Articolar pains(arthralgia) can occur in one or more joints at the same time (polyarthralgia). Arthralgias are observed in rheumatic, endocrine, infectious, tumor, neurological, autoimmune, injury, overweight diseases. The identification of the causes of joint pain has an important differential diagnostic significance; performed with radiographic, ultrasound, laboratory, invasive methods (arthrocentesis, arthroscopy). Treatment of arthralgia comes down to treating the disease that caused it. Symptomatic measures are applied (analgesics, local heat, ointments), immobilization, physiotherapy, surgical interventions.
Classification
Arthralgias differ in localization and depth, number of joints involved, nature and intensity of the pain syndrome, daily rhythm, duration of existence, connection with a certain type of movement. In the presence of pain in a single joint we speak of monoarthralgia, with simultaneous or sequential pain syndrome in several joints - of oligoarthralgia, with the involvement of 5 or more joints - of polyarthralgia syndrome.
According to the nature of the arthralgic syndrome, acute and dull pain are distinguished; by intensity - from weak and moderate to intense; according to the type of flow - transient and constant. Most often, arthralgia occurs in large joints - hip, knee, shoulder and elbow, less often in medium and small - wrist, ankle, interphalangeal.
The onset of pain in the joints is favored by the irritation of the neuroreceptors of the synovial membranes of the joint capsules with 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 involvement of the synovial membranes or progressive degenerative-dystrophic changes in cartilage;
- residual post-inflammatory or post-traumatic arthralgia of the joints;
- pseudoarthralgia.
Why the joints hurt
Common infectious diseases
Arthralgic syndrome often accompanies the course of acute infections. Joint pain can be observed both in the prodromal period of the disease, and in the initial clinical stage, which occurs with 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 their association with myalgia. Joint mobility is fully preserved. Usually, infectious arthralgia disappears within a few days as the toxic syndrome caused by the underlying disease weakens.
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 is 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 can persist for weeks or months; in the future, the well-being and functions of the limbs will be fully restored. In the chronic form of arthralgia, its exacerbations are associated with overload, meteorological lability and hypothermia.
Rheumatic diseases
Joint pain of the poly- or hologarthralgia type is the main symptom of inflammatory rheumatic diseases. Rheumatic arthralgia is characterized by continuous, intense and migrating pain syndrome, involvement of the large joints, mainly of the lower limbs, limited movement of the joints.
The onset of rheumatoid arthritis, as well as systemic rheumatic diseases, are manifested by polyarticular syndrome, which affects the 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, having appeared suddenly, quickly reach maximum intensity and do not subside for several days.
Degenerative joint injuries
The gradual increase in joint pain for a long time may indicate deforming osteoarthritis and other degenerative-dystrophic injuries. In this case, the involvement of the knee or hip joints is typical; type of dull, aching, exercise-related pain and their disappearance at rest. Arthralgia can be weather-related, accompanied by a "creak" of the joints during movement, weakening when using local distraction therapy.
Joint injuries
Bruises, dislocations of the joints, damage to the ligament apparatus, intra-articular fractures are accompanied by severe pain. The affected joint becomes swollen, deformed, hot to the touch. The supportive function of the lower limb is impaired, movement in the joint becomes difficult, and sometimes pathological mobility occurs. Injuries may be accompanied by hemorrhage into the joint cavity, which leads to its stiffness.
Oncological diseases
Long-standing persistent oligo- and polyarthralgia, accompanied by the formation of "hippocratic fingers" (deformity of the nails and distal phalanges such as "watch glass" and "rods"), indicate a paraneoplastic lesion of the synovial membranes. In such patients, oncological pathology of internal organs, mainly lung cancer, should be suspected.
Endocrine diseases
The common causes of joint pain are endocrine disorders: primary hyperparathyroidism, ovariogenic dysfunction, hypothyroidism, obesity. Joint syndrome of endocrine genesis proceeds in the form of oligoarthralgia associated with ossalgia, myalgia, pain in the pelvic bones and spine.
Other reasons
Other possible causes of arthralgia include:
- heavy metal intoxication (thallium, beryllium);
- frequent overload or microtrauma of the joints;
- long-term drug therapy;
- post-allergic reactions;
- flat feet;
- X or O deformation of the limbs;
- pseudoarthralgia, simulated by primary oxalgia, neuralgia, myalgia, vascular pathology, psychosomatic disorders.
Diagnostics
Since joint pain is only a subjective symptom, clinical and anamnestic features and physical examination come to the fore in determining the causes of their onset. It is necessary to consult a rheumatologist, an orthopedist. In order to differentiate the etiology of arthralgia, a number of objective studies are conducted:
- X-ray of the joints.It is a routine method that allows you to examine any joints in various diseases. Most often, radiography is performed in one or 2 projections, it is also possible to study in a special style, conduct contrast arthrography. A more detailed picture of the state of the osteochondral and soft tissues of the joints is available with CT and MRI.
- Joint ultrasound.It 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 for the diagnosis of rheumatic joint diseases.
- invasive methods.According to the indications, a puncture of the joint is performed, a biopsy of the synovial membrane. In questionable cases, diagnostic arthroscopy is performed, which allows you to examine the joint cavity from the inside, to carry out diagnostic and therapeutic measures.
- Lab test.Helps to identify the presence of an inflammatory process,rheumatic diseases. In peripheral blood, ESR, the level of C-reactive protein, uric acid, specific markers of immunopathology (rheumatoid factor, antinuclear antibodies, ACCP) are determined. An important diagnostic method is the microbiological and cytological examination of the synovial fluid.
- Additional diagnostic methods:thermography, podography.
Treatment
Help before diagnosis
For any pain in the joints, it is necessary to keep calm and not to load the limb. The metabolic causes of arthralgia dictate the need for a balanced diet, the normalization of weight. With fresh injuries, it is necessary to apply cold to the joint, immobilize the injured limb with a splint or a fixing bandage. You can take pain relievers or NSAIDs.
Neglect of competent examination and treatment for arthralgia is fraught with the development of irreversible functional disorders of the joints: stiffness, ankylosis, contracture. Since joint pain can act as an indicator of a variety of diseases, a doctor should be consulted 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 involves the use of non-steroidal anti-inflammatory drugs.
With moderate arthralgia or the presence of contraindications to 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, physiotherapeutic procedures (pharmacological electrophoresis, magnetotherapy, phonophoresis, UHF therapy) are recommended.
If necessary, periarticular blocks, intra-articular injections of glucocorticoids, chondroprotectors, synovial fluid prostheses are performed. Promising modern methods of therapy for chronic joint diseases are ozone therapy, joint plasmolifting and orthokine therapy.
Surgery
Various types of surgery are warranted for joint pain caused by injury, as well as for chronic diseases that lead to loss of joint function. They can be performed by open (arthrotomy) or endoscopic (arthroscopy) methods. Depending on the causative disease, the following are performed:
- arthroplasty;
- arthrodesis;
- plastic ligament;
- rehabilitation of the joint cavity;
- removal of pathological formations (cysts, intraarticular bodies);
- synovectomy;
- joint arthroplasty.