Reasons, Treatment, and When to Contact a Healthcare Provider

There are many causes of joint pain, and treatments vary depending on the cause. For many people, this is due to some form of arthritis ( inflammation of the joints). For others, such as those with fibromyalgia or an underactive thyroid, the pain occurs without underlying damage or inflammation.

Joint pain can range from mild to severe, with a burning or stinging sensation in one or more joints. In some cases, joint pain is associated with other symptoms such as joint swelling and stiffness, red and hot skin, and whole-body symptoms such as fatigue, weight loss, or fever.

Illustration by Alexandra Gordon, Get Meds Info

Causes associated with arthritis

In the case of joint pain associated with arthritis, the cause of the pain is inflammation and / or damage to the joint space. There are several types of arthritis and their causes vary.

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. OA develops as a result of the destruction of cartilage (which serves as a cushion between the bones of the joint), often as a result of aging. This type of arthritis usually affects the knees, hips, neck, lower back, and fingers.

OA pain, which often progresses from sharp, intermittent pain to persistent pain, increases with movement and decreases with rest. Joint stiffness and limited range of motion are also characteristics of joint pain in OA.

While classic OA is actually non-inflammatory arthritis, an aggressive subtype of OA called erosive osteoarthritis is inflammatory. Erosive OA is more common in postmenopausal women and causes progressive onset of joint pain, stiffness, and swelling in the joints of several fingers .

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Gout is a type of inflammatory arthritis that occurs in some people with high levels of uric acid in the blood. As uric acid builds up, it can form crystals in certain joint spaces, such as the big toe, ankle, or knee.

A classic gout attack is the sudden onset of severe, often burning joint pain that usually occurs in one joint (such as the big toe). Joint pain during a gout attack is often severe and is associated with redness, swelling, and warmth in the joint. Without treatment, an exacerbation can go from three days to two weeks on its own .

The cause of joint pain in gout is due to the rapid inflammatory response of the body's immune system, which tries to digest the foreign and unwanted crystals.

Pseudogout

Pseudogout , also known as calcium pyrophosphate deposition disease (CPPD), is a type of inflammatory arthritis that results from the accumulation of calcium crystals in certain joints, most commonly in the knees, wrists, shoulders, ankles, feet and elbows.

As with gout, the pain in an acute attack of pseudogout is sudden, severe, and is associated with other symptoms such as swelling and warmth in the joints. Unlike gout, pseudogout attacks can last longer before relapsing .

Septic arthritis

In septic arthritis , the joint becomes infected, most often with bacteria and rarely with fungi (such as Candida) or mycobacteria (such as tuberculosis ).

Septic arthritis usually affects a joint, usually the knee, ankle, wrist, or hip. The affected joint is swollen, hot, and stiff, and there is a fever.

In most cases, septic arthritis is caused by a bacterial infection in the blood, which then travels to the joint space. Less often , the cause may be surgery or an injury (such as a tick bite).

Viral arthritis

Several different viruses can cause arthritis . The most common are hepatitis B and C , parvovirus B19 and HIV , and mosquito-borne alphaviruses such as chikungunya virus (CHIKV) .

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that develops gradually over weeks or months. Although the disease predominantly affects the joints, early symptoms may not affect the joints and include:

  • Fatigue
  • Muscle pains
  • Low fever
  • Weightloss
  • Numbness and tingling in the hands.

When the joints are affected, which happens gradually, the first area is usually the small joints on the same side of the body, such as the fingers and toes. Finally, other joints, such as the wrists, elbows, hips, and neck, follow suit .

Joints also tend to get stiff, hot, red, and swollen. Unlike osteoarthritis, the severity of joint pain in RA generally increases in the morning (lasts for more than an hour) and decreases with movement.

Spondyloarthrosis

Spondyloarthritis is a family of inflammatory rheumatic diseases that includes four conditions.

Ankylosing spondylitis (AS)

Ankylosing spondylitis is an axial spondyloarthropathy that mainly affects the back, neck, and sacroiliac joints (which connect the spine to the pelvis).

Joint pain in AD usually begins in early adulthood before age 45, begins gradually, and improves with activity (similar to RA). Morning stiffness lasting more than 30 minutes is also common in AS.

