City.

Both arthritis and bursitis can cause similar symptoms, which is why it can be difficult to figure out what’s going on without the help of a doctor. The following symptoms around a joint may indicate either arthritis or bursitis:

• Pain
• Swelling
• Redness
• Warmth

In some cases, the area of your body that’s in pain might provide some clues about the cause. Bursitis, for instance, can occur anywhere you have bursa, but large joints like the shoulder and hip, which have a large range of motion, are common spots for bursitis flare-ups.

Inflammatory arthritis like RA can affect these spots, too, but the disease tends to cause pain in several areas at once, so you might have pain in both hips, or in your hip as well as your knee. Another difference: RA tends to be accompanied by some non-joint symptoms, such as unexplained fevers and extreme fatigue. While bursitis can present more like an injury that pops up suddenly and lasts for days or weeks, osteoarthritis tends to come on slowly and never go away.

Risk Factors for Bursitis

Anyone can get bursitis, but certain factors make it more likely. You’re more likely to develop bursitis if you:

• Are over age 40, as risk increases with age
• Participate in sports or activities that repeatedly strain an area of the body where you have bursa, such as your shoulder
• Are a “weekend warrior” when it comes to exercise. Being mostly sedentary and then suddenly overdoing it often leads to bursitis, says Dr. Huffstutter.
• Are overweight, since excess weight puts pressure on bursa, as well as the joints themselves)
• Have arthritis. Because both conditions have to do with the joint (or, in the case of bursa, a structure that lubricates the joint), they often overlap. Several types of arthritis, including RA, OA, and gout, may increase the risk of bursitis.

Most of these risk factors for bursitis also pertain to arthritis. For example, RA is usually diagnosed during middle age, and OA may develop after years of physical activity that causes cartilage to wear down. People who are overweight are also more prone to various types of arthritis, including RA, OA, and gout.

Does Bursitis Cause Arthritis — and Vice Versa?

Bursitis does not cause arthritis. The reverse isn’t true either, though having arthritis does make getting bursitis more likely.

“You commonly see them together. For instance, if a person develops arthritis in their shoulder, they might change the way they use their shoulder, which could lead to bursitis,” says Dr. Huffstutter. “Or people develop arthritis in their knee or hip, which changes their gait” and irritates the bursa in that area.

How Is Bursitis Diagnosed?

If you suspect you have bursitis — or if you have pain near a joint and aren’t sure if it’s arthritis or bursitis — a knowledgeable doctor should be able to find an answer. The most crucial step toward getting the right diagnoses is a thorough physical exam and patient history. “The number-one thing is getting a good history from the patient, including what specific movement bothers them and when it bothers them,” says Dr. Huffstutter.

You doctor will likely start the physical exam by asking you to point out where your body hurts. This simple question can provide a lot of insight when it comes to differentiating between bursitis and arthritis. “A lot of times a patient will say, ‘I have pain in my hip,’ and when I say, ‘Where?’ they’ll point to the outside of the joint,” says Dr. Barsoum. “That’s not arthritis. Arthritis pain comes from inside the joint.”

The doctor will then touch the painful area and ask you to move the joint. If you do have bursitis, your doctor may be able feel fluid in a tender spot. “If it hurts when I’m pressing on the area [where I know there’s bursa], then I’ll suspect bursitis,” says Dr. Barsoum. She often then uses an ultrasound to check for the presence of fluid. In some cases, an MRI might also be used to check for inflamed bursa. (X-rays aren’t used to diagnose bursitis, because they only show bone.)

How Is Bursitis Treated?

Fortunately, treatment for bursitis is relatively easy. Some possible treatment options include:

Anti-inflammatory drugs

Over-the-counter oral or topical non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can often help relieve bursitis pain and inflammation, especially when used in conjunction with comfort measures like applying ice to the painful area and resting it.

Cortisone injections

If your case is bad enough that you’ve made it to the doctor’s office, you’ll likely get an injection of cortisone along with lidocaine (a numbing agent) directly into the affected bursa. This is usually very effective because it quickly reduces pain and swelling.

Physical therapy

“There’s a growing body of evidence that some patients can go without the [cortisone] injection if they participate in physical therapy,” says Dr. Huffstutter. “Others need the exercise in addition to the injection.” Physical therapy aimed at strengthening and stretching the surrounding muscles is key because moving it prevents you from further irritating the bursa. Simply moving the joint more, however, won’t necessarily help. “You can do as much harm as good if you’re not moving correctly,” says Dr. Huffstutter.

Fluid aspiration or surgery

These are rarely necessary for bursitis, says Dr. Barsoum, because most patients benefit sufficiently from cortisone injections and/or physical therapy. Most people only need fluid aspiration or surgery if other treatments have failed.

With proper treatment — usually just rest, anti-inflammatories, and maybe an injection and some physical therapy — most people with bursitis feel better within a few weeks. Still, it’s important not to ignore the problem: If left untreated, the bursa may rupture, become infected, or cause bone or muscle problems.

Once you’ve had bursitis, it’s also wise to take steps to avoid a recurrence. Warming up before exercise, giving your body time to acclimate to new activities, and taking rest breaks can help. You can also use a pad or cushion on a bursitis-prone joint whenever you need to put extra pressure on it (like if you have to kneel on your knee).

Not Sure What’s Causing Your Pain?

Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.

Have you ever struggled to get on and off the toilet seat, become frustrated trying to squeeze a shampoo bottle or grasp a bar of soap, or worried about slipping when getting in and out of the tub or reaching down to dry your body post-shower? You’re not alone. A lot of little and big dangers lurk in the bathroom for people who live with inflammatory or degenerative arthritis. That’s why creating an arthritis-friendly bathroom is an important task.

Each year, roughly 235,000 people visit emergency rooms because of injuries that occur in the bathroom, according to the U.S. Centers for Disease Control and Prevention. More than a third when bathing or showering and more than 14 percent when on the toilet. Some 81 percent of injuries were caused by falls. People with arthritis may be especially prone to balance issues that can increase the risk of falling.

