Joint pain is not uncommon. Nearly half (45 percent) of all people over the age of 45 complain of painful joints, especially knee pain. Complaints can also occur at an early age. In most cases, joint pain is caused by signs of wear and tear - here doctors talk about osteoarthritis. In addition, acute arthritis and trauma are often the cause of joint pain. But there are many other possible reasons.
As common as joint pain is, their types are so diverse that classifications of joint pain are based on different criteria. For example, joint pain can be divided into three groups according to the time of onset:
- Acute joint pain occurs within a few hours.
- Subacute joint pain becomes noticeable during the day.
- Chronic joint pain develops over weeks or months.
Joint pain can often persist and progress (chronic progressive course). Sometimes joint pain occurs only acutely and temporarily (acute remitting course).
In some cases, joint pain affects only one joint, such as the knee joint. But also the pain can cover two to four joints (pain in the oligo-joints) or even more joints (pain in the joints of the joints).
In addition, joint pain varies, for example, in relation to:
- Painful rhythm: pain at rest, night pain, morning joint stiffness.
- Distribution patterns: Pain in the small joints (such as the wrist, knuckles) or large joints (such as the knee and hip joints), joint pain in the carpal joints, and more.
- Pain intensity: Assessment of the severity of joint pain on a scale from 0 (no pain) to 10 (unbearable, severe pain).
- Aggravating factors: eg reduction of joint pain during movement (typical for arthritis) or after rest (typical for osteoarthritis).
Such information is important for the doctor to determine the causes of joint pain.
Particularly often affected joints
Which joints are most often affected by pain depends crucially on the cause of the pain. A few examples.
Osteoarthritis, one of the main causes of joint pain, is especially noticeable in those joints that take a lot of stress throughout life. First of all, these are the knee joints, the hip joints and the hocks. Osteoarthritis can also cause pain in all other joints.
Rheumatoid arthritis is also a common cause of joint pain. Painful inflammation of the joints, most often occurs on the wrists and joints of the fingers. In addition, pain in the knee, elbow, metatarsophalangeal joints and shoulder are common in rheumatoid arthritis.
Joint pain in an acute gout attack almost always affects the leg joint, mainly the metatarsophalangeal joint. The hocks and knees are also often affected.
Bursitis can cause pain in the thigh, elbow, knee and shoulder.
Causes and possible diseases
Joint pain can have various causes. The most important are:
- Joint wear (arthritis of the joints):Osteoarthritis is the most common form of joint disease and can affect virtually all joints. Due to the destruction of the cartilage layer on the joint surfaces and bone changes, the affected joint cannot move freely, reddens, swells and hurts. Osteoarthritis is often the cause of pain in the wrist, hip and knee. Joint wear is usually caused by prolonged joint overload. In addition, osteoarthritis can be a late consequence of an accident (such as sports injuries) and joint damage due to congenital weakness or deformity of the joints.
- bursitis:The bursae are located in the form of a shock-absorbing layer in particularly tense places between the bones and soft tissues, for example in the area of the joints. They usually consist of a cavity filled with joint fluid. Inflammatory or mechanical irritation (such as sports injuries) can injure the bursa and cause pain in the affected area. For example, elbow pain is often caused by inflammation of the bursa in the elbow joint, shoulder pain from bursitis or calcification in the shoulder area, knee pain from bursa inflammation in the knee joint, and hip pain from bursa inflammation in the large colic. (convexity of the bone in the upper outer thigh).
- Bacterial inflammation of the joints (bacterial arthritis):Bacterial arthritis mainly affects the knee and hip joints. Bacteria either enter the joint through the blood or directly infect the joint (through trauma or joint surgery, or during diagnostic injections into the joint). Severe pain in the knee or hip joint with severe swelling of the joints and symptoms of inflammation (such as redness, localized heat, fever) may indicate bacterial arthritis.
- Lyme disease (Lyme arthritis):Joint pain in Lyme disease is also based on bacterial inflammation of the joints. It is caused by certain bacteria (Borrelia burgdorferi) that are transmitted by ticks to humans. Approximately four weeks after transmission, fatigue, fever, redness, and joint pain occur.
- Associated inflammation of the joints during and after infections.Inflammatory joint pain can occur during and after common infectious diseases such as hepatitis, rubella, mumps, chickenpox, scarlet fever, tuberculosis, influenza and inflammatory bowel disease (Crohn's disease, ulcerative colitis). Due to the pain in the joints and swelling, there are limitations in the movements in the joints, especially large ones (hip joint, knee joint, ankle joint).
