Joint pain(arthralgia) can occur in one or more joints (polyarthralgia). Arthralgias occur in rheumatic, endocrine, infectious, tumor, neurological, autoimmune diseases, injuries, overweight. Finding the cause of joint pain has an important differential diagnostic value; it is performed by X-ray, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). The treatment of arthralgia comes down to treating the disease that caused it. Symptomatic measures (analgesics, local heat, ointments), immobilization, physiotherapy, surgical interventions are applied.
Classification
Arthralgias differ in location and depth, number of affected joints, nature and intensity of pain syndrome, its daily rhythm, duration of existence, connection with a certain type of movement. In the presence of pain in one joint, they speak of monoarthralgia, with simultaneous or consecutive pain syndrome in several joints - oligoarthralgia, with involvement of 5 or more joints - polyarthralgia syndrome.
According to the nature of the arthralgic syndrome, there are acute and dull pain; by intensity - from weak and moderate to intense; according to the type of flow - transient and constant. More often arthralgia occurs in large joints - hip, knee, shoulder and elbow, less often in the middle and small - wrist, ankle, interphalangeal.
The appearance of joint pain is facilitated by irritation of the neuroreceptors of the synovial membranes of the joint capsules by mediators of inflammation, products of immune reactions, salt crystals, toxins, osteophytes. In rheumatology, it is common to distinguish the following types of joint pain:
- caused by toxic syndrome in acute infections;
- primary episode or intermittent arthralgia in acute or recurrent arthritis;
- long-term monoarthralgia of large joints;
- oligo- or polyarthralgic syndrome that accompanies synovial membrane involvement or progressive degenerative-dystrophic changes in cartilage;
- residual postinflammatory or posttraumatic arthralgia in the joints;
- pseudoarthralgia.
Why do my joints hurt
Common infectious diseases
Arthralgic syndrome often accompanies the course of acute infections. Joint pain can be noticed both in the prodromal period of the disease and in the early clinical phase, it occurs with fever and intoxication. The infectious form of arthralgia is characterized by "pain" in the joints of the lower and upper extremities, the polyarticular nature of the pain, and their association with myalgia. Mobility in the joint is completely preserved. Infectious arthralgia usually disappears within a few days as the toxic syndrome caused by the underlying disease weakens.
Infectious arthritis
Possible options for the development of post-infectious reactive arthralgia after acute intestinal or urogenital infections; parainfectious arthralgic syndrome caused by tuberculosis, infectious endocarditis, secondary syphilis. Often the cause of joint pain is the focus of existing chronic infections - pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasitic invasion.
Residual arthralgias after arthritis are chronic or transient. Joint pain and stiffness can last for weeks or months; in the future, the well-being and functions of the limbs are completely restored. In the chronic form of arthralgia, its exacerbations are associated with overexertion, meteorological lability, and hypothermia.
Rheumatic diseases
Poly- or ologarthralgia joint pain is a major symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by constant, intense, migrating pain syndrome, involvement of large joints, mainly the lower extremities, limited movement in the joints.
The onset of rheumatoid arthritis, as well as systemic rheumatic diseases, is manifested by polyarticular syndrome involving small symmetrical joints of the feet and hands, motor stiffness in the morning.
In microcrystalline gouty arthritis, arthralgia manifests itself in the form of recurrent paroxysmal pain in an isolated joint, which, suddenly arising, quickly peaks and does not subside for several days.
Degenerative joint lesions
Gradually increasing pain in the joints over a long period of time may indicate deforming osteoarthritis and other degenerative-dystrophic lesions. In this case, knee or hip joints are typically involved; dull, aching, a type of pain associated with exercise and their disappearance at rest. Arthralgia may be weather-dependent, accompanied by "crunching" of the joints during movement, and weakening when local distraction therapy is used.
Joint injuries
Bruises, sprains of the joints, damage to the ligament apparatus, intra-articular fractures are accompanied by severe pain. The affected joint becomes swollen, deformed, hot to the touch. The supporting function of the lower extremity is impaired, movement in the joint is difficult, and sometimes pathological mobility occurs. Injuries can be accompanied by bleeding into the joint cavity, which leads to its stiffness.
