Rheumatoid Arthritis
Discussion
At the grand old age of 35, I've just been told that I have rheumatoid arthritis. I'm starting a course of injections for three weeks, and then on to some strong anti inflammatory stuff.
It's a bit of a shock. Three months ago I was playing rugby, riding my motorbike faster than I should have been, going for a run with my dog.....and then I just seized up. Now some mornings it takes all my strength to push myself out of bed, with considerable pain too. A couple of minutes to navigate the stairs, holding on to the handrail for dear life!
I've been off work for most of the three months, and I don't think I'll be able to go back to my old job, as it is quite a physically demanding one. I've also hardly been out anywhere, as I can't walk very far. BUT, I'm very lucky to have a wonderful caring wife who has looked after me.
Anyway, this isn't a feeling sorry for myself post. Because I don't. I'm just wondering if there are any other PH'ers who have RA, who can tell me what to expect in the future. How effective are the drugs/treatments? Will it improve at all, or just get worse?
Sorry for the slightly miserable post!
It's a bit of a shock. Three months ago I was playing rugby, riding my motorbike faster than I should have been, going for a run with my dog.....and then I just seized up. Now some mornings it takes all my strength to push myself out of bed, with considerable pain too. A couple of minutes to navigate the stairs, holding on to the handrail for dear life!
I've been off work for most of the three months, and I don't think I'll be able to go back to my old job, as it is quite a physically demanding one. I've also hardly been out anywhere, as I can't walk very far. BUT, I'm very lucky to have a wonderful caring wife who has looked after me.
Anyway, this isn't a feeling sorry for myself post. Because I don't. I'm just wondering if there are any other PH'ers who have RA, who can tell me what to expect in the future. How effective are the drugs/treatments? Will it improve at all, or just get worse?
Sorry for the slightly miserable post!
the "grand old age" arthritis you are thinking of is probably OA/DJD, not RA, RA is most common around your sort of age (peak about 40ish years old and onset most common 20-60...any younger than 16 it's juvenile RA) and is actually most common in females. where have you got it, it most commonly starts in the hands. how were you diagnosed? blood test i'm guessing? did you have any x-rays?
the course varies quite greatly but if not cared for the end stages of the disease is unfortunately rather nasty and can lead to severe joint deformity. usually the disease goes through periods of remissions (getting better) and times of exacerbations/flare ups, with (unfortunately) a general progression in symptoms and severity. there can be systemic involvement to heart/lungs/vasculature/eyes etc in some cases but, again, this varies greatly. some people have a few flare ups and then never experience it again, whereas others get severe joint deformity, it really does vary that much. having said that, if the onset is under 30 years of age, the prognosis is generally worse so you should be better off in that sense (though that's a predictor, not always what happens).
any more questions feel free to ask. i don't experience it but have had to study RA as part of my degree.
Ross.
edit - forgot to add - treatment can be effective, i'm guessing you're getting steroid injections? these can really help as they reduce the inflammation (RA is an inflammatory condition, after all) but long term side effects are present, one of which is osteoporosis, local to where the injections are.
the course varies quite greatly but if not cared for the end stages of the disease is unfortunately rather nasty and can lead to severe joint deformity. usually the disease goes through periods of remissions (getting better) and times of exacerbations/flare ups, with (unfortunately) a general progression in symptoms and severity. there can be systemic involvement to heart/lungs/vasculature/eyes etc in some cases but, again, this varies greatly. some people have a few flare ups and then never experience it again, whereas others get severe joint deformity, it really does vary that much. having said that, if the onset is under 30 years of age, the prognosis is generally worse so you should be better off in that sense (though that's a predictor, not always what happens).
any more questions feel free to ask. i don't experience it but have had to study RA as part of my degree.
Ross.
edit - forgot to add - treatment can be effective, i'm guessing you're getting steroid injections? these can really help as they reduce the inflammation (RA is an inflammatory condition, after all) but long term side effects are present, one of which is osteoporosis, local to where the injections are.
