What is the Most Painful Form of Arthritis?

Arthritis means inflammation of the joints. Pain and stiffness of the affected joint is the hallmark symptom. While arthritis from wear and tear is the commonest type, there are many forms of arthritis – pain being present in most of them. A common question asked is what is the most painful form of arthritis? How can you identify it? There are more than 100 different forms of arthritis and disorders related to it.¹ The common types include osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout and fibromyalgia. Most of these conditions cause debilitating pain and affect the quality of life in various ways.

Different types of arthritis cause different types of pain – the severity varies. Knowing the basic types of arthritis and the most painful form of arthritis can help in managing the condition better. As pain is present in almost every patient with arthritis, it becomes important to be able to assess the severity of pain and find ways to manage it in a better way.

Arthritis or joint inflammation can affect one or more joints of the body. Depending on the type of arthritis the presentation may vary but usually include the following common features.

Symptoms include pain in the affected joint, stiffness, redness, swelling, tenderness, warmth, difficulty or pain while moving the joint, and affected range of motion.

Some factors increasing age, body weight, environmental changes, activity levels, overuse, injury, and associated medical complaints can affect the severity of the symptoms.

Pain has undoubtedly been the most common complaint and a debilitating symptom of arthritis. Centers for Disease Control and Prevention, states that more than one-third of the adults who have arthritis report that it limits their leisure activities and work, and 25% of them say it causes severe pain – which can be measured as seven or higher on a scale of zero to 10.¹

The most common and most painful forms of arthritis include the following:

This is an inflammatory, autoimmune condition that affects the joints and other organs of the body. In this, the immune system strikes the tissues of the body, resulting in inflammation. It can be triggered by many factors and an acute attack after an illness, infection, or injury. It can lead to gradual or sudden swelling in joints or tissues. While it can affect other tissues, joints are the commonest site. Usually, the joint inflammation is symmetrical and seen in the same joints on both sides. Morning stiffness in joints is common, which usually lasts for more than an hour and sometimes can continue even longer.

In rheumatoid arthritis, the inflammation caused in joints is considered one of the most painful forms of arthritis. It can cause painful swelling in the hands, wrists, and knees. The tissue damage can result in long-lasting changes, and chronic pain, which often results in severe, acute pain during flareups. It can also lead to difficulty in moving, loss of balance, nodule formation under the skin, and physical changes with tissue damage to other major organs like the eyes, heart, and lungs.

Osteoarthritis is the commonest form of arthritis and can be very painful at times. Osteoarthritis affects 27 million Americans and is believed to be an inevitable part of aging.² This form of arthritis is a degenerative disease, in which the protective cartilage gets worn out. In this, the synovial fluid in the joints dries up, resulting in the rubbing of bones against each other. This causes severe pain, difficulty in movement, and sometimes, inflammation with swelling. It often affects the weight-bearing joints like knees, hips, ankles, hands, and spine. It can also affect overused and injured joints, depending on the activity of a person. Movement or walking can cause more pain while periods of inactivity can cause stiffness. Morning stiffness of the affected joints is also a common feature but it often lasts for less than 30 minutes.

The severity of pain varies, usually develops gradually, and can be mild to moderate. In osteoarthritis, chronic pain usually has constant dull, aching pain but acute episodes can be very painful and debilitating. Hence, osteoarthritis is also considered one of the painful forms of arthritis.

Gout is an inflammatory type of arthritis but affects the joint in particular and does not cause inflammation in the entire body. High levels of uric acid are the typical feature of gout. Excess uric acid in the body, either due to overproduction or due to the inability to remove excess effectively, results in its accumulation in blood and deposition of uric acid crystals in the joints. This causes inflammation, redness, and very severe pain in the affected joint.

Gouty arthritis is counted among the most painful form of arthritis. It usually affects the great toes but sometimes other joints like knees, ankles wrists, and fingers too. The pain often occurs suddenly while the person has been feeling fine till then. Treatment includes pain relievers and anti-gout medicines. It is believed that restricting the intake of purine-rich foods, and alcohol and increasing water intake can help control gout attacks.

Based on the individual causes and the mode of onset of symptoms, some features help in identifying the form of arthritis. Osteoarthritis and rheumatoid arthritis are the commonest ones – it is imperative to know a few things.

As rheumatoid arthritis is an inflammatory condition of the immune system that attacks the tissues of joints, it often shows flu-like symptoms. So joint pain may not always be the first sign of rheumatoid arthritis but it can begin with fatigue, weakness, fever, and minor aches.²

Osteoarthritis on the other hand occurs due to the wearing away of the cartilage, usually occurring gradually and with increasing age. Injured joints can show these complaints earlier at times. The pain can be severe, is often related to overuse of the affected joints, and occurs after activity.

Thus, while both are one of the most painful forms of arthritis, each has a unique presentation. Also, more important is that the treatment for both is different hence it is necessary to make a proper diagnosis and plan the right treatment.

The symptoms and signs of joint disorder often prompt relevant investigations that help diagnose the condition. Clinical history and overall presentation can give a fair idea of the possible causes of joint pain however confirmation is necessary to plan the further course of action. A medical expert would examine clinically and plan a series of tests to confirm the diagnosis.

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