Joint pain is the most painful manifestation of diseases of the musculoskeletal system. About 30% of the world population suffers from this pathology. Joint diseases are of particular relevance due to the increase in life expectancy: according to epidemiological studies, joint pathology in people over 40 years of age is found in 50% of cases, and after 70 years, in 90%. of the population.
Joint pain or arthralgia (from the Greek arthron - "joint" and algos - "pain") can be observed in a variety of diseases: metabolic, rheumatic, tumor, systemic and acute infectious, endocrine and rheumatic. Therefore, it is a mistake to believe, and so do the vast majority of arthralgia sufferers who self-medicate, that joint pain is necessarily caused by arthritis. Here it should be clarified that there are dozens of types of arthritis alone, and not all of them have pain symptoms.
Joint pain is caused by irritation of the nerve endings coming from the synovial joint bag (capsule), and the irritants can be toxins, salt crystals (sodium or potassium urates), allergens, products of autoimmune processes, osteophytes and others. inflammatory components. For joint pain of any intensity, but of sufficient duration, it is mandatory to undergo a medical examination.
Types of joint pain
Joint pain is not a disease, but a symptom of many infectious and non-infectious diseases. The perception of pain depends largely on the state of the nervous system. A calm and balanced person almost does not react to minor pain. In an emotionally unstable person, the pain threshold is lowered. The pain in intensity and time is diametrically opposite and is characterized as follows:
- tolerant - intolerable;
- weak strong;
- sudden - constant;
- dull - sharp;
- frequent - rare;
- short term - long term, etc.
If persistent pain bothers a person for more than 30 days, it is considered chronic. After treatment, they go away for a while (remission stage), then come back (flare stage). The factor that provokes the return of acute pain is hypothermia, physical activity, malnutrition, extra pounds, stress.
There are several risk factors that can lead to the disease. One of the most common is inheritance. If, for example, a grandmother and a mother suffered from several sets of joints at the same time, sooner or later this problem may arise in later generations.
Gender is another risk factor. It has been observed that joint diseases are several times more common among women than men. In this case, women are more likely to get sick after the onset of menopause. This is due to the fact that before him, women were "protected" by their own female sex hormones. With age, their number begins to inexorably decrease, and after they practically disappear, there is no one to protect a woman, and the joints gradually begin to deform and collapse. In men, this problem practically does not arise. Therefore, the joints, due to a violation of the hormonal background, are hurt less often than in women.
In men, joint pain occurs mainly due to heavy physical work. This is due to the fact that they are constantly under heavy load. Gradually, the cartilage begins to wear out, the joints become inflamed and at the same time deformed.
People who often suffer from a disease such as tonsillitis may complain that their joints begin to ache. This is due to the fact that the bacteria that cause angina can also negatively affect the joints, especially the large ones. The causes and treatment of pain in all the joints of the body are closely interrelated.
Common symptoms of arthralgia
It would seem that it is easy to determine the presence of the disease, by painful symptoms. But:
- The presence of pain does not always mean the presence of a disease, since pain can be caused by a bruise, a single (acute) physical overload, dislocation and the like.
- If you already develop some kind of disease, then its symptoms may not be noticeable at first, because pain, especially acute, as a rule, is already a serious manifestation of the disease.
The first signs of arthralgia that appear even before the pain can be:
- stiffness of movement, more often in the morning or after sitting in one position for a long time;
- periodic cracking and crunching in the joint.
Such signals from the body cannot be ignored, these may be the initial symptoms of a serious illness.
Causes of joint pain
The joint is an anatomically complex structure. Pain can be caused by everything that forms it: muscles, bones, ligaments, cartilage, tendons, intra-articular cavities. In the structures of the joint, pathological conditions such as inflammation, sprains, ruptures occur, metabolic processes are disturbed. The causes of arthralgia can be very diverse. For some diseases, they have not yet been precisely identified.
Summarizing, the following can be distinguished:
- physical inactivity and sedentary lifestyle;
- too great, frequent and monotonous physical activity;
- old wounds;
- reduced immunity;
Arthralgia occurs as a result of irritation of the neuroreceptors, which are found in all joint structures, by various factors, depending on the underlying disease. One of the causes of pain in the joint can be a bruise in the joint and the formation of a bruise that is not visible to the naked eye. By the nature of painful sensations, the presence of one or another pathology can be assumed.