Edited by E21_Ross on Wednesday 3rd August 18:22
Have a look at the Arthritis Research Council site..
http://www.arthritisresearchuk.org/arthritis_information/arthritis_drugs__medication.aspx
This should give some idea of what is to come. It is difficult to give specific advice but it is likley you'll be started on a DMARD (biologic or non-biologic)
http://www.arthritisresearchuk.org/arthritis_information/arthritis_drugs__medication.aspx
This should give some idea of what is to come. It is difficult to give specific advice but it is likley you'll be started on a DMARD (biologic or non-biologic)
Hi Andy, I can second Timmybob that the ARC are a good source of information as there are far too many bits of nonsense and mis-information swimming around the interweb. Ross has covered the main bits but I would put a more positive slant on things - current treatments are very effective and there is a push to start DMARD therapy early to minimise any potential joint damage. If people fail to respond to conventional DMARD (diease modifying drug therapies) the biologic therapies can be very effective (you do have to be tried on two conventional drugs, one of which should be methotrexate, first though).
Happy to try and answer any other questions (it is the main bit of my day job).
Happy to try and answer any other questions (it is the main bit of my day job).
Thanks for the replies chaps. My hands and knees are the most painful. The pain in my knees is more concentrated at the back, and it takes a while to straighten up when I've been sat down or in bed. Next on the pain league table are my ankles, which are quite swollen. My elbows are a bit of an odd shape at the moment, but dont hurt too much.
They took a load of blood a few weeks ago, so I presume it was through the blood tests they diagnosed it. I also had a CT scan and an Echocardiogram.
Do you think the treatment will be effective enough to allow me to ride my motorbike again, or should I just give up on that one? Would I still be able to run or weight train, or will that just aggravate the disease?
They took a load of blood a few weeks ago, so I presume it was through the blood tests they diagnosed it. I also had a CT scan and an Echocardiogram.
Do you think the treatment will be effective enough to allow me to ride my motorbike again, or should I just give up on that one? Would I still be able to run or weight train, or will that just aggravate the disease?
Edited by One Amp Andy on Wednesday 3rd August 19:54
Andy - I would agree with Isaac, it is important to stay positive - current therapies are very effective and the old fashioned view of people with RA ending up with wonky looking joints is well out of date. I would not give up on the bike but it is sensible to go easy on high impact exercise until the joint swelling improves. Joint injections are just the start and the important bit is getting control of the inflammation with DMARD. Realistically it does take time to get good disease control and the first 6 months will be the "bedding in" period. Speak to your Rheumatologist, many of the units have a helpline or a specialist nurse who can help answer your questions. Another useful group is the National Rheumatoid Arthritis Society (www.nras.org.uk) who have a specific link for "newly diagnosed".
One Amp Andy said:
Thanks for the replies chaps. My hands and knees are the most painful. The pain in my knees is more concentrated at the back, and it takes a while to straighten up when I've been sat down or in bed. Next on the pain league table are my ankles, which are quite swollen. My elbows are a bit of an odd shape at the moment, but dont hurt too much.
They took a load of blood a few weeks ago, so I presume it was through the blood tests they diagnosed it. I also had a CT scan and an Echocardiogram.
Do you think the treatment will be effective enough to allow me to ride my motorbike again, or should I just give up on that one? Would I still be able to run or weight train, or will that just aggravate the disease?
I couldn't possibly say whether you should give those things up, but my advice would be to try your best to not let it impede your lifestyle as much as possible. Generally, i advise to my patients to avoid too much activity during the acute flare ups, but you can try to keep active during periods of remission. The diagnosis will have been made with the blood test, i'm surprised they did a ct scan to be honest, was the blood test done before or after the scan? In the blood test you'll be positive for rheumatoid factor, as well as having raised esr and something known as hla-b27 if I'm not mistaken, the latter 2 aren't specific for ra though. They took a load of blood a few weeks ago, so I presume it was through the blood tests they diagnosed it. I also had a CT scan and an Echocardiogram.
Do you think the treatment will be effective enough to allow me to ride my motorbike again, or should I just give up on that one? Would I still be able to run or weight train, or will that just aggravate the disease?
Edited by One Amp Andy on Wednesday 3rd August 19:54
It sounds like your condition is quite bad with a fair few joints involved, terribly sorry to hear that. As said, never had it myself but had a couple of patients with it so can only imagine how much pain you are in. Just try to not let it get you down and during periods of remission of symptoms you can try to keep active.
How strange this thread has popped up. I'm going back to the rheumatologist on Tuesday to finally try and find out what's wrong with my joints.
