Joint pain(arthralgia) can occur in one or more joints (polyarthralgia). Arthralgias are observed in rheumatic, endocrine, infectious, tumor, neurological, autoimmune diseases, trauma, overweight. Identifying the causes of joint pain has important differential diagnostic value; it is performed with the help of X-ray, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). The treatment of arthralgia comes down to treating the disease that caused it. Symptomatic measures (analgesics, local heat, ointments), immobilization, physiotherapy, surgery are applied.
Classification
Arthralgias differ in location and depth, the number of affected joints, the nature and intensity of the pain syndrome, its daily rhythm, duration of existence, connection with a particular type of movement. In the presence of pain in one joint, they talk about monoarthralgia, with simultaneous or consecutive pain syndrome in several joints - for oligoarthralgia, affecting 5 or more joints - for polyarthralgia syndrome.
According to the nature of the arthralgic syndrome, acute and dull pain are distinguished; by intensity - from weak and moderate to intense; according to the type of flow - transient and constant. Arthralgia is more common in the large joints - hip, knee, shoulder and elbow, less common in the middle and small - wrist, ankle, interphalangeal.
The appearance of joint pain is promoted by irritation of the neuroreceptors of the synovial membranes of the joint capsules with inflammatory mediators, products of immune reactions, salt crystals, toxins, osteophytes. In rheumatology, it is common to distinguish the following types of joint pain:
- caused by toxic syndrome in acute infections;
- primary episode or intermittent arthralgia in acute or recurrent arthritis;
- prolonged monoarthralgia of large joints;
- oligo- or polyarthralgic syndrome, accompanying involvement of the synovial membranes or progressive degenerative-dystrophic changes in cartilage;
- residual post-inflammatory or post-traumatic arthralgia in the joints;
- pseudoarthralgia.
Why joints hurt
Common infectious diseases
Arthralgic syndrome often accompanies the course of acute infections. Joint pain can be observed both in the prodromal period of the disease and in the early clinical stage, characterized by fever and intoxication. The infectious form of arthralgia is characterized by "pain" in the joints of the lower and upper extremities, the polyarticular nature of the pain and their relationship to myalgia. Mobility in the joint is fully preserved. caused by the underlying disease, weakens.
Infectious arthritis
Possible options for the development of post-infectious reactive arthralgia after acute intestinal or urogenital infections; parainfectious arthralgic syndrome caused by tuberculosis, infectious endocarditis, secondary syphilis. Often the cause of joint pain are foci of existing chronic infection - pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasitic invasion.
Residual arthralgia after arthritis is chronic or transient. Joint pain and stiffness can last for weeks or months; in the future the well-being and functions of the limbs are fully restored. In the chronic form of arthralgia its exacerbations are associated with overexertion, meteorological lability and hypothermia.
Rheumatic diseases
Joint pain such as poly- or ologarthralgia is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by constant, intense, migrating pain syndrome, affecting large joints, mainly the lower extremities, limited movement in the joints.
The onset of rheumatoid arthritis, as well as systemic rheumatic diseases, are manifested by polyarticular syndrome, which affects the small symmetrical joints of the legs and arms, motor stiffness in the morning.
In microcrystalline gouty arthritis, arthralgia manifests itself in the form of recurrent paroxysmal pain in an isolated joint, which, if it occurs suddenly, quickly reaches its peak intensity and does not subside for several days.
Degenerative joint lesions
Gradually increasing joint pain over a long period of time may indicate deforming osteoarthritis and other degenerative-dystrophic lesions. This case is characterized by involvement of the knee or hip joints; dull, painful, associated with pain-type exercises and their disappearance at rest. Arthralgia may be time-dependent, accompanied by "crunching" of the joints during movement, weight loss using topical distraction therapy.
Joint injuries
Bruises, sprains, ligament damage, intra-articular fractures are accompanied by severe pain. The affected joint becomes swollen, deformed, hot to the touch. The supporting function of the lower limb is impaired, movement in the joint becomes difficult, sometimes pathological mobility occurs. Injuries can be accompanied by bleeding in the joint cavity, which leads to its stiffness.
