Joint Pain

The joint is the point of meeting of bones in the body and plays an important role in the movement of the skeleton. Shoulder, hip, knees, and elbow represent different types of joints in the body.

Joint pain is a common complaint and it can be just pain or pain associated with inflammation. Joint pain or arthralgia may occur during rest or during an activity that involves the joint.

In some cases, the joint may also be inflamed, associated with warmth, pain, and swelling in the affected joint. Inflammation of the joint is referred to as arthritis.

Pain may also be due to some of the tissues surrounding the joint, including ligaments, tendons, bursae, and muscles. Polyarthralgia refers to pain in multiple joints of the body. The pain in polyarthralgia may be due to different joints at a different time. 

Pain in the joint may originate from the articular sources within the joint or from structures surrounding the joint. The main sources of pain in the joint are synovium and joint capsule. Pain can be mild, causing soreness in the affected joint.

This may affect only during an activity that involves the joint. Severe pain in the joint limits the movement of the affected region. This is particularly true of joints that bear weight, and it can be extremely painful in some cases.

Medical attention is warranted if the joint pain is sudden and is associated with many other symptoms. Swelling, reddishness, tenderness, and warmth in the affected joint need doctor’s visit.

Immediate medical attention is required if the onset of pain is after a serious injury, or if the affected joint is deformed. Severe joint pain, sudden swelling in the joint, and inability to move the joint, all need an emergency medical visit.

One of the most common causes of joint pain is arthritis. Arthritis is of two types – osteoarthritis and rheumatoid arthritis. Osteoarthritis affects people above 40 years of age and is a progressive condition.

It commonly affects wrists, hands, hips, and knees. Rheumatoid arthritis leads to pain, inflammation, and buildup of fluid in the affected joint. It is caused by an abnormal response of the immune system that attacks the linings of joints.

Joint pain may also be caused by several other factors like: 

• Injury
• Inflammation of bursae
• Autoimmune diseases like lupus
• Certain infections like mumps, influenza, and hepatitis
• Gout
• Breakdown of cartilage in knee
• Infection of bone
• Overuse of joint
• Inflammation of tendon
• Osteoporosis
• Sarcoidosis
• Rickets
• Cancer
• Fibromyalgia

The cause of joint pain is evaluated based on a review of symptoms, medical history, and physical examination. Imaging studies are helpful in assessing the damage to joints.

Blood tests are used to screen for autoimmune disorders that may lead to joint pain. The level of inflammation is assessed using erythrocyte sedimentation rate. Complete blood count is used to check for the underlying cause of pain in the joints.

Chronic conditions like rheumatoid arthritis and osteoarthritis are managed by topical pain relievers and nonsteroidal anti-inflammatory medications. Moderate exercise, maintaining healthy body weight and reducing the strain on joints help to alleviate pain due to arthritis.

Medical treatment for joint pain depends on the cause. Draining the accumulated fluid and surgical repair are recommended depending on the cause of pain. Medications and lifestyle changes are also used to treat joint pain.

Pain in multiple joint is mostly associated with inflammation caused by systemic infections or an inflammatory disorder. In some cases, arthritis may resolve before identifying the actual cause of the condition.

Acute inflammation of multiple joints is often caused by infection, systemic inflammatory disorder, or gout. Chronic pain in the joints results from rheumatoid arthritis and seronegative spondyloarthropathy.

Some of the causes of pain in multiple joints include:

• Acute rheumatic fever – it usually affects large joints in legs and elbows. This condition causes other manifestations like fever, rashes, and cardiac dysfunction.
• Hemoglobinopathies – diseases like sickle-cell anemia or thalassemia cause pain in joints.
• Hypermobility syndromes – conditions like Ehlers-Danlos syndrome and Marfan syndrome results in polyarthralgia.
• Bacterial infection – this often causes severe inflammation and pain. It is also characterized by joint effusions.
• Viral infections – hepatitis B and C, enterovirus, rubella, mumps, and HIV infections are known to cause multiple joint pain.
• Juvenile idiopathic arthritis – this has childhood onset of pain and is characterized by other symptoms like fever, rashes, and adenopathy.
• Psoriatic arthritis – this condition is similar to rheumatoid arthritis and osteoarthritis.
• Serum sickness – it causes joint pain, rather than inflammation. Fever, rashes, and lymphadenopathy are also associated with this condition.
• Systemic lupus erythematosus (SLE) – manifestations of glomerulonephritis, rashes, and oral ulcers are common symptoms of SLE along with joint pain.
• Ankylosing spondylitis – this condition causes axial pain and stiffness, along with other manifestations like uveitis. It is more commonly seen among young adults.
• Behçet syndrome – it may result in arthralgia or joint inflammation. Recurrent lesions in genitalia and oral cavity are common in this syndrome.
• Gout or pseudogout – it is characterized by acute onset of joint inflammation. The affected joint will be warm and swollen.
• Infective endocarditis – this causes both inflammation and pain in the joints. Other systemic symptoms like fever, rashes, loss of weight, night sweats, and heart murmur are also seen.
• Reactive arthritis – it affects the joints in the lower extremity. It may be associated with inflammatory bowel disease and chronic arthritis.
• Osteoarthritis – it is associated with pain in thumbs, knees, and hips.