Creating a bathroom that improves your daily function, reduces stress on your body, and decreases your risk of falling can have a big impact “not just on your performance but also on your confidence and independence for years to come,” says Daniel Crowe, ORT/L, CHT, occupational therapist/certified hand specialist at Hospital for Special Surgery in New York City.

From shower benches and stools to slip mats and bath mitts and more, here are some expert-approved modifications and products for creating an arthritis-friendly bathroom to make your life easier, more comfortable, and safer.

Invest in an adjustable shower bench

Arthritis can cause deficits in strength, endurance, and balance, which can make it difficult to get in and out of a shower-tub combo and maintain a standing position while showering, says Crowe.

Transforming your tub into a walk-in shower is the ideal solution, but it may not be affordable for you, says occupational therapist Karen Jacobs,  OT, CPE, FAOT, Clinical Professor of Occupational Therapy at Boston University.

Both Jacobs and Crowe say a great (and less expensive) alternative is a transfer bench. “The transfer bench provides you with support as you bring your legs into the shower from a seated position, eliminating the need to step up and over the tub,” says Crowe, adding that it also provides an area within the shower to wash in a seated position.

Take a seat

If you have difficulty standing for long periods, a shower seat would be a great addition to your bathroom, says Crowe.

CreakyJoints member Jennifer echoes this tip, saying that buying a swivel bathroom stool was a lifesaver. “It helps me sit down because the water pressure hurts my fibromyalgia, small fiber neuropathy, and the inflammation in my spine from [ankylosing spondylitis],” Jennifer W. tweeted. “It allows me to rest as needed, too.”

Get extra grip

Both Jacobs and Crowe recommend installing grab bars by the tub, shower, and/or toilet to suit your specific needs.

“Grab bars provide a stable point at which a person can utilize not just their lower extremities but also their arms,” Crowe says. “Instead of having two points of contact (right foot and left foot on the floor), you now can have three or four depending on the setup with the addition of one or both arms being involved.”

Although you can install grab bars yourself, you may consider seeking the help of a professional to ensure that they are secure and stable. “The last thing you want to do is drill a grab bar into nothing but dry wall only to find out that it is not secure enough when you need it most,” says Crowe.

If you’re bothered by the aesthetics, Jacobs recommends asking about flip-up grab bars that rest against the wall when not in use.

Raise your toilet seat

If you have arthritis in your knees and hips, lowering down or raising from a low toilet seat can put a lot of stress on these load-bearing joints. “The lower the seat, the more the body must work and the more stress is involved to accomplish this task,” says Crowe.

Investing in an elevated toilet seat can provide an extra two to six inches, which will reduce the effort of going up and down. “While it doesn’t seem like much, this extra height can make all the difference,” says Crowe.

Another option: Place a commode over your toilet, which will provide handles on each side to help you get up, adds Jacobs.

Move your toilet paper

Reaching over to the wall to grab toilet paper can require coordination and balance, which can feel like a lot of work when you have arthritis. To eliminate this challenge, Jacobs suggests adding a free-standing toilet paper roll right next to the toilet.

Prevent slips

“[Placing] non-slip mats in the tub, by the toilet, and by the sink is an easy and effective ways to prevent falls in areas that can easily have moisture build-up or spills on the floor resulting in a slip,” says Crowe.

Jacobs recommends purchasing mats that are absorbent, sturdy, and that have adhesive on the back so they don’t curl up on the corners and become a trip hazard. “Don’t just rely on a towel on the floor [as you get out of the shower] as this is a potential hazard,” she adds.

Trade your towel for a robe

Slipping into a lightweight terrycloth bathrobe instead of toweling off after the shower can save your joints in two ways: It will absorb the water, eliminating a slick floor and potential fall, and prevent you from having to bend down to dry off your body, says Jacobs. Just be sure to hang it on an easy-to-reach hook right next to your shower.

Swap squeeze bottles for pumps

Washing your hair and body can be tough with arthritic hands. To make things a little easier, CreakyJoints member @ralifehacks suggest putting pumps on your bottles, noting that it’s “so much easier on the joints than squeezing a bottle.”

Similarly, Jacobs recommends swapping your bar soap for containers with pumps that don’t require force. “Holding a bar of soap can be challenging, and it can fall on the floor, causing a potential fall,” Jacobs says.

Go long (when it comes to handles)

If you have arthritis in the upper extremities (fingers, wrists, elbows, and shoulders), sustained grip, fine motor coordination, and overhead/behind-the-back reaching can be difficult, says Crowe.

Using bath mitts that don’t require grasping and long-handled sponges to reach your back and behind the legs can help eliminate these challenges. Another useful tool: A hand-held shower head, which can make hard-to-reach areas more accessible.

Swap knobs for levers

This simple swap can help eliminate the grasping and turning action that can be aggravating for fingers, thumbs, and wrists, says Crowe. Using knob turners on doors, sinks, and showers can also provide a better grip.

Add rubber grips

Brushing your teeth, drying and styling your hair, cutting your toenails, and shaving your legs can be challenging when you have trouble holding or wrapping your hand around an item. “Gripping and pinching can create forces that may result in symptoms in the joints within the fingers and thumbs,” says Crowe. “Adding grips [to commonly used bathroom tools] can decrease the amount of force needed to grip and manipulate these items and therefore decrease the amount of stress placed on the joints.”

A quick Google search can also help you discover a variety of wide-handled products, including hair brushes and toe nail clippers, that are more arthritis-friendly.

Get help reaching and grabbing

Storing a reacher tool in the bathroom can be helpful if you need to get something under the sink or pick up something from the floor, says Crowe. If you have difficultly pinching toilet paper with your hands and fingers, you can use the same tool to reduce the stress on your joints.

Give yourself some air

Taking a shower that’s too long or too hot can easily be confused with the hot flashes or temperature sensitivities that occur for people with rheumatoid arthritis, says Crowe. Both Jacobs and Crowe recommend putting a small fan in the bathroom or cracking open the door to provide an escape for the hot/air steam.

You can also take time to sit and practice diaphragmatic breathing to cool off and slow yourself down, says Crowe.

