— Anonymous Probably not. Weakness, stiffness, and aching of muscles can occur in a number of illnesses, including rheumatoid arthritis, but rheumatoid arthritis would typically cause other symptoms, such as inflammation, swelling, and pain of the wrists, hands, and feet. A more likely explanation is osteoarthritis (degenerative joint disease) of the hip joint, which is often seen in the “golden” years. It also causes pain in the groin, though sometimes that follows the initial symptoms. Difficulty rising from the sitting position is a common manifestation. There are some other conditions to consider. For example, true muscle weakness can be due to inflammation of the muscles, a condition called polymyositis (PM). If polymyositis is accompanied by a characteristic rash, it is called dermatomyositis (DM). Such muscle inflammation could cause you difficulty when rising from a chair or the toilet. It’s very important that anyone with either of these conditions be evaluated by a rheumatologist because polymyositis and dermatomyositis can be associated with cancers in the middle and older years. PM or DM that is not associated with cancer responds to cortisone-like drugs (steroids) and immunosuppressive drugs, which is a type of chemotherapy. If associated with cancer, polymyositis and dermatomyositis do not respond to steroids but do improve with effective cancer treatment. Another cause for aching or even severe muscle pain is polymyalgia rheumatica (PMR). This typically develops after age 55, manifests with pain in the shoulders, neck, and pelvis, and sometimes also mild arthritis of several joints. In addition, there can (rarely) be a low-grade fever, and lab tests will show what’s called a high sedimentation rate, which is a measure of inflammation in the body. PMR is treated with small doses of steroids (5–10 mg a day). About 18–20 percent of patients with PMR have severe headaches and other manifestations of inflammation of the arteries, due to an associated condition known as giant cell arteritis (GCA). This is an inflammation of the wall of the arteries that can affect blood vessels in the neck, upper body, and arms, though it occurs most often in the arteries of the head, especially those in the temples. Because giant cell arteritis may cause sudden and irreversible blindness, an urgent evaluation by a rheumatologist and an ophthalmologist is necessary. Large doses of steroids are needed in this case (40–60 mg a day). Finally, Parkinson’s disease can also cause muscle stiffness and difficulty initiating movement, including speaking and writing, as well as tremors. A neurologist is the best specialist to diagnose and treat this condition. As you can see, there are a variety of different illnesses that could be causing your symptoms. Your best course of action is to undergo a careful evaluation; you can start with a rheumatologist. In the meantime, if getting off the toilet seat is really difficult, you might want to get a raised seat, which should help considerably. Q2. Upon arising in the morning my legs and back muscles are extremely tight and it’s somewhat difficult to straighten up while walking to the kitchen or bathroom. After 20 or 30 minutes I am okay. Could this be arthritis, or do you think I just need to stretch more? Thank you. —Susanne, California Stiffness can have a variety of causes, and treatment varies accordingly. Arthritis can certainly cause stiffness, but it also causes pain, and it is virtually impossible to have arthritis without pain. There is a condition of congenital insensitivity to pain, but I can only think of one arthritis patient who had it. If you actually have congenital insensitivity to pain, or if you have pain that you didn’t mention in your question, here are some possible reasons for your problem:
Osteoarthritis (often described as a wear-and-tear condition) of the spine’s facet joints (the joints that link your vertebrae together) is quite common, especially in middle and older age; it causes stiffness as well as pain. Osteoarthritis is classically worse at night and causes stiffness following rest.Another type of spinal arthritis that causes considerable stiffness is ankylosing spondylitis, a chronic inflammatory condition that leads to fusion of the spine and low back pain. It typically starts early in life (in the late teens to early 20s), and 90 percent of the patients are men. In women, the diagnosis is often delayed until later in life, because the illness is not suspected as readily in a female.A herniated disk of the lumbar spine (slipped disk of the lower back) usually causes pain, muscle spasm with stiffness, and often numbness and/or weakness of the leg if it presses on a nerve root.Parkinson’s disease, a degenerative neurological illness that causes stiffness, tremor, forward leaning of the body when walking, and a near expressionless face.A rare cause of stiffness is the “stiff person syndrome” (or “stiff man syndrome”), where stiffness is progressive and severe, and there are painful cramps associated with it.
The bottom line is that you could use a thorough evaluation by a rheumatologist. If Parkinson’s disease is suspected, you should then consult a neurologist for a definitive diagnosis, treatment, and follow-up. I hope this helps. Q3. I have a weird symptom that I can’t really find much about on the Internet. Simply put, I have stiff feet in the morning; that’s it…they are just stiff. They don’t hurt or ache, but I can barely walk to the bathroom. After a little while the stiffness clears but then sometimes it returns if I’ve been sitting for long periods of time. The symptom has been coming and going for about eight months now. So, what causes stiff feet? Am I coming down with some kind of arthritis? — Lee, Virginia Stiffness limited to the feet may be due to osteoarthritis (a degeneration of the joint) of the big toe or the midfoot. The joint at the base of the big toe (first metatarsophalangeal joint) can become rigid because of bony spurs (osteophytes) and reduction of the cartilage space, and thus feel stiff. Osteoarthritis in the midfoot joint is commonly due to a previous injury. A rheumatologist can be helpful in this case. At times women who wear high-heel shoes may get shortening of the Achilles tendon (the heel cord) and can experience stiffness there if they try to wear low-heel or flat shoes. Or, the special connective tissue at the sole of the foot (plantar fascia) can get irritated, inflamed, and may scar inwardly. This too can cause stiffness, but it is usually also painful. In this case, orthotic inserts in the shoe, physical therapy, and, if needed, nonsteroidal anti-inflammatory drugs can help. A rheumatologist or an orthopedist can diagnose and treat plantar fasciitis. Learn more in the Everyday Health Arthritis Center.
