Joint pain

Symptoms Of Joint Pain

The following symptoms commonly occur with joint pains -

• Pain and tenderness around the joint
• Redness, warmth or swelling around the joint
• Joint stiffness
• Reduced range of motion of the joint
• Feeling of locking sensation, where the joint feels locked in a particular position
• Severe pain that may radiate to surrounding body parts
• Weakness of the muscles surrounding the joint

Risk Factors Of Joint Pain

Joint pain is usually associated with the following risk factors:

• Previous injury to a joint
• Repeatedly use and/or overuse of a joint and muscle
• Chronic medical conditions associated with arthritis
• Old age
• Depression, anxiety or stress
• Overweight
• Poor nutritional health 
• Immunocompromising diseases

Types Of Joint Pain

Joint pain refers to a feeling of discomfort in the joints, such as knee joint, hip joint, ankle joint, spine, etc. Joint pains may occur in any joint of the body. There are two major types of joint pains:

Acute joint pain: This may affect a single joint, such as in cases of an injury or acute infection of the joint, or it may affect multiple joints, such as post-viral fever joint pains. Acute pain is usually sudden in onset and may last up to a few days. It usually responds well to conventional treatments and may get cured completely.

Chronic joint pain: Joint pains lasting more than a few weeks are called chronic joint pains. They may occur due to age-related degenerative changes in the joints known as osteoarthritis or may be due to other diseases of the bones and joints, such as rheumatoid arthritis, gout, etc. Chronic joint pains may affect a single joint or multiple joints. The pain is gradual in onset, and the severity may increase with time. Chronic joint pains are difficult to treat and may or may not recover completely.

Causes Of Joint Pain

There are various causes of joint pain, such as:

Injuries: Injuries to the joint, such as contusion, ligament sprains or tears, fracture, joint dislocation, soft tissue injuries, etc., that occur due to trauma and cause acute joint pain.

Infections: Infections can occur in the joint as a complication of injury or internal infection, such as septic arthritis, and osteomyelitis. This may further cause redness, swelling, warmth, tenderness, and acute pain in the affected joint. Infections may also be chronic, such as tuberculosis infection of the joints. 

Degenerative changes: Degenerative changes occur due to age-related wear and tear of the joint surface, cartilage, and surrounding soft tissues. Degenerative changes of the joint, also known as osteoarthritis, are the most common cause of joint pains. Osteoarthritis most commonly affects the knees, hips, spine, and hands. 

Chronic inflammation: Repetitive mild trauma to the joint and surrounding structures causes chronic inflammatory changes, such as tendinitis, bursitis, etc. Certain diseases also cause chronic inflammation in the joints which is an important cause of joint pain like gout.

Systemic Diseases: Systemic and genetic diseases associated with involvement of the bones and joints  and cause joint pains are: 

• Ankylosing spondylitis - a disease with a genetic predisposition that affects the spine
• Fibromyalgia - a chronic condition characterized by widespread musculoskeletal pain
• Avascular Necrosis - a condition in which blood supply to the joints is affected, leading to the death of bone tissue. This commonly affects the hip joints.
• Bone Cancer - Osteosarcoma, leukemia and other types of bone cancers that spread to bones and joints can cause severe joint pains.
• Paget’s Disease - in this disease, the bones become abnormally shaped and brittle, which can cause severe joint pains.Rickets - a deficiency of vitamin D that causes the bones to weaken and may cause joint pains.

Autoimmune disorders: Certain autoimmune diseases can involve joints and cause joint pains are:

• Rheumatoid Arthritis - a condition characterized by chronic inflammation, stiffness, and deformity of the joints. It commonly affects the small joints of the hands in initial phase of disease.

• Systemic Lupus Erythematosus - an autoimmune disease that causes inflammation and pain in multiple joints apart from involvement of other organ systems of the body.
  
  

Miscellaneous causes: There are many other causes of joint pains, such as viral fever, Lyme disease, sarcoidosis, juvenile idiopathic arthritis, etc.

