Athritis(joint pain) can occur singly or simultaneously in several joints (polyarthritis). Arthritis is observed in rheumatic, endocrine, infectious, tumor, neurological, autoimmune diseases, trauma, overweight. Finding the cause of joint pain has important differential diagnosis; performed by X-ray, ultrasound, laboratory, invasive methods (arthroscopy, arthroscopy). Treating joint pain is treating the disease that has caused it. Symptomatic treatment measures are applied (analgesics, topical heating, ointments), immobilization, physical therapy, surgical intervention.
Classify
Joints differ in their location and depth, the number of joints involved, the nature and intensity of the pain syndrome, its daily rhythm, its duration, its connection to a certain type of movement. When there is pain in one joint, they refer to monoarticular pain, with simultaneous or consecutive pain syndrome in several joints - about bilateral pain, with involvement of 5 or more joints - about polymyalgiajoint.
By the nature of the joint syndrome, acute and dull pain are distinguished; by intensity - from weak and moderate to intense; by type of flow - transient and constant. More often, joint pain occurs in the large joints - hips, knees, shoulders and elbows, less often in medium and small - wrists, ankles, interscapulars.
The occurrence of pain in the joints is promoted by the stimulation of neurotransmitters of the synovial membrane of the joint capsule with inflammatory mediators, products of the immune response, crystalssalt, poison, bone-forming substance. In rheumatic diseases, it is common to distinguish the following types of joint pain:
- due to toxic syndrome in acute infection;
- primary or intermittent (intermittent) joint pain in acute or recurrent arthritis;
- long-term unilateral pain of large joints;
- oligo or polyarticular syndrome accompanied by synovial membrane involvement or progressive degenerative-dystrophic changes in the cartilage;
- residual joint pain after inflammation or trauma to the joint;
- pseudomyalgia.
Why do joints hurt?
Common infectious diseases
Osteoarthritis syndrome is often accompanied by acute episodes of infection. Arthralgia can be observed both in the prodromal period and in the early clinical stage, occurring with fever and intoxication. The infectious form of arthralgia is characterized by "pain" in the joints of the lower and upper extremities, the polylinear nature of the pain and their association with myalgia. Mobility in the joint is completely preserved. Usually, joint pain caused by an infection goes away within a few days as the toxic syndrome caused by the underlying disease weakens.
Infectious arthritis
Probable options for the development of post-infectious reactive arthralgia following acute intestinal or urogenital infection; infectious arthralgic syndrome due to tuberculosis, infective endocarditis, secondary syphilis. Most often, the cause of pain in the joints is an existing foci of chronic infection - pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasitic invasion.
Joint pain that remains after arthritis is chronic or transient. Pain and stiffness may persist for weeks or months; in the future, the health and functions of the limbs are fully restored. In the chronic form of arthralgia, its exacerbations are associated with excessive stress, meteorological instability, and hypothermia.
Rheumatism
Polyarticular or migraine-type joint pain is the main symptom of rheumatoid arthritis. Rheumatic joint pain manifests as a syndrome of intermittent, severe pain, involving large joints, mainly the lower extremities, with limited joint movement.
The onset of rheumatoid arthritis, as well as systemic rheumatic diseases, is manifested by a polyarticular syndrome, affecting the symmetrical small joints of the feet and hands, and morning stiffness of movement.
In microcrystalline gouty arthritis, joint pain manifests as recurrent paroxysmal attacks of pain in a separate joint, which arise suddenly, rapidly reach peak intensity, and do not subside for several days. .
Degenerative joint damage
Progressive pain in the joints over a long period of time may indicate degenerative joint deformity and other degenerative-dystrophic lesions. In this case, knee or hip involvement is typical; A dull, throbbing pain that is exercise-related and goes away with rest. Joint pain can be weather dependent, accompanied by a "creaking" sound of the joints during movement, weakening with the use of topical distraction therapy.
Joint injury
Bruises, dislocations, damage to the ligamentous apparatus, fractures in joints accompanied by severe pain. The affected joint becomes swollen, deformed, and warm to the touch. The supporting function of the lower extremities is impaired, joint movement becomes difficult, and sometimes pathological conditions appear. Trauma may be accompanied by hemorrhage into the joint cavity, leading to stiffness.