The Bottom Line

There’s no one solution for making your bathroom more arthritis-friendly. By understanding your own strengths and weaknesses and working with an occupational therapist, you can find the adaptive equipment and creative solutions that work best for you and your home.

“The key is safety first,” says Jacobs. “Of all the rooms in one’s home, the bathroom is often used most in one day and it may be unpredictable so it’s important to think proactively.”

“Many incidents can be avoided by slowing things down and being aware of your environment and what you’re trying to accomplish,” Crowe says.

Participate in Arthritis Research — From Your Smartphone

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

When you have arthritis, you may struggle with everyday tasks, like getting into and out of cars, lifting gallon-sized jugs of milk, or chopping vegetables. To help make these tasks a little easier — and cut down on the pain, stress, and fatigue that comes with having an inflammatory or degenerative condition — your rheumatologist or primary care physician may suggest seeing an occupational therapist, or OT.

An occupational therapist is a professional who helps people develop, improve, or maintain skills needs for daily activities in their homes, offices, and communities. They will do a thorough assessment of the barriers that make it difficult for you to maintain your normal life, and then work with you to overcome those barriers. They may do this by creating an exercise plan that builds up muscles around damaged joints, prescribing splits to protect fragile joints, showing you how to do tasks in ways that minimize pain, or help you find products that make performing tasks easier.

The ultimate goal of working with an occupational therapist is to “have less pain throughout more of the day,” as Carole Dodge, OT, Supervisor of the Occupational therapy Hand Therapy Program at the University of Michigan, explains. “The payoff is huge.”

Though occupational therapy may seem unnecessary when you’re first diagnosed with arthritis, you may soon realize that your rheumatologist or physician may not be able to provide the detailed advice your need to help you get through all the different parts of your daily routine.

Read more about occupational therapists, including the role they play in your arthritis treatment plan and how to find a good one near you.

What Is an Occupational Therapist?

According to the American Occupational Therapy Association (AOTA), occupational therapists ask, “What matters to you?” and not “What’s the matter with you?”

In other words, OTs try to discern how any physical dysfunction may be getting in the way of achieving what you want in your daily life. In coordination with patients and possibly their families, occupational therapists come up with interventions to ease your way in the world. Then they evaluate how successful the interventions are and modify them if need be.

All U.S. states, Canadian provinces, the District of Columbia, Puerto Rico, and Guam require that OTs be licensed in order to “protect consumers in a state or jurisdiction from unqualified or unscrupulous practitioners,” the AOTA states on its website. The license is obtained by completing a two-year graduate program and a minimum six months of field work. A licensed occupational therapist will often have the letters “OTR/L” after their name.

With further experience and education, occupational therapists can become certified as specialists by the AOTA. Currently, the AOTA only offers certification exams for pediatric OTs. Next year, however, it will offer certification in physical rehabilitation, which emphasizes regaining functioning in daily pursuits after injury, illness, or declining strength.

If your arthritis is specific to your hand, you may also want to consider a hand therapist — 80 percent of whom are occupational therapists, according to Lenore Salomon, OTR/L, a Professor Emerita of OT at Sacred Heart University in Fairfield, Connecticut. To be certified by the American Society of Hand Therapists, practitioners need to pass an exam. That said, any OT can practice hand therapy without that specific certification.

What Does an Occupational Therapist Do?

Occupational therapists work with people of all ages in private practices, hospitals, outpatient clinics, nursing homes, and rehab facilities, according to the AOTA. They may come to your home or workplace, or you may go to their offices.

Occupational therapists are well-versed in ways to improve the daily functioning of adults with any type of arthritis. Strong evidence exists for the beneficial effects of OT on fibromyalgia, rheumatoid arthritis, and hand, wrist, and forearm problems, for example.

During sessions, occupational therapists will:

• Assess your pain levels and look for any muscle and/or joint limitations that may get in the way of your functioning in your daily life.
• Teach you exercises that will help you function better in everyday tasks. For example, if you have arthritis that makes it hard for you to grasp objects, they might help building up the muscles around your thumb.
• Custom-make and fit splints that help protect your joints.
• Recommend assistive equipment, such as jar openers, and teach you how to use them properly.
• Do a comprehensive evaluation of your home and office, and then make recommendations for how to adapt activities in these spaces. “An OT can teach a patient how to dress, shower, clean their home, and do their jobs, all while protecting their joints,” Richmond explains.
• Provide guidance to family members and caregivers on how to help you.
• Treat your pain with heat and ice, and continue to monitor it in each session.

In between sessions, occupational therapists continue to develop plans for patients. “The therapist may also go over logs that patients have been asked to keep to see how much the exercises and adaptations have altered their pain and mobility,” says Scott Trudeau, OTR/L, Productive Aging Practice Manager at AOTA. “The therapist may make further adjustments based on these logs.”

What Is the Difference Between an Occupational Therapist and a Physical Therapist?

Occupational therapy (OT) and physical therapy (PT) have completely different origins. Modern occupational therapy began in the early 1900s as part of a movement to treat people with mental illness more humanely. “Innovative nurses and volunteers saw the need for patients to be more engaged in their recuperation and began introducing purposeful activities such as arts and crafts,” explains Trudeau. The motto was: Doing is healing. As the occupational therapy profession evolved, it expanded into treating all forms of disabilities by helping people perform basic functions like bathing and cooking. Occupational therapy took off during the two world wars to assist wounded soldiers. While the training and equipment have changed over the years, occupational therapy has always emphasized looking at patients holistically, with a special focus on their mental well-being.

Modern physical therapy dates back to the early 1800s when a Swede developed gymnastic exercises to improve athletes’ medical conditions.  By the early 1900s, various forms of equipment replaced the gymnastic training. A polio epidemic in 1916 led to the development of ways to test the strength of muscles and help repair damaged ones through massage. During World War I, the U.S. army created a special medical unit for rehabilitating injured soldiers and started “reconstruction aide” programs to train what were essentially physical therapists, according to an article in the Archives of Medicine and Health Sciences. In later decades, physical therapists became independent of the military and acquired deep technological skills, such as the use of electrical stimulation to restore muscles. Throughout its history, physical therapy has always emphasized improving patients’ ability to move.