For almost 4 years now I've been having stiff, swollen and extremely painful joints. My knees, shoulders and chest are the worst, followed by my neck, wrists and triceps.
I've been tested twice for RA, both times the results were negative. Ive been taking the strongest non steroidal anti inflammatory every day for the last 2 years. Days I forget to take it, I'm in so much pain I can just about lift a duvet off me. In the mornings I have to hold onto the window sill and sink to lower myself onto the toilet. I'm 30 years old.
I'm so depressed, I used to run 4/5 times a week and was training for an ironman before whatever is wrong with me took hold.
Ive tried everything, changed my diet, lost weight, had hypnotism, stopped working shifts nothing has worked. My consultant was convinced it was stress related but I'm not stressed at all anymore.
I seem to have a run of 3-4 bad weeks, where everyday I'm aching and in pain, the 2-3 days where I feel great.
I'm completely lost as to what I should do next.
Sorry to put this on your thread op, hope you get it sorted. I know a lad who was diagnosed with RA 2 years ago, Methatraxate has worked wonders for him, he's even playing football again. Good luck.
For almost 4 years now I've been having stiff, swollen and extremely painful joints. My knees, shoulders and chest are the worst, followed by my neck, wrists and triceps.
I've been tested twice for RA, both times the results were negative. Ive been taking the strongest non steroidal anti inflammatory every day for the last 2 years. Days I forget to take it, I'm in so much pain I can just about lift a duvet off me. In the mornings I have to hold onto the window sill and sink to lower myself onto the toilet. I'm 30 years old.
I'm so depressed, I used to run 4/5 times a week and was training for an ironman before whatever is wrong with me took hold.
Ive tried everything, changed my diet, lost weight, had hypnotism, stopped working shifts nothing has worked. My consultant was convinced it was stress related but I'm not stressed at all anymore.
I seem to have a run of 3-4 bad weeks, where everyday I'm aching and in pain, the 2-3 days where I feel great.
I'm completely lost as to what I should do next.
Sorry to put this on your thread op, hope you get it sorted. I know a lad who was diagnosed with RA 2 years ago, Methatraxate has worked wonders for him, he's even playing football again. Good luck.
working class - was the onset of your symptoms gradual or sudden? any family history of the same (or similar) condition? have you noticed any scale-like skin lesions at all? have you ever had any other tests other than a blood test for rheumatoid factor? ever had any x-rays? ever had conjunctivitis and/or urinary tract infection around(ish) the time of the joint pain onset?
you say chest....do you mean where your ribs join your sternum/breast bone? is this worse when breathing in deeply? have you ever had rheumatic fever? any know heart or lungs condition? in which joint(s) did the condition come on first, and, generally, are the painful joints on both sides of your body (e.g. both hands/wrists)?
plenty of different arthritides out there, of the inflammatory conditions i can only claim to be (reasonably - i'm not a rheumatologist) knowledgeable on about 12-13 different types.
having said that, it's important to remember hardly anyone is a "text-book" case and even though osteoarthritis/degenerative joint disease is not under the "inflammatory" section, swollen joints are common. though OA is rarely bilateral and symmetrical (both sides of body), unlike the inflammatory conditions.
anyway, i'm shattered, bed time for me i think!
cheers,
Ross.
you say chest....do you mean where your ribs join your sternum/breast bone? is this worse when breathing in deeply? have you ever had rheumatic fever? any know heart or lungs condition? in which joint(s) did the condition come on first, and, generally, are the painful joints on both sides of your body (e.g. both hands/wrists)?
plenty of different arthritides out there, of the inflammatory conditions i can only claim to be (reasonably - i'm not a rheumatologist) knowledgeable on about 12-13 different types.
having said that, it's important to remember hardly anyone is a "text-book" case and even though osteoarthritis/degenerative joint disease is not under the "inflammatory" section, swollen joints are common. though OA is rarely bilateral and symmetrical (both sides of body), unlike the inflammatory conditions.
anyway, i'm shattered, bed time for me i think!
cheers,
Ross.
Edited by E21_Ross on Wednesday 3rd August 22:32
That sounds awful Working Class. Very similar to my symptoms in some respects. I hope they find out what is wrong so they can treat you properly.
