Joint pain, arthritis and Rheumatic disease 4.41/5 (39)

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Joint pain can be signs of rheumatic disease

Joint pain in adults

Definition

Rheumatic joint pain occurs with or without simultaneous joint swelling. Joint pain (arthralgia) without swelling is very common and can involve a few or many joints, be new-onset or chronic. The cause is usually harmless, but can be a sign of a serious illness.

Causes

Joint pain has many possible causes, from a harmless symptom to a serious underlying disease. The condition can be an early symptom of joint inflammation (arthritis), arthrosis, tendinitis or other disease in joints, structures close to joints or elsewhere in the body. When a rheumatologist concludes with a diagnosis of arthralgia, it is usually understood that no other joint disease has been detected.

Examinations

Disease history. A closer examination of joint pain is first carried out with a targeted medical history. A distinction is made between joint pain without and with joint swelling.

Clinical examination. The purpose of clinical examination is to detect joint swelling, increased heat over joints or reduced range of motion. In addition, signs of an underlying disease cause are examined. 

Laboratory tests may include lowering reaction (SR), CRP, leukocytes with differential count, platelets, peripheral blood smear, hemoglobin (Hb), TSH, T4, ferritin, calcium, phosphate, serum electrophoresis and antibodies (eg anti-CCP, ANA, ANCA).

Imaging may include ultrasound, X-ray or MRI examinations.

Joint pain (without swelling / without arthritis), arthralgia

Blood disorders. hemochromatosisleucemia)

Chikungunya virus causes tropical disease transmitted via mosquitoes. A rash, acute fever and severe joint pain are typical. Transition to joint swelling/arthritis occurs during the course.

Celiac Disease (Intestinal pain and bloating, varying joint pain, rarely swollen joints (artritis)

Dengue fever (tropical viral disease transmitted via mosquitoes). High fever, sweat attacks, rash, swollen lymph nodes, severe muscle and joint pain ("break bone fever").

Vitamin D (25-OH-Vitamin D) low, parathormone high (secondary form of vitamin D deficiency)

Fabry's disease: Pain in extremities in children and adolescents, fever, rash between navel and thighs, sweating, diarrhoea, nerve symptoms, osteoporosis, osteonecrosis and Raynaud's phenomenon. X-linked genetic inheritance.

Fibromyalgia. Women are attacked 10 times more often than men. Daily pain in joints, muscles and tendon attachments in both arms, legs and in the neck or back. Often varying loose and hard stools and feeling of a bloated stomach. Reduced sleep and increased fatigue. Normal blood tests.

Foot pain is discussed on its own page

Frozen shoulder (adhesive capsule, stiffening in shoulder after painful tendonitis)

Gaucher's disease (and others lysosomal deposition diseases) often debuts in childhood, severe bone pain, joint pain often with joint swelling, reduced number of red blood cells (anaemia) and platelets (thrombocytopenia) and decay of bone tissue (avascular necrosis) occur. Enlarged spleen and liver, as well as reduced growth are common.

Hemochromatosis and hemosiderosis (excess iron, high hemoglobin and ferritin in blood sample, liver and pancreas can be attacked, skin pigmentation)

Hepatitis B or Hepatitis C (Increased liver enzymes, antibody tests)

HIV (Medical history, blood test)

Hip and pelvic pain is discussed on its own page

Hypermobility syndrome. Movable joints

Knee pain is discussed on a separate page

Cancer (paraneoplastic syndrome). Disturbances in the calcium level (high calcium and low PTH in the blood) and other things that indirectly cause joint pain, usually without joint swelling.

Osteonecrosis (avascular bone necrosis). Rapid destruction of bone substance. Hips, shoulders, wrists, ankles. Risk exists at Alcoholism, Diver disease ("caisson disease »), Prednisone (cortisone) more than 20 mg/day can trigger osteonecrosis, Systemic lupus erythematosus (SLE).

Parathyroidism (hyperfunction of the parathyroid gland). Calcium and parathyroid hormone are elevated (primary form).

Tendinitis (after overload, normal blood tests). Achilles Ener (the heel), elbows, shoulders, wrists. De Quervain syndrome. Pain and slight swelling at the wrist and along the tendons of a forearm.

Sepsis (blood poisoning). Rapid development of severe infection

Serum sickness (hypersensitivity syndrome)

Checkpoint inhibitors (cancer treatment)

Bursa Inflammation (bursitis), often at the elbows and knees. Swelling above the joint (Prepatellar bursitis in the knee). Infection in some cases (need for antibiotics). In case of infection, CRP (in a blood test) is elevated.

Metabolic Disease (most often hypothyroidism, low metabolism). Women more frequently than men. Blood tests (TSH, f-T4). ANA (and anti-TPO) can knock out (TRAS at hyperthyroidism /Grave's disease).