Though they sound similar — and may both be recommended for people with arthritis — occupational therapists and physical therapists serve different purposes.

• Occupational therapists work with patients to make everyday tasks easier.
• Physical therapists work to “improve quality of life through prescribed exercise, hands-on care, and patient education,” according to the American Physical Therapy Association. “Physical therapists examine each person and then develop a treatment plan to improve their ability to move, reduce or manage pain, restore function, and prevent disability.”

OTs and PTs tend to work on different issues. A PT probably would not help you learn how to use a doorknob, while an OT probably would not work on a gait problem, says Seattle-based occupational therapist and rheumatoid arthritis patient Cheryl Crow, MOT, OTR/L, an occupational therapist in private practice in Seattle, Washington.

There may be times, however, when you might require both types of specialists. After a joint replacement surgery, for example, Salomon says an OT can help you navigate your home while you’re healing, while a PT can help you regain your muscle strength and flexibility.

Why Should People with Arthritis See an Occupational Therapist?

Arthritis pain, stiffness, and inflammation can really hinder your day-to-day activities. An occupational therapist can help you overcome those obstacles. But there are other areas in which occupational therapy may be helpful for people with arthritis:

Pain relief

OTs may engage in pain-reducing treatments such as wax baths and heated corn husks for painful hands, says Theodore R. Fields, a rheumatologist at Hospital for Special Surgery in New York City.

Joint protection

OTs may suggest assistive devices, such as jar openers, to help protect fragile joints from overuse. They may also work with you to build up muscles to take further stress off the joints, Crow explains.

Fatigue management

“Chronic tiredness is particularly common among people with inflammatory forms of arthritis,” Crow says. OTs may prescribe daily moderate-intensity exercise, such as a 30-minute walk, to improve energy. They might also suggest taking a 10-minute nap each day.

Mental health

“Mental health is always in the forefront with occupational therapy,” Salomon says. “Physical pain and mental distress affect each other — if you are anxious, that can make your pain worse.” Occupational therapists can help improve your mindset with deep breathing exercises; cognitive behavioral therapy to help change your perception of negative events; mindfulness, which research says may reduce inflammation and pain; and acceptance and commitment therapy, a form of psychotherapy that increases patients’ psychological flexibility so that they learn to accept things, such as living with chronic pain. Salomon adds, however, that an occupational therapist is not a substitute for a counselor or clinical psychologist, especially if a patient is experiencing “serious mental distress.”

“The best time to schedule an appointment with an occupational therapist is right after you’ve received a diagnosis of arthritis,” said Salomon. Therapy is useful at any time, of course, but early treatment may slow down damage to your joints. In most states, you need a referral from a nurse practitioner, physician assistant, or doctor, such as a primary care physician or a rheumatologist.

“In general, Medicare and most insurance companies do pay for occupational therapy visits, but they have restrictions on how many sessions you may receive,” notes Dodge.

What Does a Session with an Occupational Therapist Entail?

“How are you today?” That’s how most occupational therapy visits begin, says Tammy Richmond, CEO and founder of the online OT firm Go 2 Care in Los Angeles. And while you might think that the question is merely polite, your answer presents a roadmap as to how your occupational therapy session should take place that day.

“The next step is for the occupational therapist to ask, ‘What bothers you the most? Where is your pain?’” Richmond said.

Your first session with an OT will likely last longer than subsequent ones. The therapist will ask you to walk them through your day, explaining what tasks (such as doing laundry, cooking dinner, or driving) have become difficult for you because of your arthritis. This forms the basis for a highly individualized therapy plan, explains Crow. In a first visit, an OT may measure you for a joint-protecting splint. They may provide muscle-strengthening and stretching exercises to do at home, as well as recommendations for assistive devices to make some activities, like using keys, easier. In addition, the therapist will ask about your state of mental well-being.

In further sessions, the OT will continue to offer ways to modify activities (such as using two hands to lift a gallon of milk instead of one) and will track your progress.

Occupational therapy is often a short-term project, as “the goal is to teach self-management to arthritis patients,” said Dodge. As your situation changes, you may want to continue to check in with an occupational therapist from time to time.

How to Find a Good Occupational Therapist

You can find a good occupational therapist by asking for referrals from your health care provider, contacting your insurer, and going to your state government licensing website. If you live in Canada, the Canadian Association of Occupational Therapists has a search function for therapists. So does the American Society of Hand Therapists.

Here’s what to look for in an occupational therapist:

• Credentials. An occupational therapist who has passed a national exam and is licensed by a state will have the initials OTR/L after their name. Certified hand therapists, who have extensive specialized education, are identified by CHT. These credentials show that a therapist has both experience and training.
• Expertise in rheumatic conditions. “Ask if an OT has had a lot of experience with patients who suffer from arthritis,” says Dodge.
• A good questioner. “The secret to a good quality session is having a therapist who asks the right kinds of questions,” says Richmond. Look for an OT who listens and who asks about your goals and how your arthritis prevents you from achieving those goals.
• Warmth and compassion. If you are going to an OT, you are probably in some kind of pain. Your therapy will be more successful if you feel that the practitioner cares about you and is on your side.
• “You should feel that you got something out of each visit,” Dodge says. “If you don’t, go elsewhere.”

Here are some red flags to keep an eye on:

• An OT who performs therapies not related to your functioning. If you are weak in one arm, but want to do your own cooking, exercises such as using an arm bike will not be as helpful as an OT showing you ways to reach into cupboards and turning on the stove, according to AOTA.
• An OT who uses pain-relief therapies without an explicit goal. If an OT applies heat, cold, or electrotherapy to, for instance, reduce shoulder pain so you can reach into a refrigerator, that’s fine. If the therapist is using these techniques simply for pain control, they are not practicing occupational therapy.
• An OT who uses overhead pulleys. Overhead pulleys can damage shoulders and cause pain. If you are having trouble, say, setting the table, your therapist can guide your arm in the correct direction so you can safely practice the move you need to make.

