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Joint Pain Causes and Treatment Options
Joint pain has many causes. It can be hard to find out what's causing it. And treatments vary depending on the cause.
Joint pain can be from a type of arthritis (joint inflammation). Or there may be no damage or inflammation, as with fibromyalgia and hypothyroidism.
This article walks you through many common causes of joint pain and how they're diagnosed and treated.
Arthritis-Related Causes
In arthritis, inflammation and/or joint damage is responsible for the pain. Arthritis comes in many forms with many causes.
Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis. It results from the breakdown of cartilage. This is often due to aging. Trauma can cause it, too.
Cartilage provides a cushion between the bones of a joint. That helps bones glide past each other. When the cartilage wears away, bones don't glide, they grind.
OA tends to affect the:
• Knees
• Hips
• Neck
• Lower back
• Fingers
The pain of OA gets worse with movement and better with rest. It often starts with sharp, intermittent pain then grows into a constant ache.
Joint stiffness and a limited range of motion are common.
Classic OA is considered non-inflammatory. But an aggressive subtype of OA, erosive osteoarthritis, is inflammatory.
Erosive OA is most common in postmenopausal women. It causes a gradual onset of joint aches, stiffness, and swelling in multiple finger joints.
Gout
Gout is a type of inflammatory arthritis. It strikes people with high levels of uric acid in their blood.
Uric acid can build up and form crystals inside your joints. The immune system then tries to destroy them. That leads to inflammation and pain.
Common joints for gout are:
• The big toe
• Ankle
• Knee
A classic gout attack involves sudden, severe, often burning joint pain. It usually strikes just one joint.
Along with being sore, joints may be:
• Red
• Warm
• Swollen
Without treatment, an acute flare may last up to two weeks.
Pseudogout
Pseudogout is a type of inflammatory arthritis. It's caused by calcium crystals building up in the joints. The most common joints are the:
• Knees
• Wrists
• Shoulders
• Ankles
• Feet
• Elbows
• Pseudogout feels much like gout. But pseudogout attacks may last longer.
Septic Arthritis
With septic arthritis, a joint becomes infected. It's most often due to bacteria. In rare cases, it may be a fungus (like Candida) or mycobacteria (like tuberculosis).
Septic arthritis tends to affect a single joint. It's usually a:
• Knee
• Ankle
• Wrist
• Hip
The affected joint gets swollen, warm, and stiff. You'll also have a fever.
The infection usually starts in the blood, then moves into the joint.6 Less often, joint surgery or something like a tick bite may be the culprit.
Viral Arthritis
Several viruses may cause viral arthritis. The most common ones include:
• Hepatitis B and C
• Parvovirus B19
• HIV
• Mosquito-borne viruses like the Chikungunya virus (CHIKV)
Viral arthritis lasts for a short time. Then most people are symptom-free. But some viruses leave behind pain that lingers for months or years.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune disease. It develops gradually. RA predominantly affects the joints. But early symptoms may include:
• Fatigue
• Muscle pain
• Low-grade fever
• Weight loss
• Numbness and tingling in the hands
RA then progresses to the joints. It most often starts in the fingers and toes on one side of the body. Then other joints follow. The likely ones are:
• Wrists
• Elbows
• Hips
• Neck
The joint(s) also tend to be stiff, warm, red, and swollen. Unlike OA, RA pain tends to be worst in the morning and lasts for more than an hour. It improves with movement.
Spondyloarthritis
Spondyloarthritis is a family of inflammatory rheumatic diseases. It includes four conditions.
Ankylosing Spondylitis (AS)
Ankylosing spondylitis is an axial spondyloarthropathy. That means it mainly affects the:
• Back
• Neck
• Sacroiliac joints at the base of the spine
• The joint pain of AS tends to begin before age 45. It comes on gradually.
Symptoms tend to improve with activity (similar to RA). Morning stiffness that lasts longer than 30 minutes is also common in AS.
Psoriatic Arthritis
Psoriasis is an autoimmune skin disease. It causes patches of thick skin covered in silvery scales.
Up to 30% of people with psoriasis develop psoriatic arthritis. It most commonly affects the end joints of the fingers and toes. It causes:
• Throbbing pain
• Stiffness
• Swelling
• Nail problems like pitted nail beds
• In about 15% of people, joint pain shows up before psoriasis appears.
