Joint pain

1
Joint pain
2
Joint pain is discomfort that arises from any
joint the point where two or more bones meet.
Joint pain is sometimes called arthralgia.
Joint pain can be mild, causing some soreness
each time you move your joint. Or joint pain can
be severe, making it impossible to use your joint.
Definition
Joint pain can be aggravated by motion, pressure,
or weight-bearing resistance with activity. Joint
pain can be associated with local warmth,
swelling, and tenderness. Joint pain is rarely an
emergency. Most cases of mild joint pain can be
successfully managed at home.
Joint Anatomy
A typical joint is composed of bones that are
sepa- rated by cartilage that serves as
cushioning pad for the adjacent bones. Ligaments
attach bone to bone around the joint. Bursae are
?uid-?lled sacs that provide a gliding surface
for adjacent tendons. Tendons attach muscle to
bone around the joint. Injury or disease of any
of the joint structures can lead to pain in the
join.
3
Causes
Di?erent disorders tend to a?ect di?erent numbers
of joints. Because of this, doctors consider
di?erent causes of pain when the pain a?ects one
joint than when it a?ects more than one joint.
When multiple joints are involved, some disorders
are more likely to a?ect the same joint on both
sides of the body (for example, both knees or
both hands) than other disorders. This is termed
symmetric arthritis. Also, in some disorders, an
attack of arthritis remains in the same joints
throughout the attack. In other disorders, the
arthritis moves from joint to joint (migratory
arthritis).
PAIN IN JUST ONE JOINT Worsening of
osteoarthritis In older people, joint pain that
gets steadily worse is usually a sign of
osteoarthritis, which is the most common type of
arthritis in the world. It may a?ect just one
joint, or many. Osteoarthritis causes pain and
sti?ness because it damages the protective
surface of the bones and cause mild swelling of
the tissues in and around the joint. It can
sometimes a?ect younger people, especially those
who are overweight or those who have had
serious injuries to the joint in the past. You
should see your GP if you think this is the cause
of your joint pain
4
Causes
In?ammation of the joint lining If you've injured
the joint recently and it suddenly becomes
painful again, the cause could be in?ammation of
the thin layer of tissue lining the joints and
tendons - a condition called traumatic synovitis.
It usually does not to cause any redness or
heat. You should be able to manage injury-related
swelling at home with anti-in?ammatories, an
icepack and rest. Gout or pseudogout If the skin
over the joint is hot and red, and the pain comes
in repeated attacks, the cause is likely to be
gout or pseudogout, which are types of
arthritis. Gout is caused by a build-up of uric
acid (a waste product) in the body. Uric acid
builds up if the kidneys do not excrete it
properly or if too much is produced. If the level
becomes very high, crystals form in the joints.
The crystals cause the joints to become
in?amed and severely painful. You will barely be
able to move the joint and may have a slight
fever. Gout usually a?ects the joint of the big
toe ?rst, before a?ecting other joints. It's
important to correctly diagnose gout, as
treatment will prevent future attacks of joint
pain and disability. Pseudogout is a similar
condition to gout, in that crystals of calcium
are deposited in and around the joint. However,
unlike gout, pseudogout can a?ect the knee joint
?rst. You should see your GP if you think you
have either condition.
5
Causes
Bleeding into the joint space If you have
recently had an injury to the knee joint, such as
a torn ligament or knee fracture, it may cause
bleeding into the joint spaces. This is known as
haemarthrosis. This is more likely to happen to
people on anticoagulants, such as warfarin. Signs
of haemarthrosis are swelling of the knee,
warmth, sti?ness and bruising, which occur soon
after the injury. You should go to hospital
immediately for treatment if you have a very
swollen knee.

• Less common causes
• Sudden pain in a joint is less commonly caused
  by
• a bone fracture
• joint discloation
• Osgood-Schlatter's disease (swelling and
  tenderness over the bony bump just below the
  kneecap)
• septic arthritis a serious condition that
  causes a painful, hot, swollen joint that you
  won't be able to
• move (sometimes with fever) see your GP
  urgently or go to AE

6
Causes
PAIN IN MANY JOINTS Osteoarthritis In older
people, the commonest cause of joint pain is
osteoarthritis. This may a?ect just one joint, or
many. Many people also have rheumatoid arthritis
at the same time. Rheumatoid arthritis Rheumatoid
arthritis is another type of arthritis that
causes pain and swelling in the joints most
commonly the hands, feet and wrists. The pain may
come and go in the early phases, with long
periods between attacks. It can leave you feeling
generally unwell and tired. Psoriatic
arthritis Psoriatic arthritis a?ects up to one in
?ve people with psoriasis. This type of arthritis
is unpredictable, but ?are-ups can be usually be
managed with treatment. Like other types of
arthritis, it means that one or more of your
joints are in?amed and become swollen, sti?,
painful and di?cult to move.
7
Causes
A viral infection that causes arthritis Examples
are viral hepatitis (liver in?ammation caused by
a virus) and rubella (a viral infection that used
to be common in children), which can both cause
pain in the joints and symptoms of a fever.

