Joint pain (arthralgia) can occur in a single joint or simultaneously in several joints (polyarthralgia). Arthralgia is seen in rheumatic, endocrine, infectious, tumor, neurological, autoimmune diseases, trauma, overweight. Finding the causes of joint pain has an important differential-diagnostic significance; it is carried out with the help of X-ray, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). Treatment of arthralgia is limited to the treatment of the underlying disease. Symptomatic measures are used (analgesics, local heat, ointments), immobilization, physiotherapy and surgical interventions.
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Arthralgia differs in localization and depth, the number of joints involved, the nature and intensity of the pain syndrome, its daily rhythm, duration of existence, and its association with a particular type of movement. In the presence of pain in a single joint, monoarthralgia is referred to as monoarthralgia; in simultaneous or consecutive pain syndrome in several joints, oligoarthralgia is referred to as polyarthralgia; in involvement of 5 or more joints, polyarthralgia syndrome is referred to.
According to the nature of the arthralgic syndrome, a distinction is made between acute and dull pain; according to intensity – from mild and moderate to intense; according to the type of course – transient and persistent. Most often arthralgia occurs in large joints – hips, knees, shoulders and elbows, less often in medium and small – wrists, ankles, interphalangeal joints.
The occurrence of pain in the joints is facilitated by irritation of neuroreceptors of synovial membranes of joint capsules by inflammatory mediators, products of immune reactions, salt crystals, toxins, osteophytes. In rheumatology it is customary to distinguish the following types of joint pain:
Caused by a toxic syndrome in acute infections;
primary episode or intermittent (intermittent) arthralgia in acute or recurrent arthritis;
long-standing monoarthralgia of large joints;
oligo- or polyarthralgic syndrome accompanying synovial involvement or progressive degenerative-dystrophic cartilage changes;
residual post-inflammatory or post-traumatic arthralgia in the joints;
Why the joints hurt
General infectious diseases
Arthralgic syndrome often accompanies the course of acute infections. Joint pain can occur both in the prodromal period of the disease and in the early clinical stage 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 its conjugation with myalgia. Joint mobility in this case is completely preserved. Usually arthralgia of infectious nature disappears within several days as the toxic syndrome caused by the underlying disease weakens.
Possible variants of the development of postinfectious 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 a nidus of an existing chronic infection – pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasitic infestation.
Residual arthralgias after joint inflammation are chronic or transient. Pain and stiffness in the joints may persist for weeks or months; thereafter, the well-being and function of the extremities are fully restored. With the chronic form of arthralgia, its exacerbations may be associated with overexertion, meteolability, or hypothermia.
Joint pain in the type of poly- or ologarthralgia is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgias are characterized by persistent, intense, migratory pain syndrome, involvement of large joints of mainly lower limbs, limited joint motion.
The debut of rheumatoid arthritis, as well as systemic rheumatic diseases are manifested by polyarticular syndrome involving small symmetrical joints of the feet and hands, motor stiffness in the morning.
In microcrystalline gouty arthritis, arthralgia is manifested as recurrent attacks of pain in an isolated joint, which, when suddenly arising, quickly reach peak intensity and do not subside for several days.
Degenerative joint lesions
Gradually increasing joint pain over a long period of time can indicate deforming osteoarthritis and other degenerative-dystrophic lesions. In this case, involvement of the knee or hip joints is typical; dull, aching, load-related type of pain and its disappearance at rest. Arthralgia can be weather-dependent, accompanied by “crunching” of the joints while moving, and can subside with the use of local distraction therapy.
Contusions, joint dislocations, ligament apparatus injuries, and intra-articular fractures are accompanied by a pronounced pain syndrome. The affected joint becomes swollen, deformed, and hot to the touch. Supporting function of the lower extremity is disturbed, movements in the joint are hampered, and sometimes there is pathological mobility. Trauma may be accompanied by hemorrhage in the joint cavity, which leads to stiffness of the joint.