Diseases that cause joint pain.
Osteoarthritis is the most common chronic disease of the joints (often the hip, knee, interphalangeal joints of the hands), which is based on degenerative dystrophic disorders (metabolic disorders) of articular cartilage, bone tissue, synovial membranes and apparatus ligament of the joint (old age, overweight, altered metabolism, injuries, lack of vitamins C and D, occupational risks).
Reiter's disease (a separate type of reactive arthritis with a genetic predisposition) - manifests after chlamydial or intestinal infection. It is manifested by reactive arthritis (mainly of the joints of the lower extremities), joint pain, characteristic extra-articular manifestations (urethritis or prostatitis, conjunctivitis or uveitis, skin and mucosal lesions - ulcerative stomatitis, erosive balanitis), lesions of the cardiovascular system (arrhythmias , blockage, aortitis), fever (38. 6 - 40. 0).
Rheumatoid arthritis is a chronic progressive systemic inflammation of the connective tissue (autoimmune inflammation in the joint). The small joints of the hands and feet are affected, less often the knee and elbow joints. Symptoms: constant joint pain, joint deformity, joint swelling, joint stiffness in the morning, symmetry of joint damage, weakness, fatigue, weight loss.
Psoriatic arthritis: arthritis that develops in genetically predisposed patients with psoriasis, the exacerbation of arthritis coincides with the exacerbation of psoriasis. Symptoms. Joint pain (mainly the interphalangeal joints of the hands and feet are affected), purple-cyanotic skin with swelling in the joint area, asymmetry of joint damage, pain in the lumbosacral spine, pain in the heels (talalgia ), psoriatic skin plates, nail damage (fragility, stretch marks and opacity of the nail plates).
Bursitis: This disease is often confused with arthritis, although bursitis does not cause inflammation of the joint, but of the joint bursa. Bursitis can cause discomfort, stiffness, and pain in the joint area. Symptoms are associated with inflammation of the synovial membranes of the joint, usually caused by improper movement, compression, or trauma. Most often, bursitis develops in the area of the shoulder, knee or hip joint. A type of bursitis called "housemaid's knee" develops as a result of prolonged pressure on the knee joint from a hard surface.
Gout (gouty arthritis) is a microcrystalline arthritis, a hereditary disease based on a metabolic disorder (in violation of diet), namely purine metabolism, resulting in the deposition of urate crystals (salts of uric acid ) in periarticular and articular tissues. Symptoms. Pain in the joint (most often in the first metatarsophalangeal joint of the foot), bright hyperemia (redness), swelling and peeling of the skin over the joint, fever, increased local temperature in the affected joint area, skin manifestations in the area of the atria, joints of the elbows, feet, hands, in the form of tophi (local accumulation of urate salt crystals surrounded by granulomatous tissue), cardiac lesions (myocarditis, endocarditis, pericarditis, coronary arteritis, aortitis, arrhythmias ), kidney damage (amyloidosis, glomerulonephritis).
Drug-induced arthralgia is a temporary condition characterized by pain in the joints (mainly small joints) while taking certain drugs in high daily doses. It is not a disease and is not classified in ICD-10 by the WHO. The groups of drugs that can cause drug arthralgia are penicillin antibiotics, barbiturates and hypnotics and mild tranquilizers (on a chemical basis), antihypertensive drugs, contraceptives and anti-tuberculosis drugs, pump inhibitors protons. The causes, pathogenesis, clinical manifestations and diagnosis of this condition are not studied, due to the active promotion of drugs in the pharmacological market and the lack of severity of the condition in relation to functional joint disorders and individual tolerance to medications.
The same can be said for meteopathic arthralgia (joint pain occurring in meteopathic people who are sensitive to changes in atmospheric pressure).
Diagnosis of joint pain
A clinical blood test in most cases indicates various deviations depending on the nature of joint damage and its severity, an increase in ESR, reflecting the level of the inflammatory process, with a normal number of leukocytes, is characteristic of diseases rheumatic. An increase in the number of leukocytes in inflammatory diseases of the spine and joints may indicate the presence of a focus of infection in the body, etc.
immunological research. For early diagnosis of rheumatoid lesions, rheumatoid factor, an antiglobulin antibody, is of particular importance. It is formed in the lymph nodes, spleen, and synovial membrane by lymphoplasmacytic cells. To detect rheumatoid factor in blood serum and synovial fluid, the Vaaler-Rose reaction is considered positive if there is a concentration of 1: 28 or more. Rheumatoid factor is detected in 75-85% of patients with rheumatoid arthritis. In the early stages and in the seronegative form of rheumatoid arthritis, an immunocytoadherence reaction is used to isolate rheumatoid factor at the lymphocyte level.
