Introduction to joint pain

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Introduction to joint pain_mdhilJoint pain is a very common problem that can make normal day-to-day activities difficult.

The human body has many joints, large and small that help us move freely in various positions and perform a range of activities. A joint is made up of the ends of two or more bones surrounded by a fluid filled bag called bursa. In addition to bones, joints may have some soft tissues such as tendons, cartilage and a lubricating fluid called synovial fluid which prevents friction during movement.

Arthralgia – what is it?

If the joint pain is due to inflammation it is termed as arthritis, while the term arthralgia is used for joint pain without any inflammatory process.

Causes of arthralgia 

  1. Viral illnesses due to measles, mumps, chicken pox, influenza, hepatitis, AIDS.
  2. Autoimmune diseases like rheumatoid arthritis or systemic lupus erythematosus.
  3. Excessive intake of vitamin A may cause it.

Causes of joint pain

  1. Injury or strain to the joint
  2. Inflammation of joint
  3. Inflammation of tendons called tendinitis
  4. Inflammation of the bursa called bursitis
  5. Infection of bone called osteomyelitis
  6. Gout (type of arthritis)

 Related symptoms and signs of joint pain

Joint pain due to a viral infection will be accompanied by fever, body ache and sore throat. Viral hepatitis will have jaundice or high coloured urine.

  1. In rheumatic fever and bone infection, fever is a symptom.
  2. Arthritis and injury to a joint will have joint stiffness and swelling in addition to joint pain.
  3. Joint pain may be restricted to a single joint, for e.g. in a case of injury or fracture or it may involve many joints as in autoimmune disorders.
  4. Joint pain is generally worse in the morning and gets better after moving around.

Diagnosing the causes of the joint pain

The physician will ask you for a detailed history of the onset and progress of the joint pain, additional symptoms, exacerbating and relieving factors and what time of the day is it better or worse. A thorough general and local examination will help to narrow the diagnosis.

Investigations for joint pain

A complete blood test (CBC) will help to determine if infection is present, ESR and C-reactive protein are also of value. HIV test may be done and other blood tests depending on the doctors suspicion.

Imaging tests like X-rays in different views and CT scans may be advised.

Treatment of joint pain

Joint pain is a symptom and not a medical disease. It is important to diagnose and address the disease and relieve the symptom of joint pain.

Medical treatment

  1. Antibiotics are a must when there is infection of the bone, tendons or surrounding structures.
  2. Pain relief- Mild cases of joint pain can be relieved with acetaminophen. Moderate pain will require NSAID’s which are available over the counter. Severe pain requires opioid analgesics which a doctor has to prescribe. In general, painkillers should not be taken for very long periods of time as they may cause liver toxicity and gastro-intestinal bleeding in rare cases.
  3. Sometimes glucosamine or chondroitin sulphate is prescribed, these are substances which are found in the joint space and are deficient.
  4. Immunosuppressant is prescribed when autoimmune disorders are suspected.

Surgery

  1. Arthroscopy is examination of the joint by seeing it directly with the help of an arthroscope, thus the exact damage can be noted.
  2. In arthrocentesis, excessive fluid around the joint is removed.
  3. If a joint is severely damaged beyond repair, joint replacement is advised. The knee and hip are joints which are commonly replaced.

Physiotherapy

Simple stretching exercises may be effective in preventing stiffness and managing joint pain.

If the joint has become stiff for e.g. if it was in a plaster cast then exercises are done by a trained physiotherapist to relieve pain and stiffness and bring back the mobility.

Home remedies

  1. Heat is generally used to relieve painful joints. A towel dipped in very hot water should be wrung and placed on the affected joint. When the towel becomes cold, repeat the process a few times. Alternatively a hot bath can do wonders.
  2. Joint pain is generally aggravated by cold climate. When it is cold, keep joints well covered.
  3. Bananas and apple cider vinegar are said to be good for joints, carrot juice helps to strengthen ligaments.
  4. Massaging warm vinegar or olive oil or camphor oil is helpful in some cases.

Photographs by mDhil

Written by Dr Nisreen Nakhoda, General Physician

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