Can Bones Hurt? Bone Pain and Rheumatoid Disease | Rheumatoid Arthritis Warrior

Can Bones Hurt? Bone Pain and Rheumatoid Disease

 The main misconception about bones then, is that they are made up of dead tissue. This is not true, they have cells, nerves, blood vessels and pain receptors.1

Sunset over barn - awesome even via narrow window

Ever hear that bones can’t hurt?

Did you ever have the flu or a fever and your bones just ached? It can be enough to make you forget all about what your knees and wrists were screaming about. I’ve heard a doctor say that bones “can’t hurt,” but I’ve also heard patients say they do.

For years it was believed that only the surface layer of bone is innervated.2 I stumbled on some articles about bone pain this summer when I was reading about broken bones after being diagnosed with a rib fracture. It was interesting to read that bones have plenty of nerves of various kinds that can ache deep inside or hurt sharply on the surface.

Bones can be painful for several reasons

It’s easy to find information about bone pain with stress fractures or sickle cell disease, or cancers such as myeloma, lung cancer, or breast cancer. Bone pain is even associated with other “rheumatological” diseases such as Paget’s disease, osteoarthritis, or transient osteoporosis.

But what about bone pain with rheumatoid disease (RD) /RA?

It’s not as well recognized that RD can cause bone pain, but some realities support its likelihood:

1)     Rheumatoid disease can cause bone damage. And other conditions that cause bone damage are recognized as painful.
2)     Bone inflammation is associated with several conditions (including RD) and known to cause severe pain.
3)     Bone edema in RD is associated with pain, disease activity, and poor prognosis.
4)     People living with rheumatoid disease (PRD) often say their bones hurt.

WHAT ABOUT YOU?

Have you ever experienced bone pain with RD? Were you able to determine the cause? How did your doctors respond?

Related stories

Taking head-on the claims that it’s a “well established” fact people with rheumatoid disease (RD) have a lower pain threshold. Reasons this claim falls flat, and why it matters. Continue reading… Does Rheumatoid Arthritis Pain Really Hurt That Much?

The list of symptoms in people with RD is long, and fortunately not every patient has every symptom. PRD often wonder “Is this from the rheumatoid?” or “Am I the only one with this symptom?” To explore the 51 posts about “Rheumatoid Arthritis symptoms,” click here.

Recommended reading

ENDNOTES

1 Johnson DR. University of Leeds: Faculty of Biological Sciences [Internet]. Leeds (England):  Introductory Anatomy: Bones. 2001 Feb 1; [cited 2014 Sep 1]. Available from: http://www.leeds.ac.uk/chb/lectures/anatomy3.html

2 Jones KB, Mollano AV, Morcuende JA, Cooper RR, Saltzman CL. Bone and Brain: A Review of Neural, Hormonal, and Musculoskeletal Connections. Iowa Orthop J [Internet]. 2004 [cited 2014 Sep 1]; 24: 123–132. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888423/

Kelly O'Neill Young

Kelly O'Neill (formerly Kelly Young) has worked over 10 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over thirteen years with unrelenting RD. See also https:/rawarrior.com/kelly-young-press/

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22 thoughts on “Can Bones Hurt? Bone Pain and Rheumatoid Disease

  • October 17, 2014 at 5:25 am
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    I am printing this out to take to my Rheumatologist next week! I have been saying this for months. My bones constantly hurt and yes I have joint pain but the bones ache so much that has become secondary. I was diagnosed with Felty’s Syndrome in 2011 but they said I had it for a very long time undiagnosed. I will get sharp pains or sometimes just aching in the middle of my shins and also my forearms.

    Reply
    • October 17, 2014 at 3:13 pm
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      The only way to tell if you have bone oedema is by MRI. Many rheumatologists STILL have not caught up with the research on advanced imaging and RA. MRI is the standard of care in many areas of Europe. North America continues to lag behind Europe by at least 10 to 20 years in rheumatology care especially in the use of ultrasound and MRI.

      A rheumatologist cannot determine the cause of bone pain without doing an MRI. They cannot determine inflammation or many types of pathology accurately without performing ultrasound or MRI. There are at least 100 research articles on the superiority of ultrasound of MRI on detecting damage caused by RA. PLEASE insist on having an MRI of at least the dominant hand and wrist. It is common now to have MRI of both hands and feet for diagnosis and to track disease activity. Other joints that may be involved or are concerning can also be imaged.

