Everything you need to know about joint pain
Joint pain can occur for a number of reasons. For many people, it is due to arthritis (joint inflammation), of which there are several types. For others, such as those with fibromyalgia or an underactive thyroid, pain occurs with no underlying inflammation at all. Joint pain may range from a mild ache to a severe, burning or sharp sensation in one or several joints. In some instances, joint pain is associated with other symptoms, like joint swelling and stiffness, overlying red and warm skin, and whole-body symptoms like fatigue, weight loss, or fever.
Due to the multiple causes of joint pain, it is perhaps best to separate them into two classes— joint pain from arthritis versus joint pain unrelated to arthritis.
Osteoarthritis (OA) is the most common form of arthritis. OA develops as a result of age-related breakdown of cartilage, which serves as a cushion between the bones of a joint. This type of arthritis tends to affect the knees, hips, neck, lower back, and fingers.The pain of OA, which often progresses from a sharp, intermittent pain to a constant aching, worsens with movement and eases with rest. Joint stiffness and a restricted range of motion are also characteristic of OA joint pain.While classic OA is actually a non-inflammatory arthritis (even though it is still classified as an arthritis), an aggressive subtype of OA, called erosive osteoarthritis, is inflammatory. Erosive OA is most common in postmenopausal women and causes a gradual onset of joint aches, stiffness, and swelling in multiple finger joints.
Several different viruses may cause arthritis. The most common ones include hepatitis B and C, parvovirus B19, and alphavirus (viruses transmitted by mosquitoes), such as the Chikungunya virus (CHIKV) found in the Caribbean.
- Ankylosing spondylitis (AS): AS is an axial spondyloarthropathy because it affects mainly the back and neck (i.e. spine) and the sacroiliac joints (which connect the spine to the pelvis). The joint pain of AS tends to begin in early adulthood before the age of 45, come on gradually, and improve with activity (similar to rheumatoid arthritis, but the opposite of osteoarthritis). Morning stiffness that lasts longer than 30 minutes is also common in AS.
- Psoriatic arthritis: Up to 30 percent of people with psoriasis—a chronic skin condition characterized by patches of thickened skin covered by silvery scales—have psoriatic arthritis. It most commonly affects the end joints of the fingers and toes, causing a throbbing pain, along with stiffness and swelling. Other symptoms may include swollen fingers and toes that look like sausages and nail problems (for example, pitted nail beds). Interestingly, the severity of a person’s psoriasis does not correlate with the severity of their arthritis—and in about 15 percent of people, joint pain shows up before the psoriasis appears.
- Reactive arthritis: This type is characterized by the development of joint pain and swelling one to four weeks after an infection in the urinary tract, genitals, or intestines. Specific bacterial organisms linked to the development of reactive arthritis include Salmonella, Campylobacter, Shigella, Yersinia, and Chlamydia. Typical joints involved in reactive arthritis are the knee, ankle, and foot.
- Arthritis associated with inflammatory bowel disease (IBD): Throbbing joint pain and swelling, especially in larger joints like the knees and hips, may occur in people with inflammatory bowel disease (Crohn’s disease or ulcerative colitis). The arthritis tends to be more active when bowel symptoms are flaring.
Systemic Lupus Erythematosus
Joint inflammation, especially of the knees, wrists, and finger joints, is common in systemic lupus erythematosus (SLE)—a chronic, autoimmune disease that may affect nearly every organ in the body.Like RA, the same joints on the same side of the body tend to be affected in SLE. However, unlike RA, the morning stiffness does not last as long (minutes for SLE versus over an hour for RA), and the joint pain tends to be short-lived and migratory, moving from one joint to another within a 24-hour period.
Other Systemic Rheumatic Diseases
Though it may be hard to believe, the above list is not exhaustive of all the different causes of arthritis. Other less common systemic (whole-body) illnesses may cause arthritis, a few examples being:
- Systemic sclerosis
- Familial Mediterranea fever
Unrelated to Arthritis
These conditions may cause joint pain but are not related to an underlying disease or inflammatory process within the joint.
