Joint pain

Pain in the joints, known as arthralgia, is experienced by most people at some point in their life. The type of pain varies and can be due to a number of factors. It can be acute pain, pain due to an injury, or chronic pain.

Causes range from arthritis or age-related degeneration to a fracture, or pain could be down to a medical condition such as Lyme disease.

Diagnostic tests include blood tests, X-rays and joint fluid analysis.

Certain types of joint pain can be prevented (often through diet or exercise), whereas some cannot.

Types of joint pain

As there are many types of joints in the body, there are also many types of pain and many causes. When a patient experiences pain in more than four joints, it is called polyarticular joint pain.

Acute pain is a response to disease or trauma, and usually lasts less than six weeks.

Subacute or chronic pain persists after the cause has been determined, or is due to a chronic condition, which can last up to three months.

Morning stiffness is a common complaint among those with joint pain. This is because while they were immobile in their sleep, the joint pain was actually worsened.

Other kinds of joint pain are worsened by activity, such as running or cycling.

Arthralgia is different from arthritis - joint pain without the inflammation. However, joint pain is a common symptom for arthritis. It is important to note that osteoarthritis, the most common form of arthritis, does not involve systemic inflammation but does cause joint pain.

Experiencing joint pain does not usually constitute a medical emergency. However, if it is accompanied by certain symptoms, it can be indicative of an infection or other condition that may require immediate medical attention.

Causes

Joint pain can be caused by injury, disease and medical conditions. These include:

• Unusual activity or overuse, including strains and sprains;
• Common infectious diseases such as colds and flu;
• Injury and trauma, such as fractures and whiplash;
• Athletic injuries, such as tennis elbow, golfer elbow and rotator cuff injury;
• Arthritis. This term is used to describe more than 100 diseases that cause pain, stiffness and swelling in the joints. There are different types of arthritis:
• Osteoarthritis, the most common form of arthritis, can affect any joint. It's characterised by the progressive breakdown of joint cartilage and bone at the margins of the joint;
• Rheumatoid arthritis is a chronic autoimmune disease characterised by inflammation of the lining of small joints. If untreated, it can lead to long-term joint damage;
• Juvenile arthritis and juvenile rheumatoid arthritis: these affect children;
• Ankylosing spondylitis: this type causes pain and stiffness in the spine, although other joints can also be affected too;
• Gout: characterised by a build-up of excessive uric acid, which forms crystals that deposit in the joints and cause inflammation. Symptoms include sudden and severe pain and tenderness, redness, warmth and swelling in some joints. It usually affects one joint at a time, often the big toe. It's common in men, but affects many women too.
• Pseudogout: this mimics gout, but primarily affects the knee.
• Psoriatic arthritis: this is a common condition which includes the skin disease psoriasis; and
• Reiter's syndrome, a form of infectious arthritis.
• Tendinitis. Inflammation, irritation and swelling of a tendon (the fibrous structure that connects muscle to bone) can be caused by injury, overuse or age;
• Bursitis: inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin or between a tendon and bone can be caused by chronic overuse, trauma, rheumatoid arthritis, gout or infection;
• TMJ disorder. This condition involves pain where the lower jaw connects with the skull, caused by genetics, trauma, arthritis or other factors;
• Carpal tunnel syndrome. This condition can cause wrist pain and occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist;
• Systemic lupus erythematosus (SLE): an autoimmune disease which causes inflammation of the connective tissue, in particular membranes around joints;
• Fibromyalgia: a chronic disorder which causes diffuse muscle ache, stiffness and fatigue. Patients often have tender spots in specific areas on their body in places such as the neck, shoulders, back, hips, arms and legs that hurt when pressure is applied;
• Chronic fatigue syndrome: pain in multiple joints without swelling or redness is a common symptom;
• Sjogren's syndrome: an autoimmune disorder often associated with rheumatoid arthritis and other rheumatic conditions, and which can cause debilitating joint pain;
• Lyme disease: joint pain is common in early and late stages of this infectious tick-borne condition;
• Spinal stenosis: this narrowing of the passage for the spinal cord can cause pain in the back, neck, shoulders, legs and other joints;
• Osteoporosis: this common bone disorder is usually painless in early stages, but may cause severe joint or back pain in late stages because of fractures;
• Cancer: bone tumours, leukaemia and other cancers can cause joint pain due to metastasis, or spreading of the cancer into the joint;
• Sickle cell anaemia. A hereditary blood disease marked by pain in the joints, bones and elsewhere;
• Polymyalgia rheumatica: pain and stiffness in the neck, shoulder and hips typify this condition;
• Sarcoidosis: this inflammatory disease can affect the joints and other body parts;
• Complex regional pain syndrome: this chronic condition usually affects the arms or legs;
• Infection of a joint: for example, a joint may be infected during surgery such as arthroplasty;
• Osteomyelitis: acute or chronic bone infection is usually caused by bacteria;
• Meningitis: inflammation of the membranes covering the brain and spinal cord, meningitis is usually caused by infection. It can cause neck pain or stiffness;
• Encephalitis: inflammation of the brain. Symptoms can include stiffness or pain in the back or neck;
• Costochondritis: inflammation of the cartilage connecting the ribs and sternum (breastbone), costochondritis is one of the more common causes of noncardiac chest pain; or
• Scleroderma: this chronic disease can cause thickening, hardening or tightening of the skin, blood vessels and internal organs.