- Arthritis in Reiter's disease:Reiter's syndrome is a rare rheumatic disease. Symptoms include arthralgia associated with urethritis and conjunctivitis.
- Inflammation of the joints in psoriasis (psoriatic arthritis):Psoriasis is sometimes accompanied by inflammation that causes joint pain. In some cases, joint pain precedes the cutaneous manifestations of the disease, ie joint pain occurs first and only then scaly skin lesions develop. Psoriatic arthritis can be the cause, especially if the joints of the fingers and toes and / or the spine are affected.
- Inflammation of the joints in ankylosing spondylitis.Ankylosing spondylitis is a chronic rheumatic inflammation that mainly affects the spine, but can also spread to large joints. Therefore, knee pain, thigh pain, heel pain and / or ankle pain may be the cause of Bechterew's disease.
- Gout (or acute attack of gout):Gout increases the concentration of uric acid in the blood. Its excess is deposited in the form of uric acid crystals, including in the joints - there is an acute attack of gout with severe joint pain, swelling and redness in the joints. The joints of the big toe are affected in the first place. But an acute attack of gout can also cause knee pain, wrist pain, pain in the knuckles or upper ankle.
- Rheumatoid arthritis:This is the most common inflammatory disease of the joints, progressive, mostly chronic and gradually destroying the joints. Rheumatoid arthritis may be suspected if joint pain affects the fingers and wrists. Other symptoms of this condition include morning stiffness of the fingers and wrists, swelling of the joints, and inability to clench the fist.
- Rheumatic fever:This inflammatory disease, which occurs mainly in children, is caused by certain bacteria (streptococci) days or weeks after a nose and throat infection that has not been treated with antibiotics. Possible symptoms include inflammatory joint pain, skin symptoms, inflammation of the heart (carditis) and sudden involuntary and uncontrolled movements (chorea).
- Arthritis with sarcoidosis (Löfgren's syndrome):Sarcoidosis is a rare inflammatory disease of unknown origin that can affect the whole body. One form of the disease is Löfgren's syndrome (acute sarcoidosis). It occurs mainly in young women and manifests itself with the following symptoms: inflammation, joint pain (especially in the ankles), acute inflammation of the subcutaneous fat (erythema nodosum), swelling of the lymph nodes in the lungs (bronchial lymphadenopathy) and weight loss.
- Systemic lupus erythematosus (SLE):It is a rare autoimmune disease that mainly affects women, often causing joint pain and inflammation. But there may be many other different symptoms, such as a butterfly-shaped rash on the face, pleurisy, pericarditis, inflammation of the kidneys or brain, loss of appetite and weight loss. That is why lupus erythematosus is called "chameleon" in medicine.
- Joint bleeding in coagulation disorders.In rare cases of haemophilia, there is a hereditary predisposition to uncontrolled bleeding after injury or, in severe cases, for no apparent reason. Bleeding in the muscles and joints is especially common. Bleeding in the joints can cause joint pain and permanent joint damage if left untreated. In addition to hemophilia, other bleeding disorders can also lead to joint bleeding and joint pain, such as bleeding disorders due to an overdose of anticoagulants.
When should you see a doctor?
Joint pain sometimes goes away on its own or can be relieved with simple home remedies. But be careful with the following symptoms:
- Joint pain that restricts joint movement.
- Redness of the skin in the area of the diseased joint.
- Swelling of the joint.
If joint-related symptoms (joint pain with limited mobility, redness, swelling) last for three days or more, worsen or spread to other joints, you should definitely see a doctor.
What does the doctor do?
To clarify the cause of joint pain, the doctor will first ask the patient about his medical history (medical history). For example, when and where joint pain occurs and if there are other complaints (accompanying symptoms such as fever or swelling of the joints).
Accurate description of joint pain
This information is very important for diagnosing joint pain: the more accurately a patient can describe joint pain, the sooner the doctor can narrow down the number of possible causes. For example, an acute attack of gout is thought to cause pain in only one joint. In rheumatoid arthritis, on the other hand, arthralgias are observed in several joints. In addition, the localization (localization) of joint pain is indicative: if the patient experiences pain in the wrist and pain in the base and middle joints of the fingers, rheumatoid arthritis is most likely to be present. On the other hand, if the pain in the joints affects the base of the thumb and knuckles, the suspicion is in the direction of osteoarthritis.