The predominant symptom of fibromyalgia, a chronic pain condition, is widespread muscle tenderness, along with crippling fatigue. In addition to muscle pain, people often note joint aches and sometimes joint swelling, despite the lack of inflammation on physical exam.
Hemarthrosis, when bleeding into a joint occurs, may occur for a number of reasons including trauma, a bleeding disorder like hemophilia, a postsurgical complication, or tumor growth, like a synovial hemangioma.
The most common cause of hypothyroidism—an underactive thyroid gland—is Hashimoto’s thyroiditis, which is when your body’s immune system launches an attack on your thyroid. Hypothyroidism may cause numerous symptoms, including fatigue, weight gain, constipation, cold intolerance, and joint aches and stiffness.
You may be surprised to learn that a primary physical manifestation of depression is joint pain, and sometimes this is a person’s only reported symptom. That said, other common symptoms of depression include a loss of interest in pleasurable activities, a change in appetite, sleep disturbances, difficulty concentrating, and feelings of hopelessness and/or guilt.
When to See a Doctor
While it’s important to make an appointment with your doctor for any new joint problems, be sure to seek urgent medical attention if yu have any of the following symptoms associated with your joint pain or if your joint pain is severe:
- Unexplained weight loss
- Inability to function in daily life due to your joint problem
- Feeling ill
- Hot or significantly swollen joint
- Sudden numbness or burning and/or muscle weakness
Diagnosing the reason behind your joint pain requires a comprehensive medical history and physical examination, followed sometimes by blood tests, imaging tests, and a joint aspiration procedure. Rarely, a biopsy (a tissue sample) is needed.
A thorough medical history is often key to diagnosing the cause of your joint pain. It helps to be as detailed as possible when having a conversation with your doctor.
In order to sort out your diagnosis, your primary care doctor may start by inquiring about the precise location, timing, and intensity of your joint pain. This is because arthritis related to gout, pseudogout, or a bacterial infection tends to affect one joint at a time, come on suddenly, and be severe. On the other hand, pain related to arthritis from a systemic disease, like a spondyloarthropathy or RA, tends to be mild and achy, come on gradually, and affect more than one joint at a time.
Worsening and Alleviating Factors
Next, your doctor will inquire about what worsens or improves your joint pain. While the joint pain of osteoarthritis improves with rest and worsens with activity, arthritis due to a systemic connective tissue disease, like rheumatoid arthritis, is worse with rest (often in the morning) and improved with activity.
Your doctor may ask whether you have a family history of joint pain, especially since certain conditions (such as psoriatic arthritis) tend to run in families.
Associated Symptoms and Incidents
Your doctor will want to know whether you have had a recent fever or are experiencing any unusual symptoms like fatigue or weight loss. Also be sure to tell your doctor if you have had a recent trauma, surgery, or viral infection.
When examining your joints, your doctor will press on the painful joints feeling for warmth, swelling, and tenderness (signs of inflammation). He will move your joints around to see if there is any restricted range of motion or crepitus (a popping sound heard in OA), and chart the distribution of your joint pain to determine if it’s symmetric (affecting matching joints, like both knees) or asymmetric (affecting joints unevenly, like one knee but not the other).
Lastly, he will examine your body for various clues to your diagnosis such as:
- Plaques (seen in psoriatic arthritis)
- Heberden and Bouchard’s nodes (seen in osteoarthritis)
- Tophi (seen in gout)
- Rheumatoid nodules (seen in rheumatoid arthritis)
- Tender points (seen in fibromyalgia)
- Enlarged thyroid gland (hypothyroidism)
Labs and Tests
Oftentimes, a diagnosis can be made from a medical history and physical examination (as in the case of OA). But in some instances, like if a systemic disease is suspected, testing may be necessary.
Depending on what your doctor discovers during your medical history and exam, he will order various blood tests. For example, if he suspects rheumatoid arthritis, he would order an anti-citrullinated protein antibody (anti-CCP).
