Joint pain: Causes and treatment

Joint Pain- Pain that appears to come from the joints can sometimes come from structures outside them, such as ligaments, tendons, or muscles. Examples of these disorders are bursitis and tendonitis.

True joint pain (arthralgia) is not necessarily accompanied by joint inflammation (arthritis).  The most common symptom of joint inflammation is pain. Inflamed joints may also be hot and swollen and, more rarely, the skin covering them may be red. Arthritis can affect only the joints of the limbs or also the joints of the central part of the skeleton, such as the spine or pelvis. Pain can occur only when the joint moves or it can be present even at rest.  Other symptoms may also occur, such as a rash, fever, eye pain, or mouth ulcers, depending on the cause of the joint pain.

Each disorder tends to affect a different number of joints. Accordingly, doctors consider different causes of pain when it affects only one joint than when it affects multiple joints. When multiple joints are involved, some disorders are more likely than others to affect the same joint on both sides of the body (for example, both knees or both hands). This is called symmetrical arthritis. Also in some disorders an arthritis attack remains in the same joints for the duration of the attack. In other disorders, arthritis moves from one joint to another (migratory arthritis).

Joint pain
Joint pain

Causes of joint pain

In most cases, the cause of pain that comes from within multiple joints is arthritis. The disorders that cause arthritis can differ in some trends, such as:

  • How many and which joints are usually involved
  • Whether the central part of the skeleton is involved, such as the spine or pelvis
  • Whether the arthritis is sudden (acute) or long-lasting (chronic)

Acute arthritis affecting multiple joints is due more often to:

  • Viral infection
  • The onset of joint disease or the worsening of an existing chronic joint disease (such as rheumatoid arthritis  or psoriatic arthritis )
  • Gout or calcium pyrophosphate arthritis (formerly known as pseudogout)

Less common causes of acute arthritis in multiple joints include Lyme disease  (which can affect even one joint),  gonorrhea and bacterial strep infections,  reactive arthritis.

Chronic arthritis

  • Inflammatory disorders such as rheumatoid arthritis , psoriatic arthritis or
  • Non-inflammatory disease called osteoarthritis
  • Juvenile idiopathic arthritis

Some chronic inflammatory disorders can affect the spine and joints in the limbs (so-called peripheral joints). Some affect certain parts of the spine more frequently.  For example, ankylosing spondylitis most commonly affects the lower (lumbar) area of the spine, while rheumatoid arthritis most commonly affects the upper (cervical) area of the spine and neck.

The most common ailments on the outside of the joints that cause pain around the joints are:

  • Fibromyalgia
  • Polymyalgia rheumatica
  • Bursitis or tendonitis

Bursitis or tendonitis often results from trauma, usually affecting only one joint.  However, some disorders cause bursitis or tendonitis in many joints.

Diagnosis of joint pain

When assessing joint pain, doctors first try to determine whether joint pain is caused by a joint disorder and severe whole-body (systemic) disease. Severe diffuse disorders may require immediate specific treatment.  The following information can help you decide whether to see a doctor and what to expect during the evaluation.

Warning signs of joint pain

In people who have pain in more than one joint, symptoms that require prompt evaluation include:

  • Swelling, warmth and redness of the joint
  • New rashes, spots, or purplish patches
  • Ulcers in the mouth or nose or genital organs
  • Chest pain, shortness of breath, or recent or severe cough
  • Abdominal pain
  • Fever, sweating, weight loss or chills
  • Eye pain or redness

When to see a doctor

People with warning signs should see a doctor immediately. People with no warning signs should call a doctor. The doctor will decide how quickly the assessment should be made, based on the severity and location of the pain, whether the joints are swollen, whether the cause has been previously diagnosed, and other factors.  Generally, a delay of several days does not have negative repercussions for people who do not have warning signs.

How the doctor behaves

The physician begins by asking the patient questions about symptoms and medical history.  The doctor then performs a physical examination. Based on the results of the physical examination and history, the patient may suggest a cause for the joint pain and indicate the tests to be performed.

Doctors ask questions about the severity of pain (sudden or gradual), changes in symptoms over time, and whether pain decreases or increases (for example, with rest or movement, or at specific times of the day). They ask questions about joint stiffness or swelling, previously diagnosed joint diseases, risks of exposure to sexually transmitted diseases, and Lyme disease.

The doctor then performs a physical examination. Check all joints (including those in the spine) for swelling, redness, warmth, tenderness, and noises when the joint moves (crepitus). The complete mobility of the joint is checked, first with movements performed by the subject without assistance (active mobility), then by the doctor (passive mobility). This test helps determine which structure is causing pain and whether inflammation is present.

