Joint pain, medically termed arthralgia, is discomfort in one or more joints. It is a symptom rather than a specific disease, and it can accompany a wide range of underlying conditions. Its severity runs from mild, self-limiting discomfort to disability. Much of the joint pain encountered clinically is attributed to primary arthritis or to conditions in which arthritis is a prominent feature.
Terminology
Arthralgia and arthritis are frequently conflated. Arthritis is an umbrella term for several inflammatory joint conditions, while arthralgia is a medical term for joint pain without inflammation. The two overlap but do not coincide. Arthritis does not always produce pain; an x-ray can show arthritis such as osteoarthritis in a person who feels no pain. Conversely, arthralgia does not necessarily mean that the joint itself is inflamed.
The US National Library of Medicine's MeSH vocabulary limits the term arthralgia to joint pain conditions that are non-inflammatory. Some clinicians regard arthralgia as a possible early stage of arthritis. Some doctors consider arthralgia to be a precursor to arthritis. Pain in several joints at once is called polyarthralgia; when pain affects more than one joint, the medical name is polyarthralgia.
Classification
By time course. Arthralgia can be acute or chronic. Abrupt, short-lived episodes usually follow trauma, infection, or an inflammatory flare, whereas chronic cases persist for weeks or months and may be associated with conditions such as osteoarthritis or inflammatory rheumatic diseases.
By distribution. Single-joint complaints are most often located in the knee or shoulder. Pain in and around a single joint is commonly seen in the knees or shoulders. Multi-joint presentations are usually grouped into non-inflammatory and inflammatory causes.
By mechanism. The joint affliction may be inflammatory or mechanical.
Causes
The etiology varies by condition, ranging from immune-mediated inflammatory diseases and degenerative processes to infections, metabolic disorders, acute injuries, and malignancies.
Trauma and overuse
Injury is among the most common sources. Arthralgia can be caused by injury to ligaments, tendons, or bursae (fluid sacs) around the joints. Traumatic causes include broken bones, dislocation of bones, herniated disc, overuse, loose fragments of bone or cartilage within the joint space, nerve entrapment, repetitive motion disorders, sprains and strains, stress fractures, and tendon rupture. A specialized form, compression arthralgia, is pain in the joints caused by exposure to high ambient pressure at a relatively high rate of compression, experienced by underwater divers.
Degenerative disease
Osteoarthritis is the most common primary noninflammatory degenerative condition associated with joint pain. Wear over time is central to this process, and it can be worse if you are overweight, because the excess weight puts more pressure on the joint. Osteoarthritic pain usually only hurts in joints where there's been physical damage from injury or overuse.
Inflammatory and immune-mediated disease
Many inflammatory conditions produce joint pain. Immune-mediated inflammatory diseases that can cause joint pain include ankylosing spondylitis, vasculitides, Behçet disease, inflammatory bowel disease, juvenile idiopathic arthritis, polymyalgia rheumatica, psoriatic arthritis, reactive arthritis, rheumatoid arthritis, sarcoidosis, Sjögren syndrome, Still disease, lupus, and systemic scleroderma. In rheumatoid arthritis, RA usually hurts on both sides of the body — if there's inflammation in one knee, the same pain is often felt in the other knee. Most forms of arthritis occur due to a fault in the immune system that causes the body to attack its own tissues in the joints. Gout, a metabolic form of arthritis, is linked to a buildup of uric acid in the joints.
Infection
Several infections cause joint pain, including Haemophilus (bacterial infection, more common in children), hepatitis, influenza (flu), and measles. Lyme disease after a tick bite is another example. These might be triggered by other things, such as infections or vaccinations.
Metabolic, systemic, and neoplastic causes
Allergic reactions to medications or foods, pregnancy and postpartum states, sexually transmitted diseases such as gonorrhea or chlamydia, and viruses such as influenza or HIV can all be associated with joint pain. Vitamin D deficiency is also listed among causes. Joint pain can occur as a reaction to some infections, following an injury, as a symptom of leukemia, and during certain treatments for cancer.
Referred and environmental pain
Joint pain may also be caused by pain felt along the course of a nerve. This is called 'referred pain'. Some people also report that pain from arthritis, bursitis, or old injuries (including bone breaks) can be triggered by barometric pressure changes.
Diagnosis
Evaluation rests heavily on history and examination. Diagnosis involves interviewing the patient and performing physical exams, and when establishing the cause, the emphasis is on the interview. Clinicians then ask questions that narrow the number of potential causes. Further testing and referral may follow, since arthralgia is often caused by different types of arthritis, which can make the condition difficult to diagnose. Location, duration, and accompanying features such as swelling, stiffness, or fever also help. The location and pattern of pain, its duration, and the presence of swelling, stiffness, fever, or other symptoms can help determine the underlying cause.
Management
Treatment depends on the cause and the severity of pain. They will recommend treatment according to the underlying cause and the severity of joint pain.
Pharmacological treatment
Clinical guidance generally proceeds in steps matched to pain severity. For acute pain, the key is early, aggressive pain management with an equally rapid medication taper as improvement occurs. For severe pain, opioids may be required. For moderate to severe pain, nonsteroidal anti-inflammatory drug (NSAID) or cyclo-oxygenase-2 (COX-2)-specific inhibitor pain medications are commonly used. NSAIDs are a major class in this role. Acetaminophen in doses up to 4 g per day is widely recommended as a cost-effective initial therapy. For choice between agents, COX-2–selective inhibitors have reduced gastrointestinal adverse events compared with nonselective NSAIDS.
For acute musculoskeletal injuries outside the low back, the American College of Physicians and American Academy of Family Physicians recommend that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy, while oral NSAIDs or oral acetaminophen are suggested to reduce pain.
Osteoarthritis guidance
For osteoarthritis, effective medications offer only short-term benefit in pain and function. Oral and topical NSAIDs offer equivalent short-term pain relief and improved function for knee OA. With oral formulations, treatment with the lowest dose and for the shortest treatment duration possible should be recommended. Other options considered in the same guidance include tramadol, acetaminophen, or duloxetine, which may give short-term relief in select patients. Non-drug measures include balance training with or without strength training, which reduces pain from lower extremity OA. Cognitive behavior therapy is also beneficial for pain control. By contrast, the use of modified shoes, lateral and medial wedge orthotics, and manual therapies provides little relief for knee and hip OA.
Other management
For surgical-free approaches to certain joint pain, physical therapy is central. In sacroiliac joint pain, physiotherapy, lifestyle modifications, and NSAIDs are the first-line treatments for patients with acute mild to moderate pain. Lifestyle measures such as exercise, weight management, and smoking cessation are suggested for people at risk of developing arthritis.
Limitations and open questions
Evidence is uneven across conditions. For sacroiliac joint pain, given the heterogeneous data and the lack of evidence on managing SIJ pain, recommendations for clinical practice are challenging. Even in osteoarthritis, drug benefits are generally temporary, as noted above.
Terminology remains inconsistent in everyday and clinical use. People may use arthritis and arthralgia interchangeably, but this is incorrect. Because joint pain is a shared symptom of many diseases, the pattern of symptoms and objective findings, rather than pain alone, determines the diagnosis.
References
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