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Have you noticed joint pain since you’ve been diagnosed with hidradenitis suppurativa (HS)? You may be experiencing joint inflammation called arthritis. People with HS can develop different types of arthritis, but some people may develop a specific kind called osteoarthritis.
Read on to learn more about osteoarthritis, why some people with HS develop it over time, and how you can prevent or manage symptoms.
Hidradenitis suppurativa is an autoinflammatory skin disease in which the immune system makes infection-fighting cells without a threat. This can lead to painful lesions (injured skin) and abscesses (bumps filled with pus) around hair follicles.
People with HS are three times more likely than the general population to develop inflammatory arthritis, a type of arthritis where the immune system targets the joints. Psoriatic arthritis, spondyloarthritis, and rheumatoid arthritis are three examples of this type of arthritis among people with HS. Researchers aren’t sure how HS and inflammatory arthritis are connected, but they think it may be due to overlapping risk factors, like genetics, environment, and abnormal immune activity.
Research has also linked HS to osteoarthritis, a condition where cartilage (the cushion in your joints) and other joint tissues wear down over time. Osteoarthritis isn’t a type of inflammatory arthritis, but it can cause similar symptoms as the joints experience wear and tear. Common symptoms of osteoarthritis include:
People with HS are 1.37 times more likely to get osteoarthritis compared to people who don’t have HS. They’re also more likely to have symptoms early, or before age 45.
About 800 members of myHSteam report joint pain as a symptom of HS. “I always thought my pain was because I sit and lie in such uncomfortable positions to ease my HS, but it seems there is a link, so definitely mention it to your doctor,” wrote one member.
Some members have been diagnosed with osteoarthritis, although symptoms vary from person to person. One member shared their experience: “I have osteoarthritis from my neck to the tailbone and both knees, although I had a total knee replacement on the right. My fingers also get stiff at times.”
More research is needed to understand why people with HS can develop osteoarthritis, but early studies suggest three links: long-term inflammation, excess body weight, and physical inactivity.
Osteoarthritis isn’t a type of inflammatory arthritis. However, it can develop as a result of inflammatory issues in the joint, which are common among those with HS. This is called secondary arthritis. For example, people who have rheumatoid arthritis are 2.75 times more likely to get secondary osteoarthritis. Researchers believe this is due to long-term joint inflammation.
Long-term inflammation throughout the body — not just the joints — might also lead to osteoarthritis. One study suggests that people with HS have higher levels of pro-inflammatory cytokines (proteins that tell the immune system to create inflammation) in their bodies. The same protein is associated with cartilage breakdown in people with osteoarthritis.
Higher body weight is an overlapping risk factor for HS and early osteoarthritis symptoms. Excess body fat can create more widespread inflammation, which can lead to an increased risk of osteoarthritis. Health conditions associated with a higher body weight, including diabetes, hypertension, and dyslipidemia (abnormal levels of fat in the blood, like high cholesterol), may similarly increase the risk of osteoarthritis.
Extra weight also creates more stress on weight-bearing joints (like the knees and hips), especially if the muscles around each joint aren’t strong. Over time, these joints can experience more wear, which could contribute to osteoarthritis.
Some people on myHSteam have a hard time working out due to HS symptoms. “I used to weight train a lot. Since I reached stage 3 in my underarms, my range of motion has greatly decreased. Weightlifting is no longer fun due to the joint pain,” wrote a myHSteam member.
Physical inactivity is a risk factor for osteoarthritis, however. Your joints count on regular activity to keep cartilage healthy and surrounding muscles strong. Without activity, joints’ structures weaken, leaving them vulnerable to overload, injury, and possibly osteoarthritis (with time).
People with HS and osteoarthritis can manage — and prevent — symptoms of both conditions by controlling inflammation, maintaining a healthy weight, and staying active. But the same treatment approach doesn’t work for everyone. Talk to your healthcare team to find the right plan for you.
Widespread and joint-specific inflammation could worsen HS and osteoarthritis, so it’s important to keep inflammation levels low. Medication could help. For example, biologics can block pro-inflammatory proteins, which can improve HS symptoms and joint inflammation. Biologics aren’t used to treat osteoarthritis, but they do treat HS and forms of inflammatory arthritis.
Some myHSteam members talk about using biologic medications for HS inflammation. “I have to keep my inflammation level low. If that level is elevated, I suffer from arthritis and sarcoidosis. For me, a biologic keeps the HS in check,” wrote one member.
Your dermatology provider will pick the right medication for your symptoms and any associated health conditions.
HS and osteoarthritis symptoms won’t go away with weight loss, but weight loss can help control inflammation and reduce the load on painful weight-bearing joints. For every 1 pound of weight lost, the knee experiences 3 to 6 pounds less force with every step.
Eating a healthy diet can prevent weight gain or promote weight loss. For some people, a healthy diet can also help HS symptoms. Research hasn’t established a single effective diet for HS. Several small studies found that limiting sugar and processed foods could prevent flare-ups while promoting a healthy weight. Your HS care team can help you find the right diet that controls your weight, inflammation, and osteoarthritis pain.
It’s important to note that dramatic weight loss can lead to excess skin and more rubbing, which could worsen HS symptoms. “I lost 220 pounds, but removing my hanging skin is what improved things,” wrote one myHSteam member.
The first-line treatment for osteoarthritis is physical activity tailored to your symptoms. A physical therapist can teach you tips on rehabilitating a painful joint and staying active. They may teach you how to use a cane to off-load the joint at first, then move on to stretches and exercises that improve strength with consistency.
People with HS may find exercise painful, especially when they’re experiencing active flare-ups. Repetitive rubbing and sweat may worsen symptoms. A myHSteam member reported flare-ups in the groin that prevented them from enjoying their favorite exercises, but they found alternatives that work. “Yoga, swimming, and walking are safer options for me,” they wrote.
If you’re unsure how to stay active without causing HS flares or joint pain, talk to your care team about your options.
On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.
Have you noticed joint pain since your HS diagnosis? What helps you keep symptoms at bay? Let others know in the comments below.
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