joint pain(arthralgia) can occur in a single or multiple joints at the same time (polyarthralgia). Arthralgia is observed in rheumatism, endocrine, infection, tumor, neurological, autoimmune disease, injury, overweight. Identifying the cause of joint pain has important differential diagnostic implications; performed using X-rays, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). Treatment of joint pain is reduced to treatment of the disease that causes it. Apply symptomatic measures (analgesics, topical heating, ointment), immobilization, physiotherapy, surgical intervention.
Classification
The location and depth of the joint pain, the number of joints involved, the nature and intensity of the pain syndrome, its daily rhythm, the duration of its presence, and its association with a certain type of exercise vary. In the case of pain in a single joint, they talk about monoarticular pain, pain syndrome in multiple joints at the same time or in succession - about oligoarthralgia, involving 5 or more joints - about polyarthralgia syndrome.
According to the nature of joint pain, it is divided into acute pain and dull pain; according to intensity - from weak and moderate to strong; according to the type of flow - transient and constant. More commonly, joint pain occurs in the large joints - hips, knees, shoulders and elbows, and less often in the small and medium joints - wrists, ankles, interdigital joints.
The stimulation of synovial nerve receptors in the joint capsule by inflammatory mediators, immune response products, salt crystals, toxins, and osteophytes promotes the occurrence of joint pain. In rheumatology, it is customary to distinguish the following types of joint pain:
- Caused by toxic syndrome in acute infection;
- Primary or intermittent (intermittent) arthralgia in acute or relapsing arthritis;
- Long-term monoarticular pain in large joints;
- Oligoarticular or polyarticular syndrome with synovial involvement or progressive degenerative dystrophic changes of cartilage;
- Post-inflammatory or post-traumatic arthralgia remaining in the joint;
- False joint pain.
Why do joints hurt
Common infectious diseases
Arthralgia syndrome usually accompanies the course of acute infection. Joint pain with fever and toxicity can be observed in both the prodromal and early clinical stages of the disease. Infectious arthralgia is characterized by joint "pain" in the lower and upper extremities, the polyarticular nature of the pain, and an association with myalgia. The mobility of the joints is completely preserved. Typically, infectious arthralgia resolves within a few days as the toxic syndrome from the underlying disease subsides.
Infectious arthritis
Possible options for post-infectious reactive arthralgia following acute intestinal or genitourinary infection; parainfectious joint syndrome due to tuberculosis, infective endocarditis, secondary syphilis. The cause of joint pain is usually the foci of an existing chronic infection - pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasite invasion.
Arthralgia that remains after joint inflammation is chronic or temporary. Pain and stiffness in the joints may persist for weeks or months; in the future, the health and function of the extremities will fully return. In chronic forms of arthralgia, its exacerbation is associated with overexertion, meteorological instability and hypothermia.
rheumatic diseases
Joint pain of the polyarthralgia type or oligoarthralgia is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by a persistent, severe, migratory pain syndrome involving large joints, mainly the lower extremities, and limited joint mobility.
The first presentation of rheumatoid arthritis and systemic rheumatic disease is a polyarticular syndrome affecting the small symmetrical joints of the feet and hands, and stiffness with morning exercise.
In microcrystalline gouty arthritis, arthralgia manifests as recurrent paroxysmal pain in an isolated joint that comes on suddenly, rapidly reaches peak intensity and does not subside for several days.
Degenerative joint disease
A prolonged and gradual increase in joint pain may indicate osteoarthritis deformity and other degenerative dystrophic conditions. In this case, knee or hip involvement is typical; dull, painful, movement-related type of pain that disappears with rest. Arthralgia can be weather related, accompanied by a joint "crunching" sound during exercise that diminishes with topical distraction therapy.
joint damage
Bruises, joint dislocations, ligament injuries, and intra-articular fractures are all accompanied by severe pain. The affected joint becomes swollen, deformed, and hot to the touch. The lower extremity support function is impaired, joint movement becomes difficult, and sometimes pathological movement occurs. The injury may be accompanied by bleeding into the joint cavity, resulting in joint stiffness.
