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Joint Pain What You Should Know

Joint Pain: Symptoms & Signs, Causes and Treatment Options

Joint Pain What You Should Know

Joints form the connections between bones. They provide support and help you move. Any damage to the joints from disease or injury can interfere with your movement and cause a lot of pain. Joints form the connections between bones. They provide support and help you move. Any damage to the joints from disease or injury can interfere with your movement and cause a lot of pain.

Joint pain can be caused by injury affecting any of the ligaments, bursae, or tendons surrounding the joint. Injury can also affect the ligaments, cartilage, and bones within the joint. Pain is also a feature of joint inflammation (arthritis, such as rheumatoid arthritis and osteoarthritis) and infection, and extremely rarely it can be a cause of cancer of the joint. Pain within the joint is a common cause of shoulder pain, ankle pain, and knee pain. Joint pain is also referred to as arthralgia. The sexually transmitted diseases (STDs) chlamydia and gonorrhea can lead to joint pain.

Chronic pain caused by arthritis affects millions of people in the United States every year. About one in four adults with arthritis—15 million people—report experiencing severe joint pain related to arthritis.1 Additionally, nearly half of adults with arthritis have persistent pain

Joint pain causes are many, and treatments vary depending on the cause. For a lot of people, it’s due to some kind of arthritis (joint inflammation). For others, such as those with fibromyalgia or an underactive thyroid, pain occurs with no underlying damage or inflammation.

Joint pain may range from a mild ache to a severe, burning, or sharp sensation in one or several joints. In some instances, joint pain is associated with other symptoms, like joint swelling and stiffness, red and warm skin, and whole-body symptoms like fatigue, weight loss, or fever.

What Is A Joint?

A joint is a point where bones make contact, connecting the skeletal system. Most joints are mobile, which allows the body to make different types of movement. There are three kinds of joint: fibrous, cartilaginous, and synovial.

Fibrous joints are usually immovable. They include the cranium in the skull, the joints between the teeth and the sockets in the jaw, and the joints between the bones of the lower leg.

Cartilaginous joints are those where cartilage joins two bones. These joints are partially movable. One example is the joint between the right and left pubic bone.

Synovial joints are the joints that allow limbs to move freely. These joints have a cavity in them that contains synovial fluid. This fluid allows the bones that connect the joint to move around with ease. Some examples include the knee, elbow, hip, and shoulder.

What Is Joint Pain?

Joint pain is the sensation of discomfort or soreness in a joint or joints of the body. Joints are the spaces or areas where two or more bones meet, such as the hip, knee, shoulder, elbow and ankle. Joint pain can occur with or without movement and can be severe enough to limit movement. People may describe joint pain as discomfort, inflammation, increased warmth or burning, soreness, stiffness, or pain.

The joints allow our bones to move. They are made up of cartilage, ligaments, tendons, bursas (fluid-filled sacs that help cushion the joint), and the synovial membrane (lining of the joint capsule that secretes synovial fluid to lubricate the joint). Any of the structures in a joint can become irritated or inflamed in response to a variety of mild to serious diseases, disorders or conditions.

Your joint pain may last briefly or it may be chronic, which is defined as lasting more than three months. Joint pain has many causes. Sudden joint pain can be due to a mild muscle or ligament sprain, bursitis, or a dislocation. Chronic joint pain can be a symptom of serious and even life-threatening conditions, such as rheumatoid arthritis, osteoarthritis, leukemia, or bone cancer.

If you experience sudden joint pain with loss of mobility, contact a medical professional as soon as possible or seek emergency medical care. Early diagnosis and treatment can minimize discomfort and reduce your risk of serious complications.

If the pain lasts for more than a few days or is accompanied by a fever, unexplained weight loss or other unusual symptoms, contact a medical professional as soon as possible.

What Other Symptoms Might Occur With Joint Pain?

Joint pain often occurs in conjunction with other signs and symptoms that vary depending on the underlying disease, disorder or condition. Other symptoms can include joint swelling, redness, and fever. Tell your health care provider about any additional symptoms you are experiencing. This information will help your health care provider diagnose the reason of your pain.