Get Mental Health Support

We understand the mental health struggles that can occur when you are living with chronic illness. It is important to talk to someone who can help. You should contact your primary care physician or your insurance provider to learn about the supportive resources that are available to you. Here are other mental health resources for your reference:

• To find local support groups and services, you can call 1-800-950-NAMI (6264) or email info@nami.org. The National Alliance on Mental Illness HelpLine can be reached Monday through Friday, 10 AM to 6 PM ET.
• For a counselor or therapist in your area, view the resources page at Mental Health America: Finding Therapy.
• Crisis Text Line (free 24/7 support via text): Text HOME to 741741
• The Friendship Line from the Institute on Aging (toll-free 24/7 support for people ages 60 or over and adults living with disabilities): 1-800-971-0016
• LGBT National Hotline (free, confidential support for the lesbian, gay, bisexual, transgender, queer, and questioning community): 1-888-843-4564
• If your mental health concern is an emergency for you or someone else, you should call 911.
• If you are having suicidal thoughts or have or are thinking of hurting yourself, you should call the National Suicide Prevention Lifeline’s 24-hour toll-free crisis hotline, 1-800-273-TALK (8255).

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Having an invisible illness that causes chronic pain, like rheumatoid arthritis, lupus, or axial spondyloarthritis, comes with a long list of burdens. There are the physical burdens, like the stiff, swollen joints that prevent you from ever feeling comfortable and the 24/7 fatigue that keeps you in bed. There are the emotional burdens, such as sadness over how your life has changed since being diagnosed and anxiety over how your illness may progress over time. And then there is a burden that takes a physical, emotional, and mental toll: the constant challenge of explaining your illness to others.

Telling — or, more accurately, teaching — people about an invisible illness can be challenging. Because, as the name implies, it can’t be seen by others. Unlike a broken bone, where people can see evidence of the injury and pain, an invisible illness does internal damage, and its symptoms hide beneath the surface. Not to mention many invisible illnesses are, well, complicated. Even medical experts can be stumped by the challenges an invisible illness can present.

Of course, sometimes chronic pain is visible. Your gait may change if you have bad arthritis in your hip, say. You could get psoriasis or lupus rashes on your skin. But in general, rheumatic diseases are invisible relative to how much pain, disability, and long-term damage they cause.

Still, telling others about your lived experience with an invisible illness is important. It allows people to better understand your situation, which (hopefully) allows them to make helpful adjustments and offer empathy. It also helps raise awareness which, in turn, can lead to changes that improve the care and quality of life for those living with invisible illnesses.

As part of Arthritis Awareness Month, we asked members of our community how they explain their invisible illness to others. It seems that people have different approaches when trying to teach others about their conditions. Some, like Julie M., compare it to “having the flu every day.” Others, like manasi_i, tell people that “my body is treating itself as an enemy.” One person, Luzsanti, describes their illness as, “the kind of tired and the kind of pain that can knock you out even when you think you are prepared for it.”

But several members of our community shared a sad truth: they don’t even try to explain their condition to others. For many of them, trying to get others to understand an invisible illness can be practically as draining as the illness itself.

People living with chronic diseases should not feel obligated to have to always educate other people about their health issues, yet they often take on that duty or it is thrusted upon them. Every so often they may help enlighten someone who genuinely wants to understand what they’re going through; someone who asks thoughtful questions and offers empathy. Often, however, their “students” hurl judgement and unsolicited advice their way. And the energy required to respond to or brush off these comments is energy people with chronic illnesses can’t spare.

“It’s exhausting trying to get people to get it, and the process usually comes with judgments, assumptions, and bias,” Josie P. says of explaining her illness. “Unless it’s a very close friend or someone who needs to know what’s going on, I just say ‘I have three autoimmune diseases’ and leave it at that.” Josie adds that this approach has been beneficial for their well-being and that, “if people want to learn and ask questions then I am here to educate as much as I can, but as soon as [they] start getting rude and judgmental, we are no longer having a conversation.”

Lisa T. echoes Josie’s thoughts, saying that sharing their story, “brings nothing but judgment and unwanted advice on how easily I can cure myself.”

“I don’t even try,” Velma M. says. “I’m sick of being told to ‘suck it up’ and ‘get over it.’”

Just as bad as the judgment, are the implications that your chronic illness is a burden to others; that the physical and emotional pain you experience has a negative impact on them.

“I try to get people to understand more [but] it’s apparently too depressing and bothersome,” Michelle S. shares. “[People are] not too concerned about how it’s a life-altering thing and it will eventually take my life.”

Gayle R. has had similar experiences. “I’ve given up trying. I live amidst a world where everyone has something more important going on,” they wrote.

Similar to being told you don’t look sick, having your experience disregarded is harmful to people living with chronic conditions. It dismisses what they physically, mentally, and emotionally go through each day. It silences them. And silencing someone with an invisible illness keeps them from raising awareness and bringing visibility not only to their individual struggles, but to the struggles of the millions of people living with chronic diseases.

Want to Get More Involved with Patient Advocacy?

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation, comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspective and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here.

Everyone feels achy on occasion. But a pain so intense you can barely function is a red flag that deserves your attention. If your elbow or shoulder has recently started hurting a lot, it’s quite possible that your recent return to tennis or pickleball is responsible. If one of your fingers is in pain and seems to lock when you try to fully extend it, too much typing and texting could very well be the culprit. But what’s actually happening inside your body? Arthritis or tendonitis could be to blame for these issues. Unfortunately, the difference between arthritis and tendonitis isn’t always so obvious. This means you’ll most likely need medical attention to find out the culprit behind your pain — and figure out how to treat it so you can start feeling better.

Both tendonitis and arthritis can cause pain and swelling in or near a joint, hence the confusion. Although arthritis refers to inflammation that occurs within a joint and tendonitis refers to inflammation of a tendon (which connects muscle to bone), don’t assume you’ll be able to ID the exact source of your discomfort. “Patients just know that the area hurts or notice that it’s swollen or red,” says Joseph E. Huffstutter, MD, rheumatologist and partner with Arthritis Associates in Hixson, Tennessee.

Whether you have a preexisting condition like arthritis or not, your best bet is to see a doctor and get the right diagnosis so you can be treated appropriately.