Persistent oligo- and polyarthralgias of a long course, accompanied by the formation of “Hippocratic fingers” (deformities of nails and distal phalanges similar to “watchglasses” and “drumsticks”), indicate paraneoplastic lesion of synovial membranes. In such patients, cancerous pathology of internal organs, primarily lung cancer, should be suspected.
Common causes of joint pain are endocrine disorders – primary hyperparathyroidism, ovarian dysfunction, hypothyroidism, obesity. Joint syndrome of endocrine genesis occurs in the form of oligoarthralgia, associated with ossalgia, myalgia, pelvic bone pain and spine pain.
Other possible causes of arthralgia include:
- Intoxication by heavy metals (thallium, beryllium);
- Frequent overloading or microtrauma of the joints;
- prolonged drug therapy;
- post allergic reactions;
- X-shaped or O-shaped limb deformities;
- pseudoarthralgia simulated by primary ossalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Since joint pain is only a subjective symptom, clinical and anamnestic characteristics and physical examination are of primary importance in determining its cause. Consultation with a rheumatologist or orthopedist is necessary. In order to differentiate the etiology of arthralgia, a number of objective examinations are performed:
Radiography of the joints. It is a routine method that allows the examination of any joints in various diseases. Most often x-rays are taken in one or two projections, it is also possible to study in special layouts, contrast arthrography. A more detailed picture of the state of bone, cartilage and soft tissue joints is available with CT and MRI-visualization.
Ultrasound of joints. Allows you to detect effusion in the joint cavity, bone erosions, changes in the synovial membrane, and measure the width of the joint gaps. Availability of sonography makes it indispensable for diagnosing rheumatic joint pathologies.
Invasive methods. When indicated, the puncture of the joint, biopsy of the synovial membrane. In controversial cases, diagnostic arthroscopy is performed, which allows to inspect the joint cavity from the inside, to carry out diagnostic and therapeutic measures.
Laboratory tests. Help determine the presence of inflammation, rheumatic diseases. In peripheral blood, they determine the sedimentation rate, the level of C-reactive protein, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ADCP). Microbiological and cytological examination of synovial fluid is an important diagnostic method.
Additional diagnostic methods: thermography, subgraphy.
Help before diagnosis
For any joint pain, it is necessary to rest and not to strain the limb. Metabolic causes of arthralgias dictate the need for a balanced diet and weight normalization. With fresh injuries it is necessary to apply cold to the joint, immobilize the injured limb with a splint or fixation bandage. It is allowed to 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, and contracture. As joint pain can be a marker of a variety of diseases, it is necessary to consult a doctor when joint syndrome occurs and persists for more than 2 days.
In the treatment of joint pain, the main role is given to the treatment of the underlying pathology. Medication treatment of arthralgia is aimed at stopping the inflammatory intra-articular processes and pain syndrome. Systemic therapy includes the use of nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac, naproxen, nimesulide).
If the arthralgia is moderate or there are contraindications to oral medication, local external therapy with warming, anti-inflammatory and analgesic ointments containing diclofenac, ketoprofen, turpentine ointment is carried out. Applying applications with dimethyl sulfoxide on the joint area. Recommended joint exercises, physical therapy procedures (drug electrophoresis, magnetic therapy, phonophoresis, DMV therapy).
If necessary, periarticular blocks, intraarticular injections of glucocorticoids, chondroprotectors, prosthetic synovial fluid are performed. Promising modern methods of therapy of chronic joint pathologies are ozone therapy, joint plasmolifting, and orthokine therapy.
Various types of surgical interventions are justified for joint pain caused by trauma, as well as chronic diseases leading to loss of joint function. They can be performed by open (arthrotomy) or endoscopic (arthroscopy) methods. Depending on the causative disease, they are performed:
- Sanation of the joint cavity;
- removal of pathological masses (cysts, intraarticular bodies);
- joint endoprosthetics.
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