Diagnosis Of Joint Pain 

The following evaluations are performed by the doctor to evaluate joint pain and establish a cause-

History and physical examination

The doctor will take a detailed history of the onset of symptoms, perform a thorough physical examination, and check for joint stiffness, inflammation around the joint, joint mobility, muscle spasms, muscle strength, etc., to evaluate the affected joints.

Imaging studies

X-Rays: X-Ray studies of the affected joint are performed to evaluate the bony changes in and around the affected joint. Based on the location of the pain, your doctor may advise you to go for:

• X-Ray Both Knee Standing AP & Lateral Views

• X-Ray Hip Joint AP View

• X-Ray Cervical Spine AP & Lateral

• X-Ray Lumbar Spine AP & Lateral

• X-Ray Right Ankle AP & Lat View

• X-Ray Right Wrist AP & Lat View 

MRI: MRI scans of the affected joints are performed to perform in-depth study of the bony and soft tissue changes occurring in the affected joint. These include:

• MRI Both Knee Joints

• MRI Both Hip Joint

• MRI Screening of Whole Spine

• MRI Ankle Joint

• MRI Shoulder Joint

Other imaging studies: Bone Densitometry Whole Body - to check for concomitant osteoporosis, a condition where the bones lack calcium and become brittle and weak.

Laboratory tests

• Complete Blood Count (CBC), Erythrocyte Sedimentation Rate, C-Reactive Protein Quantitative to detect any ongoing infection or inflammation in the body.

• Serum Uric Acid in suspected Gout.

• Anti Nuclear Antibody to check for auto-immune diseases.

• Rheumatoid Arthritis Panel in cases of suspected Rheumatoid Arthritis. It consists of 3 tests - antinuclear antibody, anti-cyclic citrullinated peptide antibody, and rheumatoid factor.

• HLA-B27, PCR in case of suspected ankylosing spondylitis.

• Serum Calcium - to check for calcium deficiency which plays an important part in bone and joint pains.

• Vitamin D (25 - OH) - to check for Vitamin D deficiency which plays an important role in absorbing calcium into the body.

• Other tests like synovial fluid analysis, tissue biopsy, etc., may be performed for certain conditions.

Prevention Of Joint Pain

Certain conditions that cause joint pain cannot be prevented. A few things that can help prevent the occurrence of severe joint pains and maintain the overall health of your joints are:

1. Following a healthy diet rich in calcium and other minerals.

2. Enough exposure to the morning sunlight to ensure a sufficient level of Vitamin D in the body.

3. Regular exercise to maintain strength and mobility in the joints.

4. Following correct ergonomics while weight lifting and exercising.

5. Avoiding sudden, jerky, and twisting movements of the joints.

6. Weight loss lessens strain on joints.

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Specialist To Visit 

When symptoms of joint pain start to become bothersome and it becomes difficult to perform daily activities, or you have sustained an injury to the joints, it is essential to visit a doctor who will diagnose and treat the condition. Specialists who can help in the diagnosis of the condition such as fractures, arthritis, etc. include:

• General physician
• Orthopedician
• Rheumatologists

Treatment Of Joint Pain

Depending on the cause and severity of the joint pain, your doctor may advise you to take medications to relieve the pain or go for surgery. 

Medical management

It involves use of medications to relieve the symptoms and treat the underlying cause of the joint pain such as arthritis or gout. In some cases, medications to improve overall bone and joint health can be prescribed.

Symptom Relief

• NSAID Analgesics help relieve pain and inflammation. These medicines must always be consumed with meals, as taking them on an empty stomach can irritate the gastric lining. Some of the common drugs are Ibuprofen, Diclofenac, Paracetamol.

• Narcotics (opioids)  i.e. tramadol, morphine, may be required for severe pain, which is not relieved by the first line of medications. These tablets must be used only as prescribed by the physician as they are potentially habit-forming.

• Muscle Relaxants help relieve the painful spasms and stiffness associated with osteoarthritis of the spine. Examples include Cyclobenzaprine.

• Corticosteroids may be prescribed for a short duration or even as an injection to address resistant pain. These include drugs containing prednisolone.