Arthritis vs. Tendonitis

Arthritis, by definition, means inflammation within a joint or directly around it. Tendonitis, in contrast, is inflammation of a tendon, which is a flexible, rope-like cord that connects muscle to bone.

Arthritis can occur wherever you have joints. There are two general categories of arthritis.

• Osteoarthritis (the “wear-and-tear” kind) often impacts the knees, hips, and hands, especially as you get older.
• Inflammatory arthritis, which includes rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis, can strike at any age and impact a wider range of joints, including the ankles, wrists, feet, and lower back (in addition to the knees, hips, and hands), depending on which kind you have. This kind of arthritis is caused by an overactive immune system that is causing inflammation around the joint.

Tendonitis can occur anywhere you have a tendon, but some common spots include:

• Elbow (aka “tennis elbow”)
• Shoulder
• Behind the heel (Achilles tendonitis)

There are also two types of tendonitis that frequently impact the fingers:

• DeQuervain’s tenosynovitis happens when the tendon sheath in the thumb become swollen.
• Trigger finger (or thumb) occurs when a tendon in a finger gets inflamed and becomes thicker, which may cause it to “lock.”

Tendonitis vs. Enthesitis

To add to the confusion, many people who have inflammatory arthritis — especially axial spondyloarthritis or psoriatic arthritis — develop something called enthesitis as part of their disease.

Enthesitis is inflammation of the spot (enthesis) where a tendon or ligament attaches to bone. Most doctors use the word “tendonitis” to refer to an inflammation of the sheath covering the tendon rather than the place at which tendon attaches to a bone, which they would likely call “enthesitis,”says Dr. Huffstutter.

In other words, enthesitis and tendonitis are not technically the same thing. But they could cause similar symptoms and be mistaken for each other.

Does Arthritis Cause Tendonitis — and Vice Versa?

In a word, no. Although both involve inflammation — arthritis is joint inflammation and tendonitis is inflammation of a tendon — having one doesn’t directly cause you to develop the other.

That said, these conditions sometimes overlap.  “People with psoriatic arthritis frequently get enthesitis and tendonitis,” says Dr. Huffstutter. In fact, enthesitis is a unique feature of psoriatic arthritis and axial spondyloarthritis (as compared to other types of inflammatory arthritis).

Do You Have Arthritis or Tendonitis?

Both arthritis and tendonitis can cause pain, swelling, and inflammation. If you feel like that’s happening around a joint, it can be hard to know what the problem is. Both arthritis and tendonitis may cause:

• Pain that gets worse when you move the area/joint
• Swelling
• Redness

Because the symptoms can be so similar, doctors may rely heavily on information about where the pain occurs and when the pain first started to determine whether your issue could be arthritis or tendonitis. For example, an achy knee that’s been slowly getting worse over the years is more apt to be osteoarthritis, whereas someone who suddenly has pain behind their ankle probably has Achilles tendonitis. Your doctor should also pay attention to risk factors that might make you more vulnerable to one or the other.

Risk Factors for Tendonitis

Anyone can get tendonitis, but some risk factors make it more likely. Those include:

• Being a “weekend warrior” when it comes to exercise: Quickly increasing your activity level without giving your body time to adjust can easily inflame a tendon.
• Working in a job that calls for repetitive motion: Construction workers, hairstylists, and others who frequently repeat the same motions are more prone to tendonitis. Using tools that vibrate (including power tools and hairdryers) can also be problematic because repetitive vibrations put excessive stress on tendons, according to the Canadian Center for Occupational Health and Safety.
• Playing certain sports: Baseball, basketball, bowling, golf, running, swimming, and tennis are all on the list of activities that could put you at risk for tendonitis. The common factor: repetitive motion.
• Having other medical conditions: People with rheumatoid arthritis, gout, and blood or kidney disease may be more likely to injure a tendon, though the reasons are not well understood.
• Getting older: Your flexibility — and that of your tendons — decreases after age 40.
• Taking certain medications: It’s not so common, but antibiotics in the fluoroquinolone class like Cipro might increase the chances of a tendon rupturing. Taking a statin (cholesterol-lowering drug) also occasionally causes this issue.

How Tendonitis Is Diagnosed

If you suspect you have tendonitis — or if you have pain and aren’t sure if it’s tendonitis or arthritis — there are a few ways your doctor may diagnose you. These include:

• A physical exam: Your doctor will ask questions about your pain symptoms and review your medical history. They will also manually feel the impacted area. Paying attention to the specific location of the pain is very important, says Dena Barsoum, MD, a physical medicine and rehabilitation specialist with Hospital for Special Surgery in New York City. “Tendonitis can happen almost anywhere in the body, but it often happens around the joints at the hip or in the hamstrings, shoulder, elbow, or around the foot and ankle,” she says.
• Ultrasound: If your doctor is having trouble pinpointing the source of your pain, an ultrasound may be useful.
• MRI (magnetic resonance imaging): MRIs aren’t usually necessary for diagnosing tendonitis, but your doctor may order one if they need to see more detail than what an ultrasound provides, says Dr. Barsoum.

How Tendonitis Is Treated

There are many ways to ease the pain of tendonitis. Sometimes resting the impacted area and applying ice is enough to do the trick. But additional treatment might include:

