Main reasons
Most often, the joint swells after an injury: damage to the ligaments, meniscus, intra-articular fracture is accompanied by effusion or accumulation of blood. The second large group is inflammatory diseases: rheumatoid arthritis, reactive arthritis after intestinal or urogenital infection, psoriatic arthritis, ankylosing spondylitis. Separately, there is gout with violent inflammation, most often of the first metatarsophalangeal joint. Osteoarthritis also causes swelling, but usually moderate and associated with stress. The most dangerous cause is purulent arthritis, which requires immediate intervention.
- Injury: ligaments, meniscus, fracture
- Osteoarthritis with reactive effusion
- Rheumatoid and other autoimmune arthritis
- Reactive arthritis after infection
- Gout and pseudogout
- Suppurative arthritis
- Bursitis and tendonitis of periarticular tissues
What does the picture of edema indicate?
The doctor cares about details that the patient often considers unimportant. If one joint is affected, it often indicates injury, infection, or gout. Symmetrical damage to the small joints of the hands with morning stiffness is characteristic of rheumatoid arthritis. Migrating swelling of different joints occurs with reactive arthritis. Rapid development over hours with severe pain and redness is typical for a gouty attack. A gradual increase in swelling during exercise and a decrease at rest indicates osteoarthritis or overload.
- One joint: injury, gout, infection
- Symmetrically small joints: rheumatoid arthritis
- Migratory lesion: reactive arthritis
- Sharpest pain in hours: gout
- Relationship with load: osteoarthritis and overload
- Damage to joints and skin: psoriatic arthritis
What to do before seeing a doctor
In the first days after an injury or in case of acute swelling, a simple set of measures works: rest for the joint, cold through the tissue for 15–20 minutes several times a day, soft elastic fixation without tightening and an elevated position of the limb. It is better to limit the load, but you should not completely immobilize the joint for a long time. It is impossible to warm the joint, rub it with warming ointments and visit the bathhouse during acute inflammation - this increases the swelling. It is acceptable to take a painkiller once, but it does not eliminate the need for an examination, especially if the swelling does not decrease within 2-3 days.
- Rest and unloading of the joint
- Cold through the cloth without applying ice directly
- Elastic fixation without compression
- Elevated limb position
- Refusal of warming up and massage in the acute period
- See a doctor if swelling lasts longer than 2–3 days
Survey
The examination begins with an examination: the range of motion, the stability of the ligaments, the presence of fluid, and the temperature of the skin over the joint are assessed. Ultrasound shows well the effusion, the condition of the synovial membrane and periarticular structures and allows you to control the puncture. X-rays are needed in case of injury and to assess the condition of the bones and joint space. The tests look at a complete blood count, CRP and ESR as indicators of inflammation, uric acid if gout is suspected, rheumatoid factor and antibodies to CCP if rheumatoid arthritis is suspected. If the diagnosis is unclear and there is a large effusion, a puncture is performed to examine the fluid.
- Examination with assessment of movement and stability
- Ultrasound of the joint
- X-ray of the joint
- Complete blood count, CRP, ESR
- Uric acid
- Rheumatoid factor and antibodies to CCP
- Joint puncture with fluid analysis
Treatment
Treatment is directed to the cause. In case of injury, a load regime, fixation and rehabilitation are selected; in case of damage to the meniscus or ligaments, surgery is discussed. For osteoarthritis, the basis remains weight loss, physical therapy and medications selected by a doctor. Inflammatory arthritis is treated by a rheumatologist, and it is important not to waste time: basic therapy stops the destruction of the joints. Gout is treated by stopping the attack and then continuously reducing uric acid. Purulent arthritis requires urgent drainage and antibiotics in the hospital. Large intense effusion is removed by puncture.
- Unloading and rehabilitation after injury
- Physical therapy and weight loss
- Anti-inflammatory therapy as prescribed by a doctor
- Basic therapy for autoimmune arthritis
- Reducing uric acid levels in gout
- Joint puncture for tense effusion
- Urgent treatment of purulent arthritis in a hospital