Joint pain

Joint Pain (Arthralgia)

Joint pain, medically termed arthralgia, is a common symptom that can affect one or multiple joints. It ranges from mild discomfort to severe, disabling pain and may be temporary or chronic. Causes vary widely, from mechanical injury to systemic diseases. Understanding the underlying etiology is essential for effective management.

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Causes of Joint Pain

• Injury and trauma

  • Sprains, strains, ligament or tendon injuries

  • Dislocations or fractures involving the joint

• Degenerative conditions

  • Osteoarthritis (cartilage wear and tear with age)

• Inflammatory conditions

  • Rheumatoid arthritis (autoimmune joint inflammation)

  • Psoriatic arthritis

  • Gout (uric acid crystal deposition)

  • Septic arthritis (joint infection)

• Overuse or repetitive strain

  • Tendinitis, bursitis, occupational or sports-related overuse

• Systemic and metabolic disorders

  • Lupus erythematosus

  • Thyroid disorders

  • Hemochromatosis

• Other contributing factors

  • Obesity (extra load on joints)

  • Vitamin D deficiency

  • Post-viral arthritis (after infections like influenza, hepatitis, or COVID-19)

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Associated Symptoms to Monitor

• Swelling, warmth, and redness (suggesting inflammation or infection)

• Stiffness, particularly morning stiffness lasting >30 minutes (common in inflammatory arthritis)

• Reduced range of motion

• Systemic signs: fever, fatigue, unexplained weight loss (may indicate autoimmune disease or infection)

• Nodules, rashes, or deformities (autoimmune markers)

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Diagnosis

• Clinical evaluation: history of onset, duration, and associated features

• Physical examination: joint swelling, tenderness, range of movement

• Laboratory tests:

  • Inflammatory markers (ESR, CRP)

  • Rheumatoid factor (RF), anti-CCP antibodies

  • Uric acid levels (for gout)

  • ANA (for lupus)

• Imaging:

  • X-ray for bone changes

  • MRI or ultrasound for soft tissue and cartilage evaluation

• Joint aspiration (arthrocentesis) if infection or gout is suspected

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Treatment

Management depends on the underlying cause and severity:

• General measures

  • Rest and protection of the joint

  • Ice or heat application

  • Weight management and regular low-impact exercise (e.g., swimming, cycling)

  • Physical therapy to strengthen surrounding muscles

• Pharmacological therapy

  • Analgesics: Paracetamol (acetaminophen) 500–1000 mg every 4–6 hours (max 4 g/day)

  • NSAIDs: Ibuprofen 200–400 mg every 6–8 hours, Naproxen 250–500 mg twice daily (reduce inflammation and pain)

  • Corticosteroids: Prednisone (oral, variable dose depending on condition) or intra-articular injections for severe inflammation

  • Disease-modifying antirheumatic drugs (DMARDs): Methotrexate, Sulfasalazine, Leflunomide for rheumatoid arthritis

  • Biologics: TNF-α inhibitors (adalimumab, etanercept) in resistant autoimmune arthritis

  • Colchicine: 0.5–1 mg for acute gout attacks

  • Antibiotics: If septic arthritis is confirmed

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Precautions

• Avoid prolonged use of NSAIDs due to risk of gastric ulcers, renal impairment, and cardiovascular effects

• Corticosteroids should be used with caution due to risks of osteoporosis, diabetes, and infections

• Regular monitoring of blood tests in patients on DMARDs or biologics

• Early treatment of infections to prevent joint destruction

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Drug Interactions

• NSAIDs: interact with anticoagulants (warfarin, DOACs), antihypertensives (ACE inhibitors, diuretics), lithium, and methotrexate

• Corticosteroids: interact with antidiabetic agents, live vaccines, and can potentiate GI bleeding when combined with NSAIDs

• Methotrexate: interacts with trimethoprim, sulfa drugs, NSAIDs (risk of toxicity)

• Biologics: increased infection risk when combined with immunosuppressants

• Colchicine: interacts with CYP3A4 inhibitors (clarithromycin, ketoconazole) increasing toxicity risk