Reactive Arthritis
Reactive arthritis shows up within six weeks after an infection in the urinary tract, genitals, or intestines. It causes joint pain and swelling.
Bacteria linked to reactive arthritis include:
• Salmonella
• Campylobacter
• Shigella
• Yersinia
• Chlamydia
• Typical joints are the knee, ankle, and foot.
Arthritis Associated With Inflammatory Bowel Disease (IBD)
Some people with inflammatory bowel disease (IBD) develop a type of arthritis. It tends to be more active when bowel symptoms flare.
IBD includes Crohn's disease and ulcerative colitis.
Arthritis associated with IBD causes throbbing joint pain and swelling. It's more common in larger joints like the knees and hips.
Systemic Lupus Erythematosus
Joint inflammation is common in systemic lupus erythematosus (lupus or SLE). That's a chronic autoimmune disease. It can affect nearly every organ in the body.
Lupus especially hits the:
• Knees
• Wrists
• Finger joints
Like RA, joints on the same side of the body tend to be affected. Unlike RA, the morning stiffness doesn't last as long (minutes for SLE versus an hour for RA).
Joint pain also tends to be short-lived. It may move from one joint to another throughout the day.
Polymyalgia Rheumatica
Polymyalgia rheumatica (PMR) is an inflammatory joint disease. It causes:
• Significant muscle and joint aches
• Stiffness in the shoulders, neck, and hips
• Sometimes, mild swelling and tenderness in the wrists and fingers
• The feet and ankles are never affected. And the disease almost exclusively affects people over 50.15
PMR is associated with another condition called giant cell (temporal) arteritis. That's an inflammatory blood vessel disease. It causes inflammation in the arteries of the head and scalp.
Other Systemic Rheumatic Diseases
Other systemic (whole-body) conditions may cause arthritis, too. They include:
• Systemic sclerosis: Involves the abnormal growth of connective tissues.
• Sarcoidosis: Produces lumps of cells (granulomas) in organs and tissues, especially the lungs.
• Familial Mediterranea fever: Rare genetic disorder that causes recurrent bouts of fever, abdominal pain, lung inflammation, and swollen joints.
Non-Arthritis Causes
Many other conditions cause joint pain that's not related to joint disease or inflammation.
Fibromyalgia
Fibromyalgia is a chronic pain condition. The pain comes from nervous system dysfunction and hypersensitive nerves.
Fibromyalgia pain usually moves around the body. It can affect joints, muscles, and connective tissues. Nerves may cause shooting, zinging, or tingling pain.
Other symptoms include crippling fatigue and cognitive dysfunction ("fibro fog"). Some people with this illness have joint aches and minor swelling.
However, exams and tests don't generally find any serious inflammation or joint damage.
Hemarthrosis
Hemarthrosis occurs when you have bleeding into a joint. It may be due to a number of reasons, including:
• Trauma
• A bleeding disorder like hemophilia
• A postsurgical complication
• Tumor growth like a synovial (joint lining) hemangioma
Blood can damage the cartilage inside your joints. Symptoms include:
• Joint pain and stiffness
• Swelling
• Bruising
• Redness and warmth
It can take weeks or months to go away on its own. Treatment helps prevent pain and disability.
Hypothyroidism
Hypothyroidism involves an underactive thyroid gland. The most common cause is Hashimoto's thyroiditis. That's an autoimmune disease in which your body attacks your thyroid gland.16
The thyroid is responsible for keeping numerous hormones in balance. When they're out of balance, a lot of things can go wrong.
Symptoms of hypothyroidism include:
• Joint aches
• Stiffness
• Fatigue
• Weight gain
• Constipation
• Cold intolerance
Lyme Disease
Lyme disease is transmitted via tick bites. Lyme bacteria in your joint tissue causes inflammation and pain known as Lyme arthritis.17
The main symptom is swelling of one or more of the joints. Common sites include:
• Knee
• Shoulder
• Ankle
• Elbow
• Jaw
• Wrist
• Hip
Depression
It may seem odd, but unexplained joint pain is a primary physical symptom of depression.18 Other common symptoms include:
• A loss of interest in pleasurable activities
• Appetite changes
• Sleep disturbances
• Difficulty concentrating
• Feelings of hopelessness and/or guilt
When to See a Healthcare Provider
New joint pain is a reason to see your healthcare provider. Also, make an appointment if you have a pain condition but:
• Have pain in a new area
• A markedly different type of pain
• New symptoms along with the pain
• Many people with one pain condition go on to develop another. For example, it's common for someone with RA or lupus to eventually develop secondary fibromyalgia.