      Reply
  • October 17, 2014 at 9:40 am
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    I know how much it hurts after surgery on the bones of the hands and feet, and how long it takes for that type of bone pain to diminish.
    Now I am at the stage where there is damage to my joints and most of the pain I report is dismissed as mechanical pain, since there is no swelling and inflammation. I get the message that it doesn’t matter to the Dr. and I will just have to deal with it.
    That’s likely not the way he feels or the message he intends to give me but that’s the way I take it when no solution is offered

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  • October 17, 2014 at 9:42 am
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    Kelly, I’m sorry to hear about your fracture. I’ve heard rib fractures can be very painful and hard to deal with. I hope you’re on the mend. As for bones, yes, mine hurt sometimes. Especially the ankle bones. It can be a very deep pain if that makes sense. My Rheumy did some X-rays and didn’t find anything (of course). She just prescribed gabapentin and sent me on my way. Don’t get me wrong, she a fantastic doctor but sometimes she just shrugs at my different symptoms. I’m sero-negative and just happy she believes me and treats me anyway. It worries me though to think there could be damage happening to my bones and nothing being done about it.

    Reply
    • October 17, 2014 at 3:17 pm
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      Mandy, there are now many research articles that show that x-rays are pretty much obsolete in rheumatology care. These articles show that x-rays do not show the damage that is caused by RA in soft tissues. X-rays don’t show bone damage (erosions of the surface of the bones) for at least one to two years AFTER it has occurred. Using x-rays in rheumatology can actually be harmful because doctors assume there is nothing wrong (a false negative) when an ultrasound or MRI will show damage of the bones as well as soft tissue. PLEASE insist on an MRI of at least your dominant hand and wrist as well as any other area that is concerning.

      Reply
  • October 17, 2014 at 12:41 pm
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    Unfortunately, I believe you have to have experienced the pain of RA/RD to fully understand what we go through. Doctors can’t truly relate… no one can! I’ve had severe RA 21 years, nothing has worked. When I try to walk in my small condo, I am aware of all my bones, because they hurt. I feel like a struggling skeleton . How many healthy people can say, I can feel the pain in my bones ? RA’s do!
    Wishing Kelly and all warriors strength as we live each day.

    Reply
  • October 17, 2014 at 12:50 pm
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    All I know is that I wake up every day with deep bone pain. Mainly in my feet/ankles. It can also be in my spine. It’s not just joint pain. I am constantly telling everyone my legs hurt, but no one seems to do anything about it.

    Reply
  • October 17, 2014 at 12:58 pm
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    How could it be assumed that bone, which contains marrow & blood vessels, doesn’t contain nerves? I had a knee replacement 4 months ago to fix a 20 degree valgus deformity (thanks RD). The pain associated with the surgery was almost laughable compared with the pain of the “old” knee & the one that is yet to be done. There’s no question that bones can hurt. Next time, maybe the researchers could just listen to us when they’re looking for information. Unless they’re worried that our “low pain thresholds” would affect the study…

    Reply
  • October 17, 2014 at 3:30 pm
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    No one with RA needs to suffer in silence without adequate explanations of what is going on in the joints. There are advanced imaging tests (power doppler ultrasound and MRI) that are far superior to a simple joint exam or x-ray.

    One of the best researchers in the world, in my humble opinion, on the use of advanced imaging in rheumatology is Dr. Fiona McQueen from New Zealand. She has conducted research and published widely. Here is a link to her most recent publication on the use of MRI in rheumatology and why it is superior to other types of imaging. She clearly explains all of the pathology that can be seen on MRI related to our rheumatoid disease. We are far beyond simply accepting that doctors poke around on our joints, take an x-ray, and send us home without an adequate explanation of what is going on or reasonable treatment. http://pmj.bmj.com/content/90/1064/332.long

    For the use of ultrasound in rheumatology, probably one of the best researchers in the world is Dr. Richard Wakefield at Leeds in the UK. He is involved in the Targeted Ultrasound Initiative and has published widely on the topic, as well.

    Reply
  • October 19, 2014 at 3:15 pm
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    Oh yes, my bones hurt!! Sometimes more than the joints. My doc can poke at my joints and I have to explain the pain is deep inside, not at the surface.

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  • October 20, 2014 at 11:26 am
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    Being Sero-negative and not showing any related disease activity in my blood, I will not stand for my doctor to just say that my xray results are normal. I’ve had a MRI of my foot five years ago, where bone edema was identified. At the time, nothing was said about that finding, and I did not know the significance till I read this article. I recently insisted on a MRI of my hand and wrist, after xrays were normal and found synovial fluid thickening at my knuckles and a cyst were bone had erroded in my hand. I have some noticeable swelling, but not significant as compared to the level of pain that my hand brings me on a daily basis. And this is not my dominant hand. By pushing my Rheumatologist to perform these tests, I’ve moved him past the struggling through Methotrexate (with no relief) and on to my first Biologic. If something hurts, don’t be satisfied with your xrays are normal. Pain is there for a reason and without treating what is truly causing the pain, how will it ever get better?