tumor disease
Long-lasting oligoarticular and polyarticular pain with the formation of "Hippocratic fingers" (deformities of the nails and distal phalanx, such as "watch glass" and "drumstick"), indicating paraneoplastic lesions of the synovium. In such patients, tumor pathology of internal organs, mainly lung cancer, should be suspected.
endocrine disease
Common causes of joint pain are endocrine disorders - primary hyperparathyroidism, ovarian dysfunction, hypothyroidism, obesity. Endocrine-producing joint syndromes take the form of oligoarthralgia associated with bone pain, myalgia, pelvic bone and spinal pain.
other reasons
Other possible causes of joint pain include:
- Heavy metal poisoning (thallium, beryllium);
- Frequent overloading or microtrauma of the joint;
- long-term drug therapy;
- post-allergic reaction;
- flatfoot;
- X-shaped or O-shaped deformation of limbs;
- Pseudoarthralgia, modeled by primary bone pain, neuralgia, myalgia, vascular pathology, psychosomatic disease.
diagnosis
Because joint pain is a subjective symptom, clinical and memory features and physical examination are particularly important in determining its cause. It is necessary to consult a rheumatologist, an orthopedist. To differentiate the etiology of joint pain, several objective studies were performed:
- X-ray of the joint.This is a routine method that allows you to examine any joint for various diseases. In most cases, X-rays are performed in one or 2 projections, and special shapes can also be investigated, and contrast arthrography can be performed. More detailed pictures of articular osteochondral and soft tissue status can be obtained with CT and MRI imaging.
- Joint ultrasound.Allows you to detect joint effusion, bone erosion, synovial changes, measure the width of the joint space. The availability of ultrasonography makes it essential for the diagnosis of rheumatic arthropathy.
- invasive method.Arthrocentesis, synovial biopsy is performed according to the indication. In controversial cases, diagnostic arthroscopy is performed to examine the joint cavity from the inside for diagnostic and therapeutic measures.
- lab testing.Helps identify the presence of inflammatory processes,Rheumatic diseases. In peripheral blood, ESR, C-reactive protein levels, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ACCP) were determined. An important diagnostic method is the microbiological and cytological examination of synovial fluid.
- Other diagnostic methods:Thermal imaging, foot photography.
treat
help before diagnosis
For any pain in the joint, it is necessary to remain calm and not put a load on the limb. The metabolic causes of joint pain dictate the need for a balanced diet and weight normalization. For fresh injuries, cold compresses must be applied to the joint, and the injured limb must be immobilized with a splint or immobilization bandage. You can take pain relievers or NSAIDs.
The neglect of effective examination and treatment of arthralgia is fraught with the development of irreversible joint dysfunction - stiffness, rigidity, contractures. Since joint pain can be a marker of many diseases, if joint syndrome develops and persists for more than 2 days, you need to consult your doctor.
Conservative treatment
In the treatment of joint pain, the main role is the treatment of the dominant pathology. Medications for joint pain aim to stop inflammatory intra-articular processes and pain. Systemic treatment includes the use of non-steroidal anti-inflammatory drugs.
For moderate arthralgia or where oral medications are contraindicated, topical topical therapy with warm, anti-inflammatory, and analgesic creams is used. Apply to the joint area with dimethyl sulfoxide. Joint gymnastics, physiotherapy procedures (drug electrophoresis, magnetotherapy, sonophoresis, UHF therapy) are recommended.
Periarticular block, intra-articular glucocorticoids, chondroprotective agents, synovial prosthesis, if necessary. Promising modern approaches for the treatment of chronic arthropathy are ozone therapy, joint plasma lift and ortho-factor therapy.
Operation
Various types of surgical intervention are available for joint pain due to injury, as well as for chronic diseases that lead to loss of joint function. They can be done by open (arthrotomy) or endoscopic (arthroscopic) methods. Depending on the causative disease, do the following:
- Arthroplasty;
- Arthrodesis;
- ligament plastic;
- Repair of joint cavity;
- removal of pathological tissue (cysts, intra-articular bodies);
- synovectomy;
- Joint replacement surgery.