Joint pain

9 January 2024

Joint pain- These are unpleasant sensations of pain and pulling in the area of the articular joints, the intensity of which sometimes reaches the level of pain. The symptom is combined with muscle pain, weakness, weakness, clicking, limited movement and may precede joint pain (arthralgia). Joint pain is accompanied by injuries of the musculoskeletal system, infections, diseases of the hematopoietic system and vascular pathology. To identify the cause of the disorder, laboratory tests, ultrasound, radiographs and invasive methods are used. Treatment involves treating the disease that caused the pain.

Causes of joint pain

Mild or moderate joint discomfort is not always a manifestation of a pathological process. Sometimes the symptom has natural causes. Transient joint pain is felt when wearing uncomfortable shoes and in weather-sensitive people - when the weather changes. During puberty, painful sensations in the shoulder and knee joints are caused by insufficient blood supply due to accelerated bone growth.

Meaningful physical activity

During intense training or heavy work, a common cause of the symptom is excessive tension of the musculoligamentous apparatus, less often caused by microtraumas of the cartilage and synovium. A typical combination of joint pain and discomfort in the bones and muscles. Joint and muscle discomfort occurs immediately after the impact of physical activity or against the background of prolonged monotonous work with constant tension on the same muscle groups. Pain in the joints of the body occurs without fever. With large overloads, a moderate violation of the general condition and weakness are possible.

The disorder can last for several days and, with limited physical activity, gradually diminishes until it disappears completely without any treatment. If pain resulting from sports or heavy physical work is replaced by persistent pain, swelling in the wrist, elbow, shoulder, ankle, knee and hip joints and limitation of usual movements, you should consult a doctor.

Age-related changes in the musculoskeletal system

The causes of moderate pain in bones and joints in elderly people are degenerative processes with loss of calcium, thinning of bone bundles, impaired blood supply to cartilage and a decrease in the volume of intra-articular fluid. Mild discomfort is only the first manifestation of senile joint damage. Typically, periodic discomfort occurs after 45-50 years. At the age of 60-65, unpleasant pain occurs even with small efforts, accompanied by stiffness of movements, stooped and shuffling gait and gradually gives way to pain.

Pregnancy

Complaints of joint pain are made more frequently in the second half of gestational age. Painful, pulling discomfort is often felt in the joints of the pelvis and lower extremities. It intensifies at the end of the day, after standing for a long time or walking long distances. A night's rest alleviates the condition. Joint pain during pregnancy is caused by the following reasons:

Vitamin and mineral deficiency. The biggest role is played by calcium and vitamin D deficiency, leading to osteomalacia. A characteristic feature of the manifestation of the symptom is a feeling of pain not only in the joints, but also in the bones, fatigue, the presence of other signs of hypocalcemia and hypovitaminosis D - caries, brittle nails, muscle weakness, muscle pain, and the frequent occurrence of ARVI .
Significant weight gain. Joint discomfort is most often a concern for pregnant women who have gained a lot of weight or are obese. Pain at the end and, possibly, in the middle of the day, is felt in the hip joints, knees, ankles, whose cartilages suffer loads several times greater than permitted. To alleviate the condition, women deliberately limit physical activity, which leads to even faster weight gain.
Softening of cartilage and ligaments. About half of pregnant women experience discomfort in the pelvic joints caused by the action of the hormone relaxin. In most cases, the discomfort is pain in the pubic region and hip joints. In the pathological course with the development of symphysitis, painful sensations are replaced by pain, which intensifies when pressing on the uterus, trying to separate the legs, during sex. The appearance of pain in the pubic area is a serious reason for consulting an obstetrician-gynecologist.
Carpal tunnel syndrome. A specific manifestation found in the 2-3 trimesters in almost 20% of pregnant women is the so-called tunnel syndrome. The cause of the disorder is swelling of the soft tissues of the hands and compression in the carpal tunnel of the nerves that pass to the fingers. In addition to pain in the small joints of the hand, patients complain of skin numbness, tingling and a tingling sensation. The condition improves with an elevated position of the arms.

Obesity

In overweight people, pressure on cartilaginous tissue increases, causing it to wear out faster. The degenerative-dystrophic process usually involves large joints of the lower extremities and intervertebral joints. The disorder increases as obesity progresses. Discomfort in the joints first manifests itself in the form of pain without fever at the end of the day, then the increasing destruction of cartilage leads to the development of deforming arthrosis, spondylosis, osteochondrosis with an acute pain syndrome that limits the patient's motor activity.