The antistreptolysin O (ASL-O) test reflects immunologic reactivity to streptococcal infection. An increase in ASL-0 titer is observed in patients with rheumatism, infectious allergic polyarthritis.
Leukocyte migration inhibition reaction. Normally, leukocytes have the ability to migrate into the environment with the formation of clusters. If there is a sensitization of the body to a certain antigen, when the sensitized leukocytes encounter this antigen, the lymphocytes secrete an inhibitory factor that inhibits the migration of leukocytes. This reaction is positive in rheumatism, rheumatoid arthritis and other rheumatic diseases.
Blood in the HLA system - the possibility of an early diagnosis of Bechterew's disease, the determination of HLA B-27 is of great importance. The HLA complex is located on the cell membrane and is isolated by immunological methods.
Immunoelectrophoresis - reveals immunoglobulins of classes A, G, M, which are of great importance for the development of the pathological process in rheumatoid arthritis.
Radiography is a reliable method of examining joints. Indeed, without it, the doctor cannot establish a diagnosis and make a differential diagnosis. X-ray examination allows you to determine the stage and prognosis of the disease, and in the dynamics to objectively assess the effectiveness of therapy. It is necessary to compare the radiological data with the clinical picture, the duration of the disease and the age of the patient.
Tomography allows you to more accurately determine focal lesions or individual segments of the vertebra.
Myelography is a contrast method of studying the spine, using this method it is possible to clarify the localization of the pathological process, especially in cases where surgical intervention is necessary.
Intraosseous phlebography: to study the venous blood flow of the epidural space. This method allows you to judge the state of blood circulation in the paravertebral space and indirectly about a possible degenerative lesion.
Arthroscopy is a research method that allows you to visually see the structure of the knee joint and take a biopsy of the desired area, the contours, color and capillary network of the synovial membrane, cruciate ligaments, menisci are detected and the fat pad.
Discography - the introduction of a contrast agent into the intervertebral disc, followed by radiography, makes it possible to judge the state of the intervertebral discs, the location and extent of the lesion.
Radionuclide scanning is an important objective method for early diagnosis of joint damage.
Arthrography - with the help of intra-articular injection of various contrast agents, allows you to more accurately determine the pathology in deeply located articular parts.
How to treat joint pain
The treatment of joint pain itself is symptomatic, that is, it is aimed at eliminating or reducing the pain syndrome. At the same time, it is obvious that the elimination of joint pain must inevitably be complemented by the treatment of the underlying cause of arthralgia. But regardless of the identified cause of joint pain, as well as in the absence of direct contraindications, doctors most often prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), which have the ability to relieve pain, swelling, hyperemia, fever, lower temperature, reduce inflammation. .
Side effects of almost all NSAIDs are irritation of the gastrointestinal tract, since the drugs are made from acids, inhibition of platelet aggregation (decreased blood clotting), and impaired renal blood flow (with kidney failure). . Otherwise, if there are no individual contraindications and there is a desire to comply with all the doctor's prescriptions, NSAIDs are quite harmless.
But the effective treatment of joint pain is not limited to taking NSAIDs, because after eliminating the primary or acute pain syndrome, it makes sense to switch to homeopathic or non-pharmacological treatment, including some types of physiotherapy (SWT, magnetic therapy, ultrasound therapy and electrical impulses), therapeutic gymnastics exercises, manual therapy, swimming, etc. Also, be sure to check out the mode and nutrition.
diet for joint pain
General nutritional requirements for joint pain:
- limiting the content of carbohydrates, especially sugar;
- reduction (maximum) of table salt;
- fractional and frequent meals (5-6 meals a day);
- exclusion from the diet of spicy, salty, extractive foods (strong broths, fried foods), strong drinks, strong tea, coffee.
Dishes are prepared without salt, meat and fish, in boiled or slightly fried form (after boiling); vegetables must be well cooked.
General nutrition recommendations in joint diseases:
- Soups, mostly vegetarian, as well as cereals, milk, fruit, weak meat or fish soups - 1-2 times a week.
