Restless Leg Syndrome and Arthritis

Itchy, achy, throbbing, creepy-crawly: Those are some of the words used to describe the symptoms of restless leg syndrome (RLS). This condition causes such uncomfortable sensations in your legs that you have to move them.

That intense, irresistible urge to stretch or jiggle your legs provides temporary relief. Symptoms of restless leg syndrome typically occur in the evening or nighttime hours when you’re sitting and resting or lying in bed, which can make it tough to fall or stay asleep.

Also known as Willis-Ekbom disease, restless leg syndrome can begin at any age; as you get older, however, symptoms generally happen more often and last longer. RLS may affect up to 10 percent of Americans, according to the National Institute of Neurological Disorders and Stroke.

But among arthritis patients, restless leg syndrome is much more common: Research published in the Journal of Clinical Rheumatology found that restless leg syndrome occurred in about 28 percent of patients with rheumatoid arthritis (RA), and about 24 percent of patient with osteoarthritis — more than double the prevalence of RLS in the general population.

What Could Cause Restless Legs in People with Arthritis?

Experts can’t say for certain. In fact, in most cases, there’s no known cause for restless leg syndrome. Some evidence suggests that an imbalance of the brain chemical dopamine, which is needed to produce smooth and purposeful muscle movement, may lead to RLS. If there’s a disruption in these pathways, it can result in involuntary movements.

Heredity may also be a factor, particularly if RLS symptoms start before age 40. And in some cases, iron deficiency — even without anemia — might cause or worsen restless legs. RLS also seems to be related to other conditions, such as kidney failure, nerve damage, spinal cord conditions, and pregnancy.

Why restless leg syndrome occurs more frequent in arthritis patients is unclear. Scientists suspect with RA, the disease process itself may play a role in developing RLS.

Rheumatoid Arthritis and Restless Leg Syndrome

“An immunologic response may be driving both disease states,” says John Gjevre, MD, professor of medicine at the University of Saskatchewan in Canada. Dr. Gjevre, an expert in sleep medicine, co-authored a number of studies on restless leg syndrome and rheumatoid arthritis, with his wife, Regina Taylor-Gjevre, MD, professor of medicine and head of the division of rheumatology at the same university.

Pro-inflammatory proteins (called cytokines) that are produced by the immune system when you have rheumatoid arthritis also impact sleep quality.

Some small studies have shown elevated rates of RLS in people with other autoimmune diseases, such as lupus.

Iron deficiency is another possible link to RA, adds Dr. Gjevre. Both RLS and RA are associated with low levels of iron or iron stores in the blood.

Osteoarthritis and Restless Leg Syndrome

Osteoarthritis, which occurs because degeneration or wear and tear on the joint often due to age or injury, doesn’t have the same inflammatory response as RA. Experts believe a number of different factors may contribute to a higher rate of RLS in osteoarthritis, but more research is needed.

What Are the Symptoms of Restless Leg Syndrome?

The tell-tale sign of RLS is a consistent desire or urge to move to your legs, which is accompanied by:

Uncomfortable sensations in your legs

People with RLS often say it’s tough to define the feeling, but it may be described as aching, tingling, throbbing, burning, pulling, itching, crawling, or creeping. The sensation can occur in just one leg, but often affects both legs; and it can range from uncomfortable to painful.

Relief with activity

Keeping your legs in motion minimizes or prevents the RLS sensations. You might pace, stretch, or constantly move your legs when you’re sitting, or toss and turn in bed. Movement makes the feeling go away for a few minutes, but it comes back after you sit or lie still again.

Worsening symptoms at night

The desire to move and the uncomfortable sensations happen mainly at night. Restless leg symptoms may also occur when you’re inactive or sitting for a long stretch of time, like at a movie theater or on a road trip.

Twitching when you sleep

More than 80 percent of people with RLS also experience periodic limb movement of sleep (PLMS), a condition that causes your legs to twitch and kick while you sleep, sometimes throughout the night.

RLS symptoms may occur once or twice a week, or more often in severe cases. They may disappear for a period of time, then come back. But in general, they worsen over time.

How Is Restless Leg Syndrome Diagnosed?

There’s no one test for RLS. Your doctor will take your medical history and ask you to describe your symptoms. A clinical diagnosis for RLS is based on the following five criteria:

  • You have a strong, overwhelming need to move the legs that is often associated with abnormal or uncomfortable sensations.
  • Your symptoms start or get worse when you’re resting or inactive.
  • Your symptoms are partially or temporarily relieved by movements.
  • Your symptoms start or get worse at night.
  • Your symptoms are not caused by any other medical or behavioral condition.

Your doctor may also do a physical and neurological exam, check your iron levels, and run lab tests to rule out other possible causes for your symptoms. You may also be referred to a sleep specialist to help determine other causes of your sleep disruptions.

How Is RLS Treated if You Have Arthritis?

RLS is treated the same whether or not you have RA, explains rheumatologist Vinicius Domingues, MD, CreakyJoints medical advisor and assistant professor of medicine at Florida State University. Still, it’s important to manage your RA and keep it under good control for your overall health.

Sometimes, treating an underlying condition can relieve symptoms of RLS. If your iron levels are low, for example, your doctor may prescribe iron supplements to correct the deficiency. However, do not take iron supplements without checking with your doctor first.

If you have RLS without an associated condition, treatment may focus on lifestyle changes first. Some steps to help alleviate symptoms:

  • Cut back on caffeine, alcohol, and nicotine to help improve sleep
  • Exercise
  • Take a warm bath and massage your legs to relax your muscles
  • Try a heating pad or cold pack to lessen sensations in your legs
  • Stick to a regular sleep schedule

Your doctor may also prescribe medications to reduce the restlessness in your legs, such as:

  • Medicines to increase dopamine in the brain
  • Anti-seizure drugs to slow or block pain signals from nerves in the legs
  • Muscle relaxants and sleep medications
  • Opioids to treat refractory RLS that hasn’t responded to other therapy

It may take a few trials for you and your doctor to find the right treatment combination that works for you. Talk to your doctor about potential side effects of RLS medications, and which may be safest for you.

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