Other joint symptoms that may occur with joint pain

Joint pain may occur with other symptoms related to the joint, including:

  • Joint noise (clicking, popping, crackling)
  • Redness
  • Reduced mobility (range of motion of the joint)
  • Stiffness
  • Swelling
  • Visible deformity of the affected joint

Other symptoms that may occur along with joint pain

Joint pain may accompany symptoms that may seem unrelated to the joint, including:

  • Abdominal pain
  • Aching muscles
  • Butterfly-shaped rash over bridge of nose
  • Dry mouth and skin
  • Fatigue
  • Fever not associated with flu symptoms
  • Flulike symptoms such as fever, chills, sore throat, muscle aches, and headache
  • Increased urine output
  • Rash
  • Scaly patches of skin
  • Yellow skin and eyes with dark urine output (jaundice)

Serious symptoms that might indicate a life-threatening condition

In some cases, joint pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as rheumatic fever, which should be immediately evaluated in an emergency setting. Symptoms that may indicate a serious or life-threatening condition include:

  • Bleeding from minor injuries
  • Chest pain
  • Debilitating pain
  • Difficulty breathing
  • Heart palpitations
  • High fever (higher than 101 degrees Fahrenheit)
  • Muscle weakness
  • Pain in several joints with rash
  • Rapid, jerky movements
  • Redness
  • Swollen lymph nodes
  • Unexplained weight loss

What Are The Causes Of Joint Pain?

There are many causes of joint pain. The possible causes will partly depend on your age. The possible causes for joint pain in children are different to the possible causes for adults.

The cause of joint pain may be obvious, such as following a sports injury. At other times it may need investigations and a referral for you to see a specialist to find the diagnosis.

Joint pain may also be caused by different structures in or around the joint. The underlying cause may therefore be a problem with:

  • The lining of the joint.
  • The bones of the joint or near the joint.
  • The tendons, ligaments or muscles around the joint.

Joint pain may also be caused by pain felt along the course of a nerve. This is called ‘referred pain’. For example, a problem in your hip may cause you to also feel pain in your knee. Nerve pain also occurs when a ‘slipped disc’ in your back causes pain in your leg (called sciatica after the sciatic nerve which is often the one being squashed by the out-of-place disc).

The following is a list of the most common causes of joint pain. There are many more less common causes that your doctor may need to consider. See the links for more information about each condition that can cause joint pain.

The list separates conditions usually affecting one joint from conditions affecting more than one joint for each age group. However, it isn’t as simple as this as the two lists overlap. Sometimes conditions usually affecting one joint may affect a few different joints. Conditions usually affecting many joints may sometimes cause pain in just one joint, especially at the beginning of any underlying illness.

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis.1 OA develops as a result of the breakdown of cartilage (which serves as a cushion between the bones of a joint) often due to aging. This type of arthritis tends to affect the knees, hips, neck, lower back, and fingers.

The pain of OA—which often progresses from a sharp, intermittent pain to a constant aching—worsens with movement and eases with rest.2 Joint stiffness and a restricted range of motion are also characteristic of OA joint pain.

While classic OA is actually a non-inflammatory arthritis, an aggressive subtype of OA, called erosive osteoarthritis, is inflammatory. Erosive OA is most common in postmenopausal women and causes a gradual onset of joint aches, stiffness, and swelling in multiple finger joints.

Gout

Gout is a type of inflammatory arthritis that occurs in some people with high levels of uric acid in their blood. As the uric acid builds up, it may form crystals in certain joint spaces, like the big toe, ankle, or knee.

A classic gout attack refers to a sudden episode of severe, often burning joint pain that usually occurs in one joint (for example, the big toe). The joint pain of a gout attack is often extreme and associated with redness, swelling, and warmth of the joint. Without treatment, an acute flare can take anywhere from three days to two weeks to resolve on its own.4

The “why” behind gout joint pain is attributed to the rapid, inflammatory response of the body’s immune system as it tries to digest the unwanted and foreign crystals.

Pseudogout

Pseudogout, also known as calcium pyrophosphate deposition disease (CPPD), is a type of inflammatory arthritis that occurs as a result of calcium crystal buildup in certain joints, most commonly the knee, wrists, shoulders, ankles, feet, and elbows.