Ross, I was 're-assigned' to another rheumatology department at another hospital last month, as the original hospital I was under lost all my results, and forgot to book me in with their rheumatology department. They lost them in May, and I was quite ill for a while, with no diagnosis. I'm also experiencing fevers, night sweats, generally feeling and looking like crap, with an odd looking rash on my biceps and sides. So I think the scan was just to check my insides just in case. Everything was fine fortunately.
On another note, I'm feeling *relatively* good today, as you can probably tell from the time of my post! Everything still hurts and is swollen, but not as much as usual. And I'm wide awake for once instead of sleeping in 'til 11-12.
Ross, I was 're-assigned' to another rheumatology department at another hospital last month, as the original hospital I was under lost all my results, and forgot to book me in with their rheumatology department. They lost them in May, and I was quite ill for a while, with no diagnosis. I'm also experiencing fevers, night sweats, generally feeling and looking like crap, with an odd looking rash on my biceps and sides. So I think the scan was just to check my insides just in case. Everything was fine fortunately.
On another note, I'm feeling *relatively* good today, as you can probably tell from the time of my post! Everything still hurts and is swollen, but not as much as usual. And I'm wide awake for once instead of sleeping in 'til 11-12.
It started gradually 4 years ago. Over a period of 5 days I had a pain in my left knee that got so bad It stopped me from running and I was walking with a limp. After an xray and MRI scan (which showed nothing wrong) the did an arthroscopy and found a small synovial tear and removed it.
At the same time as this my right shoulder started playing up, literally I could not raise my arm 7/8 inches away from my waist. Then my right hip started giving me grief along with my left wrist. It just goes on but I'll bore you.
As it stands today, left wrist, left tricep, chest, right hand (forefinger knuckle), shoulder blades, left glute, both knees and neck are all giving me trouble.
My right knuckle is permanently swollen and very hot temperature wise to touch.
Thing that is frightening me is I seem to be getting worse and days I forget to take my anti inflamms I'm literally like a crippled old man. I just hope they find something next Tuesday.
Eta: for Ross.
My nan had RA and I have recently been diagnosed with having intertrigo (type of eczema) in between my legs. That flares up about every 4-6 weeks but I have steroid cream that clears that up within a few days.
I've had no other blood tests apart from the RA factor ones. My chest, the pain is all across my pecs but concentrated most right in the centre above my sternum. It hurts the most to sneeze, I have to stop myself it's that painful. I sound like a right invalid
At the same time as this my right shoulder started playing up, literally I could not raise my arm 7/8 inches away from my waist. Then my right hip started giving me grief along with my left wrist. It just goes on but I'll bore you.
As it stands today, left wrist, left tricep, chest, right hand (forefinger knuckle), shoulder blades, left glute, both knees and neck are all giving me trouble.
My right knuckle is permanently swollen and very hot temperature wise to touch.
Thing that is frightening me is I seem to be getting worse and days I forget to take my anti inflamms I'm literally like a crippled old man. I just hope they find something next Tuesday.
Eta: for Ross.
My nan had RA and I have recently been diagnosed with having intertrigo (type of eczema) in between my legs. That flares up about every 4-6 weeks but I have steroid cream that clears that up within a few days.
I've had no other blood tests apart from the RA factor ones. My chest, the pain is all across my pecs but concentrated most right in the centre above my sternum. It hurts the most to sneeze, I have to stop myself it's that painful. I sound like a right invalid
Edited by Working class on Thursday 4th August 08:18
Working class said:
It started gradually 4 years ago. Over a period of 5 days I had a pain in my left knee that got so bad It stopped me from running and I was walking with a limp. After an xray and MRI scan (which showed nothing wrong) the did an arthroscopy and found a small synovial tear and removed it.
At the same time as this my right shoulder started playing up, literally I could not raise my arm 7/8 inches away from my waist. Then my right hip started giving me grief along with my left wrist. It just goes on but I'll bore you.
As it stands today, left wrist, left tricep, chest, right hand (forefinger knuckle), shoulder blades, left glute, both knees and neck are all giving me trouble.
My right knuckle is permanently swollen and very hot temperature wise to touch.
Thing that is frightening me is I seem to be getting worse and days I forget to take my anti inflamms I'm literally like a crippled old man. I just hope they find something next Tuesday.
Eta: for Ross.
My nan had RA and I have recently been diagnosed with having intertrigo (type of eczema) in between my legs. That flares up about every 4-6 weeks but I have steroid cream that clears that up within a few days.