Oncological diseases
Persistent oligo- and polyarthralgia of long course, accompanied by the formation of "Hippocratic fingers" (deformities of the nails and distal phalanges such as "watch glass" and "stick drum"), indicate a paraneoplastic lesion of the synovial membranes. In such patients, oncological pathology of internal organs should be suspected, primarily lung cancer.
Endocrine diseases
Common causes of joint pain are endocrine disorders - primary hyperparathyroidism, ovarian dysfunction, hypothyroidism, obesity. The articular syndrome of endocrine genesis runs in the form of oligoarthralgia associated with osalgia, myalgia, pelvic and spinal pain.
Other reasons
Other possible causes of arthralgia include:
- heavy metal intoxication (thallium, beryllium);
- frequent overload or microtrauma of the joints;
- long-term drug therapy;
- post-allergic reactions;
- flat feet;
- Deformation of limbs in the shape of the letter X or O;
- pseudoarthralgia, simulated by primary osalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Diagnosis
Since joint pain is only a subjective symptom, clinical-anamnestic characteristics and physical examination come to the fore when determining the cause of their occurrence. It is necessary to consult a rheumatologist, orthopedist. In order to differentiate the etiology of arthralgia, a number of objective studies are being conducted:
- X-ray of the joints. It is a routine method that allows you to examine all the joints in various diseases. Most often, radiography is performed in one or 2 projections, it is also possible to study in a special styling, perform contrast arthrography. A more detailed picture of the condition of osteochondral and soft tissue of the joints is available with CT and MRI images.
- Ultrasound of the joints.It allows you to detect effusions in the joint cavity, bone erosion, changes in the synovial membrane, measure the width of the joint space. The availability of ultrasound makes it indispensable for the diagnosis of rheumatic joint pathologies.
- invasive methods.According to the indications, a puncture of the joint and a biopsy of the synovial membrane are being performed. In controversial cases, diagnostic arthroscopy is performed, which enables examination of the joint cavity from the inside, and implementation of diagnostic and therapeutic measures.
- Laboratory tests.It helps to recognize the presence of an inflammatory process,rheumatic diseases. Peripheral blood determines ESR, level of C-reactive protein, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ACCP). An important diagnostic method is microbiological and cytological examination of synovial fluid.
- Additional diagnostic methods:thermography, podography.
Treatment
Help before diagnosis
For any pain in the joints, it is necessary to stay calm and not burden the limb. Metabolic causes of arthralgia dictate the need for a balanced diet, normalization of body weight. In case of fresh injuries, it is necessary to apply cold to the wrist, immobilize the injured limb with a splint or fixing bandage. You can take painkillers or NSAIDs.
Neglecting the competent examination and treatment of arthralgia is fraught with the development of irreversible functional disorders of the joints - stiffness, ankylosis, contractures. Since joint pain can serve as a marker of various diseases, it is necessary to consult a doctor if joint syndrome occurs and lasts longer than 2 days.
Conservative therapy
In the treatment of joint pain the main role is to treat the leading pathology. Arthralgia treatment with drugs is aimed at stopping inflammatory intra-articular processes and pain. Systemic therapy involves the use of nonsteroidal anti-inflammatory drugs.
With moderate arthralgia or the presence of contraindications for oral administration of drugs, local external therapy with heating, anti-inflammatory and analgesic ointments is carried out. Dimethyl sulfoxide coatings are applied to the joint area. Joint gymnastics, physiotherapy procedures (drug electrophoresis, magnetotherapy, phonophoresis, UHF therapy) are recommended.
If necessary, periarticular blockades, intra-articular injections of glucocorticoids, chondroprotectors, synovial fluid prostheses are performed. Modern methods of treatment of promising chronic joint pathologies are ozone therapy, plasmolifting of joints and orthokin therapy.
Operation
Different types of surgical interventions are justified in joint pain caused by injuries, as well as in chronic diseases that lead to loss of joint function. They can be performed by open (arthrotomy) or endoscopic (arthroscopy) methods. Depending on the cause of the disease, the following are done:
- arthroplasty;
- arthrodesis;
- ligament plastic;
- joint cavity repair;
- removal of pathological formations (cysts, intra-articular bodies);
- synovectomy;
- joint arthroplasty.