Psoriasic arthritis

Up to 30% of people with psoriasis , a chronic skin condition characterized by thickened patches of skin covered with silver scales, have psoriatic arthritis .

The terminal joints of the fingers and toes are most commonly affected, causing throbbing pain, stiffness, and swelling. Other symptoms can include swollen fingers and toes like hot dogs and nail problems (like nail dimples).

Interestingly, the severity of a person's psoriasis does not correlate with the severity of their arthritis. And about 15% of people experience joint pain before psoriasis appears .

Reactive arthritis

Reactive arthritis is characterized by the development of pain and swelling in the joints one to six weeks after a urinary tract, genital, or intestinal infection .

Specific bacterial organisms associated with the development of reactive arthritis include:

The typical joints affected by reactive arthritis are the knee, ankle, and foot.

Arthritis associated with inflammatory bowel disease (IBD)

Throbbing joint pain and swelling, especially in large joints like the knees and hips, can occur in people with inflammatory bowel disease (IBD), including Crohn 's disease and ulcerative colitis . Arthritis becomes more active when intestinal symptoms get worse .

Systemic lupus erythematosus

Inflammation of the joints, especially the knees, wrists, and finger joints, is common in systemic lupus erythematosus (SLE) , a chronic autoimmune disease that can affect almost every organ in the body.

As with RA, SLE affects the same joints on one side of the body. However, unlike RA, morning stiffness does not last as long (minutes for SLE versus more than an hour for RA). Joint pain is also short-term and migratory, moving from one joint to another within 24 hours .

Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory joint disorder that causes severe muscle and joint pain and stiffness in the shoulders, neck, and hips. Joint swelling and pain can also occur in the wrists and fingers, although they are usually mild. The feet and ankles are never affected, and the disease almost exclusively affects people over 50 years of age .

Interestingly, PMR is associated with another rheumatic disease called giant cell (temporal) arteritis , which is an inflammatory disease of the blood vessels that causes inflammation in the arteries of the scalp and scalp.

Other systemic rheumatic diseases

While it may be hard to believe, the above list is not an exhaustive list of all causes of arthritis. Other less common systemic (whole body) diseases can cause arthritis. Here are some examples:

Causes not related to arthritis

Numerous conditions can cause joint pain that is not related to the underlying disease or joint inflammation.

Fibromyalgia

The predominant symptoms of fibromyalgia , a chronic pain condition, are generalized muscle pain, nerve pain, crippling fatigue, and cognitive dysfunction called fibrous fog . Some people with this condition have joint pain and sometimes mild joint swelling. However, health care providers generally do not detect severe inflammation on physical exam or markers of inflammation on blood tests .

Fibromyalgia pain is associated with nervous system dysfunction and increased nerve sensitivity. Fibromyalgia pain is more likely not related to specific areas of the body, but rather moving from place to place.

Hemarthrosis

Hemarthrosis occurs when there is bleeding in the joint. This can be due to a number of reasons, including trauma, a bleeding disorder such as hemophilia , a postoperative complication, or the growth of a tumor such as synovial hemangioma.

Hypothyroidism

The most common cause of hypothyroidism , an underactive thyroid gland, is Hashimoto's thyroiditis , when your body's immune system attacks your thyroid gland. Hypothyroidism can cause many symptoms, including:

  • Fatigue
  • Weight gain
  • Constipation
  • Cold intolerance
  • Joint pain
  • Rigidity

Lyme's desease

Lyme disease is transmitted through ticks. When Lyme bacteria invade joint tissue, it can cause inflammation and a condition known as Lyme arthritis. The main symptom is swelling in one or more joints, including the knees, shoulder, ankle, elbow, jaw, wrist, and hip.

Depression

You may be surprised to learn that unexplained pain, including joint pain, is the main physical manifestation of depression . Other common symptoms of depression include loss of interest in enjoyable activities, changes in appetite, sleep disturbances, trouble concentrating, and feelings of hopelessness and / or guilt.

When to contact a healthcare provider

A new joint pain is a reason to see a doctor. If you have a painful condition but are experiencing pain in a new area or a completely different type of pain, be sure to make an appointment.