• Topical application of analgesic ointments (diclofenac), sprays and rubefacient can help with symptomatic pain relief.

• Dietary supplements, like glucosamine, calcium, vitamin D3 may help in improvement. 

• Intra-articular Injections can be given In cases of severe pain that does not respond to medications, a hydrocortisone injection may be given in the joint to offer quick relief. In some cases, hyaluronic acid injections are also given in the joint to aid joint lubrication.

Treatment of underlying cause

1. Rheumatoid arthritis: Disease-modifying anti-rheumatic drugs (DMARDs), such as Methotrexate and Leflunomide are used to treat rheumatoid arthritis.

2. Gout: Allopurinol formulations and colchicine formulations are used to treat Gout.

3. Arthritis: Antibiotics are also used to treat septic arthritis.

Surgical management and other invasive procedures

In this, use of injections to relieve the pain or corrective surgeries to improve the condition can be advised. Joint replacement surgery is another common procedure used to treat joint pain.

Corrective surgery

Corrective surgeries like synovectomy, osteotomy, laminectomy, spinal fusion, fracture reduction, etc., are performed in the case of severe joint deformities that cause limitation of function and pain.

Joint replacement surgery

For severely damaged knees and hips, a prosthesis may be fitted, and the worn-out joints are completely replaced by mechanical joints. This can be done for hip, knee and shoulder joints. surgeon removes parts of the patient’s bone and implants an artificial joint made from metal or plastic. This procedure has had excellent results and the majority of patients feel long-lasting pain relief after this type of surgery.

Home Care For Joint Pain

Along with medications, the following home care tips can help manage symptoms and lead to the best possible disease outcomes-

• Take a wholesome, balanced diet rich in calcium and other minerals.

• Follow the exercise routine suggested by the doctor or physiotherapist.

• Hot fomentation or icing (as applicable) and application of topical analgesic preparations help relieve pain and stiffness.

• Gentle massage performed by a massage therapist can aid relaxation and promote pain relief.

• Use joint supports, such as knee caps, cervical collar, lumbosacral belt, wrist cuffs, etc., to help support the frail joints.

• The use of walking aids, such as a cane or walker, may help offload the diseased joints, promote safer walking, and offer pain relief.

• Avoid lifting heavyweights. When weight training is a part of an exercise program, it must be done with extreme caution and correct ergonomic posture.

• Change the mattress and sleeping pillow if not proper and use those that offer good support and stabilize the spine.

Complications Of Joint Pain

If join pain is left untreated, the following complications can occur -

• Complete loss of mobility and extreme stiffness in the joints rendering a patient bed-ridden or with severe walking issues. Deformities in the hands can hinder skillful activities, such as writing, sewing, etc.

• Chronic debilitating pain may hamper a patient’s quality of life, interfere with sleep, and be a source of anxiety or depression.

• Infection in the joints may spread to surrounding areas and may cause septicemia.

Alternative Therapies Of Joint Pain

Along with medicines and topical analgesic preparations, various other treatment options help manage joint pains-

Exercise and yoga: Regular exercises and yoga focused on strengthening the joints and surrounding musculature and improving mobility help manage the pain and stiffness caused by arthritis and other joint conditions.

Massage: Gentle massage improves blood flow to the affected parts, promotes relaxation, and helps with pain relief. Massage must be performed only by a qualified massage therapist.

Physiotherapy: Physiotherapeutic modalities, such as Interferential Therapy (IFT) and Transcutaneous Electrical Nerve Stimulation (TENS), are very useful in pain relief, even from nerve pain. IFT and TENS use electric currents, applied via electrodes directly over the joint to stimulate the surrounding nerves and muscles. This leads to muscle relaxation and inhibition of the painful sensation. The rehabilitation exercises focus on strengthening and correcting weight-bearing of the joint and surrounding muscles, improving the overall strength and mobility of the affected joints.

Acupressure and acupuncture: Chronic joint pain may respond to acupuncture or acupressure therapy, an alternative form of therapy that works by applying pressure or noxious stimuli on the peripheral trigger points. Accupressure and accupuncture must be performed by a qualified therapist or under supervision of a qualified therapist only.

