Joint pain

Joint pain- This is an unpleasant pain, a pulling sensation in the area of the articular joint, the intensity of which sometimes reaches the level of pain. These symptoms are combined with muscle pain, weakness, weakness, crunch, limited movement and may precede joint pain (arthralgia). Joint pain is accompanied by lesions of the musculoskeletal system, infections, diseases of the hematopoietic system, and vascular pathology. To identify the cause of the disorder, laboratory tests, ultrasound, radiography and invasive methods are used. Treatment involves treating the disease that is causing the pain.

Causes of joint pain

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

Significant physical activity

During intense training or heavy work, the usual cause of symptoms is excessive fatigue of the musculo-ligamentous apparatus, less often it is caused by microtraumas of cartilage and synovium. A common combination of pain in the joints 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 in the same muscle group. Joint pain occurs without fever. With a large load, moderate violations of the general condition and weakness are possible.

These disturbances can last up to several days and, with limited physical activity, gradually decrease until they disappear completely without any treatment. If aches and pains from sports or heavy physical work are replaced by constant pain, swelling in the wrists, elbows, shoulders, ankles, knee and hip joints, and normal range of motion, you should visit a doctor.

Age-related changes in the musculoskeletal system

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

Pregnancy

Complaints about joint pain are more often made in the second half of pregnancy. Discomfort is interesting, pain is usually felt in the pelvic joints and the lower part of the legs. It gets stronger towards the end of the day, after standing for a long time or walking a long distance. An overnight rest eases the situation. Joint pain during pregnancy is caused by the following reasons:

• Lack of vitamins and minerals. The biggest role is played by the lack of calcium and vitamin D, which leads to osteomalacia. Characteristic manifestations of symptoms are 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 frequent occurrence of ARVI.
• Significant weight gain. Joint discomfort is more often a concern for overweight pregnant women or those who are obese. Pain at the end, and finally in the middle of the day, is felt in the hip joints, knees, ankles, cartilage that experiences loads several times higher than allowed. To alleviate the situation, women deliberately limit physical activity, which leads to faster weight gain.
• Softens 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 in the nature of pain in the genital area and hip joints. In the pathological course with the development of symphysitis, the pain sensation is replaced by pain, which increases when pressing on the uterus, trying to separate the legs, during sexual intercourse. The appearance of pain in the genital area is a serious reason for a visit to 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 hand and compression in the carpal tunnel of the nerve that passes through the fingers. In addition to pain in the small joints of the hand, the patient complains of skin numbness, tingling, and a crawling sensation. The condition is improved with a high arm position.

Obesity

In people who are overweight, the pressure on the cartilage tissue increases, causing it to wear out faster. The degenerative-dystrophic process usually involves the large joints of the lower leg and intervertebral joints. The disorder increases as obesity develops. 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 a sharp pain syndrome that limits the motor activity of the patient.

Acute infection

Body and joint pain is one of the early signs (prodromal) of many acute respiratory viral infections. The main cause of joint discomfort is intoxication of the body due to the spread of viruses and bacteria, the accumulation of toxins, and the development of the inflammatory process. Usually the patient complains that the whole body hurts, mild and moderate pain is noted both in the joints and in the muscles and bones. These symptoms are accompanied by weakness, fatigue, insomnia, and frequent waking. At the same time as signs of pain and general lethargy, shivering and hyperthermia are observed.

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

Pain in the joints is possible with acute infectious lesions of the gastrointestinal tract - toxic food infection, salmonellosis. Joint pain of varying intensity appears suddenly a few hours after consuming contaminated food and is combined with a sudden increase in temperature, severe chills, and headache. Pain is preceded by nausea, vomiting, pain in the abdominal cavity, foul-smelling diarrhea with mucus impurities and sometimes blood.

Collagenous

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

• Joint pain. The symptoms are "unpredictable": aching pain and then pain is felt in the large joints of the arms and legs - elbows, shoulders, hips, knees, ankles. The affected area swells. Joint discomfort is often preceded by a sore throat. With treatment, changes in the joints can be reversed.
• Rheumatoid arthritis. Unpleasant sensations often appear after 40 years. Typical pain in the small joints of the hands and feet, combined with significant swelling and morning stiffness of movement. In the future, pain and curvature of the articular joints come to the fore.
• Systemic scleroderma. It is characterized by variable localization of pain sensations, the presence of morning stiffness in the joints of the hands, elbows, and knees. Aches and pains are usually symmetrical. The swelling did not last long. Due to the sclerosis of the skin, the mobility of the articular joints is limited, damage to the tendons causes a feeling of friction when moving.

