Joints are complex structures that connect the different bones of our body and allow us to make our daily moves like walking, bending, raising our hands, writing etc. Joint pain is then a frequent reason for medical consultation. So, knowing what is joint pain, its origin and causes, is as important as knowing how to heal it.
Origin of joint pain (arthralgia)
A joint is made up of:
- Joint surfaces of two bones coated by articular cartilage.
- Joint cavity full of synovial fluid which surrounds the joint, acting like a lubricant.
- joint capsule (a fibrous structure which covers the joint).
Others elements like muscles, tendons and ligaments surround the joint. So, any pain felt in the joints can come from the joint structures or from the others elements mentioned. There can be inflammatory pain or mechanical pain (it’s arthrosis due to joint wear).
What are the risk factors of joint pain?
They can be classified into two groups: non-modifiable and modifiable risk factors.
The non-modifiable risk factors are those which we can’t prevent:
- Age: the risks increase with advanced age but arthritis (painful inflammation of the joint) can occur at any age.
- Sex and hormones: especially pregnant and menopausal women. A hormonal component could exist especially in rheumatoid arthritis. In the menopause case, it’s the sexual hormone deficit which leads to bone demineralization, weight gain and then to arthrosis.
- Genetic susceptibility.
The modifiable risk factors can be:
- Obesity.
- Joint trauma (sprain, dislocation).
- Metabolic diseases such as chondrocalcinosis or gout due to microcrystals deposit in the joint which can cause a quick cartilage wear and inflammation.
- Bone anomalies and deformities: valgus (inward) or varus (outward) knees deformities.
- Physical work or sport: those which need intense and repetitive moves (swimming or manual work).
Others risk factors such as infection, tobacco and less physical activities can be involved.
What are the causes of joint pain?
An acute joint pain can be cause by:
- General bacterial infection (causing reactive arthritis) or a localised infection straight in the joints like knees, wrists, elbows etc. Generally, it comes with fever, redness, swelling and heat in the joint. Also, viral infections like flu can cause joint pain.
- Trauma or injuries occurring during an accident, sport or physical work.
- A severe gout attack due to uric acid microcrystal deposit in the joints both in big joints (wrists, knees or elbows) and small joints in the hands and feet. A high protein diet or a chronic renal failure increase the risk of gout attack.
Some drugs like quinolone antibiotics, Salazopyrin (intestinal anti-inflammatory drug), incretins (oral antidiabetic drugs), bisphosphonate, diuretic drugs can have joint pain as side effects.
Chronic joint pain (more than 3 months) are essentially due to cartilage wear and chronic inflammatory arthritis, also named chronic inflammatory rheumatism. The latter is a group of diseases called autoimmune disorder that causes the human organism to produce antibodies, and thus attack its different organs and components including joints. We have diseases such as rheumatoid arthritis, psoriatic arthritis, lupus, dermatomyositis, scleroderma and ankylosing spondylitis; also, blood vessels inflammation like Kawasaki or Behcet disease etc.
Symptoms and progression
There are 2 types of joint pain: mechanical and inflammatory pain.
The mechanical pain is felt in the case of an arthrosis and keeps you awake at night. It occurs when the joint moves and disappears at rest. The pain intensity is lower in the morning, but increases during the day to reach its maximal level in the evening. It comes with morning joint stiffness lasting less than 15 minutes and a functional discomfort which means joint moves limitation. The general state is kept (no fever, no tiredness).
On the other hand, the inflammatory pain is triggered when the joint is at rest with a morning stiffness (more than an hour). It may be accompanied with local signs of inflammation which are pain, redness, heat and swelling. It also comes with general signs (fever, tiredness) and incidentally, others symptoms of rheumatism diseases.
The inflammatory joint pain can touch one or several joints. The affected joints disposition can reveal a specific disease, for example, the symmetrical damage of metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis.
The pain progression is unpredictable, it depends on the cause. It can involve a slow or quick worsening, occasional pain crisis leading to a progressive cartilage wear if the care is not suited.
Joint pain: when do you have to see a doctor?
A joint pain can occur during an intense effort and disappear after a few days with a simple painkiller treatment. You need to see a doctor in those cases:
- A pain lasting more than 2 months.
- A pain coming with fever, tiredness, weight loss, swelling and a bad general condition.
- A pain that doesn’t allow you to make your daily activities.
- A pain coming with others symptoms such as joint deformity, chest pain, stains on the skin etc.
The doctor will first make an examination, looking for your antecedents (sports you’ve practised, a past trauma, drugs, similar case in the family), the risk factors, other symptoms (fever, swelling, stiffness etc.).
In order to find the cause of the joint pain, the doctor could ask biological and radiological analyses:
- The Complete Blood Count looking for hyperleukocytosis which is an infection sign.
- High CRP or sedimentation rate in inflammation.
- Joint fluid aspiration with biological and biochemical tests can be necessary if there’s an infection for example.
- Conventional radiography, a CT scan or an RMI of the joint (knees, elbows or wrist).
Other exams can be asked according to your clinical state.
How to treat the joint pain?
The purpose is to relieve pain. We can eventually use drug and non-drug treatment.
Which drugs to use?
Paracetamol
Paracetamol is effective on mechanical pain. He hasn’t side effects and the dosage should not exceed 3 grams per day, one taking every 6 or 8 hours.
Nonsteroidal Anti-Inflammatory Drugs (NSDAI)
More effective on important inflammatory pain because they have analgesic and anti-inflammatory effect using local treatment (with cream or ointment) or oral treatment. In order to avoid gastric ulcer in case of oral treatment, the association with Proton Pump Inhibitor is recommended.
Other side effects such as arterial hypertension, asthma, rash etc. may arise.
NSDAI should not be used if there’s a gastric ulcer antecedent, age more than 65 years old, pregnancy beyond the 6th month. Always consult your doctor before using it.
Local treatment with corticosteroid infiltrations
In general, drug treatment needs a medical prescription and a background treatment can be introduced according to the underlying disease.
The non-drug treatment
The R.I.C.E protocol includes rest, icing (applying to an acute mechanical joint pain), compression and elevation. Heat can be use as treatment of an inflammatory pain. You should always keep a moderate physical activity by minimizing as much as possible the use of the painful join.
Some natural treatments using plants such as Sencha green tea, harpagophytum roots also named “devil claw” (ointment or capsule), turmeric or essential oils of eucalyptus lemon have proved their efficiency in the joint pain treatment with their analgesic and anti-inflammatory effects.
The non-drug treatment should not replace a real medical consultation.
How to prevent joint pain?
It’s all about applying simple hygiene and dietary rules including:
- Having a healthy and balanced diet avoiding overweight and obesity.
- Having a diet rich in calcium, vitamin D and trace elements such as zinc, copper, sulphur, silicon etc.
- Avoiding tobacco.
- Practising regular exercises, especially water sports.
- Avoiding sedentary lifestyle.
Those rules help to eradicate the risk factors and keep joints healthy.