No matter where the joint pain occurs, the doctor must clarify the question: does the joint really hurt or does the presumed joint pain come from an area close to the joints or adjacent bones? In some cases, the doctor can find the answer to this question simply by palpating the painful area. However, very often additional tests are needed, such as X-rays or ultrasound.
Further research on joint pain
Such tests can help identify the cause of pain if joint pain occurs directly in the joint:
- Orthopedic examination:If joint pain is caused by wear and tear (arthritis), bursitis, rheumatism or an acute attack of gout, relevant information can be found during an orthopedic examination.
- Dermatological examination:Skin examinations help identify suspected psoriatic arthritis or sarcoidosis as possible causes of joint pain.
- Blood tests:Blood tests are useful for identifying various causes of joint pain, such as bacterial arthritis or Lyme disease. Sometimes a blood test requires specific measurements, such as blood clotting, if joint bleeding (due to coagulation disorders) can cause joint pain. If rheumatoid arthritis is the cause of joint pain, then the blood determines primarily rheumatoid factor and other signs of inflammation, which are crucial. And if gout or an acute attack of gout is suspected, the focus is on the level of uric acid in the blood.
- Ultrasound examinations:Ultrasound (ultrasound) is indicated when bursitis, gout or systemic lupus erythematosus are suspected as causes of joint pain.
- X-rays:X-ray shows signs of joint wear (arthritis), rheumatoid arthritis and ankylosing spondylitis.
- Joint puncture:if the doctor suspects bacterial inflammation of the joints as the cause of joint pain, he will take a sample of joint fluid (joint puncture) From this sample a bacterial culture is made: if bacteria grow from the joint sample, it shows bacterial inflammation of the joint.
It is not always possible to detect disease or pathological tissue change as the cause of joint pain. Doctors talk about "joint sensitivity". If the cause of the joint pain is determined, the doctor can start appropriate treatment and treat the underlying condition with medication or surgery.
You can do it yourself
General tips for joint pain
- Lose weight. Each extra kilogram is an unnecessary additional burden on the joints and contributes to their wear and tear, which inevitably leads to joint pain.
- Make sure you get enough rest after a workout.
- Do regular endurance exercises to strengthen muscles and articular cartilage. For example, swimming and cycling are suitable for joint training. Regular strength training (such as lifting weights, jumping rope) is also recommended to strengthen bones. Consult an experienced trainer or sports doctor to determine the right dose and develop a well-balanced exercise program that strengthens all muscles equally.
- Avoid one-sided loads, such as carrying heavy bags over your shoulder.
- According to Jacobson, it is necessary to reduce mental stress, for example through autogenic training or progressive muscle relaxation. Emotional pressure also puts pressure on joints, shoulders and bones.
- Joint pain and other joint complaints are treated in traditional Chinese medicine with acupuncture. Consult an experienced therapist.
Tips for treating joints
- If osteoarthritis is diagnosed, ie a recent severe inflammation of the joints with pain, swelling and redness, you should immobilize the affected joint (bed rest). Hold it so that the muscles associated with it are not tense. Make wet and cool compresses (like a quark shell) to relieve joint discomfort. The effect of the anti-inflammatory and painkillers you receive from your doctor may be enhanced with the help of herbs. Arnica is very suitable (as a decoction for compresses or as an ointment or gel for rubbing into the joints). In addition, there are anti-inflammatory and analgesic preparations based on willow bark, as well as combined preparations with rosemary and eucalyptus oils. In addition, peppermint oil can relieve pain due to its cooling effect.
- Once the joint pain, including redness and swelling, subsides, the doctor talks about inactive osteoarthritis. At this stage of the disease is carried out to prevent the resumption of active joint complaints. This is facilitated by sufficient, healthy sleep on an orthopedic mattress, as the muscles relax well and the spine and joints rest.
- In addition, you should regularly use meditative relaxation techniques (such as gradual muscle relaxation, autogenic training) if you often suffer from stressed muscle tension.
- Regular exercises and exercises that improve the supply of synovial fluid and nutrients to the articular cartilage. Useful sports are swimming, cycling and water aerobics. In contrast, running on hard surfaces is not recommended, especially if osteoarthritis has already damaged the knee and hip joints. If possible, run on soft forest grass and wear sneakers with soft soles that provide a good effect. Better yet, walk instead of run.
