Joint pain can be signs of rheumatic disease

Joint pain in adults

Definition of joint pain

Rheumatic pains in joints occur with or without concomitant joint swelling. Joint pain may include few or many joints, be newly emerged or chronic. The cause is most often harmless, but may be a sign of serious illness.

Causes

Joint pain has many possible causes from harmless symptoms to severe underlying disease. Further descriptions below:

Swollen joint

One or more joints are swollen, sore and the skin above the joint is often warm

• Generally, the general condition is affected (lax, night sweats, feverishness)
• Blood tests often show elevated CRP, Lowering Reaction (SR). The number of platelets (platelets) may be increased
• Ultrasound and / or MRI studies show typical changes in affected joints (CT and / or X-ray do not show early joint changes)

Many possible diseases with arthritis (alphabetical order):

• Adult Stills disease (high and varying fever, arthritis, rash on fever, high CRP and ferritin in blood test)
• Bekhterev's disease / ankylosing spondylitis (Stiffness in the back, hip knee, hip pain, Achilles tendonitis, eye inflammation)
• Connective Tissue Diseases, systemic, autoimmune (ANA test, typical symptoms)
  • MCTD (RNP antibody, swollen hands, Raynaud's phenomenon)
  • Myositis (CK is high, muscular weakness)
  • Sjögren's syndrome (Dry eyes and dry mouth)
  • Systemic Lupus Erythematosus (SLE) (ANA is high, skin and more organs)
  • Systemic sclerosis (scleroderma) (Raynaud's phenomenon, tight skin)
• 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 / serositis)
• Infection / septic arthritis (strong pain, hot and red joints, fever, often just one joint)
  • Arthritis, blood tests
  • Tuberkulosis (Tbc) can cause major joint damage / osteomyelitis (despite relatively little pain)
• Chondrocalcinosis ("Pseudo-goat", goat-like symptoms, elderly persons, normal uric acid in blood test)
• Medication
  • Cancer treatment with checkpoint inhibitors; please see separate page here
• Psoriatic arthritis (5-10% of those with psoriasis in the skin)
• Reactive arthritis (few weeks after bacterial infection of the intestine or urinary tract)
  • Clamydia, Yersinia, Salmonella, Campylobacter
• Rheumatoid arthritis (RA) (arthritis, most often swollen fingers and feet, wrists and ankles)
  • Anti-CCP (ACPA-Antibodies) is most often elevated in blood test
  • Close relatives with RA
  • Early symptoms of RAReference: Van Steenbergen HW, 2017, EULAR definition)
    • New joint pain (less than one year's duration)
    • Pain in the basics of the fingers (MCP joint)
    • Morning stiff joints for at least an hour and most pain in the morning
    • Hard to make a fist (close the hand)
    • Pain if you press across the MCP joints
• Sarcoidosis (Løfgren Syndrome): swollen in both ankles, erythema nodosum / nodule and swollen lymph nodes in both lungs
• Bowel inflammation, chronic (Ulcerative colitis, Crohn's disease; Knee and ankle arthritis most often, especially when the intestine is troublesome)
• Gout (most often men can be triggered by chronic kidney failure, after much alcohol or large meal)
  • Sudden start (hours), intense pain. Uric acid and CRP elevated in blood test
• Vasculitis, systemic
  • GPA / Wegeners granulomatosis (PR3-ANCA +, sinuses, kidneys, lungs attacked)
• Virus inflammation (Parvovirus B19, may resemble Rheumatoid arthritis, good prognosis)
• Whippel's disease (arthritis can precede other symptoms for several years)

More about arthritis, please read more on your own page about arthritis diseases here

Osteoarthritis

• After the age of 40
• Fingers (bone thickening at the end joint (DIP-joints), intermediate joints (PIP joints) and thumbs
• Toes (great toes` main joint, hallux valgus)
• Hips (pain with radiance to the groin, reduced rotation in the joints)
• Knee (pain and swelling at and after stress. Previous injuries are predisposed)
• Pain at stress (no pain when resting)
• X-ray examinations show typical changes
• No findings in blood tests
• More about osteoarthritis, please read more about osteoarthritis here

Joint pain (without swelling / without arthritis), arthralgia

• Fibromyalgia
  • Women are 10 x more frequent than one
  • Daily pain in joints, muscles and tendons in both arms, legs and neck or back
  • Often varying loose and hard stools and feeling of inflated stomach
  • Reduced sleep and increased tiredness
  • Normal blood samples
• Osteonecrosis (Avascular Bone Necrosis)
  • Rapid destruction of bone substance
  • Hips, shoulders, wrists, ankles
  • Risks
    • Alcoholism
    • Diver disease ("caisson disease »)
    • Prednisone (cortisone) more than 20 mg / day may trigger osteonecrosis
    • Systemic lupus erythematosus (SLE)
• Tendon inflammation (After overload, Normal blood tests)
  • Achilles Ener (Heel), elbows, shoulders, wrists
  • De Quervain syndrome
    • Pain and slight swelling at the wrist and along the tendons of an underarm
  • Frozen shoulder (adhesive capsule, stiffening in shoulder after painful tendonitis)
  • Hypermobility syndrome
    • Movable joints
• Bursa Inflammation
  • Elbows
  • Knees
    • Swelling over joint (Pre-patellar bursitis)
  • Infection in some cases (need for antibiotics)
    • In the case of infection, CRP (in blood sample) is elevated

Joint pain may have different causes

Joint pain caused by underlying disease

• Arthritis Disease (please see above
  • Early symptoms of incipient joint swelling
• Celiac Disease (Intestinal pain and bloating, varying joint pain, rarely swollen joints (artritis)
• Hyperparathyroidism
  • Calcium and parathomone are elevated (primary form)
  • Vitamin D (25-OH-Vitamin D) low, parathormone high (secondary form of vitamin D deficiency)
• 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)
• Cancer disease (paraneoplastic syndrome)
  • Calcium level disorders (high calcium and low PTH in blood) and others that indirectly cause joint pain, usually without swelling of the joints
  • Treatment with checkpoint inhibitors
• Sepsis (blood poisoning)
  • Rapid development of severe infection
• Serum sickness (hypersensitivity syndrome)
• Metabolic Disease (most often hypothyroidism, low metabolism)
  • Women more frequent than men
  • Blood Tests (TSH, F-T4)
  • ANA (and anti-TPO) may be present (TRAS at hyperthyroidism / Graves disease)
• Bowel inflammation, chronic (20% have pain, 34% get joint swelling (arthritis)
  • Ulcerative colitis
  • Crohn's disease
• Tropical disease
  • Dengue Fever ("Breakbone fever")
  • Chikungunya

Joint pain in children

• Please read more on your own page here

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