Don't take joint pain lightly

DR MAXWELL ADEYEMI

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.

Causes

Arthritis: In arthritis, inflammation and joint damage is responsible for the pain. Arthritis comes in many forms with many causes.

Osteoarthritis is the most common form of arthritis. It results from the breakdown of cartilage. This is often due to ageing. It can also be caused by trauma. 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. It tends to affect the knees, hips, neck, lower back, and fingers

The pain 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 osteoarthritis is non-inflammatory. But an aggressive sub-type, erosive osteoarthritis, is inflammatory and most common in postmenopausal women. It causes a gradual onset of joint aches, stiffness, and swelling in multiple finger joints.

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 and swollen.

Pseudo-gout 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. Pseudo-gout feels much like gout. But pseudogout attacks may last longer.

In 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 such as, knee, ankle, wrist, and hip.

The affected joint gets swollen, warm, and stiff and may be accompanied by fever, infection usually starts in the blood, then moves into the joint.

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 and zika.

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 is a chronic autoimmune disease that develops gradually and predominantly affects the joints. But early symptoms may include: fatigue, muscle pain, low-grade fever, weight loss, numbness and tingling in the hands.

The joints also tend to be stiff, warm, red, and swollen, pain tends to be worse in the morning and lasts for more than an hour. It improves with movement.

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 tends to begin before age 45. It comes on gradually.

Psoriasis is an autoimmune skin disease. It causes patches of thick skin covered in silvery scales.Up to 30 per cent 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, and nail problems like pitted nail beds.

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 affected are the knee, ankle, and foot.

Arthritis linked to inflammatory bowel disease

Some people with inflammatory bowel disease such as Crohn’s disease and ulcerative colitis develops a type of arthritis. It tends to be more active when bowel symptoms flare. Arthritis associated with these conditions causes throbbing joint pain and swelling. It's more common in larger joints like the knees and hips.

Joint inflammation is common in systemic lupus erythematosus. That's a chronic autoimmune disease. It can affect nearly every organ in the body. Lupus especially hits the: knees, wrists and finger joints.

Other systemic conditions that may cause arthritis include:

Systemic sclerosis: Involves the abnormal growth of connective tissues.

Sarcoidosis: Produces lumps of cells (granulomas) in organs and tissues, especially the lungs.

Fibromyalgia: It 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, some people with this illness have joint aches and minor swelling.

Hemarthrosis: occurs when you have bleeding into a joint. It may be due to a number of reasons, including: trauma, a bleeding disorder like haemophilia, a postsurgical complication, tumour 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.

Hypothyroidism: It 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.

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.

Depression: It may seem odd, but unexplained joint pain is a primary physical symptom of depression. Other common symptoms include: A loss of interest in pleasurable activities, appetite changes, sleep disturbances, difficulty concentrating, feelings of hopelessness and guilt.

Diagnosis

Some investigations that may help diagnosis include:

-Blood tests

-Imaging tests

-A joint aspiration procedure

-Biopsy (tissue sample)

-Ultrasound

-Magnetic resonance imaging (MRI)

-Computed tomography (CT) scan

Treatment

Treatments for joint pain depend on the diagnosis. Options include:

• Self-care

• Medication

• Physical therapy

Medication

Several different medications can ease joint pain. The specific type depends on your diagnosis. Some possible medications are: A topical or oral nonsteroidal anti-inflammatory drug, acetaminophen, opioids, and Steroid joint injections.

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

Depending on your condition, your physical therapist may recommend a walking aid, brace, or splint.

Surgery

Surgery is generally reserved for advanced cases of joint pain. This may include knee or hip arthritis that hasn't responded to less invasive treatments.

Contact Dr Maxwell on 363-1807or 757-5411.