Cancer
Persistent headache and polyarthritis, accompanied by the formation of "Hippocratic fingers" (malformations of the fingernails and distal phalanges such as "clock glasses" and "drumsticks"), suggest aparaneoplastic lesions of the synovial membrane. In these patients, cancer of the internal organs should be suspected, mainly lung cancer.
Endocrine disease
Common causes of joint pain are endocrine disorders - primary hyperparathyroidism, ovarian dysfunction, hypothyroidism, obesity. Joint syndrome of endocrine origin develops in the form of myalgia associated with myalgia, myalgia, and pain in the pelvis and spine.
Other reasons
Other possible causes of joint pain include:
- intoxication with heavy metals (talium, beryllium);
- frequent overload or micro-joint injury;
- long-term drug therapy;
- post-allergic reactions;
- flat feet;
- X- or O-shaped deformity of the limbs;
- pseudomyalgia, simulating primary myalgia, neuralgia, myalgia, vascular disease, mental disorder.
Diagnose
Since arthralgia is only a subjective symptom, clinical features, pathology, and physical examination are important in determining their cause. It is necessary to consult a rheumatologist, orthopedist. To distinguish the etiology of joint pain, several objective studies are carried out:
- Joint X-ray.This is a common method that allows you to examine any joint for various diseases. Usually, radiographs are done in one or two sessions, but special studies can also be done, doing contrast arthroscopy. More detailed images of the condition of the bone and soft tissues of the joint are available with CT and MRI imaging.
- Joint ultrasound.Allows you to detect effusion in the joint cavity, bone erosion, changes in the synovial membrane, measure the width of the joint spaces. The availability of ultrasound makes it indispensable in the diagnosis of rheumatic diseases.
- invasive methods.As indicated, joint puncture, synovial biopsy. In disputable cases, diagnostic arthroscopy is performed, which allows to examine the joint cavity from the inside, to carry out diagnostic and therapeutic measures.
- Laboratory tests.Helps determine the presence of an inflammatory process,rheumatic diseases. In peripheral blood, ESR, levels 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:Thermometer, podography.
Treatment
Help before diagnosis
For any pain in the joints, it is important to stay calm, not picky. Metabolic causes of joint pain require a balanced diet, normalizing weight. With a newly healed wound, it is necessary to apply cold compresses to the joint, immobilize the injured limb with a splint or immobilizer. You can take pain relievers or NSAIDs.
Neglecting a competent rheumatology examination and treatment will lead to the development of irreversible functional disorders of the joints - stiffness, joint stiffness, spasticity. Since pain in the joints can be a sign of many diseases, it is important to consult a doctor if joint syndrome occurs and persists for more than 2 days.
Conservative therapy
In the treatment of joint pain, the main role is to treat the leading pathologies. Medicines for joint pain are aimed at stopping inflammatory and painful processes in the joints. Systemic treatment includes the use of non-steroidal anti-inflammatory drugs.
With moderate arthralgia or with a contraindication to taking the drug, local external therapy is carried out with warming, anti-inflammatory and analgesic ointments. Applications with dimethyl sulfoxide are applied to the joint area. Joint exercise, physiotherapeutic procedures (drug electrophoresis, magnetic therapy, electrophoresis, UHF therapy) are recommended.
If necessary, blockade of peristalsis, intra-articular glucocorticoid injections, chondroprotectors, synovial fluid restoration are performed. Promising modern treatments for chronic joint diseases are ozone therapy, joint plasmolifting, and chiropractic therapy.
Surgery
Different types of surgical interventions have been shown to treat pain in joints caused by trauma, as well as chronic diseases that lead to loss of joint function. They can be performed either open (arthroscopic surgery) or endoscopic (arthroscopic). Depending on the disease causing it, the following are done:
- orthopedic joints;
- arthrodesis;
- plastic ligaments;
- rehabilitation of the joint cavity;
- removal of pathological formations (cysts, intraocular bodies);
- synovialectomy;
- joint alignment.