Joint Pain Overview

Written by: SphynxCatVP
Link to original: http://sphynxcatvp.nocturna.org/health/sc-jointpain.html

The average person should not be in acute pain on a daily basis - pain should be short-term, self-limiting, and ideally, show improvement in under six weeks.

However, if the pain is chronic, steps should be taken to ensure that the doctor or appropriate medical staff do a thorough investigation and determine the true cause of the pain. If the patient is overweight, many doctors will simply tell you "If you'd lose the weight you'll be just fine." That's not true in all cases - but getting the doctors to recognize this is quite often an uphill battle. It is not "drug seeking" behavior to keep trying to find a doctor who actually listens (If the patient is overweight and/or female, chances are very high they will NOT listen) - but there will be a lot of doctors who will think that anyway. It's absolutely vital that the patient be specific in stating that they are still looking to find the CAUSE of the pain, not just to keep treating it.

Doctors, to a certain point, are lazy - if a patient comes in and says "I have x-health problem", and that health problem is known to cause pain issues, they typically will NOT look any further without anything seriously indicating that they should. This WILL hamper effective treatment if the original diagnosis (whether self-diagnosed or official) is incorrect!

Always remember that the underlying cause of the pain must be identified, then cured or treated when possible in order to properly resolve the pain. Proper pain management is ESSENTIAL!

This article is written with the assumption that the reader has not had any major accidents or violent trauma causing severe lifelong pain. I recgonize that those are extenuating circumstances, and that they do cause severe pain, but they are beyond the scope of this article - generally in those cases the doctors DO recognize both the source AND the amount of pain the patient is in.

Glossary

Arthralgia

General medical term for joint pain.

Arthritis

Pain with redness, warmth, possible inflammation, and possible fluid in the joints, depending on the cause.

Autoimmune

A disease or condition caused by an overreaction of the body's immune system to it's own substances and tissues. Basically, the body is internally attacking itself.

Axial joints

In medicine, this is referring to the joints most people would think of as being vertical - primarily the spine and neck.

Intraarticular

Pain coming from within the joint itself.

Mechanical

Medically, this refers more to structural anatomy - skeletal bones - rather than soft tissues, ligaments, muscles and blood vessels. (I don't know whether this is an "official" medical term, but I've now heard it used in medical podcasts. It may simply be used for lack of anything better to denote structural references. *shrugs*)

Monoarticular

Pain affecting one joint, usually from an injury (broken finger, broken ankle, etc.)

Oligoarticular

Pain affecting 2-4 joints in an asymmetrical (uneven) pattern, and only the peripheral (arms, legs, hands, feet) joints.

Polyarticular

Pain affecting 4 or more joints, symmetrical (even) pattern, including both peripheral and axial joints

Periarticular

Pain that is outside of the affected joint - such as pain in the muscles, tendons, and ligaments. Mild sports injuries (such as "Tennis Elbow") usually fit in this category.

What causes joint pain?

Most common causes of chronic joint pain in otherwise healthy people:

  • Gonorrhea infection in young adults
  • Juvenile Rheumatorid Arthritis - A type of arthritis in children; possible autoimmune problem.
  • Osteoarthritis - A type of noninflammatory arthritis
  • Rheumatoid Arthritis - A type of inflammatory arthritis

Some Causes: Monoarticular Disorders

  • Acute infectious arthritis (can be caused by gonorrhea or other bacteria, as well as fungal)
  • Avascular Necrosis (non-blood vessel death) can cause joint pain
  • Blood thinners, if a spontaneous swelling develops
  • Cancer Tumors cause slowly progressive, constant pain, that is also present at night
  • Gout or other crystals-in-the-joint problem (usually starts in a big toe)
  • Injury (usually obvious, and based on history)
  • Osteoarthritis - slowly progressive pain in patients older, overweight, or who stress affective joints
  • Pain from around a joint
  • Periarticular syndromes - pain only on certain movements, but minimal pain when at rest

Some Causes: Oligoarticular Disorders

  • Ankylosing Spondylitis (arthritis that primarily affects the spine)
  • Gout or other crystals-in-the-joint problem
  • Fibromyalgia
  • Infective endocarditits (heart infection by bacteria or other organisms)
  • Osteoarthritis
  • Reactive / enteropathic arthritis (Arthritis conditions aggravated by gut problems)

Some Causes: Polyarticular Disorders

  • Acute Rheumatic Fever (inflammatory disease that can develop after strep infection)
  • Bacterial infections can cause septic arthritis (Most affect only a few joints, a few affect many joints)
  • Hemoglobinopathies (sickle cell, thalassemias, etc)
  • Hypothyroidism (typically in shoulders and hips)
  • Iron Overload / Toxicity
  • Juvenile Idopathic Arthritis
  • Lyme Disease
  • Progressive Systemic Sclerosis / Scleroderma (excessive buildup of collagen in joints/soft tissues)
  • Sjoren's syndrome - polymyalgia rheumatica
  • Rheumatoid Arthritis
  • Lupus
  • Systemic Vasculitis (inflammation of blood vessels)
  • Hypersensitivity Vasculitis (reactive inflammation of blood vessels)
  • Viral causes such as parvo, enterovirus, adenovirus, epstein-barr, cocsackie, cytomegalovirus, rhubella, mumps, Heb-B/C, Varocella and HIV

How is it diagnosed?