• A disease of the connective tissue
• Widespread joint pain is sometimes a sign of a
  disease that a?ects almost all the organs of the
  body, such as
• lupus where the immune system mistakenly
  attacks healthy cells, tissue and organs
• scleroderma where the immune system attacks
  connective tissue underneath the skin, causing
  hard, thickened areas of skin
• Less common causes
• Widespread joint pain can less commonly be caused
  by
• a rarer type of arthritis such as anklyosing
  spondylitis, juvenile arthritis or reactive
  arthritis
• Behçets syndrome a rare and poorly understood
  condition that causes in?ammation of the blood
  vessels
• some treatments including steroid therapy,
  isoniazid and hydralazine
• hypertrophic pulmonary osteoarthropathy a rare
  disorder that causes clubbing of the ?ngers, seen
  in people with lung cancer
• sarcoidosis a rare condition that causes small
  patches of tissue to develop in the organs

8
Diagnostic
Doctors ?rst ask questions about the person's
symptoms and medical history. Then they do a
physical examination. Doctors ask about pain
severity, onset , how symptoms vary over time,
and what increases or decreases pain . They ask
about joint sti?ness and swelling, previously
diagnosed joint disorders, and risk of exposure
to sexually transmitted diseases and Lyme disease.

• Doctors then do a complete physical examination.
  They check all joints (including those of the
  spine) for swelling, redness, warmth, tenderness,
  and noises that are made when the joints are
  moved (called crepitus). The joints are moved
  through their full range of motion. This
  examination helps determine which structure is
  causing the pain and if in?ammation is present.
  They also check the eyes, mouth, nose, and
  genital area for sores or other signs of
  in?ammation. The skin is examined for rashes.
• Lymph nodes are felt and the lungs and heart
  examined. Doctors usually test function of the
  nervous
• system so that they can detect disorders of the
  muscles or nerves.
• Tests that may be done include
• Tests of joint ?uid
• Blood tests for autoantibodies
• Erythrocyte sedimentation rate (ESR) and
  C-reactive protein

9
Diagnostic
If joints are swollen, doctors usually insert a
needle into the joint to take a sample of the
?uid in the joint for testing (a procedure called
joint aspiration or arthrocentesis). Doctors also
often do blood tests for autoantibodies. Examples
of such tests are antinuclear antibod- ies,
antidouble-stranded DNA, anticyclic
citrullinated peptide, and rheumatoid factor.
Autoantibodies in the blood may indicate an
autoimmune disorder such as rheumatoid arthritis
or systemic lupus erythematosus.
The ESR is a test that measures the rate at which
red blood cells settle to the bottom of a test
tube containing a blood sample. Blood that
settles quickly typically means that bodywide
(systemic) in?am- mation is likely, but many
factors can a?ect the ESR test including age and
anemia, so the test is some- times inaccurate. To
help determine whether bodywide in?ammation is
present, doctors sometimes do another blood test
called C-reactive protein (a protein that
circulates in the blood and dramatically
increases in level when there is in?ammation) in
addition to the ESR test. Imaging tests are
sometimes necessary, especially if there is a
possibility of bone or joint tumors. X-rays are
done ?rst, but sometimes computed tomography (CT)
or magnetic resonance imaging (MRI) is needed.
10
Treatment
The underlying disorder is treated. For example,
people with an autoimmune disorder (such as
systemic lupus erythematosus) may need a drug
that suppresses the immune system. People with a
gonorrhea infection in the joint need
antibiotics. Septic arthritis often requires
surgery.

• Symptoms can usually be relieved before the
  diagnosis is known.
• For moderate-to-severe joint pain with swelling,
  an over-the-counter or prescription nonsteroidal
  anti-in?ammatory drug (NSAID) such as aspirin,
  ibuprofen (Advil, Motrin), or naproxen sodium
  (Aleve), can provide relief. A newer generation
  of NSAIDs known as Cox-2 inhibitors (Celebrex) is
  also good for pain relief.
• If you have milder pain without any swelling,
  acetaminophen (Tylenol) can be e?ective. .
• If your pain is so severe that NSAIDs and Cox-2
  medicines aren't e?ective enough, your doctor may
  prescribe a stronger opioid medication. Because
  opioid drugs can cause drowsiness, you should
  only use them under a doctor's care.

11
Treatment

• Immobilizing the joint with a splint or sling can
  sometimes relieve pain.
• Applying heat (for example, with a heating pad)
  may decrease pain by relieving spasm in the
  muscles around joints (for example, after an
  injury). Applying cold (for example, with ice)
  may help relieve pain caused by joint
  in?ammation. Heat or cold should be applied for
  at least 15 minutes at a time to allow deep
  penetration. The skin must be protected from
  extremes of heat and cold. For example, ice
  should be put in a plastic bag and wrapped in a
  towel.

After the acute pain and in?ammation have
lessened, physical therapy may be useful to
regain or maintain range of motion and strengthen
surrounding muscles. In people with chronic
arthritis, contin- ued physical activity is
important to prevent permanent joint sti?ness
(contractures) and muscle loss (atrophy). Alternat
ive medical practices such as acupuncture and
yoga can also help alleviate pain and prevent it.