Swollen joints, arthrosis and arthritis

One or more joints are swollen, tender and the skin over the joint is often warm. Generally, the general condition is affected (lethargy, night sweats, tendency to fever). On clinical examination, mobility is also reduced.

Blood tests most often show elevated CRP, lowering reaction (SR) and thrombocytes (platelets) in joint inflammation, but are normal in osteoarthritis (see below).

Imaging with ultrasound and/or MRI examinations showing typical changes in affected joints (CT and/or X-rays do not show early joint changes).


Some diseases with joint swelling (alphabetical order):

Adult Stills disease (high and varying fever, arthritis, rash with fever, high CRP and ferritin in blood test).

Joint pain may have different causes

Osteoarthritis seen from the age of 40. Fingers are attacked with pain, especially after strain. Bone thickening is seen at the end joint (DIP joint), middle joint (PIP joint) and thumbs. Toes are affected, especially the base of the big toe, hallux valgus. Hips with pain radiating to the groin, reduced rotation in the joint. Knees with pain and swelling during and after strain. Previous injuries are predisposing. X-ray examinations show typical changes. No results in blood tests. More about osteoarthritis, please read more on the separate page about osteoarthritis.

Arthritis characterized by pain, stiffness, increased heat and swelling in joints. Various reasons.

Connective Tissue Diseases, systemic, autoimmune (ANA test, typical symptoms)

Borrelia infection (Lymes disease) (weeks-months after tick bite, usually a swollen knee, elevated IgM borrelia antibody in blood sample, borrelia by PCR examination of joint fluid)

Familiar Mediterranean Fever (FMF) (Ethnic from the Mediterranean and North Africa, family history, acute self-limiting attacks with arthritis and inflammation in pericardium og lung membranes / serocyte).

Granulomatosis with arteritis (GPA/Wegener's granulomatosis) vasculitis. (PR3 -ANCA+, sinuses, kidneys, lungs are attacked).

Infection / septic arthritis (severe pain, hot and red joint, fever, often only one joint). Synovial fluid examinations, blood tests show infection.

Chondrocalcinosis ("Pseudo-goat", goat-like symptoms, elderly persons, normal uric acid in blood test)

MCTD (Connective tissue disease, RNP antibody, swollen hands, Raynaud's phenomenon)

Myositis is characterized by muscle inflammation (CK is high, muscle weakness), but arthritis in finger joints and others occurs.

Psoriatic arthritis About 5-10% of those with skin psoriasis develop swollen, inflamed joints.

Reactive arthritis occurs quite acutely with swollen, painful joints a few weeks after a bacterial infection in the intestines or urinary tract. Chlamydia, Yersinia, Salmonella, Campylobacter and more. Knees and ankles are most often attacked.

Rheumatoid arthritis (RA) (arthritis) is most often characterized by swollen fingers and feet, wrists and ankles). Gradually increasing symptoms. Anti-CCP (ACPA-Antibodies) is most often elevated in a blood test, close relatives with RA (Reference: Van Steenbergen HW, 2017, EULAR definition). Pain in the base joints of the fingers (MCP joints). Morning stiff joints for at least an hour and most pain in the morning. Difficulty closing the hand. Pain if pressed across the MCP joints.

Sarcoidosis (Løfgren Syndrome): swollen in both ankles, erythema nodosum / nodular rosacea and swollen lymph nodes in both lung hilus.

Sjögren's syndrome characterized by chronic dry eyes and dry mouth, most often in women. Pain in the joints and muscles is not uncommon, but joint swelling is less common.

Systemic Lupus Erythematosus (SLE) pain and swelling in finger joints are usually combined with eczema on the face or body. Kidneys, pleura and heart (internal organs) can be attacked.

Systemic sclerosis (scleroderma) characterized by "corpse fingers" (Raynaud's phenomenon), tight skin, most often on fingers. Joint swelling is less common.

Intestinal inflammations, chronic. About 20% have joint pain, 3-4% get joint swelling (arthritis). Pain and diarrhea complaints in (Ulcerative colitis or Crohn's disease; knee and ankle arthritis most common, especially when the gut is bad. Increased occurrence of Ankylosing spondylitis with back pain and stiffness.

Tuberkulosis (Tbc) can cause major joint damage/osteomyelitis (despite relatively little pain).

Gout most often attacks men and can be triggered by chronic kidney failure, after a lot of alcohol or a large meal. Sudden onset (hours), intense pain, often in the base of the big toe (gout). Uric acid and CRP are typically elevated in blood tests.

Vasculitis diseases in the skin and other organs can cause joint pain and slight swelling.

Viral arthritis with painful joint inflammation can be caused by various viruses, of which Parvovirus B19 -infection may resemble Rheumatoid arthritis, but with a good prognosis.

Whippel's disease can begin with varying joint inflammation (arthritis) several years before chronic intestinal complaints and weight loss develop.

More about arthritis, please read more on the separate page about arthritis diseases

Joint pain in children


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