Articular pain(arthralgia) can occur in one or more joints simultaneously (polyarthralgia). Arthralgias are observed in rheumatic, endocrine, infectious, tumoral, neurological, autoimmune diseases, injuries, overweight. Uncovering the causes of joint pain has important differential diagnostic significance; performed using X-rays, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). Treatment of arthralgia is reduced to the treatment of the disease that caused it. Symptomatic measures are applied (analgesics, local heat, ointments), immobilization, physiotherapy, surgical interventions.
Classification
Arthralgias differ in their localization and depth, the number of joints involved, the nature and intensity of the pain syndrome, its daily rhythm, the duration of its existence, its connection with a certain type of movement. In the presence of pain in only one joint, it is called monoarthralgia, with simultaneous or sequential pain syndrome of several joints - oligoarthralgia, with involvement of 5 or more joints - polyarthralgia syndrome.
Depending on the nature of the arthralgic syndrome, sharp and dull pains are distinguished; by intensity - from weak and moderate to intense; depending on the type of flow - transient and constant. More often, arthralgia occurs in large joints - the hip, knee, shoulder and elbow, less often in medium and small - wrist, ankle, interphalangeal.
The occurrence of joint pain is favored by the irritation of the neuroreceptors of the synovial membranes of the joint capsules by inflammatory mediators, products of immune reactions, salt crystals, toxins, osteophytes. In rheumatology, it is customary to distinguish the following types of joint pain:
- caused by toxic syndrome in acute infections;
- primary episode or intermittent (intermittent) arthralgia in acute or recurrent arthritis;
- long-term monoarthralgia of large joints;
- oligo- or polyarthralgic syndrome accompanying damage to synovial membranes or progressive degenerative-dystrophic changes in cartilage;
- residual post-inflammatory or post-traumatic arthralgia in the joints;
- pseudoarthralgia.
Why joints hurt
Common infectious diseases
Arthralgia syndrome often accompanies the course of acute infections. Joint pain can be observed both in the prodromal period of the disease and in the early clinical stage, manifested by fever and intoxication. The infectious form of arthralgia is characterized by "pain" in the joints of the lower and upper limbs, the polyarticular nature of the pain and its association with myalgia. Mobility in the joint is completely preserved. Usually, infectious arthralgia subsides within a few days as the toxic syndrome caused by the underlying disease subsides.
Infectious arthritis
Possible options for the development of post-infectious reactive arthralgia after acute intestinal or urogenital infections; parainfective arthralgic syndrome caused by tuberculosis, infective endocarditis, secondary syphilis. Often the cause of pain in the joints are the foci of the existing chronic infection - pyelonephritis, cholangitis, adnexitis, paratonsillar abscess or parasitic invasion.
Residual arthralgia after joint inflammation is chronic or transient. Joint pain and stiffness may persist for weeks or months; in the future, the well-being and functions of the limbs are fully restored. In the chronic form of arthralgia, its exacerbations are associated with overstrain, weather lability and hypothermia.
Rheumatic diseases
Joint pain of the poly- or ologarthralgia type is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by a constant, intense and migrating pain syndrome, damage to large joints, mainly the lower extremities, limited joint mobility.
The beginnings of rheumatoid arthritis, as well as systemic rheumatic diseases, are manifested by polyarticular syndrome, which affects small symmetrical joints of the feet and hands, motor stiffness in the morning.
In microcrystalline gouty arthritis, arthralgia manifests itself in the form of recurrent paroxysmal pains in an isolated joint, which, appearing suddenly, quickly reach maximum intensity and do not subside for several days.
Degenerative joint damage
The gradual increase in pain in the joints for a long time may indicate deforming arthrosis and other degenerative-dystrophic lesions. In this case, involvement of the knee or hip joints is typical; dull, aching, exercise-related type of pain and their disappearance at rest. Arthralgia can be weather-dependent, accompanied by "crunching" of the joints during movement, weaken when using local distraction therapy.
