What does joint pain mean?
The cartilage itself has no nerve endings, so the pain comes from other structures: the synovium, capsule, ligaments, tendons, underlying bone and surrounding muscles. That is why pain in the joint area does not always mean damage to the joint itself - often the source is nearby. For example, shoulder pain is more likely to be related to the rotator cuff tendons, hip pain is more likely to be due to trochanteric bursitis, and knee pain in a teenager may come from the tibial tuberosity. A separate situation is referred pain: a problem in the spine or hip joint can be felt in the knee.
- Source of pain - capsule, ligaments, tendons, bone
- Cartilage has no nerve endings
- Periarticular structures are often the real cause
- Possible referred pain from the spine
- Knee pain may originate from the hip joint
Possible reasons
Mechanical causes are the most common: overload during unusual work or training, microtrauma, tendonitis, bursitis, initial osteoarthritis. Inflammatory causes include rheumatoid arthritis, psoriatic and reactive arthritis, and systemic connective tissue diseases. Metabolic - gout with severe attacks and increased uric acid. Infectious - viral arthralgia with influenza, parvovirus infection, hepatitis, as well as septic arthritis as an emergency condition. It is also worth remembering about hypothyroidism, vitamin D deficiency and medicinal causes, such as pain when taking statins or after discontinuation of glucocorticosteroids.
- Overload, microtraumas, tendonitis and bursitis
- Osteoarthritis
- Rheumatoid, psoriatic, reactive arthritis
- Gout
- Viral infections
- Septic arthritis
- Hypothyroidism and vitamin D deficiency
- Fibromyalgia
- Side effects of drugs
What to pay attention to
An accurate description is very helpful to the doctor. It is important how many joints hurt: one, two to four or more than five, whether they are symmetrically affected, whether large or small joints are involved. The key symptom is morning stiffness: short, up to fifteen minutes, characteristic of mechanical causes and arthrosis, long-term, from half an hour or more, indicates an inflammatory disease. Pay attention to what relieves pain: with arthrosis, rest helps, with inflammatory arthritis, on the contrary, movement. Finally, accompanying signs are significant: rash, fever, weight loss, dry eyes and mouth, recent intestinal or sexually transmitted infection.
- Number and symmetry of affected joints
- Duration of morning stiffness
- What relieves pain - rest or movement?
- Is there swelling, redness and local fever?
- Connection with injury or unusual load
- Associated rash, fever, weight loss
- Recent infections
What examinations are needed
The volume is determined by the nature of the complaints, and not by the desire to check everything at once. The basic kit for persistent pain includes a general blood test with ESR and C-reactive protein - they show the presence of inflammation in the body. Uric acid is tested when gout is suspected, although it may be normal at the time of the attack. Rheumatoid factor and ACCP are prescribed for suspected rheumatoid arthritis, antinuclear antibodies for signs of systemic disease. Of the instrumental methods, ultrasound shows soft tissues, tendons and effusion well, X-ray shows changes in the bone and joint space, and MRI is used in complex cases.
- Complete blood count with ESR
- C-reactive protein
- Uric acid
- Rheumatoid factor and ACCP according to indications
- Antinuclear antibodies for systemic signs
- TSH and vitamin D
- Ultrasound of joints
- X-ray of the affected joint
What to do before the visit and how to be treated
If the pain is associated with stress, it is reasonable to temporarily reduce it, but not to immobilize the limb completely: prolonged rest weakens the muscles and increases the pain. In the first days after overload or injury, cold helps, and for chronic pain, heat. Painkillers from the group of non-steroidal anti-inflammatory drugs can be used in a short course according to the instructions, if there are no contraindications from the stomach, kidneys or heart. Further treatment depends on the cause: for inflammatory arthritis, it is determined by a rheumatologist; for arthrosis, physical therapy, muscle strengthening and weight loss become the basis. Chondroprotectors and dietary supplements have no proven effect, and heating for acute inflammation is contraindicated.
- Temporarily reduce, but do not eliminate, the load
- Cold in the first days after overload, heat for chronic pain
- Short course painkillers according to instructions
- Physical therapy and muscle strengthening
- Weight reduction when putting stress on the leg joints
- Comfortable shoes and correction of working posture
- See a doctor if pain lasts longer than 2 weeks