Because joint pain can have a variety of causes, there are a variety of diagnostic methods used to determine where the problem originates from. These start from basic and move up to the more complex/expensive - why send a person out for xrays if the problem will show up on simple bloodwork, for example.

Labwork - specific inflammatory markers include

  • ANA/Antinuclear Antibodies
  • CBC with differential smear
  • CCP/Cyclic Citrullinated Peptide Antibody
  • Complete/Comprehensive Metabolic Panel
  • CRP/C-Reactive Protein
  • ESR/Sedimentation Rate
  • Fibrinogen
  • HLA-B27/Human leukocyte antigen B27
  • RF/Rheumatoid Factor
  • TNF/Tumor Necrosis Factor
  • Uric Acid
  • If necessary, a synovial fluid test will be done to look at the joint fluid for crystals or other signs
  • Xrays or CT scan if a bone abnormality is under consideration or they're looking for intraarticular problems.
  • Bone scans to detect things like a bone infection or cancer tumors within the bone.
  • Hypothyroidism may be the cause if TSH, T4 or other thyroid indicators are tested and found abnormal

Patient history gives important clues such as

  • Day / Night variations (cancer pain doesn't stop at night)
  • Injury history (fluid in the joint or inflammation may stem from that)
  • Past Illness (Strep Throat, for example, can lead to Acute Rheumatic Fever)
  • Sexual history (to rule in/out specific sexually transmitted diseases)
  • Situations that make it worse (weather, temperature, other environmental factors)
  • Travel history for bug and pest factors
  • Travel history and temperature ("tropical climate" can mean Florida as well as the Caribbean!)
  • Whether it's persistent or intermitten
  • Worse while active (suggesting a mechanical issue)
  • Worse while inactive (suggesting an inflammatory process)
  • Worse with specific foods/drinks (suggesting a reactive process)

Physical exam can show

  • Deformities in the joint
  • Injured areas that are obvious (broken bones, etc.)
  • Joint testing and flexing (range of motion, pain on pressure; ruling in or out ligament or cartilage problems)
  • Rashes suggesting various diseases by pattern and location
  • Tender areas (differentiates between problems IN or AROUND the joint)
  • Warmth, redness, inflammation

Example symptom combinations

You should make a list of all of your symptoms - even if you spend a week writing them down when you think of them to make a more complete list - to give to your doctor or other medical professional and discuss what possible indications there may be. This is not a complete list of symptom associations, only a representative sample:

  • Prior trauma and pain within the joint may indicate a fracture, ligament tear, or bleeding into the joint spaces.
  • Acute pain developing over several hours but no trauma may indicate crystal-based or infectious arthritis. Arthritis due to crystals tends to repeatedly come back over time.
  • Gradual onset of pain without traume may indicate Rheumatoid Arthritis or other non-infectious cause, but may also results from fungal infections.
  • Pain after resting or starting activity suggests an inflammatory cause.
  • Pain relieved by rest suggests a mechanical problem such as osteoarthritis or an injury.
  • Pain with active movement suggests something like tendonitis, bursitis, muscle sprain, and the like.
  • Inflammation within the joint will restrict both active movement AND affect resting positions.
  • Swelling on one side or away from the joint suggests a source outside of the joint such as ligaments, tendons and such.
  • Crystal problems such as Gout can affect many joints, but the big toes are commonly affected first (gravitational effect).
  • Recent sore throat with migraiting joint pain suggest Rheumatic Fever (Rheumatic Fever can migrate to, and infect, the heart and cause "Rheumatic Heart Disease". Any cases of suspected strep throat should be treated promptly to avoid this risk!)

How is it treated?

Commonly, joint inflammation is treated with NSAIDs such as asprin; without inflammation, Tylenol (Acetaminphen) is usually recommended instead. Immobilization can sometimes help. Heat therapy can help muscle spasm, while cold can help relieve inflammation and swelling.

Alternatively, Glucosamine and/or Chondroitin (over-the-counter at most herbal / organic food shops) are sometimes used by people to manage their joint pain. I've been told it's about a 50/50 chance whether it works, and it may take up to a few weeks to kick in.

Because pain can be caused by so many different things, treatment options will always depend on the type and cause of the pain - this is why proper and thorough evaluation is critical, as well as knowledge of ALL symptoms.

Acute issues need to be investigated and treated PROMPTLY to resolve the underlying problem.

Credits/References