I've had no other blood tests apart from the RA factor ones. My chest, the pain is all across my pecs but concentrated most right in the centre above my sternum. It hurts the most to sneeze, I have to stop myself it's that painful. I sound like a right invalid
really sorry to read all of that, they are some pretty horrendous symptoms you have there! can i just confirm you don't get any associated headaches? or any numbness, tingling/pins and needles or any particular muscle weakness in your arms and/or legs? what type of pain do you experience in your muscles (e.g. triceps)? is it a dull ache, sharp pain, burning type pain etc? is this different or the same sort of pain to what you feel in your joints? other than anti-inflammatories have you found anything else that relieves your symptoms? what makes it worse (movement, inactivity etc?) and when is it at its worst (morning, evening, after activity etc?)At the same time as this my right shoulder started playing up, literally I could not raise my arm 7/8 inches away from my waist. Then my right hip started giving me grief along with my left wrist. It just goes on but I'll bore you.
As it stands today, left wrist, left tricep, chest, right hand (forefinger knuckle), shoulder blades, left glute, both knees and neck are all giving me trouble.
My right knuckle is permanently swollen and very hot temperature wise to touch.
Thing that is frightening me is I seem to be getting worse and days I forget to take my anti inflamms I'm literally like a crippled old man. I just hope they find something next Tuesday.
Eta: for Ross.
My nan had RA and I have recently been diagnosed with having intertrigo (type of eczema) in between my legs. That flares up about every 4-6 weeks but I have steroid cream that clears that up within a few days.
I've had no other blood tests apart from the RA factor ones. My chest, the pain is all across my pecs but concentrated most right in the centre above my sternum. It hurts the most to sneeze, I have to stop myself it's that painful. I sound like a right invalid
Edited by Working class on Thursday 4th August 08:18
an arthritide is, by definition, a joint disease. you are also (by the sounds of it at least) getting muscle pain. you may or may not have overlying conditions (i.e. more than 1). your muscle pain could be caused by the joint problems (or vice versa) or be totally separate. i suspect the joint problems are causing the muscle pain, but i could be wrong!! have you been seeking care for the last 4 years but still have yet to find a diagnosis, or have you only recently decided to finally get checked out?
what are they doing next tuesday for you? may sound rude but can you keep me posted on what they do/find (either here or by PM) as i'm genuinely interested in it.
RA could still be a possible cause for your pain, though odd the blood tests didn't pick up rheumatoid factor. psoriatic arthritis unlikely given no skin lesions of that nature. if you've never had conjunctivitis or urethritis a condition known as reiter's syndrome is unlikely, this can cause widespread joint pain too and is most common around your age (and by far most common in males too), but rarely causes any wrist problems.
have you had any recent x-rays of any of the troublesome joints? most types of athritis have some x-ray findings (especially in long standing cases) and a the findings you see on x-rays are (generally) different which helps with the diagnosis. i wouldn't rule out a condition called HADD (hydroxyapatite deposition disease) or CPPD (calcium pyrophosphate dihydrate crystal deposition disease) as these can cause problems in all of the joints you are experiencing pain with, however, CPPD is most common in older folks, but can affect people at 30 (though at 26 is pretty bloomin' rare) and HADD is rare below 40 so again, is probably quite unlikely.
there are a few widespread muscular conditions which can cause joint pain (e.g. polymyalgia rheumatica, fibromyalgia) but these seem unlikely as they don't strictly fit with your symptoms.
i'm pretty stumped. please keep me posted though if you can/want
Edited by E21_Ross on Thursday 4th August 09:49
Hi Ross. The only numb/tingling I had was on a patch of skin on my left hand. The consultant said it was due to the lump that has grown over my tendon putting pressure on the nerves running into my hand.
He wanted to operate after seeing the MRI scan which showed localised inflammation, for no apparent reason. I refused the op because I don't believe it will do me any good, as they need to find the root cause of my I'm getting so much inflammation over my body.
The type of pain is a sharp shooting pain when trying to use that particular muscle. My shoulders for instance, it feels like the pain is running along my tendons if that makes sense. Especially in my traps. My knees feel like they are swollen constantly behind my kneecap. The most pain I get from them is when trying to use steps or squat etc. at night the left one (which was operated on) gives me a dull ache.