Some of the causes of pain in and around single joint include:

• Hemarthrosis – this is associated with acute pain and effusion that follows trauma in a joint.
• Infections – Bacterial, viral, fungal, and mycobacterial infections may cause acute pain, swelling, and warmth in the affected joint. It may also affect the range of motion of the joint.
• Lyme disease – joint pain is usually seen in the later stages of Lyme disease.
• Osteoarthritis – this is commonly seen in older adults where chronic pain may or may not be associated with swelling in a joint.
• Osteonecrosis – this is caused by sickle cell disease or long-term use of corticosteroids
• Periarticular disorders – bursitis, tendonitis, tendinitis, and epicondylitis cause pain during movement of joint. Pain often reduces with rest of the affected joint.
• Psoriatic arthritis – it is associated with psoriasis and is characterized by pain and effusion in the joint
• Trauma – recent trauma to the joint may result in a sprain, fracture or meniscal tear.
• Tumor – it is a progressive condition, leading to constant pain. It is usually associated with swelling of the joint.

Evaluation of the cause of joint pain is based on a review of medical history, symptoms, and physical examination. Review of history helps to identify the characteristics of joint pain and other symptoms.

Characteristics that are important in diagnosis are the onset of pain, the pattern of pain, duration, and factors that worsen or improve the symptom. Pain and swelling may have sudden or gradual onset.

The pain may worsen during activity or improve with rest, and some in others pain may be worst early in the morning. Past medical history of the person may give clues on inflammatory disorders and other medical conditions.

A thorough evaluation of all organs is done during physical evaluation. This includes nail, skin, genitals, heart, lungs, abdomen, and lymph nodes. Vital signs of the person are also reviewed.

Important tests used in the identification of cause are:

• Arthrocentesis
• Blood tests, particularly erythrocyte sedimentation rate and C-reactive protein
• Serologic testing
• Imaging studies

Arthrocentesis is used to rule out infections and accumulation of crystals in the joint. It also helps to distinguish inflammatory and non-inflammatory causes of the condition. Synovial fluid is checked for levels of WBCs, gram stain cultures, and the presence of crystals.

ESR and C-reactive protein tests are suggestive of inflammatory conditions that cause joint pain. Serologic testing is used to test for antinuclear antibodies, rheumatoid factor, and antineutrophil cytoplasmic antibodies. In chronic arthritis imaging studies like x-ray are used to detect the extent of joint damage.

Both osteoarthritis and rheumatoid arthritis are associated with pain which cannot be prevented. Many home remedies and treatment may be helpful in alleviating pain associated with the conditions.

Pain due to these conditions can be managed by: 

• Taking topical painkillers and non-steroidal anti-inflammatory medications that help in alleviating swelling and inflammation.
• Being physically active and engaging in moderate exercise
• Stretching before the exercise to improve the range of movement of joints
• Maintaining healthy body weight
• Having a warm bath, massage and adequate rest

Medications suggested for controlling joint pain depend on the underlying condition. If the fluid has accumulated in the joint, draining the same helps to reduce pain. Surgical repair may be the option for some conditions if the damage is severe.

Medications and lifestyle changes are also suggested to relieve pain and inflammation. In the case of rheumatoid arthritis, reducing inflammation is the first step in treatment. Once the condition is in remission, medications are used to prevent flare-ups.

For joint pain caused by inflammatory diseases, heat or cold therapy may help in reducing pain. If the pain of the joint is without inflammation, acetaminophen is recommended for relieving pain. Physical therapy and joint rehabilitation may also be suggested.