Joint pain(arthralgia) can occur in one or at the same time in several joints (polyarthralgia). Arthralgias are observed in rheumatic, endocrine, infectious, tumor, neurological, autoimmune diseases, injuries, overweight. Discovering the causes of joint pain has an important differential diagnostic significance; performed using X-ray methods, ultrasound, laboratory, invasive (arthrocentesis, arthroscopy). Treatment of arthralgia is reduced to treating the disease that caused it. Symptomatic measures are applied (analgesic, local heat, ointment), immobilization, physiotherapy, surgical interventions.
Distribution
Arthralgias vary in location and depth, the number of joints involved, the nature and intensity of the pain syndrome, its daily rhythm, the duration of existence, the connection to a certain type of movement. In the presence of pain in a single joint, they talk about monoarthralgia, with simultaneous or successive pain syndrome in several joints - for oligoarthralgia, with the involvement of 5 or more joints - for polyarthralgia syndrome.
According to the nature of arthralgic syndrome, acute and dull pains are distinguished; by intensity - from weak and moderate to intense; according to the type of flow - transient and constant. Most often, arthralgia occurs in large joints - thigh, knee, shoulder and elbow, less often in the middle and small - wrist, ankle, interphalangeal.
The appearance of pain in the joints is stimulated by irritation of neuroreceptors of the synovial membranes of articular 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 (permanent) arthralgia in acute or recurrent arthritis;
- long-term monoarthralgia of large joints;
- oligo- or polyarthralgic syndrome that accompanies the involvement of synovial membranes or progressive degenerative-dystrophic changes in cartilage;
- residual post-inflammatory or post-traumatic arthralgia in the joints;
- pseudoarthralgia.
Why do 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, which occurs with 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 association with myalgia. Mobility in the joints is fully preserved. Usually, infectious arthralgia disappears within a few days as the toxic syndrome caused by the underlying disease weakens.
Infectious arthritis
Possible options for developing post-infectious reactive arthralgia after acute intestinal or urogenital infections; parainfectious arthralgic syndrome caused by tuberculosis, infective endocarditis, secondary syphilis. Often the cause of joint pain are foci of existing chronic infection - pyelonephritis, cholecystitis, adnexitis, paratonsillar abscess or parasitic invasion.
Arthralgia remaining after joint inflammation is chronic or transient. Joint pain and stiffness may persist for weeks or months; in the future, the well-being and functions of the limbs are completely restored. In the chronic form of arthralgia, its exacerbations are associated with overexertion, meteorological persistence, and hypothermia.
Rheumatic diseases
Joint pain of the poly- or ologartralgia type is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by constant, intense, migratory pain syndrome, palpation of the large joints, mainly of the lower extremities, limited movement in the joints.
The onset of rheumatoid arthritis, as well as systemic rheumatic diseases, is manifested by polyarticular syndrome, which affects the small symmetrical joints of the feet and hands, motor stiffness in the morning.
In gout microcrystalline arthritis, arthralgia manifests itself in the form of recurrent paroxysmal pain in an isolated joint, which, after appearing suddenly, quickly reaches its peak intensity and does not subside for several days.
Degenerative joint lesions
Gradual increase in joint pain over a long period of time may indicate deforming osteoarthritis and other degenerative-dystrophic lesions. In this case, touching the knee or hip joints is typical; The dull, painful type, associated with exercise and their disappearance at rest. Arthralgia may be weather-dependent, accompanied by a "jump" of the joints during movement, weakened when local distraction therapy is used.
Joint injuries
Bruising, joint dislocations, ligament damage, intra-articular fractures are associated with severe pain. The affected joint becomes swollen, deformed, hot to the touch. The supporting function of the lower limbs is impaired, movement in the joints becomes difficult and sometimes pathological mobility occurs. Injuries can be associated with hemorrhage in the ankle cavity, which leads to its hardening.