Diagnosis
Healthcare providers have myriad tools for diagnosing the cause of your back joint pain. They include:
• A thorough medical history
• A comprehensive physical examination
• Blood tests
• Imaging tests
• A joint aspiration procedure
• In rare cases, a biopsy (tissue sample)
The specific tests you get depend on your symptoms.
Medical History
The first step in the diagnostic process is a medical history. That includes the details of your joint pain, such as:
• Where does it hurt?
• How intense is it?
• Is it worse at certain times of day? After rest or certain activities?
• What makes it better and worse?
Your healthcare provider will also ask whether you have a family history of joint pain. That's because some conditions (like psoriatic arthritis) tend to run in families.19
Be sure to tell your healthcare provider if any of the following apply to you:
• Recent fever
• Unusual symptoms, like fatigue or unexplained weight loss
• Recent trauma
• Recent surgery
• Recent viral infection
Before your appointment, think about all of these things so you can provide helpful information.
How Symptoms Help
Details about your pain can help narrow down possible diagnoses. For example, if sudden, severe pain hits one joint at a time, it may be:
• Gout
• Pseudogout
• Bacterial infection
Mild, achy pain that comes on gradually and affects more than one joint? It could be:
• Rheumatoid arthritis
• A type of spondylitis
• Lupus
• Joint pain of osteoarthritis improves with rest and worsens with activity. Arthritis due to RA is worse with rest and improves with activity.
Being thorough at that first appointment can help you get to the right tests, and the right treatments, faster.
Physical Examination
During the physical exam, your healthcare provider will press on the painful joints. They're looking for:
• Warmth
• Swelling
• Tenderness
These are signs of inflammation. They'll also move your joints around to check for a limited range of motion or crepitus (popping and grinding).
They'll note whether your pain is symmetrical (in the same joint on both sides) or asymmetrical. Lastly, they'll look for various clues such as:
• Plaques (seen in psoriatic arthritis)
• Heberden and Bouchard's nodes (distinctive finger swelling in osteoarthritis)
• Tophi (crystalline deposits like those seen in gout)
• Rheumatoid nodules (bumps under the skin seen in RA)
• Tender points (pain in 18 specific places, sometimes used to diagnose fibromyalgia)
• Enlarged thyroid gland (goiter, seen in hypothyroidism)
Exam findings may lead to a clear diagnosis. But much of the time, more work is needed.
Labs and Tests
Blood tests are necessary for diagnosing many systemic (body-wide) causes of joint pain. They may include:
• Complete blood count (CBC): Identifies infections and blood-based problems.
• Erythrocyte sedimentation rate (ESR or sed rate): Checks for inflammatory markers.
• C-reactive protein (CRP): Checks for inflammatory markers.
• Rheumatoid factor: An antibody present in RA, Sjögren's syndrome, and other autoimmune diseases.
• Anti-citrullinated protein antibody (anti-CCP): A peptide seen in autoimmune diseases.
• Uric acid level: Checks for the possibility of gout.
• Anti-nuclear antibody (ANA): Can indicate certain autoimmune diseases.
• Kidney and liver function tests: May be abnormal in inflammatory arthritis.
• Hepatitis B and C tests: Joint pain is a common symptom of these infections.
• Parvovirus test: Joint pain is a common symptom of this infection.
If they suspect autoimmune disease, your provider may order tests for certain antibodies. Those are your immune system's "attack" cells.
If they suspect fibromyalgia, you may be given questionnaires to fill out. These are measurements of pain, other symptoms, and their impact on you.
Imaging
Imaging tests can help confirm or rule out a diagnosis.
For example, an X-ray may reveal:
• Osteophytes (bony growths common in OA)
• Joint space narrowing (see in OA)
• Erosions (craters in the bone seen in inflammatory arthritis)
Other imaging tests may provide more information about a joint and its surrounding tissues. Common ones include:
• Ultrasound
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
Procedures
A few procedures can help confirm a diagnosis.
Joint Aspiration and Synovial Fluid Analysis
With joint aspiration, a needle is used to remove fluid from inside the synovium (joint lining). The fluid is then analyzed under a microscope. This can help diagnose:
• Gout
• Septic arthritis
Synovial Biopsy
If your healthcare provider suspects tuberculosis or fungal infection, they may perform a synovial biopsy.