Like gout, the pain of an acute pseudogout joint attack is sudden, severe, and associated with other symptoms like joint swelling and warmth. Unlike gout, the attacks of pseudogout may last longer before remitting.

Septic Arthritis

With septic arthritis, a joint becomes infected, most commonly with a bacteria and rarely with a fungus (for example, Candida) or mycobacteria (such as tuberculosis).

Septic arthritis tends to affect a single joint, usually the knee, ankle, wrist, or hip. The affected joint is swollen, warm, and stiff, and a fever is also present.

In most cases, septic arthritis is caused by a bacterial infection in the blood that then travels to the joint space.

 Less commonly, joint surgery or trauma (for example, a tick bite) may be the culprit.

Viral Arthritis

Several different viruses may cause arthritis. The most common ones include hepatitis B and C, parvovirus B19, and HIV, as well as alphaviruses (transmitted by mosquitoes) like the Chikungunya virus (CHIKV).

Spondyloarthritis

Spondyloarthritis is a family of inflammatory rheumatic diseases that includes four conditions.

Ankylosing Spondylitis (AS)

Ankylosing spondylitis is an axial spondyloarthropathy, meaning it mainly affects the back and neck and the sacroiliac joints (which connect the spine to the pelvis).

The joint pain of AS tends to begin in early adulthood before the age of 45, come on gradually, and improve with activity (similar to RA).9 Morning stiffness that lasts longer than 30 minutes is also common in AS.

Psoriatic Arthritis

Up to 30% of people with psoriasis—a chronic skin condition characterized by patches of thickened skin covered by silvery scales—have psoriatic arthritis.10

It most commonly affects the end joints of the fingers and toes, causing a throbbing pain, along with stiffness and swelling. Other symptoms may include swollen fingers and toes that look like sausages, and nail problems (for example, pitted nail beds).

Interestingly, the severity of a person’s psoriasis does not correlate with the severity of their arthritis. And in about 15% of people, joint pain shows up before the psoriasis appears.11

Reactive Arthritis

Reactive arthritis is characterized by the development of joint pain and swelling one to six weeks after an infection in the urinary tract, genitals, or intestines.12

Specific bacterial organisms linked to the development of reactive arthritis include:

  • Salmonella
  • Campylobacter
  • Shigella
  • Yersinia
  • Chlamydia

Typical joints involved in reactive arthritis are the knee, ankle, and foot.

Arthritis Associated With Inflammatory Bowel Disease (IBD)

Throbbing joint pain and swelling, especially in larger joints like the knees and hips, may occur in people with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. The arthritis tends to be more active when bowel symptoms are flaring.

Systemic Lupus Erythematosus

Joint inflammation, especially of the knees, wrists, and finger joints, is common in systemic lupus erythematosus (SLE)—a chronic, autoimmune disease that can affect nearly every organ in the body.

Like RA, the same joints on the same side of the body tend to be affected in SLE. However, unlike RA, the morning stiffness does not last as long (minutes for SLE versus over an hour for RA). The joint pain also tends to be short-lived and migratory, moving from one joint to another within a 24-hour period.

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory joint disease that causes significant muscle and joints aches and stiffness in the shoulders, neck, and hips. Joint swelling and tenderness may also occur in the wrists and fingers, although it is usually mild. The feet and ankles are never affected, and the disease almost exclusively affects people over the age of 50.15

Interestingly, PMR is associated with another rheumatic condition called giant cell (temporal) arteritis, which is an inflammatory blood vessel disease that causes inflammation in the arteries of the head and scalp.

Treatments for Joint Pain

oint pain can range from mildly irritating to debilitating. It may go away after a few weeks (acute), or last for several weeks or months (chronic). Even short-term pain and swelling in the joints can affect your quality of life. Whatever the cause of joint pain, you can usually manage it with medication, physical therapy, or alternative treatments.

