Our joints are under constant stress and strain from the moment we are born till the moment we die.
They are subject to twists and turns, some of them natural, some not so much. Injuries are common and can cause significant amount of pain on movement and even at rest. In addition, there are a number of different clinical conditions that can result in stiffness of the joints and pain. Age-related changes are also a recognised cause of joint stiffness and pain.
We shall take a brief look at the different aspects of joint pain and stiffness, particularly concentrating upon the different causes and various treatment options that are available.
What causes joint pains and stiffness?
Joint pains are usually caused by trauma or injury to joint. This causes inflammation of the tissue within the joint resulting in pain on movement. A number of different disease processes can also cause inflammation of the joints with associated stiffness.
The common causes of joint pain and stiffness include rheumatoid arthritis, osteoarthritis, age-related changes and certain autoimmune conditions (conditions with antibodies are produced within the body that against the joint tissue) such as systemic lupus erythematosus.
The video below discusses rheumatoid arthritis as a cause of joint stiffness and pain.
Certain infections such as mumps, measles, rubella, hepatitis and chickenpox have all been implicated as causes for joint pains. Inflammation of the cartilage and gout can cause swelling along with joint pains.
Joint stiffness can occur due to the involvement of the muscles that attach into the joint. For example, in patients with fibromyalgia, the muscles are weak and stiff and this in turn can result in joint stiffness.
Finally, active joint infection i.e. septic arthritis is a recognised cause of joint stiffness and pain and has to be treated on an urgent basis.
The video below briefly discusses the causes of hip joint pains.
Clinical symptoms and signs
The clinical symptoms that the patient demonstrates depend primarily upon the underlying condition causing joint stiffness and paints. In patients with rheumatoid arthritis, the joint stiffness is characteristically early in the morning (called early-morning stiffness) and the joints involved are those of the hands and feet.
In osteoarthritis, age-related changes can occur in larger joints such as the hip and knee joint causing stiffness and restricted movement. Patients complain of difficulty in mobilising as a result and experience tremendous amount of pain on joint moment.
In patients with autoimmune disease, there may be associated symptoms such as chest pain or breathing problems along with joint pain and stiffness. Patients with septic arthritis can have a high fever with a swollen joint and tenderness on movement of the joint.
The primary diagnosis of joint pain and stiffness is made through clinical history. However, the actual cause for this joint pain and stiffness is usually determined through a series of clinical investigation is.
For example, in patients with rheumatoid arthritis, a blood test may demonstrate the presence of rheumatoid factor. X-rays of the joints that are stiff and painful can determine whether there is wear and tear of the surfaces of the bones which could be the cause of pain.
The x-rays in this video describe the changes in more detail.
In patients with gout, aspiration of the joint will reveal fluid that is rich in uric acid crystals. In septic arthritis, the joint capsule may be filled with pus and aspiration will demonstrate the presence of high white cells and bacteria.
It is also useful in making a diagnosis of fractures or tears within the ligaments of the joint. If required, additional investigation such as a CT scan or MRI scan may provide better information regarding the anatomy of the joint affected. However, not always at these tests are required but when performed they do offered extremely useful information that will aid a diagnosis.
Treatment of joint pain and stiffness
The treatment of joint pain stiffness depends mostly on the underlying cause.
In patients who have suffered some form of injury or trauma to the joint, simple analgesics such as paracetamol or ibuprofen can be extremely beneficial. Some patients may require stronger painkillers such as morphine or tramadol to help get rid of the pain. In the event of injury, patients are also requested to rest the joint and avoid any physical exertion that may damage the joint.
In patients who have autoimmune diseases, steroids can be helpful in managing the condition. Patients with gout particularly benefit from drug called colchicine which can help reduce the uric acid concentration in the blood and get rid of the crystals within the joint.
Patients with osteoarthritis often benefit from regular painkillers and physical therapy. Injection of steroids into the joint can help reduce inflammation and restore a greater degree of movement.
Rheumatoid arthritis treatments are a lot more complicated with research constantly being conducted in the field. Disease modifying anti rheumatic drugs are particularly beneficial and are prescribed by a specialist rheumatologist. Steroid still have a great degree of benefit in these patients.
Patients who develop septic arthritis need urgent joint aspiration and a course of high-dose intravenous antibiotics to help treat the condition.
In advanced cases of joint disease, surgery may be required. This can include joint replacement treatments or joint fusion (arthrodesis). Prior to performing any surgeries, a detailed background history will be taken to ensure that undergoing them is safe.
Joint replacement surgery is usually offered for patients who suffer from osteoarthritis of the knee and hip and rheumatoid arthritis of the small joints of the hands and feet. In the case of the former, the prosthesis usually last for many years though in the case of the latter, further surgeries may be required to help improve joint movement.
Physical therapy also forms an important part of managing joint pains and stiffness. Physical therapists will advise patients about the different exercises that they may be able to perform at home that will help keep the joints mobile and allow the patient to perform their day-to-day activities easily.
Joint stiffness and pain is often an indicator of an underlying condition within the joint. Treatment options vary depending on the cause and long-term outcomes are also variable.