Ayurveda: There are various Ayurvedic preparations in the form of oils and liniments such as menthol and camphor oil, sesame oil, etc. to be applied locally at the site of pain. They provide good relief from symptoms and promote joint health.

Homeopathy: Homeopathic preparations in the form of injections or oral drops/pills, such as Rhus Toxicodendron, Arnica Montana, Solanum Dulcamara, etc., are known to improve pain and other troublesome symptoms of patients with joint pain.

External orthoses support: Using knee caps, cervical collars, lumbosacral belts, and walking aids like a stick or walker offer much-needed support to the degenerative joints and are useful in alleviating joint pain. Use them if advised by your doctor and exactly as instructed as misuse may cause more harm to the joints.

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Living With Joint Pain

Joint pain has a great impact on an individual’s quality of life. Severe, chronic, and debilitating pain may interfere with basic activities, such as walking, thereby leading to restrictions in movements and travel. Often, chronic pain is a source of anxiety and depression in patients with osteoarthritis, rheumatoid arthritis, and other joint diseases. They find themselves withdrawn from society and the community at large. Joining knee care, spine care, and other such musculoskeletal health clubs may help these patients deal with joint issues and bond with others suffering from similar pain.

Winters are known to be the worst for people with joint pain because change in weather causes changes in the atmospheric pressure resulting in more inflamed tissue leading to swelling and pain. Here are a few lifestyle changes one can incorporate into their routine life to ease off joint pains, especially during winter.

1. Supplement bone & joint healthy foods: Stock up dairy products and spend at least 15 minutes in sunlight daily to increase the intake of vitamin D. 

• Include foods rich in omega-3 fats such as salmon, nuts, fish oil in your diet as these ease inflammation. 
• Foods rich in vitamin K are helpful because of its pain-soothing properties. Include greens in your meal such as spinach, fenugreek (methi), cabbage, kale, etc.
• Foods rich in vitamin C halt cartilage loss associated with arthritis. Add juicy oranges, sweet red peppers, tomatoes, amla and other vitamin C-rich foods in your diet.

2. Exercise regularly:Go for a 30-minute walk daily. If cold weather makes you lazy to go out in the mornings, go for an afternoon walk. Also, stretch your muscles as it helps maintain your mobility.

3. Stay hydrated: Drink plenty of water in winters as dehydration reduces flexibility and increases stiffness.

4. Get a massage: Massage therapy by a professional helps in relaxing the muscles around the painful joints, thereby reducing pain and making you more mobile.

5. Cover up: Try to keep painful joints covered with a sleeve or wrap. Keeping them warm helps reduce pain and increases mobility. Using a muscle relaxant gel on the aching joints and then covering up has been seen to be very helpful.

6. Use hot packs:Hot packs/hot baths/steam helps to soothe the painful joints. Heat stimulates blood flow, which brings healing nutrients to the affected area and inhibits the pain messages being sent to the brain.

7. Take medication on time: Do not forget to take your medications as advised by your doctor. If you suffer from chronic joint pain, consult your doctor for painkillers. Do not self-medicate. Also, go for regular doctor consultation, especially if your symptoms recur/worsen.

8. Watch your weight: Major joints like the hips, knees and back carry one’s body-weight while performing daily activities. The pressure gets compounded depending upon the nature of activity and more the pressure; more is the wear and tear that the joints are subject to. So lose weight.

9. Improve your posture: Consciously maintaining a correct upright posture is paramount. While you are standing, your spine should be straight, buttocks pressed against each other, belly in and chest out. When sitting, your core should firmly rest on the chair’s backrest and it is advisable that you sleep on a firm mattress facing sky-wards. Do not slouch when watching TV or using a laptop.

10. Get enough sleep: Sleep is the best healer is a saying that is all the more true for our joints. Our bones, muscles and tendons are never off-duty during an average day so letting them recover is something that cannot be skipped. A tired tissue is more susceptible to injury.