joint pain(arthralgia) can occur in one or several joints simultaneously (polyarthralgia). Arthralgias are observed in rheumatic, endocrine, infectious, tumoral, neurological, autoimmune diseases, injuries, overweight. Knowing the causes of joint pain has an important differential diagnostic importance; performed by X-ray, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). The treatment of arthralgia is reduced to the treatment of the disease that caused it. Symptomatic measures (analgesics, local heat, ointments), immobilization, physiotherapy, surgical interventions are applied.
Classification
Arthralgias differ in localization and depth, the number of joints involved, the nature and intensity of the pain syndrome, its daily rhythm, duration of existence, connection with a certain type of movement. In the presence of pain in a single joint, we speak of monoarthralgia, with simultaneous or sequential pain syndrome in several joints - oligoarthralgia, with involvement of 5 or more joints - polyarthralgia syndrome.
Depending on the nature of the arthralgic syndrome, sharp and dull pain are distinguished; by intensity - from weak and moderate to intense; depending on the type of flow - transient and constant. Most often, arthralgia occurs in large joints - the hip, knee, shoulder and elbow, less often in medium and small ones - wrist, ankle, interphalangeal.
The appearance of pain in the joints 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 customary to distinguish the following types of joint pain:
- caused by toxic syndrome in acute infections;
- primary episode or intermittent (intermittent) arthralgia in acute or recurrent arthritis;
- long-term monoarthralgia of large joints;
- oligo or polyarthralgic syndrome that accompanies the involvement of the synovial membranes or progressive degenerative-dystrophic changes in the cartilage;
- post-inflammatory or post-traumatic residual 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 presents 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 its association with myalgia. Mobility in the joint is fully preserved. Infectious arthralgia usually resolves within a few days as the toxic syndrome caused by the underlying disease weakens.
infectious arthritis
Possible options for the development of postinfectious reactive arthralgias after acute intestinal or urogenital infections; parainfectious arthralgic syndrome caused by tuberculosis, infective endocarditis, secondary syphilis. Often the cause of pain in the joints are the foci of the existing chronic infection: pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasitic invasion.
Residual arthralgias after joint inflammation are chronic or transient. Joint pain and stiffness can persist 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 of the type of poly or ologarthralgia is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by a syndrome of constant, intense and migratory pain, involvement of large joints, mainly of the lower extremities, limited movement in the joints.
The debut of rheumatoid arthritis, as well as systemic rheumatic diseases, are manifested by polyarticular syndrome, which affects small symmetrical joints of the feet and hands, motor stiffness in the morning.
In microcrystalline gouty arthritis, arthralgia manifests itself in the form of recurrent paroxysmal pain in an isolated joint, which, arising suddenly, rapidly reaches maximum intensity and does not disappear for several days.
degenerative joint injuries
Gradual increase in joint pain over a long time may indicate osteoarthritis deformans and other degenerative dystrophic lesions. In this case, involvement of the knee or hip joints is typical; type of dull, aching pain, related to exercise and its disappearance at rest. Arthralgia can be weather-dependent, accompanied by a "crack" of the joints during movement, weaken when using local distraction therapy.
joint injuries
Hematomas, joint dislocations, damage to the ligamentous apparatus, intra-articular fractures are accompanied by severe pain. The affected joint swells, deforms, feels hot to the touch. The supporting function of the lower limb is impaired, movement in the joint becomes difficult, and sometimes pathological mobility occurs. Injuries may be accompanied by bleeding into the joint cavity, which leads to its stiffness.
oncological diseases
Long-term persistent oligoarthralgias and polyarthralgias, accompanied by the formation of "hippocratic fingers" (deformities of the nails and distal phalanges such as "watch glass" and "drumsticks"), indicate a paraneoplastic lesion of the synovial membranes. In such patients, oncological pathology of the internal organs, primarily 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 occurs in the form of oligoarthralgia associated with osalgia, myalgia, pain in the pelvic bones and spine.
Other reasons
Other possible causes of arthralgia include:
- heavy metal poisoning (thallium, beryllium);
- frequent overload or microtrauma of the joints;
- long-term drug therapy;
- post-allergic reactions;
- flatfoot;
- X-shaped or O-shaped deformation of the limbs;
- pseudoarthralgia, simulated by primary osalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Diagnosis
Since joint pain is only a subjective symptom, the clinical, anamnestic features and physical examination come to the fore in determining the causes of its occurrence. It is necessary to consult a rheumatologist, orthopedist. To differentiate the etiology of arthralgia, a number of objective studies are carried out:
- X-ray of the joints.It is a routine method that allows you to examine any joint in various diseases. Most often, radiography is performed in one or 2 projections, it is also possible to study in a special style, perform contrast arthrography. A more detailed picture of the state of the osteochondral and soft tissues of the joints is available with CT and MRI images.
- Joint ultrasound.It allows you to detect effusion into the joint cavity, bone erosion, changes in the synovial membrane, measure the width of the joint spaces. The availability of ultrasound makes it essential for the diagnosis of rheumatic joint pathologies.
- invasive methods.According to the indications, a puncture of the joint is performed, a biopsy of the synovial membrane. In debatable cases, a diagnostic arthroscopy is performed, which allows examining the joint cavity from the inside, to carry out diagnostic and therapeutic measures.
- Lab tests.It helps to identify the presence of an inflammatory process.,rheumatic diseases. In peripheral blood, the ESR, the level of C-reactive protein, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ACCP) are determined. An important diagnostic method is microbiological and cytological examination of synovial fluid.
- Additional diagnostic methods:thermography, podography.
Treatment
Help before diagnosis
For any joint pain, it is necessary to remain calm and not load the limb. Metabolic causes of arthralgia dictate the need for a balanced diet, weight normalization. With recent injuries, it is necessary to apply cold to the joint, immobilize the injured limb with a splint or fixation bandage. You can take pain relievers 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 for a variety of diseases, it is necessary to consult a doctor if joint syndrome occurs and persists for more than 2 days.
conservative therapy
In the treatment of joint pain, the leading role is given to the treatment of the main pathology. Pharmacological treatment of arthralgia is aimed at stopping intra-articular inflammatory processes and pain. Systemic therapy includes the use of nonsteroidal anti-inflammatory drugs.
With moderate arthralgia or the presence of contraindications to the oral administration of drugs, local external therapy is carried out with warming, anti-inflammatory and analgesic ointments. Dimethyl sulfoxide applications are applied to the joint 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. Promising modern methods of therapy for chronic joint pathologies are ozone therapy, joint plasmolifting and orthokine therapy.
Surgery
Various types of surgical interventions are warranted for joint pain caused by injuries, as well as for chronic conditions that lead to loss of joint function. They can be performed by open (arthrotomy) or endoscopic (arthroscopy) methods. Depending on the causative disease, the following are performed:
- arthroplasty;
- arthrodesis;
- ligament plastic;
- rehabilitation of the joint cavity;
- removal of pathological formations (cysts, intra-articular bodies);
- synovectomy;
- joint arthroplasty.