Doctors also check the eyes, mouth, nose, and genitals for ulcers or other signs of inflammation. The skin is examined for any rashes. The lymph nodes are palpated and the lungs and heart examined. Doctors usually examine the function of the nervous system.

Some results give useful insights into the cause. For example, if tenderness is present around the joint but not the joint, bursitis or tendonitis is likely to be the cause. If there is general tenderness, it is possible that you have fibromyalgia. If pain is present in both the spine and joints, possible causes include osteoarthritis, reactive arthritis, ankylosing spondylitis, and psoriatic arthritis. By analyzing the hand, doctors can tell the difference between rheumatoid arthritis and osteoarthritis, two particularly common types of arthritis. For example, rheumatoid arthritis most often involves the joints of the large knuckles (those of the fingers of the hand) and wrist. Osteoarthritis usually involves the joint of the finger near the nail.

Test for joint pain

The following tests are the most important in general:

  • Joint fluid analysis
  • Blood tests for antibodies
  • Erythrocyte sedimentation rate (ESR) and c-reactive protein levels

If the joints are swollen, doctors usually insert a needle into the joint to take a sample of fluid for examination (a procedure called joint aspiration or arthrocentesis). The doctor numbs the area before taking a sample so that the patient does not feel pain during the procedure.  Doctors usually do a culture of the fluid to check for infection. Then, under the microscope, it detects the presence of crystals in the liquid, which indicate gout or related disorders. The number of white blood cells in the fluid indicates whether the joint is inflamed.

Often, doctors also order blood tests to look for autoantibodies. Examples of these tests include antinuclear antibodies, double-stranded DNA antibodies, citrullinated cyclic anti-peptide, and rheumatoid factor.  The presence of autoantibodies in the blood can indicate an autoimmune disorder, such as rheumatoid arthritis or systemic lupus erythematosus.

ESR is a test that measures the rate at which red blood cells settle to the bottom of a tube that contains a blood sample.  Rapidly settling blood typically means there is probably inflammation throughout the body (systemic), but many factors can affect the ESR test, including age and anemia, so the test is often inaccurate. To make it easier to establish the presence of widespread inflammation, doctors usually do another blood test to detect C-reactive protein (a protein that circulates in the blood and whose level increases dramatically in the presence of inflammation).

Imaging tests are sometimes needed, especially if bone or joint cancer is suspected. An x-ray is done first , but  computed tomography (CT) or magnetic resonance imaging (MRI) is sometimes needed .

If a specific disease is suspected, other tests may be needed.

Treatment of joint pain

Attempts are made to treat the condition underlying excessive clotting. For example, people with an autoimmune disease (such as systemic lupus erythematosus) may need a drug that suppresses the immune system. People with a gonorrhea joint infection need antibiotics.

Symptoms can be alleviated before the diagnosis is known. Inflammation can be relieved with non-steroidal anti-inflammatory drugs (NSAIDs). In the absence of inflammation, pain is usually treated more safely with acetaminophen.  Sometimes the pain can be relieved by immobilizing the joint with a splint or bandage.

The warm compresses (eg with hot bearings) can decrease the pain by calming spasms in the muscles around the joints (for example after a trauma). The cold packs(e.g. with ice) can help relieve pain caused by joint inflammation. Hot or cold compresses should be applied for at least 15 minutes, so that they penetrate deeply.  The skin must be protected from extreme heat or cold. For example, ice should be placed in a plastic bag and wrapped in a towel.

When acute pain and inflammation have subsided, physical therapy may help to regain or maintain range of motion and strengthen surrounding muscles. For people with chronic arthritis, it is important to continue physical activity in order to avoid permanent joint stiffness (contractures) and muscle loss (atrophy).

Basic indications for the elders

Osteoarthritis is the most common cause of joint pain in older adults. Although it appears more commonly in young adults (between the ages of 30 and 40),  rheumatoid arthritis can also begin later (after the age of 60). Older adults who may have rheumatoid arthritis may also have cancer.  People over the age of 55, with stiffness and pain in the hips and shoulders that worsen in the morning, may also suffer from polymyalgia rheumatica .  It is important to recognize polymyalgia rheumatica because other problems can be avoided by treating it. The gout in older women it tends to affect the distal interphalangeal joints (AID) of the hands (the first knuckles starting from the fingertips).

Key facts about joint pain

  • Acute pain in several joints is most often due to inflammation, gout, or the onset or flare-up of chronic joint disease.
  • Chronic pain in several joints is usually due to osteoarthritis or an inflammatory disorder (such as rheumatoid arthritis) or, in children, juvenile idiopathic arthritis.
  • When a considerable amount of fluid accumulates inside the joint, it must be withdrawn and analyzed.
  • Regular physical activity helps maintain joint mobility in people with chronic arthritis.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.