• Oral pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can ease both pain and inflammation.
• Topical pain relievers: Topical NSAIDs come in a cream, gel, or ointment that you rub on the achy spot. Voltaren (diclofenac) gel is technically approved for over-the-counter use for arthritis but should also help with tendonitis pain, says Dr. Huffstutter.
• Injectable corticosteroids: These stronger anti-inflammatories can be injected around a tendon. “We never want to inject steroids into a tendon because it can cause it to tear,” says Dr. Barsoum. However, this treatment isn’t usually recommended for long-term use, since repeated injections may weaken tendons and increase the chance of ruptures, according to the Mayo Clinic.
• Physical therapy: Learning how to properly strengthen the muscle that’s attached to the injured tendon can be incredibly helpful. In fact, it’s now considered the first-line treatment for tendonitis, so your doctor might suggest it even before trying an injection or other therapy.
• Platelet-rich plasma (PRP): A newer treatment, PRP entails taking your own blood, separating out the plasma (a nutrient-rich yellow liquid), and injecting it directly into the tendon. “Tendons have a poor blood supply, so when a tendon gets injured, it tends to stay that way for a while,” explains Dr. Barsoum. “We don’t really know if PRP can heal a tear, but we do have evidence that it’s helpful for pain.”
• Dry needling: Your doctor may suggest this treatment, which involved poking tiny holes into the tendon with a super thin needle. The tiny injuries caused by needling prompt the tendon to heal itself by promoting blood flow and boosting collagen production, according to a report in the journal Physical Therapy Review.
• Percutaneous tenotomy: During this minimally invasive procedure, your doctor will use a small tool that emits ultrasonic waves to break up scar tissue. They will then flush out and remove the debris so the remaining tendon can heal.
• Surgery: It’s a last resort, but if other treatments haven’t helped you may need surgery to remove scar tissue from the tendon.

Whatever option(s) you and your doctor decide on, you should know that most people fully recover from tendonitis. Sometimes the problem even resolves on its own, though it could take several weeks or even months so plan to be patient.

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As temperatures rise, it’s easy to become very parched (very quickly) and not even realize it. But forgoing water during the heat is dangerous, and becoming dehydrated when you have arthritis can result in added pain and issues. Dehydration causes a host of symptoms, such as sleepiness and dizziness, and increases your risk for heat injury or low blood volume shock. But it can also affect the mechanisms that keep your joints functioning smoothly; it can reduce the fluid that cushions your joints or increase inflammation throughout your body.

“There’s no scientific study at this point or to my knowledge that shows arthritis patients may need more water [than those without arthritis], but ensuring adequate hydration might be more important in terms of joint health,” says clinical rheumatologist Magdalena Cadet, MD, Associate Attending Physician at NYU Langone Health in New York City.

It’s important to look out for yourself and others year-round, but especially in the summer when temperatures are high. Here’s everything to know about dehydration and arthritis, and how to make sure you drink enough water to manage joint pain and stay safe during the summer.

How Dehydration Affects Your Arthritis

When you’re dehydrated, the parts of your body that help keep arthritis aches and pains at bay may not function as well.

Water helps create synovial fluid, a thin layer of fluid that cushions and delivers nutrition to your joints. Synovial fluid also reduces friction when you move your joints, according to a July 2019 study in Nutrients. When you’re dehydrated, your body may struggle to create synovial fluid, which may result in more friction and pain.

“We know that synovial fluid can reduce friction and the rubbing of joints together,” says Dr. Cadet. “And water is important for maintaining tissue health and keeping our joints healthy.”

Water is also crucial for your cartilage, as about 65 to 80 percent of cartilage is made of water, according to an article in the British Medical Bulletin. (That percentage decreases as you age.) Cartilage is a strong and flexible tissue that covers the ends of your bones. Your cartilage allows your bones to glide over each other, which helps you move, and it also protects bones by preventing them from rubbing against each other.

“When we drink water, we not only help stimulate the production of synovial fluid, but also help with cartilage regeneration and lubrication of the cartilage to reduce joint inflammation,” says Dr. Cadet.

It helps to think of cartilage as a sponge: When it has enough water, it’s soft. When it dries out, it becomes stiff and difficult to move.

Hydration also supports the supply of blood to the heart cells and other organs, which is important for people with an underlying health issue that may impact other organs, such as arthritis.

“We know that rheumatoid arthritis and psoriatic arthritis involve other organs, and we know hydration is important for the protection of our heart, our skin, and other organs, so it’s also good to stay hydrated to allow good blood volume to those organs,” says Dr. Cadet. “Hydration also helps your muscles function properly, and we need our muscle function to help with our joint function.”

So, how much water should you be drinking? According to the National Academies of Sciences, Engineering, and Medicine, the adequate intake (AI) of water — which can come from beverages (like water and tea) and food (like fruits and vegetables) — for men ages 19 and older is 3.7 liters (about 16 cups) liters each day, with 3 liters (13 cups) coming from beverages. For women, the AI is 2.7 liters (about 11 cups) of water, with 2.2 liters (9 cups) coming from beverages.

This number, however, may change depending on the season and your activity level. For example, if you’re spending time working outside in the heat, the U.S. Centers for Disease Control and Prevention (CDC) recommends drinking one cup of water (8 ounces) every 15 to 20 minutes.

It’s also recommended that you drink water in short intervals throughout the day rather than drinking a lot of water at once, as the latter may cause discomfort.

Similarly, you don’t want to drink too much water. According to the Mayo Clinic, this can lead to hyponatremia, a rare condition that occurs when the kidneys are unable to get rid of excess water, thus reducing the concentration of sodium in your blood to a dangerously low level. This can cause muscle spasms and cramps, as well as headaches, fatigue, and nausea.

Is Your Joint Pain Related to Dehydration?

If it’s hot and you feel particularly uncomfortable, it’s likely that dehydration is at least partially to blame. Even mild dehydration may have effects on your pain level.

“The synovial fluid and the cartilage tissue cells need water to help reduce friction and maintain motion between the joints,” says Dr. Cadet. “Even small amounts of dehydration or not drinking enough water daily can contribute to joint pain.”

Depending on how dehydrated you are and your specific condition, your symptoms may be mild or severe.

“I don’t know if we can put a time course on it, but obviously the more dehydrated you are [and] the more time that lapses, the more apparent joint pain or other symptoms may be,” says Dr. Cadet. “There are also other more serious conditions, like heat stroke and muscle breakdown, that can occur with severe dehydration.”

Common signs of dehydration, according to the Cleveland Clinic, include:

• Headache, confusion, or delirium
• Tiredness/fatigue
• Dizziness, weakness, and light-headedness
• Dry mouth and/or a dry cough
• High heart rate but low blood pressure
• Loss of appetite
• Flushed skin, swollen feet, and muscle cramps
• Heat intolerance or chills
• Constipation
• Dark-colored pee (it should be a pale, clear color)

You may see symptoms of dehydration improve five to 10 minutes after drinking water. But if you think your symptoms are severe, or are taking longer to improve, call 911 or go to the emergency room immediately.