I'm always worst in the morning or if I have been sitting/standing in one position for anything longer than 30 minutes. It's like my body is starting to sieze up. The best relief is a meloxicam at night, then on a real bad day 2 co-codemols really help. I'm just sick of taking tablets everyday, so try to avoid the co-codemols if possible.
It's taken 4 years because Ive 2 periods where I got so pissed off with going to see various consultants I gave up. These periods I felt at my lowest, so low most days I don't want to be alive anymore.
So next Tuesday I'm going back to see the rheumatologist as she said I must if my symptoms got any worse which they have. I'm pretty certain she's going to try me on steroidal anti inflamms, I'm just worried I won't be able to work anymore and I'll put on weight.
I'll pm you from now on as it's not fair on the op me whining on like this on his thread
He wanted to operate after seeing the MRI scan which showed localised inflammation, for no apparent reason. I refused the op because I don't believe it will do me any good, as they need to find the root cause of my I'm getting so much inflammation over my body.
The type of pain is a sharp shooting pain when trying to use that particular muscle. My shoulders for instance, it feels like the pain is running along my tendons if that makes sense. Especially in my traps. My knees feel like they are swollen constantly behind my kneecap. The most pain I get from them is when trying to use steps or squat etc. at night the left one (which was operated on) gives me a dull ache.
I'm always worst in the morning or if I have been sitting/standing in one position for anything longer than 30 minutes. It's like my body is starting to sieze up. The best relief is a meloxicam at night, then on a real bad day 2 co-codemols really help. I'm just sick of taking tablets everyday, so try to avoid the co-codemols if possible.
It's taken 4 years because Ive 2 periods where I got so pissed off with going to see various consultants I gave up. These periods I felt at my lowest, so low most days I don't want to be alive anymore.
So next Tuesday I'm going back to see the rheumatologist as she said I must if my symptoms got any worse which they have. I'm pretty certain she's going to try me on steroidal anti inflamms, I'm just worried I won't be able to work anymore and I'll put on weight.
I'll pm you from now on as it's not fair on the op me whining on like this on his thread
Working class - have they tested you for Lupus at all? This mimics arthritis very well and it was thought that I had RA initially, but is in fact Systemic Lupus. I was diagnosed nearly 6 years ago and have been taking Hydroxychloroquine Sulphate since then and feel generally great, only a flare-up occasionally.
If they haven't tested you, ask them to, you need to know what's wrong one way or the other.
Best of luck.
H
If they haven't tested you, ask them to, you need to know what's wrong one way or the other.
Best of luck.
H
adminH said:
Working class - have they tested you for Lupus at all? This mimics arthritis very well and it was thought that I had RA initially, but is in fact Systemic Lupus. I was diagnosed nearly 6 years ago and have been taking Hydroxychloroquine Sulphate since then and feel generally great, only a flare-up occasionally.
If they haven't tested you, ask them to, you need to know what's wrong one way or the other.
Best of luck.
H
SLE mimics just about everything If they haven't tested you, ask them to, you need to know what's wrong one way or the other.
Best of luck.
H
i'm not so sure it fits well with all of the OPs symptoms. it's pretty rare to have SLE in a few of the locations the OP mentions - knees for instance are very rare but not unheard of from what i'm aware. it's a good shout and it's possible i guess. pretty rare in males though.Edited by E21_Ross on Thursday 4th August 12:04
RemainAllHoof said:
Re diets ie the food you eat, do you eat a lot of vinegar or other sour things eg lemon juice? Some people find it can trigger arthritis as IIRC crystals can form in the joints.
that's gout, which is a type of arthritis but is not what the OP has. gout almost always starts in the big toe because the monosodium urate crystals form because that is where the body is cold (comparitively) and the crystals are less soluble where it's colder and hence they usually form there first Firstly, thank you everyone for your replies so far, it's really cheering me up.
Re: my diet, I don't eat much fruit, I eat a fair bit of veg, but I will confess I do eat a fair bit of meat, red 2/3 times per week, then fish and chicken the rest.
I also should of mentioned that my joints crack all the time. Even when not under load they crunch.
Re: my diet, I don't eat much fruit, I eat a fair bit of veg, but I will confess I do eat a fair bit of meat, red 2/3 times per week, then fish and chicken the rest.
I also should of mentioned that my joints crack all the time. Even when not under load they crunch.
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