- Meat or poultry of low-fat varieties, mainly in boiled or baked form. It is desirable to exclude liver, tongue, brain, chickens, veal.
- Fish - a variety of varieties, with the exception of salted and smoked.
- Soft-boiled eggs, omelettes.
- Vinaigrettes and salads with vegetable oil from various vegetables, vegetables in the form of side dishes. Limit (up to one exception) beans, peas, kidney beans, spinach, sorrel.
- Fruit dishes, berries: any, limit grapes.
- Cereal dishes, dairy products are not limited.
- Fats: butter, vegetable (1/3 of the total).
- Sweets: sugar - up to 30 g per day (4 pieces), honey, jam, marmalade.
- Beverages: soft tea, coffee drink, vegetables, fruits, berry juices (except grape). Alcoholic beverages are excluded.
- Spices, condiments: bay leaf, dill, parsley, cinnamon, cloves.
Therapeutic exercise (LFK)
Physiotherapy is prescribed at almost any stage of any disease. If physical exercises cause discomfort, painkillers are prescribed with ointments, tablets or injections (depending on the situation). Exercise therapy is exercise specifically designed to restore healthy mobility to the joints without damaging them. On the one hand, these exercises are gentle, on the other hand, they make the necessary areas of the body "wake up". Physical education is also recommended for people at risk as a preventive measure.
For the most part, this is an Eastern practice, but today this method has already been adopted by official medicine and is successfully used in many public and private clinics. One problem: there are not that many professionals in this area who know their business well. Therefore, before being treated in this way, we recommend that you carefully consider the choice of a specialist. Acupuncture affects the body in a very interesting way. It is unlikely that they will be able to completely cure arthralgia, but after several sessions, patients usually feel much better: all symptoms disappear.
Manual therapy also does not tolerate amateurism and lack of professionalism. But if you came to a person who knows his business, you can be calm: the results will be. With the help of manual therapy, you can eliminate muscle spasms in a problem area of the body. In its application, regularity is important, procedures can be performed quite often - from 12 times a year or more. There are contraindications to manual therapy, including some types of exacerbation of arthralgia! It is unacceptable that you prescribe it to yourself, contact a chiropractor; they will inform you about the effective treatment in your particular case and will select the most appropriate methods.
Massage gives good results when combined with other therapies. In order to correctly influence the diseased joint, the masseur must have medical knowledge and experience in medical (therapeutic) massage.
This option is used in cases where surgery is simply not enough.
- Puncture. Or a mini-surgery in which the inflammatory fluid is removed from the joint cavity with a needle.
- Arthroscopic debridement. In this case, wide incisions are not required; everything happens through miniholes (removal of dead tissues from the joint cavity) using endoscopic instruments.
- Periarticular osteotomy. It is used if joint replacements are prohibited. The essence of the operation is to file the articular bones, and then fuse them at a different angle to improve mobility and reduce the load.
- endoprosthesisA radical treatment option with a long recovery, in which the joint is replaced by a prosthesis.
Many methods have been invented for the treatment of various pathologies of the joints. True, for the success of treatment, you must first find an experienced specialist. Self-medication in this matter is categorically unacceptable!
Prevention of joint diseases.
To save your joints, you need to constantly protect them and do preventive work. After all, it is not for nothing that people agree with the statement that the disease is easier to prevent than to cure. The first thing you should do is avoid hypothermia whenever possible, as it can lead to a condition like tonsillitis. And she, in turn, can give complications. And in itself, hypothermia can lead to inflammation of several groups of joints at once.
Don't forget physical activity! The load on diseased joints, of course, must be dosed, but it would be a mistake to leave them immobile. Reasonable movement stimulates the production of synovial fluid, improves circulation and nutrition of tissues. Swimming, cycling and therapeutic exercises will help maintain the working conditions of your joints. In addition to physical education, you may be prescribed physical therapy and rehabilitation measures, such as electrophoresis, therapeutic massage, mud baths, various body wraps, among others.
Both women and men should carefully monitor their weight, as excess weight is a direct path to deforming osteoarthritis of at least the knee and hip joints. Also, you need to monitor your drinking regimen. It is known that the average adult needs to drink at least two liters of liquid per day. In this case, the synovial joint fluid is constantly updated. If there is not enough fluid, the cartilage begins to rub together, causing severe pain, and the joints begin to deform.