Osteoarthritis

The pain syndrome in the early stages of the disease is mild and is perceived as discomfort, pain in the joints of the legs, and less often, the arms. The direct cause of osteoarthritis is the degeneration and destruction of cartilage tissue. Usually, pulling sensations or pain 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 himself.

Metabolic disorders

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

• Osteoporosis. When calcium is washed out of the bone tissue, the articular surface of the bone becomes fragile, the cartilage becomes thinner, which is accompanied by painful sensations. The pain syndrome increases gradually 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 - hips and knees; shoulders, elbows and ankles are less affected.
• Gout. A little pain in the big toe is already a concern in the preclinical stage of the gouty process. There may be painful discomfort in the knees, elbows, wrists and fingers. Accumulation of urate in the joint cavity leads to the rapid manifestation of the disease with a change from pain to acute painful joint pain that does not subside for several hours. The affected joint is hot to the touch. There is redness on the skin and limited movement.

Oncological diseases

In acute and chronic leukemia, widespread osteoarticular pain, followed by pain, often occurs even before significant pathological changes in general blood tests and other clinical symptoms - general malaise, night sweats, fever, loss of appetite, bleeding. Unpleasant sensations at first periodically hurt, then 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. Pain sensations are common, usually mild. A short period of pain in the knee joint and thigh muscles, which intensifies at night, and with energy turns into pain that constantly increases with lameness, is observed with osteosarcomas. Other joints are less affected by this pathology.

Joint injuries

Joint pain is provoked by a mild traumatic injury, which causes damage to the ligaments surrounding the joint and bruising of the soft tissue of the articular area. More severe pain occurs when the meniscus is damaged. These symptoms are clearly related to time with blows, falls, or awkward movements. Usually the discomfort is felt in one affected joint, less often it spreads to adjacent areas of the body.

Chronic infectious process

A possible cause of joint pain that occurs without fever or with a background of low-grade fever is a long-term infection. In patients suffering from chronic infectious and inflammatory diseases, joint discomfort is a result of body intoxication or the direct damaging effect of microorganisms on joint tissue (usually streptococci, mycoplasmas, chlamydia). The appearance or increase of pain may indicate the severity of chronic tonsillitis, sinusitis, genitourinary infection, adnexitis, pyelonephritis.

The characteristic features of joint pain in common chronic infections that occur with intoxication are moderate severity of joint discomfort, gradual development, periodic intensification and weakness of symptoms. In patients suffering from tuberculosis and hematogenous osteomyelitis, the background for the development of painful painful sensations is an increase in temperature to a subfebrile level, general malaise - fatigue, weakness, weakness. Without treatment, the patient's condition worsens.

Complications of pharmacotherapy

Taking some medications may be complicated by moderate aches and pains in the small joints of the hands. Unpleasant sensations are not accompanied by redness or deformation of the joint. Patients may complain of muscle pain, fever, skin rash, and other manifestations of drug allergy. Discomfort quickly disappears after the cessation of the drug that provoked it, and special treatment for complications that arise is less likely to be needed. Mild pain and arthralgia caused by:

• Antibiotics: penicillin, fluoroquinolone.
• Rounder: phenazepam, diazepam, lorazepam, etc.
• Contraceptives: combined oral contraceptives (COCs).

A rare cause

• Inflammation of the respiratory system: pneumonia, bronchitis, tracheitis.
• Intestinal pathology: nonspecific ulcerative colitis, Crohn's disease.
• Skin disease: psoriasis.
• Endocrine disorders: diabetes mellitus, diffuse toxic goiter, hypothyroidism, Itsenko-Cushing's disease.
• Autoimmune process: Hashimoto's thyroiditis, vasculitis.
• Facial damage: necrotizing fasciitis in the recovery stage.
• Congenital defects of bones and joints.