Acute infections

Body and joint pain is one of the first (prodromal) signs of many acute respiratory viral infections. The main causes of joint discomfort are intoxication of the body due to the spread of viruses and bacteria, the accumulation of toxins and the development of the inflammatory process. Typically, the patient complains that the whole body hurts, there is mild and moderate pain in both the joints and the muscles and bones. The symptom is accompanied by weakness, fatigue, insomnia and frequent awakenings. Simultaneously with signs of pain and general malaise, chills and hyperthermia are observed.

The most pronounced joint and body pain occurs with the flu. Up to 50% of patients experience constant pain in their legs, arms and trunk. The intensity of the pain is so high that it becomes difficult for a person to perform the simplest actions - get out of bed, go to another room, get a glass of water. The situation is aggravated by high temperature (febrile) and severe headaches. Sore throat and nasal congestion occur after a few hours or even days. Less joint discomfort occurs with parainfluenza, an adenoviral infection.

A feeling of pain in the joints is possible with acute infectious lesions of the gastrointestinal tract - toxic food infections, salmonellosis. Joint pains of varying intensity appear suddenly a few hours after consuming contaminated food and are combined with a sharp rise in temperature, severe chills and headaches. The pain is preceded by nausea, vomiting, pain in the abdominal cavity, fetid diarrhea with mucous impurities and sometimes blood.

Collagenoses

Joint pain is a harbinger of most diseases that occur with autoimmune inflammation of connective tissue, including articular tissue. The location, prevalence and intensity of unpleasant sensations are determined by the characteristics of a specific collagenosis. The general patterns are the involvement of certain groups of joints in the process, a gradual increase in sensations to an unbearable and debilitating pain, observed first during movement and then at rest. Deformation of the articular joints is possible. The main systemic inflammatory causes of the disorder:

Rheumatism. The symptom is "volatile": aching and then aching pains are felt in the large joints of the arms and legs - elbows, shoulders, hips, knees, ankles. The affected areas are swollen. Joint discomfort is often preceded by a sore throat. With treatment, changes in the joints are reversible.
Rheumatoid arthritis. Unpleasant sensations usually appear after 40 years. A typical feeling of pain in the small joints of the hands and feet, combined with noticeable swelling and morning stiffness of movement. In the future, pain and curvature of the articular joints will come to the fore.
Systemic scleroderma. It is characterized by variable localization of painful sensations, presence of morning stiffness in the joints of the hands, elbows and knees. Aches and pains are usually symmetrical. The swelling is short-lived. Due to skin sclerosis, the mobility of the articular joints is limited, damage to the tendons causes a feeling of friction during movement.

Osteoarthritis

The pain syndrome in the initial stages of the disease is mild and is perceived as discomfort, pain in the joints of the legs and, less often, in the arms. The immediate cause of osteoarthritis is the degeneration and destruction of cartilaginous tissue. Typically, pulling or aching sensations without fever appear in adulthood and old age. Pain may begin earlier in the presence of occupational hazards (vibration, heavy physical work). Gradually, the joints become stiff, the person experiences severe pain and difficulty walking and taking care of themselves.

Metabolic disorders

The causes of metabolic disorders in which joint pain occurs are insufficient supply of vitamins, minerals, accelerated accumulation or excessive excretion of metabolic products. Unpleasant sensations are caused by inflammatory or dystrophic processes, have varying severity and most often serve as a manifestation of pathological conditions such as:

Osteoporosis. When calcium is eliminated from bone tissue, the articular surfaces of the bones become fragile, the cartilage becomes thinner, which is accompanied by pain sensations. The pain syndrome gradually increases from mild pain to severe arthralgia, combined with unpleasant sensations in the bones and muscle weakness. The joints that experience the maximum load are most often affected – the hip and knee; the shoulder, elbow, and ankle are less commonly affected.
Drop. Slight pain in the big toe is already a concern in the pre-clinical phases of the gouty process. There may be painful discomfort in the knees, elbows, wrists and fingers. The accumulation of urates in the joint cavity leads to a rapid manifestation of the disease, with a change from joint pain to sharp, aching pain that does not disappear for several hours. The affected joint feels warm to the touch. There is redness of the skin and limitation of movement.