Oncological diseases
Persistent oligo- and persistent polyarthralgia of a long course, accompanied by the formation of "Hippocrates fingers" (deformations of the nails and distal phalanges such as "clock glass" and "drum sticks"), indicate a paraneoplastic lesion of the synovial membranes. In such patients, oncological pathology of internal organs, mainly lung cancer, should be suspected.
Endocrine diseases
Common causes of joint pain are endocrine disorders - primary hyperparathyroidism, ovarian dysfunction, hypothyroidism, obesity. Articular syndrome of endocrine genesis develops in the form of oligoarthralgia accompanied by ossalgia, myalgia, pain in the pelvic bones 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;
- post-allergic reactions;
- flat feet;
- X-shaped or O-shaped limb deformity;
- pseudoarthralgia, simulated by primary ossalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Diagnosing
Since joint pain is only a subjective symptom, clinical and anamnestic features and physical examination come to the fore when determining the causes of their occurrence. It is necessary to consult a rheumatologist, orthopedist. To distinguish the etiology of arthralgia, a series of objective studies are performed:
- X-ray of the joints.It is a routine method that allows you to examine each node in different diseases. Most often, radiography is performed in one or 2 projections, it is also possible to study in a particular style, to perform contrast arthrography. A more detailed view of the condition of the osteochondral and soft tissue of the joints is available with CT and MRI images.
- Joint ultrasound.Allows you to detect shedding in the joint cavity, bone erosion, changes in the synovial membrane, measure the width of the joint spaces. The availability of sonography makes it indispensable for the diagnosis of rheumatic joint pathologies.
- invasive methods.According to the indications, a puncture of the wrist, a biopsy of the synovial membrane is performed. In controversial cases, diagnostic arthroscopy is performed, which allows you to examine the ankle cavity from the inside, perform diagnostic and therapeutic measures.
- Laboratory tests.Helps to identify the presence of an inflammatory process,rheumatic diseases. In the peripheral blood is determined ESR, the level of C-reactive protein, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ACCP). An important diagnostic method is the microbiological and cytological examination of synovial fluid.
- Other diagnostic methods:thermography, podography.
Treatment
Help before diagnosis
For any joint pain, it is necessary to stay calm and not load the limb. The metabolic causes of arthralgia dictate the need for a balanced diet, weight normalization. With fresh injuries, it is necessary to apply cold to the joints, immobilize the damaged limb with a splint or fixative bandage. You can take painkillers or NSAIDs.
Neglect of competent examination and treatment for arthralgia is fraught with the development of irreversible functional disorders of the joints - stiffness, ankylosis, contracture. Since joint pain can serve as a marker of a variety of diseases, it is necessary to consult a doctor if articular syndrome appears and persists for more than 2 days.
Conservative therapy
In the treatment of joint pain, the main role is given to the treatment of the main pathology. Medication treatment of arthralgia aims to stop intra-articular inflammatory processes and pain. Systemic therapy involves the use of non-steroidal anti-inflammatory drugs.
With moderate arthralgia or the presence of contraindications for oral administration of drugs, topical external therapy is performed with warming ointments, anti-inflammatory and analgesic. Dimethyl sulfoxide applications are applied to the wrist area. Joint gymnastics, physiotherapy procedures (drug electrophoresis, magnetotherapy, phonophoresis, UHF therapy) are recommended.
If necessary, periarticular blockades, intra-articular injections of glucocorticoids, chondroprotectors, synovial fluid prostheses are performed. Modern promising methods of therapy for chronic joint pathologies are ozone therapy, joint plasmolysis and orthokine therapy.
Surgery
Different types of surgical interventions 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 methods (arthrotomy) or endoscopic (arthroscopy). Depending on the underlying disease, the following are performed:
- arthroplasty;
- arthrodesis;
- ligament plastics;
- joint cavity rehabilitation;
- removal of pathological formations (cysts, intra-articular bodies);
- synovectomy;
- joint arthroplasty.