Survey

To determine why aches and pains are felt in the joints and bones, it is necessary to consult a therapist or family doctor, who will carry out an initial diagnosis and prescribe an examination by a specialist. Taking into account the nature of the unpleasant sensation, the speed of its occurrence, and the accompanying symptoms, the following is recommended to determine the cause of the disorder:

• Laboratory blood tests. Evaluation of leukocyte count and ESR level is necessary to exclude infection, inflammatory process and oncohematology. In systemic diseases, it is important to measure the content of total protein, the fractional ratio of proteins in the blood, specific acute phase proteins, markers of rheumatoid arthritis and other inflammation. 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 is felt in the joints and the whole body is likely to be infectious. Urine, feces, sputum, and discharge 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 supplemented with serological reactions (RIF, ELISA, PCR).
• Articular joint sonography. It is usually used for clear localization of painful sensations and the presence of suspected rheumatic diseases. Ultrasound of the joint allows us to examine its structure, identify the destruction of cartilage and bone, preclinical inflammatory changes, and study the state of the periarticular soft tissue. The advantages of this method are its accessibility, non-invasiveness, and high information content.
• X-ray technique. Changes in the width of the joint space, hardening of the soft tissues, the presence of calcifications, osteophytes, and erosion of the articular surface are detected during joint radiography. To improve diagnostic efficiency, special techniques are used - contrast arthrography, pneumoarthrography. In the early stage of the lesion, tomography (MRI, CT joint) is considered more indicative. Bone density can be easily assessed using densitometry.
• Invasive examination techniques. In some cases, to determine the cause of joint pain, a puncture is performed with a biopsy of cartilage, the inner layer of the synovial membrane, and tophi. Morphological analysis of biopsy specimens and examination of synovial fluid reflects the nature of the pathological process occurring in the joint. Collection of material simultaneously with visual inspection of the articular cavity is easy to do during arthroscopy with tissue biopsy.

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

Treatment

Help before diagnosis

For painful joints related to physical activity, special treatment is not required; a long rest with a loading dose is sufficient. Unpleasant joint sensations that occur during pregnancy usually disappear 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: sufficient physical activity, a diet of appropriate calorie content with sufficient plant food content.

Pain in the bones, joints and muscles, combined with general malaise and fever, increased pain and pulling sensations to the level of severe pain, and the continuous development of pain are indications to consult a doctor. To reduce joint discomfort caused by ARVI, it is recommended to rest, drink enough water, rosehip infusion, and dried fruits. Until a serious disease that causes joint pain is excluded, self-medication with painkillers, the use of compresses, lotions, decoctions, etc. which are unsuccessful in the long term cannot be accepted.

Conservative therapy

You can get rid of joint pain with the right treatment, aimed at eliminating the cause of the disorder and the individual part of the mechanism of its development. Etiopathogenetic therapy is usually supplemented with symptomatic drugs that quickly reduce the severity of nagging and painful pain. Treatment regimens for diseases that occur with joint pain may include:

• Antimicrobial. Basic therapy for infections is based on the prescription of antibiotics that are susceptible to pathogens. In severe cases, broad-spectrum drugs are used until the sensitivity of microorganisms is established.
• Nonsteroidal anti-inflammatory drugs. They reduce the production of inflammatory mediators and thus prevent the inflammatory process in the joints. By affecting central pain receptors, they reduce the level of joint discomfort. 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, corticosteroid drugs are combined with immunosuppressants to increase their effect.
• Chondroprotectors. They act as a substrate for the synthesis of protein glycans, a sufficient amount of which increases the elasticity of articular cartilage. Nourishes cartilage tissue and restores its damaged structure. Intra-articular drug administration is possible.
• Xanthine oxidase inhibitor. Used as an anti-gout medicine. They block the main enzyme necessary for the synthesis of uric acid, thereby reducing its concentration in the body and promoting the dissolution of existing urate deposits.
• Vitamin-mineral complex. Recommended for the treatment of joint pain caused by metabolic disorders. The most commonly used drugs contain calcium and vitamin D. They are also elements of complex therapy for inflammatory and metabolic diseases.
• Chemotherapy agents. They serve as the basis for most treatment regimens for various types of oncohematological pathologies. Depending on the clinical variant and the severity of the neoprocess, they are combined with radiotherapy and surgical intervention.

Physiotherapy

After the actual cause of pain and reduction of acute inflammation, patients, except those suffering from cancer, are prescribed physiotherapy and exercise therapy. Microwave and ultrasound therapy sessions, electrophoresis, and pulsed current have good anti-inflammatory and analgesic effects. In the case of chronic pathology, physiotherapeutic treatment is carried out for several months and is supplemented with spa therapy.