Joint injuries
Bruises, joint dislocations, injuries to the ligamentous apparatus, intra-articular fractures are accompanied by severe pain. The affected joint becomes swollen, deformed, warm to the touch. The supporting function of the lower limb is impaired, movement in the joint becomes difficult, and sometimes pathological mobility occurs. Injuries may be accompanied by hemorrhage in the joint cavity, which leads to its stiffness.
Oncological diseases
Long-lasting persistent oligo- and polyarthralgia, accompanied by the formation of "Hippocratic fingers" (deformations of the nails and distal phalanges like "watch glass" and "drum rings"), indicate a paraneoplastic lesion of the synovial membranes. In these patients, an oncological pathology of the internal organs, mainly lung cancer, should be suspected.
Endocrine diseases
Common causes of joint pain are endocrine disorders - primary hyperparathyroidism, ovariogenic dysfunctions, hypothyroidism, obesity. The articular syndrome of endocrine genesis presents in the form of oligoarthralgia associated with ossalgia, myalgia, pain in the bones of the pelvis and the spine.
Other reasons
Other possible causes of arthralgia include:
- heavy metal poisoning (thallium, beryllium);
- frequent overload or microtrauma of the joints;
- long-term drug therapy;
- post-allergic reactions;
- flat foot;
- X-shaped or O-shaped deformity of the limbs;
- pseudoarthralgia, simulated by primary ossalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Diagnostic
Since joint pain is only a subjective symptom, clinical and anamnestic features and physical examination are at the forefront in determining the causes of their appearance. It is necessary to consult a rheumatologist, orthopedist. In order to differentiate the etiology of arthralgia, a number of objective studies are carried out:
- X-ray of the joints.This is a routine method that allows you to examine all joints in various diseases. Most often, the x-ray is performed in 1 or 2 projections, it is also possible to study in a special style, to perform contrast arthrography. A more detailed picture of the condition of the osteochondral and soft tissues of the joints is 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 joint spaces. The availability of ultrasound makes it essential for the diagnosis of rheumatic joint pathologies.
- invasive methods.According to the indications, a puncture of the joint, a biopsy of the synovial membrane is performed. In contentious cases, diagnostic arthroscopy is performed, which makes it possible to examine the joint cavity from the inside, to carry out diagnostic and therapeutic measures.
- Laboratory tests.Helps identify the presence of an inflammatory process,rheumatic diseases. In peripheral blood, ESR, C-reactive protein level, 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:thermography, podiatry.
Treatment
Help before diagnosis
For any pain in the joints, it is necessary to remain calm and not to load the limb. The metabolic causes of arthralgia dictate the need for a balanced diet, weight normalization. With fresh injuries, it is necessary to apply cold to the joint, immobilize the injured limb with a splint or fixing bandage. You can take painkillers or NSAIDs.
Neglect of a competent examination and treatment of arthralgia leads to the development of irreversible functional disorders of the joints - stiffness, ankylosis, contracture. Since pain in the joints can serve as a marker of various diseases, it is necessary 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 given to the treatment of the main pathology. Drug treatment of arthralgia is aimed at stopping intra-articular inflammatory processes and pain. Systemic therapy includes the use of nonsteroidal anti-inflammatory drugs.
With moderate arthralgia or the presence of contraindications to the oral administration of drugs, local external therapy is carried out with warming, anti-inflammatory and analgesic ointments. Applications with dimethyl sulfoxide are applied to the joint area. Joint gymnastics, physiotherapy procedures (drug electrophoresis, magnetotherapy, phonophoresis, UHF therapy) are recommended.
If necessary, periarticular blockades, intraarticular injections of glucocorticoids, chondroprotectors, synovial fluid prostheses are performed. Promising modern methods of therapy for chronic joint pathologies are ozone therapy, joint plasmolifting and orthokine therapy.
Operation
Various types of surgical procedures are warranted for joint pain caused by injury, as well as for chronic diseases resulting in loss of joint function. They can be performed openly (arthrotomy) or endoscopically (arthroscopy). Depending on the causative disease, the following operations are performed:
- arthroplasty;
- arthrodesis;
- ligament plastic;
- rehabilitation of the joint cavity;
- removal of pathological formations (cysts, intra-articular bodies);
- synovectomy;
- joint arthroplasty.