Other potential blood tests (in no particular order) include:
- Complete blood count
- Kidney and liver function tests
- Inflammatory markers: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
- Uric acid level
- Anti-nuclear antibody (ANA)
- Hepatitis B and C tests
- Parvovirus test
A joint aspiration procedure, also called an arthrocentesis, entails a doctor (often a rheumatologist) removing fluid from inside the synovium (an affected joint that is painful and/or inflamed) using a needle and a syringe. The fluid can then be examined under a microscope. Synovial fluid analysis is useful for diagnosing conditions like gout (presence of urate crystals) and septic arthritis (presence of a high white blood cell count).
Imaging tests can be helpful in the diagnostic process, either by supporting or confirming a diagnosis. For example, an X-ray may reveal osteophytes (bony growths) and joint space narrowing—both classic signs of osteoarthritis. An X-ray can also reveal subtle signs of inflammatory arthritis, like erosions (craters in the bone that occur as a result of joint damage).Other imaging tests, such as an ultrasound, magnetic resonance imaging (MRI), or a computed tomography (CT) scan, may provide further information about a joint and its surrounding tissues.
Less commonly, a rheumatologist will remove a tissue sample of the lining of the synovium. This may be useful for diagnosing septic arthritis due to tuberculosis or a fungus.
Sometimes, what is perceived as joint pain is actually due to a non-joint related condition, like tendonitis, a muscle strain, or a bone fracture. Rarely, a bone tumor may manifest as joint pain.The good news is that an evaluation by a healthcare professional, along with imaging tests can sort this out. For instance, an X-ray can diagnose a fracture.
Once you receive a diagnosis, you and your doctor can devise a treatment plan that includes medication along with self-care strategies, physical therapy, and less commonly, surgery.
A part of treating joint pain entails you taking an active role in your joint and overall health. Here are some self-care strategies to consider under the guidance of your doctor:
- Seeing your primary care doctor for vaccinations and regular health screenings (for example, for osteoporosis, cancer, and depression)
- Educating yourself about your diagnosis
- Engaging in daily exercise, both aerobic and strengthening
- Eating nutritiously
- Losing weight if overweight or obese
Several different medications are used to ease joint pain, depending on your underlying diagnosis. For example, with osteoarthritis, a number of different treatments may be used, including:
- A topical or oral nonsteroidal anti-inflammatory drug (NSAID)
- Topical capsaicin
- Cymbalta (duloxetine)
- Steroid joint injections
- Hyaluronic acid injections
In addition to pain medications, if you have a systemic disease,you may need to take a medication that alters how your immune system works—for instance, a tumor necrosis factor (TNF) inhibitor for ankylosing spondylitis and methotrexate for rheumatoid arthritis.If you have been diagnosed with septic arthritis, you will need to take one or more antibiotics through your vein (intravenous).
Physical therapy for joint pain focuses on maintaining joint function and range of motion, strengthening muscles surrounding the joint, and minimizing joint stiffness and pain. Depending on your condition, your physical therapist may recommend a walking aid, brace, or splint to improve your functioning.For people with fibromyalgia, a supervised physical exercise program is especially important for minimizing muscle and joint pain and easing other symptoms, like fatigue and anxiety.
Complementary and Alternative Medicine
Several mind-body therapies have been used, often in conjunction with medication and physical therapy, to alleviate joint pain. Some of these include:
- Tai Chi
In addition, while there was an initial hype about taking the dietary supplements glucosamine and chondroitin for repairing the damaged cartilage of osteoarthritis, the scientific evidence is unfortunately not so supportive.That said, for some people, there may be a small pain-alleviating benefit to taking them. In the end, it’s best to talk with your doctor about whether these supplements are right and safe for you.
Surgery is generally reserved for advanced cases of joint pain, such as knee or hip osteoarthritis that has not responded to conservative measures. In severe cases, total joint replacement may be necessary.Alternatives to total knee or hip replacement include knee or hip osteotomy—surgeries that entail cutting and reshaping bones to ease pressure on the joint. While an osteotomy may delay the need for a joint replacement for several years, only young, active adults with osteoarthritis limited to one side of the knee or people with certain hip conditions are generally candidates.
A Word From Verywell
Pain is your body telling you there is something amiss. The good news is that with a proper diagnosis of the cause of your joint pain, you and your doctor can address and tackle the root problem so you can feel and live your best.