Question: From past issues of this newsletter, it appears that Cushing's doesn't cause arthritis. If it's not arthritis, why in the world do I have all these aches and pains?

Answer: The feeling of fatigue and the aches and pains in the muscles and joints of patients with Cushing's during the postoperative period are common and result from the withdrawal of the body from the high cortisol levels of active disease and the gradual return of the biochemistry of the brain to normal. Also, some of the aches and pains during the postoperative period are probably related to decreased muscle strength. As muscle strength returns to normal, these aches and pains should dissipate. It may take over a year for the patient to fully return to normal.

Cushing's does not cause the most common form of arthritis which is associated with the loss of cartilage from the joints. Rheumatoid arthritis, a different form of arthritis, is an inflammatory disease which gets better with glucocorticoid therapy. It is very unusual for a patient with active Cushing's to also have rheumatoid arthritis, because the immune system of such a patient is suppressed. After correction of the hypercortisolism, however, patients with Cushing's are at increased risk for developing autoimmune inflammatory diseases, such as rheumatoid arthritis and primary thyroiditis, because the activity of their immune system rebounds to a higher than normal level. This effect usually lasts only 2 to 3 months and occurs even though these patients receive normal cortisol replacement. Patients with immune system disorders should discuss their replacement dosage with their endocrinologist.