Many people with one pain syndrome develop another. For example, people with rheumatoid arthritis or lupus often develop secondary fibromyalgia .

Seek emergency medical attention if you have severe joint pain or any of the following additional symptoms:

  • Hot
  • Unexplained weight loss
  • Inability to function in daily life due to joint problems.
  • I feel bad
  • Hot or very swollen joint
  • Sudden numbness or burning and / or muscle weakness.

Diagnostics

A complete history is often the key to diagnosing the cause of joint pain. It helps to be as detailed as possible when speaking with your healthcare provider.

In addition, your healthcare provider will perform a complete physical exam and, in some cases, blood tests, imaging, and a joint aspiration procedure. In rare cases, a biopsy (tissue sample) is required.

History of the disease

To determine your diagnosis, your healthcare provider can begin by finding out the exact characteristics of your joint pain:

  • Where exactly does this happen?
  • How severe is joint pain?
  • Does this happen at certain times of the day? After certain activities or periods of rest?
  • What causes or relieves joint pain?

These details can help narrow the range of possible diagnoses.

For example, arthritis associated with gout, pseudogout, or a bacterial infection usually affects one joint at a time, occurs suddenly, and is severe. On the other hand, pain associated with arthritis caused by a systemic disease such as spondyloarthropathy or RA is usually mild and painful, occurs gradually, and affects more than one joint at a time.

While joint pain in osteoarthritis improves at rest and worsens with physical activity, arthritis caused by a systemic connective tissue disease such as rheumatoid arthritis worsens at rest (often in the morning) and improves with physical activity.

Your doctor will also ask if you have a family history of joint pain, especially since certain conditions (such as psoriatic arthritis) tend to be inherited.

Be sure to tell your doctor if you find yourself in any of the following cases:

  • Recent fever
  • Unusual symptoms such as tiredness or unexplained weight loss.
  • Recent trauma
  • Recent surgery
  • Recent viral infection

Physical exam

When examining the joints, your doctor will press on the sore joints, feeling warm, swollen, and tender (signs of inflammation). They will move your joints to see if there is any limited range of motion or crepitus (the popping sound you hear with OA) and will map the distribution of your joint pain to determine if it is symmetrical (affects overlapping joints, for example , both knees) or asymmetric (uneven joint damage, such as one knee but not the other).

Finally, they will perform a complete medical examination looking for various clues, such as:

Laboratories and tests

Often times, the diagnosis can only be made on the basis of the medical history and physical examination (as in the case of OA). However, in some cases, such as suspected systemic disease, tests may be required.

Depending on what your healthcare provider discovers during your medical history and examination, he or she may order different blood tests. For example, if they suspect rheumatoid arthritis, they will test their levels of rheumatoid factor and anti-citrullinated protein (anti-CCP) antibodies.

Other possible blood tests include:

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Imaging tests can be helpful in the diagnostic process, supporting or confirming the diagnosis.

For example, X-rays can reveal osteophytes (bony growths) and joint space narrowing, both classic signs of osteoarthritis. X-rays can also reveal subtle signs of inflammatory arthritis, such as erosion (craters in the bone that result from joint damage).

Other imaging techniques, such as ultrasound, magnetic resonance imaging (MRI) , and computed tomography (CT) , can provide additional information about the joint and surrounding tissues.

Procedures

A joint aspiration procedure (arthrocentesis) involves a healthcare professional, often a rheumatologist , who uses a needle and syringe to remove fluid from the synovium (lining of the joints) of a painful or inflamed joint. The fluid can then be examined under a microscope.

Synovial fluid analysis is helpful in diagnosing conditions such as gout (the presence of urate crystals) and septic arthritis (the presence of a high white blood cell count ).

Less commonly, a rheumatologist removes a tissue sample from the lining of the synovium. This is called a synovial biopsy and can be helpful in diagnosing septic arthritis caused by tuberculosis or fungi.

In some cases, you may need to see a specialist (or more than one) to get an official diagnosis.