Your doctor will first try to diagnose and treat the condition that is causing your joint pain. The goal is to reduce pain and inflammation and preserve joint function. Treatment options include:

Medications

For moderate-to-severe joint pain with swelling, an over-the-counter or prescription nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, celecoxib, ibuprofen, or naproxen can provide relief. NSAIDs can have side effects, potentially increasing your risk for gastrointestinal bleeding.

If you have mild pain without any swelling, acetaminophen can be effective. Be careful when taking this medicine though, especially if you drink alcohol, because high doses may cause liver damage. Because of the risks, you should take any of these pain medications with caution.

If your pain is so severe that NSAIDs aren’t effective enough, your doctor may prescribe a stronger opioid medication. Because opioid drugs can cause drowsiness, you should only use them under a doctor’s care. They also can cause constipation, which you can relieve by taking laxatives.

Other drugs that may help relieve pain include:

  • Muscle relaxants to treat muscle spasms (may be used together with NSAIDs to increase the effect)
  • Some antidepressants and antiepileptic drugs (which both interfere with pain signals)

Topical Agents

Capsaicin — a substance found in chili peppers — may relieve joint pain from arthritis and other conditions. Capsaicin blocks substance P, which helps transmit pain signals, and it triggers the release of chemicals in the body called endorphins, which block pain. Side effects of capsaicin cream include burning or stinging in the area where it is applied. Another topical option is an arthritis cream containing the ingredient, methyl salicylate.

Injections

For people who don’t find joint pain relief from oral or topical medications, the doctor may try injections.

  • Steroids. Mostly commonly, they might inject a steroid medication (which may be combined with a local anesthetic) directly into the joint every 3 to 4 months. Steroid injections are most commonly used in patients with arthritis or tendinitis. If steroid injections mask an injury, you could overuse the joint and damage it even further. The procedures are effective, but in many situations the effect may be temporary.
  • Platelet-rich plasma therapy. Platelet-rich plasma (PRP) is made from your own blood, which is then injected into your painful joint. Your joint contains a large number of platelets and proteins that have anti-inflammatory and immune-modulating effects.
  • Prolotherapy. It involves a series of injections of an irritant (often a sugar solution) into joints, ligaments, and tendons. The theory is that the injections stimulate local healing of injured tissues. A treatment program may involve 15-20 shots given monthly for 3-4 months.

Other injection options include:

Removing fluid from the joint (and is often done in connection with a steroid injection)
Injections of hyaluronan, a synthetic version of the natural joint fluid. This is used to treat osteoarthritis.

Physical Therapy

You can work with a physical therapist to strengthen the muscles around the joint, stabilize the joint, and improve your range of motion. The therapist will use techniques such as ultrasound, heat or cold therapy, electrical nerve stimulation, and manipulation.

If you are overweight, losing weight can relieve some of the pressure on your painful joints. Exercise is one effective way to lose weight (along with diet), but be careful to stick with low-impact exercises that won’t further irritate the joint. Swimming and bicycling are among the best exercises because both allow you to exercise your joints without putting impact on them. Because water is buoyant, swimming also relieves some of the pressure on your joints.

Home Care

You can relieve short-term joint pain with a few simple techniques at home. One method is known by the acronym PRICE:

  • Protect the joint with a brace or wrap.
  • Rest the joint, avoiding any activities that cause you pain.
  • Ice the joint for about 15 minutes, several times each day.
  • Compress the joint using an elastic wrap.
  • Elevate the joint above the level of your heart.

Applying ice to your painful joints can relieve the pain and inflammation. For muscle spasms around joints, try using a heating pad or wrap several times a day. Your doctor may recommend that you tape or splint the joint to minimize movement or reduce pain, but avoid keeping the joint still for too long because it can eventually become stiff and lose function.

Alternative Treatments

Some research shows that glucosamine and chondroitin supplements can help with joint pain and improve function. Both of these substances are components of normal cartilage, which helps cushion the bones and protect joints. Glucosamine and chondroitin supplements are available in capsule, tablet, powder, or liquid form. Although these supplements don’t work for everyone, they are safe to try because they don’t have any significant side effects.

When to Call Your Doctor

No matter what treatment you’re following, get medical help right away if the pain gets intense, your joint suddenly becomes inflamed or deformed, or you can no longer use the joint at all.

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