Many people think that developing joint pain is a normal part of aging. It is easy to brush off aching in your back, hips, or knees and attribute this to “getting older” or the wear and tear of past injuries. But when joint pain is accompanied by swelling, or other symptoms like psoriasis, or if joint pain begins before age 40, then there may be more to the story. This is where a rheumatologist can be helpful in identifying types of arthritis in men.

Arthritis encompasses a range of disorders, each with its own distinct characteristics and treatment options. In this blog post, we will explore common types of arthritis that can affect men, including gout, osteoarthritis, joint pain from low testosterone, and inflammatory arthritis, including rheumatoid arthritis. We will also discuss unique factors that are more likely to influence the diagnosis of arthritis syndromes in male adults, regardless of age or athletic history.

Gout: More Than Just Joint Pain

Gout is a type of arthritis characterized by sudden and severe joint pain, often affecting the big toe, ankles, or knees. It is caused by the buildup of uric acid crystals in the joints, leading to very intense inflammation and significant discomfort. Gout is historically referred to as the “rich man’s disease” due to its association with diets rich in purine-containing foods, but gout can affect individuals from all walks of life.

Gout Risk Factors

• Genetics: We now know that genetics play a more important factor in the likelihood of developing gout, much more than dietary habits. These genetic factors are not always passed from parents, though it is more common to develop gout if a male relative had gout too.
• Hormones: There are some hormone factors that influence the likelihood of developing gout, and gouty arthritis in men is more common than in women.
• Age: We also tend to see the severity of gout increase with time and age, as uric acid builds up slowly and deposits throughout the body over time.

Flares or attacks of joint pain and swelling can be intermittent and managed periodically. But more long-term treatment is indicated if someone has 2 or more flares within 6 months, joint damage to a bone called an erosion, tophi or collections of uric acid under the skin, or other symptoms like a uric acid kidney stone.

Osteoarthritis: Wear and Tear on the Joints

Osteoarthritis is the most common form of arthritis in men, often referred to as “wear and tear” arthritis. It occurs when the protective cartilage in the joints breaks down over time, resulting in joint pain, stiffness, and reduced mobility. Although osteoarthritis can affect any joint, it commonly affects the lower back or lumbar spine, knees, hips, and hands, particularly the thumb joint near the wrist.

Osteoarthritis Risk Factors

Several factors can contribute to the development of osteoarthritis in men:

• Age
• Obesity
• Joint injuries
• Repetitive stress on the joints
• Genetic predisposition

Men who work in construction, with heavy machinery, or prior athletes in high-impact sports and running can develop osteoarthritis earlier than other men and may have more joints involved. Additionally, low testosterone levels have been linked to an increased risk of osteoarthritis in men, as testosterone plays a vital role in maintaining bone health and joint function.

Osteoarthritis pain is often more noticeable at the end of the day or after activity, then again when first waking up. When we stop moving our bodies, the tendons and ligaments surrounding our joints tend to tighten and tense up, causing the feeling of more stiffness when we rest or relax. Degenerative disc disease or osteoarthritis of the spine can be more painful with standing and may result in weakness of the core muscles over time, which then leads to more pain and stiffness in the back. This can then trigger pain in the hips, knees, and feet as we compensate for walking and standing off balance.

Joint Pain from Low Testosterone: A Multifaceted Connection

Low testosterone levels, known as hypogonadism, have been associated with joint pain and an increased risk of developing certain forms of arthritis in men. Testosterone is involved in the maintenance of bone density and muscle mass, as well as the regulation of inflammatory processes in the body.

In a study published in The Journal of Rheumatology, researchers found that men with low testosterone levels were more likely to experience joint pain and stiffness. However, it is important to note that while low testosterone may contribute to joint pain, it is not the sole cause of arthritis. Testosterone replacement is also not a perfect treatment for joint pain and can involve increased risk of certain cancers in men, including prostate cancer.

Low testosterone has also been found to be more common in patients who use opiate medications on a regular basis. So while medications may be prescribed for pain such as chronic back pain from osteoarthritis, this can then lead to lower levels of testosterone that can then lead to more joint pain, and the cycle continues.

Inflammatory Arthritis: Autoimmune Disorders at Play

Inflammatory arthritis encompasses a group of conditions characterized by chronic joint inflammation resulting from an overactive immune system. Common forms of inflammatory arthritis include rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Men are not immune to inflammatory arthritis, although some conditions may affect them differently than women. For example, men are more likely to develop ankylosing spondylitis, which primarily affects the spine and sacroiliac joints. Psoriatic arthritis, which is associated with the skin condition psoriasis, also commonly affects men. And while rheumatoid arthritis in men is less common, it is still diagnosed.

Typically large joints like the knees and ankles, or the low back (lumbar and sacroiliac joints of the spine) may be the first location of symptoms. It is important to recognize that inflammatory arthritis is not associated with age and can commonly occur before the age of 40. These types of arthritis involve stiffness primarily in the morning that may improve with exercise, so it is not unusual to hear that a young man will develop an early morning exercise or stretching routine just to be able to get going for the day.

Male Arthritis Diagnosis and Treatment

If you are being treated for arthritis or joint pain, or have a combination of psoriasis and joint pain, and are not improving with your treatment plan, a rheumatologist may help determine if you are being treated with the correct type of medication for your symptoms.

The accurate diagnosis of arthritis syndromes in male adults requires a comprehensive evaluation by a rheumatologist. Your rheumatologist will take a thorough history, perform a physical exam, and order comprehensive laboratory tests and imaging like X-rays to evaluate your symptoms.

Summit Rheumatology is accepting new patients. If you or someone you know seems to have symptoms of any of these arthritis syndromes, give us a call at: (480) 494-2770 or send us a message to schedule an appointment with one of our arthritis specialists.