Oncological diseases

In acute and chronic leukemia, generalized osteoarticular pain, followed by pain, often occurs even before pathological changes noticeable in a general blood test and other clinical symptoms - general malaise, night sweats, fever, loss of appetite, bleeding. The unpleasant sensations at first hurt periodically, then they are constantly strong, weakening the patient.

Hodgkin's lymphoma and lymphogranulomatosis are characterized by a combination of joint pain with muscle discomfort, weakness, enlarged lymph nodes and other lymphoid formations. Painful sensations are common, usually moderate. A short period of pain in the knee joint and thigh muscles, which intensifies at night and with exertion turns into increasing pain with lameness, is seen in osteosarcomas. Other joints are less affected by this pathology.

Joint injuries

Joint pain is caused by mild traumatic injuries, which cause damage to the ligaments that surround the joint and bruising in the soft tissues of the joint region. More intense pain occurs when the meniscus is damaged. The symptom is clearly related to a blow, a fall or a strange movement. Discomfort is usually felt in one affected joint, less frequently spreading to adjacent areas of the body.

Chronic infectious processes

Possible causes of a feeling of joint pain that occurs without fever or in the context of a low-grade fever are long-term infections. In patients suffering from chronic infectious and inflammatory diseases, discomfort in the joints becomes a consequence of intoxication of the body or the direct harmful effects of microorganisms on joint tissues (usually streptococci, mycoplasmas, chlamydia). The appearance or intensification of pain may indicate an exacerbation of chronic tonsillitis, sinusitis, genitourinary infections, adnexitis, pyelonephritis.

Distinctive features of joint pain in common chronic infections occurring with intoxication are moderate severity of joint discomfort, gradual development, periodic intensification and weakening of symptoms. In patients suffering from tuberculosis and hematogenous osteomyelitis, the background for the development of painful sensations is an increase in temperature to subfebrile levels, general malaise - fatigue, weakness, weakness. Without treatment, patients' condition progressively worsens.

Complications of pharmacotherapy

Taking some medications can be complicated by moderate pain in the small joints of the hands. Unpleasant sensations are not accompanied by redness or deformation of the joints. Patients may complain of muscle pain, fever, rashes and other manifestations of drug allergies. The discomfort disappears quickly after discontinuing the medication that caused it, and it is less likely that special treatment will be needed for complications that arise. Pain and mild arthralgia are caused by:

Antibiotics: penicillins, fluoroquinolones.
Tranvilizers: phenazepam, diazepam, lorazepam, etc.
Contraceptives: combined oral contraceptives (COCs).

Rare causes

Inflammation of the respiratory system: pneumonia, bronchitis, tracheitis.
Intestinal pathology: nonspecific ulcerative colitis, Crohn's disease.
Skin diseases: psoriasis.
Endocrine disorders: diabetes mellitus, diffuse toxic goiter, hypothyroidism, Itsenko-Cushing's disease.
Autoimmune processes: Hashimoto's thyroiditis, vasculitis.
Facial damage: necrotizing fasciitis in the convalescent phase.
Congenital bone and joint defects.

Survey

To find out why joint and bone pain occurs, you need to consult a therapist or family doctor, who will make an initial diagnosis and prescribe examinations by specialized specialists. Taking into account the nature of unpleasant sensations, the speed of their occurrence and the accompanying symptoms, the following are recommended to determine the cause of the disorder:

Laboratory blood test. An assessment of the leukocyte count and ESR level is necessary to exclude infections, inflammatory and oncohematological processes. In systemic diseases, it is important to measure the content of total proteins, the proportion of protein fractions in the blood, specific acute phase proteins, markers of rheumatoid arthritis and other inflammations. Tests for the concentration of vitamins, electrolytes (especially calcium) and uric acid help diagnose metabolic disorders.
Bacteriological examination. Bacterial culture is necessary if the pain felt in the joints and throughout the body is likely to be infectious. Urine, feces, sputum and secretions from the urogenital tract are collected for research. To select an antimicrobial therapy regimen, sensitivity to antibiotics is determined. In doubtful cases, microscopy and culture are complemented with serological reactions (RIF, ELISA, PCR).
Ultrasound of articular joints. It is generally used for clear localization of painful sensations and suspicion of rheumatic diseases. Ultrasound of the joint allows you to examine its structure, identify destruction of cartilage and bone, preclinical inflammatory changes and study the condition of periarticular soft tissues. The advantages of the method are accessibility, non-invasiveness and high informative content.
X-ray techniques. Changes in the width of the joint space, hardening of soft tissues, presence of calcifications, osteophytes and erosions of the joint surfaces are detected during joint radiography. To improve diagnostic efficiency, special techniques are used - contrast arthrography, pneumoarthrography. In the early stages of the injury, tomography (magnetic resonance imaging, computed tomography of the joints) is considered more indicative. Bone density can be conveniently assessed using densitometry.
Invasive examination techniques. In some cases, to determine the cause of joint pain, a puncture is performed with a biopsy of the cartilage, the inner lining of the synovial membrane and the tophi. Morphological analysis of biopsy samples and examination of synovial fluid reflect the nature of the pathological processes occurring in the joints. Simultaneous collection of materials with visual examination of the joint cavity is convenient during arthroscopy with tissue biopsy.