When to contact a doctor

Patients should seek medical assistance if joints are hot or swollen, or

• Joint pain is accompanied by fever, weight loss or malaise (a general feeling of discomfort, illness or lack of well-being); or
• Joint pain is accompanied by a burning pain or paresthesia (sensation of tingling, pricking or numbness of the skin).

What to expect

In order for a doctor to establish the cause of joint pain, he or she will first review your medical history and then perform a physical examination. Some of the questions you can expect include:

* How long have you been experiencing the pain?

* Is the pain consistent, or does it come and go?

* Does resting or movement make the pain better or worse?

Should the doctor suspect the pain is due to an underlying injury, condition or a disease, a variety of other tests, including blood tests, will be performed.

However, it is also a good idea to have some of your own questions prepared. Some questions to consider include:

* What's causing it?

* Does this mean I have arthritis?

* I hurt a joint when I was young, does this mean I will have joint pain in the future?

* (If caused by a disease) Will the pain disappear if the disease is cured?

* What tests can I expect to go through and what do they involve?

* Are there any medications I can take to ease the pain?

* Is there any way to relieve the pain without medication?

* When is surgery an option?

Prevention

In order to prevent or reduce joint pain, there are a number of lifestyle changes and therapies patients can employ. These include:

• Getting regular exercise to keep joints mobile and strengthen muscles.
• Improve posture.
• Avoid activities that put excessive stress on the joints.
• Lose excess weight, as it puts unnecessary strain on joints.
• Using heat, cold and water treatments - heat relaxes the muscle and stimulates blood circulation, and cold numbs the affected area.
• Getting enough sleep to restore energy and rest joints.
• Relaxing may reverse some of the effects of stress on the body, reducing pain.
• Physical therapy and manipulation therapy - works especially well in arthritic patients.
• Walking aids, such as canes or walkers relieve stress on certain joints.
• Occupational therapy includes task simplification, energy conservation and instruction in adaptive equipment, for conditions ranging from acute trauma to chronic fatigue syndrome.
• Braces and splints assist in unloading weights to certain joints, including knees.
• Cognitive behavioural therapy is primarily used on those with chronic sources of pain ranging from arthritis to fibromyalgia.

Treatment through medication

Depending on the type of joint pain and the underlying cause, medication may be prescribed to relieve the pain. Common over-the-counter medications include analgesics or anti-inflammatory medications which assist in relieving pain and swelling.

However, if the cause of the joint pain is an underlying disease or condition, that needs to be treated directly. Antibiotics are prescribed for infections, and antivirals for diseases caused by viruses. If the pain is caused by arthritis, there are several medications that patients may take to relieve the pain. These include:

• Analgesics
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Disease-modifying antirheumatic drugs (DMARDs)
• Biologic response modifiers (BRMs)
• Antidepressants
• Topical pain relievers
• Opioids
• Muscle relaxants
• Anticonvulsants
• Injection therapy.

Surgery

If the joint pain cannot be treated or controlled with medication, surgery is an option. Types of surgery include:

* Arthroscopy,

* Joint replacement (arthroplasty),

* Synovectomy (removal of the synovium, the lining of the joint),

* Osteotomy,

* Spinal surgery, and

* Carpal tunnel release surgery.