This involves removing a small tissue sample from the synovium. The tissue is then examined in the lab.
In some cases, you may need to see a specialist
Differential Diagnoses
Sometimes, what's perceived as joint pain comes from a non-joint related condition. These may include:
• Tendonitis
• Muscle strain
• Bone fracture
• Rarely, a bone tumor
• These causes are typically easy for your health team to rule out.
Treatment
Treatments for joint pain depend on the diagnosis. Options include:
• Self-care
• Medication
• Physical therapy
• Complementary and alternative treatments
• Less often, surgery
Self-Care Strategies
Simple things you can try at home, before or after a diagnosis, include:
• Ice or heat
• Topical pain relievers
• Gentle stretching
• Rest
• Supportive wraps
You can take good care of your joint(s) and yourself by:
• Staying up-to-date on vaccinations and regular check-ups
• Educating yourself about your diagnosis
• Doing aerobic and strengthening exercise regularly
• Eating a nutrient-rich diet
• Losing extra weight
•
You may want to try an anti-inflammatory diet. Some illnesses, such as gout, may be improved with specific dietary changes.
Be sure to involve your healthcare practitioner in any lifestyle change you make.
Medication
Several different medications can ease joint pain. The specific type depends on your diagnosis. Some possible medications are:
• A topical or oral (by mouth) nonsteroidal anti-inflammatory drug (NSAID)
• Other painkillers (acetaminophen, opioids)
• Topical capsaicin
• Steroid joint injections
• Hyaluronic acid injections
Medications for autoimmune diseases change how your immune system works. These include:
• Disease-modifying anti-rheumatic drugs (DMARDs): Methotrexate, Plaquenil (hydroxychloroquine), Xeljanz (tofacitinib citrate)
• Biologics: Enbrel (etanercept), Humira (adalimumab), Orencia (abatacept), Rituxan (rituximab)
Fibromyalgia and depression are often treated with drugs that alter brain chemistry. These include:
• Cymbalta (duloxetine)
• Savella (milnacipran)
• Lexapro (escitalopram)
• Elavil (amitriptyline)
Fibromyalgia is also treated with anti-seizure medications:
• Lyrica (pregabalin)
• Neurontin (gabapentin)
Other conditions require specific treatments.
Hypothyroidism is treated with replacement thyroid hormones.
Some drugs help with gout by preventing uric acid crystal formation.
For septic arthritis, intravenous (through a vein) antibiotics are typical.
Physical Therapy
Physical therapy for joint pain focuses on:
• Maintaining (or regaining) joint function and range of motion
• Strengthening muscles surrounding the joint
• Minimizing joint stiffness and pain
Depending on your condition, your physical therapist may recommend a walking aid, brace, or splint.
For fibromyalgia, a supervised physical exercise program is especially important. It can help manage symptoms like muscle and joint, fatigue, and anxiety.
Complementary and Alternative Medicine
Several mind-body therapies can alleviate joint pain. They can be used alone (alternative) or along with other treatments (complementary).20
Some of these include:
• Tai chi
• Yoga
• Acupuncture
• Biofeedback
• Nutritional supplements
Your healthcare provider can help you decide which approaches may be helpful or harmful to you.
Surgery
Surgery is generally reserved for advanced cases of joint pain. This may include knee or hip OA that hasn't responded to less invasive treatments.
An osteotomy is sometimes a good option. It involves cutting and reshaping bones to ease pressure on a joint. That may delay the need for a joint replacement.
Good osteotomy candidates are:
• Young
• Active
• Have one-sided knee or hip problems
In severe cases, total joint replacement may be necessary.
Summary
Many conditions cause joint pain. Some are chronic (long-lasting). Others may be temporary. They may run their course without treatment or only clear up with the right treatments.
Some joint-pain causes just affect the joints. Others are systemic conditions with many other symptoms.
New joint pain, or a new type of joint pain, are reasons to see a healthcare provider. To diagnose the problem, they'll use your medical history, a physical exam, and possibly blood tests, imaging, and special procedures.
Treatment depends on the diagnosis. Medication, physical therapy, and sometimes surgery are standard. You may also benefit from lifestyle changes, self-care strategies, and complementary therapies.
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