A less common way to diagnose the cause of joint pain is scintigraphy with the introduction of technetium, which accumulates in the affected tissues. In recent years, there has been increasing interest in joint thermography as a modern non-invasive method for recognizing inflammatory diseases, tumors and circulatory disorders in joints and periarticular tissues. If the number of figured elements in a clinical blood test decreases, an extra-articular bone puncture is performed. Patients with joint pain without fever are advised to consult a rheumatologist and an orthopedic traumatologist.

Treatment

Help before diagnosis

For joint pain associated with physical activity, no special treatment is required, a long rest with a dosage of loads is enough. Unpleasant joint sensations that occur during pregnancy usually go away on their own after pregnancy or are corrected by controlling weight and taking vitamin and mineral supplements. Elderly and obese patients are advised to change their lifestyle: adequate physical activity, a diet with adequate calorie content and sufficient content of plant foods.

Pain in the bones, joints and muscles, combined with general malaise and fever, increased aching and pulling sensations to the point of severe pain, and the development of persistent pain are indications for consulting a doctor. To reduce joint discomfort caused by ARVI, it is recommended to rest, drink plenty of water, rosehip infusions and dried fruits. Until serious diseases that cause pain in the joints, self-medication with painkillers, prolonged and unsuccessful application of compresses, lotions, decoctions, etc. are excluded.

Conservative therapy

You can get rid of joint pain with adequate treatment, which is aimed at eliminating the cause of the disorder and individual parts of the mechanism of its development. Etiopathogenetic therapy is usually supplemented with symptomatic medications that quickly reduce the severity of dull, dull pain. The treatment regimen for diseases occurring with joint pain may include:

Antimicrobials. Basic therapy for infections is based on prescribing antibiotics to which the pathogen is susceptible. In severe cases, broad-spectrum medications are used until the sensitivity of the microorganism is established.
Nonsteroidal anti-inflammatory drugs. They reduce the production of inflammatory mediators and thus inhibit inflammatory processes in the joints. By influencing central pain receptors, they reduce the degree of discomfort in the joints. Used in the form of tablets, ointments, gels.
Corticosteroids. They have a strong anti-inflammatory effect. Hormone therapy is the basis for the treatment of systemic collagenosis. In severe and resistant forms of the disease, corticosteroids are combined with immunosuppressants to enhance the effect.
Chondroprotectors. They act as a substrate for the synthesis of glycan proteins, a sufficient amount of which increases the elasticity of articular cartilage. Nourishes cartilaginous tissue and restores its damaged structure. Intra-articular administration of medications is possible.
Xanthine oxidase inhibitors. Used as an anti-gout medicine. They block the key enzyme required for the synthesis of uric acid, thus reducing its concentration in the body and promoting the dissolution of existing urate deposits.
Vitamin-mineral complexes. Recommended for the treatment of joint pain caused by metabolic disorders. The most commonly used medicines contain calcium and vitamin D. They are also an element of complex therapy for inflammatory and metabolic diseases.
Chemotherapeutic agents. They serve as the basis for most treatment regimens for various types of oncohematological pathologies. Depending on the clinical variant and severity of the neoprocess, they are combined with radiotherapy and surgical interventions.

Physiotherapy

After the exact cause of the pain has been determined and the acute inflammation has subsided, patients, except those suffering from cancer, receive physical therapy and exercise therapy. Microwave and ultrasound therapy sessions, electrophoresis and pulsed currents have a good anti-inflammatory and analgesic effect. In the case of chronic pathology, physiotherapeutic treatment is carried out over several months and complemented by spa therapy.