Oncological diseases
Persistent oligo- and polyarthralgia with long course, accompanied by the formation of "Hippocratic fingers" (deformities of the nails and distal phalanges such as "clock" and "drumsticks"), show paraneoplastic lesion of the synovial membranes. In such patients, oncological pathology of the internal organs, mainly lung cancer, should be suspected.
Endocrine diseases
Common causes of joint pain are endocrine disorders - primary hyperparathyroidism, ovariogenic dysfunction, hypothyroidism, obesity. The joint syndrome of endocrine genesis takes the form of oligoarthralgia associated with osalgia, myalgia, pain in the pelvis and spine.
Other reasons
Other possible causes of arthralgia include:
- heavy metal intoxication (thallium, beryllium);
- frequent overload or microtrauma of the joints;
- long-term drug therapy;
- postallergic reactions;
- flat steps;
- X-shaped or O-shaped deformity of the limbs;
- pseudoarthralgia simulated by primary osalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Diagnosis
As joint pain is only a subjective symptom, clinical and anamnestic characteristics and physical examination come to the fore in determining the reasons for their occurrence. It is necessary to consult a rheumatologist, orthopedist. In order to distinguish the etiology of arthralgia, a number of objective studies are conducted:
- X-ray of the joints.This is a routine method that allows you to examine all kinds of joints in various diseases. Most often, radiography is performed in one or 2 projections, it is also possible to examine in a special style, to perform contrast arthrography. A more detailed picture of the condition of osteochondral and soft tissues of the joints is available with CT and MRI images.
- Ultrasound of the joints.Allows you to detect effusion in the joint cavity, bone erosion, changes in the synovial membrane, measuring the width of the joint spaces. The presence of sonography makes it indispensable for the diagnosis of rheumatic joint pathologies.
- invasive methods.According to the indications, a puncture of the joint, a biopsy of the synovial membrane is performed. In controversial cases, diagnostic arthroscopy is performed, which allows to examine the joint cavity from the inside, to perform diagnostic and therapeutic measures.
- Laboratory researches.Helps detect the presence of an inflammatory process,rheumatic diseases. Peripheral blood determines ESR, the level of C-reactive protein, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ACCP). An important diagnostic method is microbiological and cytological examination of synovial fluid.
- Additional diagnostic methods:thermography, podography.
Treatment
Help before diagnosis
With any joint pain you need to stay calm and not strain the limb. Metabolic causes of arthralgia dictate the need for a balanced diet, normalization of weight. In case of fresh injuries, it is necessary to apply cold to the joint, to immobilize the injured limb with a splint or fixative bandage. You can take painkillers or NSAIDs.
Neglecting the competent examination and treatment of arthralgia is fraught with the development of irreversible functional disorders of the joints - rigidity, ankylosis, contracture. As joint pain can serve as a marker for various diseases, it is necessary to consult a doctor if the joint syndrome occurs and lasts more than 2 days.
Conservative therapy
In the treatment of joint pain a major role is given to the treatment of the leading pathology. Drug treatment of arthralgia is aimed at stopping inflammatory intra-articular processes and pain. Systemic therapy involves the use of non-steroidal anti-inflammatory drugs.
In moderate arthralgia or the presence of contraindications for oral administration of drugs, topical external therapy is performed with warming, anti-inflammatory and analgesic ointments. Dimethyl sulfoxide applications are applied to the joint area. Joint gymnastics, physiotherapeutic procedures (drug electrophoresis, magnetotherapy, phonophoresis, UHF therapy) are recommended.
If necessary, periarticular blockades, intra-articular injections of glucocorticoids, chondroprotectors, synovial fluid prostheses are performed. Promising modern methods for the treatment of chronic joint pathologies are ozone therapy, plasmalifting of joints and orthokin therapy.
Surgery
Different types of surgery are justified for joint pain caused by injuries, as well as chronic diseases leading to loss of joint function. They can be performed by open (arthrotomy) or endoscopic (arthroscopy) methods. Depending on the cause of the disease, the following activities are performed:
- arthroplasty;
- arthrodesis;
- ligament plastics;
- rehabilitation of the joint cavity;
- removal of pathological formations (cysts, intra-articular bodies);
- synovectomy;
- arthroplasty of the joints.