    Reply
  • October 23, 2014 at 12:14 am
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    Thanks for this Kelly, and thanks for all the responses, I have been off my Xeljanz for about 5 weeks now, because my blood counts got low. I have been in a horrible flare for the past 6 days or so. I always forget how much the meds help until I have to stop them. Ouch!! I have been saying for days “my bones hurt!” not just my joints, but bones. These other comments helped me so much. My Rhuemy moved way so I have to go to a new one soon, I am so afraid she might simply look at my negative blood work and dismiss me as crazy. Pray she listens. Gentle hugs to all

    Reply
  • October 25, 2014 at 12:44 am
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    My RA progressed a few years ago (I’ve had it 30 years) and every muscle in my body hurt and was sensitive to touch. And I had deep unrelenting pain in my bones. I seriously thought I had I diagnosed cancer with bone metastases. I had no idea that RA would cause such pain. And I had doctors try to pin a fibromyalgia diagnosis on me. But when I started taking my Enbrel more regularly (yes I had a medication phobia), the muscle and bone pain lessened.

    Reply
  • October 25, 2014 at 12:45 am
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    Oops…that was supposed to read: an undiagnosed cancer!

    Reply
  • September 18, 2015 at 12:07 pm
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    I was not sure where I could post this. I’ve suffered with what I think is joint pain for few years. My pain is in feet, ankles, knees, hips and hands. I tested slightly positive for RA and also inflamation. Got a referral for a rhumatologist. Went to see a different regular pcm today and she said she dose not think I have RA. Because my joints don’t hurt when she pokes and pride them from the outside and when she moves my joints all around. My pain is internal…deep inside. She prescribed PT and pain meds
    Also I do have a family history of RA. Is she righy though? I am only 32

    Reply
    • September 18, 2015 at 12:09 pm
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      Also xrays of hands and spine appear normal. Today the took some of knees and ankles….I don’t know the results

      Reply
  • April 24, 2016 at 3:30 pm
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    Yes they can hurt!! The only way I can describe the pain was that it felt like someone holding hot fire pokers to them especially if a weather front was moving through..

    Reply
  • April 9, 2017 at 6:30 pm
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    I’ve been telling my rheumatologist my spine hurts. He says, “RA doesn’t affect the spine.” Really? Then he tells me my SED rate is in the high end of the normal range, so it’s not the RA. Guess I complained enough about pain over the past year that he finally sent me for a nuclear bone scan. (It’s not a bone density scan, but a radioactive substance is injected and a gamma ray camera takes pics.) It showed degenerative bones in my spine, knees, shoulders and feet. My bones hurt! It doesn’t matter what the doc says. I now have proof. When the nurse called me with the results she said, “Wow, no wonder you’re in pain.” It’s frustrating getting through to the doc sometimes, but your bone pain is real.

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    • April 9, 2017 at 9:45 pm
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      Kathleen, thanks for sharing. Glad you got it and someone to read it correctly.

      For anyone reading Kathleen’s comment:
      Bones can hurt. RD does affect the spine. And nuclear bones are a real thing.
      All 3 of those things are often doubted by doctors. It’s not hocus pocus or patients exaggerating – it’s science.

      Here are 7 posts on nuclear bone scans on RAW. https://www.rawarrior.com/tag/nuclear-bone-scan/

      Reply
  • May 30, 2017 at 10:30 pm
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    Since all of started and I was diagnosed in 2014 I have experienced deep rib pain. I have had bone scans and various other tests for cancer but the docs refuse to say it is RD related. Thanks for this article

    Reply
  • December 19, 2017 at 12:31 am
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    I know of what most of you are talking about… sadly. Now that the weather is getting colder and still wet outside, my bones just ache!!!
    It took quite a bit of complaining that my bones hurt… I also have Fibromyalgia and the dr kept trying to say it was my muscles… I know the difference between my muscles and my bones.
    Now trying to find something that will help…

    Reply
  • March 28, 2018 at 12:40 pm
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    My right hip bone hurts – the pain continues underneath my belly. Can the pain underneath my belly button be from arthritis? I have gone thru numerous tests and they all came out just fine.

    Reply
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