- Avoid sports with sudden changes of direction (such as tennis, squash), as they strain the joints (such as the knee joint) and quickly cause joint pain.
- Try not to stand or sit in one position for a long time.
- Eat a diet low in arachidonic acid. This omega-6 fatty acid plays a central role in inflammatory reactions (such as arthritis-induced osteoarthritis). Arachidonic acid is found mainly in fatty pork, egg yolks, lard, tuna, liver, beef and Camembert.
- Take omega-3 fatty acids regularly, as they act as competing analogues of arachidonic acid in inflammatory reactions. You can find more of these fatty acids in fish oil (eat fish at least once a week! ).
- Make sure you get enough vitamin E, which is important for synovial fluid as it provides its antioxidant effect against inflammation. Vitamin E is found in vegetable oils, especially in wheat germ, soybeans and sunflowers.
- Joint pain associated with osteoarthritis and other joint complaints can often be alleviated by applying circulatory stimulants, such as sachets of fango, paraffin, senna, rosemary baths.
- In osteoarthritis of the finger joints, kneading with warm clay or clay soil can help with joint pain and swelling. Regular finger exercises in hot sand are also highly recommended. It is especially good for morning stiffness and joint pain.
- Massage and rubbing with essential oils of eucalyptus, juniper, rosemary, lavender or lemon help to improve blood circulation and therefore to combat joint inflammation.
- In inactive osteoarthritis, devil's claw root tea is recommended: pour a tablespoon of coarsely ground root into two cups of boiling water and leave for eight hours. Boil before use, then strain, divide the prepared amount of tea into three portions and drink throughout the day. The effect of devil's claw infusion is manifested around the third week of treatment.
- For the treatment of inactive osteoarthritis, a tea mixture of blackcurrant leaves, willow bark, nettle grass, horsetail and meadow blossom (20 g of each component) is also recommended. Take two teaspoons of this mixture and pour a glass of boiling water, boil for half an hour, then strain. Drink 5-6 cups of this tea throughout the day. It has anti-inflammatory and analgesic effects.
- Also useful in the treatment of arthritic irritations are dry cups and leech therapy (also anti-inflammatory). Treatment with own blood is controversial, especially if the treated fluid is injected into the joint (risk of infection! ).
Rheumatoid Arthritis Tips
Some tips for osteoarthritis should also apply to people with rheumatoid arthritis. These include nutritional tips, topical recommendations for arnica and devil's claw root. Additional tips that can help with rheumatic joint pain and other joint problems:
- During periods of mild discomfort (inactive rheumatoid arthritis), you can use physical therapy and massage to keep your joints flexible.
- In case of exacerbation of the inflammatory process (active rheumatoid arthritis) you can prepare an anti-inflammatory tea mixture of meadow, willow bark, goldenrod, blackcurrant and nettle (20 g of each herb). Pour one tablespoon of this mixture into a glass of cold water and leave for an hour. Then heat to boiling, but do not boil! Remove from the heat, leave for five to ten minutes, then strain. Drink three to four cups of this tea daily.
- In acute inflammation of the joints should help the consumption of enzymes that absorb proteins such as bromelain.
- Highly recommended for rheumatic diseases such as rheumatoid arthritis, tai chi and qigong. These are holistic Chinese forms of movement that can improve patient mobility, muscle strength, endurance, quality of life and mood, studies show. The effect, according to Chinese medicine, is that calm, fluid movements and breathing exercises release blockages in the body and make the life force (Qi) flow. Slow exercise is also suitable for patients whose mobility is already limited due to pain and inflammation in the joints.
- Inflammatory joint pain can be relieved with cold or heat treatment - try what works best for you. Cooling is generally recommended for acute inflammation of the joints to stop the inflammation. In chronic diseases, the heat is usually more pleasant, such as warming baths (such as hay flowers), fengo wraps or mud treatments.
- Even creams and ointments on medicinal plants have anti-inflammatory and analgesic effects. These include ready-to-use preparations containing willow bark or rosemary and eucalyptus oils. In addition, peppermint oil can relieve the sensation of pain by irritating cold receptors in the skin.
- Ayurvedic therapists recommend cleansing procedures (panchakarma treatment) for rheumatic diseases to remove toxins (called ama) from the body. According to this teaching, the accumulation of ama is the cause of the disease. In acute inflammation of the joints with joint pain, Indian incense (shalaki) and trifala (herbal mixture) are used. Both have strong anti-inflammatory effects.