Severe symptoms of dehydration may include:

• A body temperature of 103^o Fahrenheit or higher
• Muscle twitching
• Red, hot, dry skin
• Nausea
• Rapid pulse
• Seizures
• Lack of sweating
• Confusion, altered mental state, slurred speech
• Dizziness
• Fainting, loss of consciousness
• Hallucinations

How to Avoid Dehydration

The best way to avoid dehydration is to drink up before you get thirsty. It’s especially important to monitor your water intake when your region is experiencing a heat wave, says Dr. Cadet.

To see if you’re getting enough water, take a day to track how much water you drink and any symptoms you may experience. Gradually increase the amount of water each day, while continuing to track your symptoms. You’ll know you’re getting the right amount of water when the symptoms subside. You may, however, need more water during times of high temperatures. But having a baseline water intake level can help you adjust as seasons change.

In addition to increasing your water intake, you want to make sure you’re getting enough electrolytes. These are minerals like sodium, calcium, potassium, chloride, phosphate, and magnesium that have an electric charge and help balance the amount of water in your body, according to the U.S. National Library of Medicine. You can get them through fluids like milk, or foods like bananas and watermelon.

Of course, drinking enough water is easier said than done. But there are several simple steps that can help you make hydration a part of your everyday life.

“I always encourage patients to drink water when they get up in the morning, try to drink water with their meals, and to drink water instead of sugary drinks,” says Dr. Cadet. You might even try replacing at least one sugary beverage, like soda, with water every day until drinking plain or fruit-infused water becomes a habit.

And remember, it’s not enough to drink a lot of water occasionally. You need to increase your overall water intake each day to get the long-term benefits of hydration.

“The idea of building hydration as a habit is important, because the more something becomes habitual, the less conscious attention we have to give to it,” says occupational therapist Julie Dorsey, OTD, OTR/L, a Professor of Occupational Therapy at Ithaca College in Ithaca, New York.

Here are Dorsey’s five tips for making hydration a habit.

Set reminders. Use your phone, a smartwatch, or fitness tracker to remind yourself to hydrate at regular intervals throughout the day (say, every hour). “Those are really helpful because they become part of your everyday routine,” says Dorsey. There are even water bottles that help you track your water intake by the hour, such as this Motivational Water Bottle with Time Marker & Hourly Hydration Measurements.

Give yourself visual cues. For a low-tech solution, try putting reminders in places you’ll see them regularly. For instance, put sticky notes that read, “Time to hydrate!” on various doors throughout your house or place filled, reusable water bottles throughout your home, like next to your bed, in your living room, or on your desk.

Set attainable goals for yourself. Hourly goals may feel more manageable than setting a large goal like drinking a certain number of ounces per day, says Dorsey.

Do challenges with other people. Most things are easier to accomplish if you have a partner (or two, or three.) If your family, friends, or coworkers want to reach a similar water intake goal, set up a group that keeps each other accountable and checks in on each other.

Flavor your water. Admittedly, normal water can get boring, which is why Dorsey suggests adding fresh fruit, cucumbers, or mint. “Changing the flavors throughout the day and trying new combos can help you get excited about it,” she says. You can even find water bottles designed to infuse water with fruit, like the Hydracy Fruit Infuser Water Bottle. You may also want to try eating more water-rich foods such as celery, iceberg lettuce, zucchini, and watermelon, per the Cleveland Clinic.

How to Handle Joint Pan in the Heat

You may feel like the heat intensifies your joint inflammation, swelling, and stiffness. If you’re generally uncomfortable from the heat, Dorsey recommends using ice or cold compresses on achy joints, elevating your hands, and moving with light and gentle exercises to avoid stiffness.

Not surprisingly, ice is a favorite way for members of our community to soothe their joints during heat waves. Becca R. says she uses, “ice baths for my hands and feet with Epsom salt and tea tree,” to relieve pain during hot weather.

“The one good thing about having arthritis and being in extreme heat is I already had a ton of ice packs in the freezer and great cooling down skills from always feeling overheated with rheumatoid arthritis,” Eileen D. says.

And if you don’t have a freezer of ice packs, there are plenty of  household items you can turn into ice packs.

Track Your Symptoms with ArthritisPower

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Learn more and sign up here.

Axial spondyloarthritis (axSpA), a chronic inflammatory form of arthritis that targets the spine, has long been broken into two types: radiographic — meaning that a patient has evidence of joint damage that can be seen on X-rays — and non-radiographic, which causes the same symptoms but a patient does not have visible  proof of joint damage on X-rays. Radiographic axial spondyloarthritis is known as ankylosing spondylitis (AS).

Yet as research advances, the line between the two has gotten blurrier. Many experts have been saying that these conditions are really variations of the same disease and ought to be treated as such.

In other words, non-radiographic axial spondyloarthritis (nr-axSpA) is not a “less serious” form of AS.

This isn’t just about semantics. In the U.S., many drugs used to treat axSpA are only FDA-approved for use in people with the radiographic type, which means those with non-radiographic axSpA aren’t officially able to use them (and health insurance companies may deny coverage). Yet proof continues to mount that the disease burden of “both” conditions is the same.

One new study, published in the journal Annals of the Rheumatic Diseases, compared symptoms and disease activity among 185 people with radiographic axSpA and 484 with non-radiographic axSpA over a five-year period. They determined that there was no significant difference between the groups in terms of patient-reported symptoms, the number of sick days taken, and non-joint symptoms (such as skin, eye, or gastrointestinal problems).

“These highlighted results confirm the concept of axSpA as a single disease, which implies that both [radiographic] axSpA and [non-radiographic] axSpA patients should be treated with equal priority,” the authors wrote.

This educational resource was made possible with support from UCB, a global biopharmaceutical company focused on neurology and immunology.

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Keep Reading

• Non-Radiographic Axial Spondyloarthritis: What Is It, and How Is It Treated?
• Understanding the Progression of Non-Radiographic Axial Spondyloarthritis
• Treatment for Non-Radiographic Axial Spondyloarthritis: Medication, Exercise, More