Differential diagnosis

Sometimes what is perceived as joint pain is actually due to a condition that is not related to the joints, such as tendonitis , a muscle strain, or a bone fracture. Although rare, bone swelling can even manifest as joint pain.

The good news is that physical exams and imaging tests can usually fix this problem. For example, an X-ray can diagnose a fracture.

Watch out

Once you are diagnosed, you and your healthcare provider can develop a treatment plan that includes medications, as well as self-help strategies, physical therapy, and, rarely, surgery. What you recommend depends on the cause of your joint pain, as protocols vary.

Self-service strategies

As part of your treatment for joint pain, you should be actively involved in improving joint health and overall health. Some self-care strategies to consider under the guidance of your healthcare provider include:

  • Visit your PCP for vaccinations and regular checkups (for example, for osteoporosis , cancer, and depression)
  • Know your diagnosis
  • Daily exercise, both aerobic and strengthening.
  • Eat nutritionally
  • Lose weight if you are overweight or obese

Medicine

Several different medications are used to relieve joint pain, depending on your underlying diagnosis. For example, several different treatments can be used for osteoarthritis, including:

In addition to pain relievers, if you have a systemic illness, you may need medications that disrupt your immune system, such as a tumor necrosis factor (TNF) inhibitor for ankylosing spondylitis and methotrexate for rheumatoid arthritis.

If you have been diagnosed with septic arthritis, you will need to give one or more antibiotics through a vein (intravenously).

Physiotherapy

Physical therapy for joint pain focuses on maintaining joint function and range of motion, strengthening the muscles around the joint, and minimizing joint pain and stiffness. Depending on your condition, a physical therapist may recommend a walking aid, brace, or splint to improve your function.

For people with fibromyalgia, a supervised exercise program is especially important to minimize muscle and joint pain and other symptoms such as fatigue and anxiety.

Alternative and complementary medicine

Various mind and body therapies have been used to relieve joint pain, often in combination with medications and physical therapy. Some of these include:

Additionally, while there has been some enthusiasm for taking glucosamine and chondroitin dietary supplements (or foods that contain them, such as Osteo Bi-Flex ) to repair damaged osteoarthritis cartilage, the current scientific evidence unfortunately does not support this. However, for some people, taking these supplements may provide little pain relief.

In the end, it is best to talk to your doctor about whether they are right for you and whether they are safe.

Operation

Surgical intervention, as a rule, is used for advanced cases of joint pain, for example, with osteoarthritis of the knee or hip joint, which cannot be treated conservatively. In severe cases, a complete joint replacement may be necessary.

An alternative to total knee or hip replacement is knee or hip osteotomy, surgeries that involve cutting and reshaping the bones to relieve pressure on the joint.

Although an osteotomy can delay the need for a joint replacement for several years, candidates are generally only young, active adults with osteoarthritis limited to one side of the knee or people with certain hip problems .

Get the word of drug information

Pain is your body telling you that something is wrong. Joint pain is especially hard to miss, but it serves as a reminder of the importance of visiting a doctor to get a correct diagnosis. The good news is that once the cause is identified, you and your healthcare provider can address and fix the root problem so you can feel and live your best.

Frequently asked questions

  • You may have a temporomandibular disorder (TMJ). The temporomandibular joints are the two joints on either side of the face just below the ears that connect the lower jaw to the skull. There are three types of TMJ, two of which directly affect the joints: internal joint damage, osteoarthritis, and rheumatoid arthritis.

  • In the case of true joint pain (arthralgia), polyarticular joint pain (pain in many joints) is caused by some type of arthritis or other inflammatory disease. Multi-joint pain that occurs outside the joints, such as in a tendon or bursa, can be caused by tendonitis , bursitis, polymyalgia rheumatica , and fibromyalgia .

  • If you experience these symptoms three days in a row or several times a month, make an appointment with your doctor:

    • Pain, swelling, or stiffness in one or more joints
    • Redness, warmth, or pain in one or more joints
    • Decreased mobility.

  • Cold therapy, such as using an ice pack, is often more effective for acute joint inflammation because it reduces blood flow to the affected area. Heat can relieve chronic joint pain by opening blood vessels, allowing blood, oxygen, and nutrients to reach painful joints.

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