Why the joints hurt

16 March 2022

Joint pain is not uncommon. Almost half (45%) of all people over the age of 45 complain of pain in the joints, particularly in the knee. Complaints can arise even at a young age. In most cases, joint pain is caused by wear and tear - doctors speak here of osteoarthritis. Additionally, acute arthritis and trauma are often the cause of joint pain. But there are many other possible reasons.

Description

As common as joint pains are, their types are so diverse, so joint pain classifications are based on different criteria. For example, joint pain can be divided into three groups based on time of onset:

Acute joint pain occurs within hours.
Subacute pain in the joints becomes evident during the day.
Chronic joint pain develops over weeks or months.

Joint pain can often persist and progress (chronic progressive death). Sometimes joint pain occurs only acutely and temporarily (acute remitting course).

In some cases, joint pain affects only one joint, such as the knee joint. But pain can also affect two to four joints (pain in the oligo-joints) or even more joints (pain in the joints of the joints).

Furthermore, joint pain varies, for example, in relation to:

Painful rhythm: pain from rest, pain at night, morning stiffness in the joints.
Distribution patterns: pain in the small joints (such as the wrist, knuckles of the fingers) or large joints (such as the knee and hip joints), pain in the joints of the carpal joints, etc.
Pain intensity: Assessment of the severity of joint pain on a scale of 0 (no pain) to 10 (unbearable and extreme pain).
Aggravating factors: for example, reduction of joint pain during movement (typical of arthritis) or after rest (typical of osteoarthritis).

This information is important for the doctor to determine the causes of joint pain.

Joints particularly commonly affected

Which joints are most often affected by pain depends decisively on the cause of the pain. A few examples.

Osteoarthritis, a major cause of joint pain, is particularly evident in those joints that experience a lot of stress throughout their lives. First of all, these are the knee, hip and hock joints. Osteoarthritis can also cause pain in all other joints.

Rheumatoid arthritis is also a common cause of joint pain. Painful inflammation of the joints, most often appears on the wrists and joints of the fingers. Also, pain in the knee, elbow, metatarsophalangeal joints, and shoulder is common in rheumatoid arthritis.

Joint pain in an acute attack of gout almost always affects the leg joint, primarily the metatarsophalangeal joint. The hocks and knee joints are also often affected.

Bursitis can cause pain in the hip, elbow, knee, and shoulder.

Causes and possible diseases

Joint pain can have a variety of causes. The most important are:

Joint wear (arthritis of the joints):Osteoarthritis is the most common form of joint disease and can, in principle, affect all joints. Due to the destruction of the cartilage layer on the joint surfaces and bone changes, the affected joint cannot move freely, turns red, swells and hurts. Osteoarthritis is often the cause of wrist, hip and knee pain. Joint wear is usually caused by long-term overload of the joints. Additionally, osteoarthritis can be a late consequence of an accident (such as sports injury) and joint damage due to congenital weakness or joint deformity.
Bursitis:Bursae are found in the form of a cushioning layer at particularly stressed points between the bone and soft tissues, for example in the joint area. They usually consist of a cavity filled with joint fluid. Inflammatory or mechanical irritation (such as sports injuries) can injure the bursa and cause pain in the affected area. For example, elbow pain is often caused by inflammation of the bursa in the elbow joint, shoulder pain due to bursitis or calcification in the shoulder area, knee pain due to inflammation of the bursa in the knee joint, and pain in the hip from inflammation of the bursa to the greater colliculus (swelling of the bone on the upper thigh).
Bacterial joint inflammation (bacterial arthritis):Bacterial arthritis primarily affects the knee and hip joints. Bacteria enter the joint through the blood or directly infect the joint (through trauma or surgery on the joint or during diagnostic injections into the joint). Severe knee or hip pain with severe joint swelling and inflammatory symptoms (such as redness, localized heat, fever) may indicate bacterial arthritis.
Lyme disease (Lyme arthritis):Joint pain in Lyme disease also relies on bacterial inflammation of the joints. It is caused by certain bacteria (Borrelia burgdorferi) which are transmitted from ticks to humans. About four weeks after transmission, fatigue, fever, redness, and joint pain occur.
Associated joint inflammation during and after infections.Inflammatory joint pain can occur during and after common infectious diseases such as hepatitis, rubella, mumps, chickenpox, scarlet fever, tuberculosis, flu, and inflammatory bowel diseases (Crohn's disease, ulcerative colitis). Due to the resulting joint pain and swelling, there are restrictions on the movement of the joints, especially the large ones (hip joint, knee joint, ankle joint).
Arthritis in Reiter's disease:Reiter's syndrome is a rare rheumatic disease. Symptoms include arthralgia associated with urethritis and conjunctivitis.
Joint inflammation in psoriasis (psoriatic arthritis):Psoriasis is sometimes accompanied by inflammation that causes joint pain. In some cases, joint pain precedes the skin manifestations of the disease, i. e. joint pain occurs earlier, and only then do squamous skin lesions develop. The cause can be psoriatic arthritis, especially if the joints of the fingers and toes and / or the spine are affected.
Joint inflammation in ankylosing spondylitis.Ankylosing spondylitis is a chronic rheumatic inflammation that primarily affects the spine but can also spread to large joints. Therefore, knee pain, hip pain, heel pain, and / or ankle pain can be the cause of Bechterew's disease.
Gout (or acute attack of gout):Gout increases the concentration of uric acid in the blood. Its excess is deposited in the form of uric acid crystals, among other things, in the joints: an acute attack of gout occurs with severe pain in the joints, swelling and redness in the joint area. First of all, the joints of the big toe are affected. But an acute gout attack can also cause knee pain, wrist pain, pain in the knuckles of the fingers or upper ankle.
Rheumatoid arthritis:This is the most common inflammatory disease of the joints, progressive, mostly chronic and gradually destroying the joints. Rheumatoid arthritis can be suspected if joint pain affects the fingers and wrists. Other symptoms of this condition include morning stiffness in the fingers and wrists, swelling of the joints, and inability to make a fist.
Rheumatic fever:This inflammatory disease, which occurs mainly in children, is caused by certain bacteria (streptococci) days or weeks after a nose and throat infection that has not been treated with antibiotics. Possible symptoms include inflammatory joint pain, skin symptoms, inflammation of the heart (carditis), and sudden uncontrolled, involuntary movements (chorea).
Arthritis with sarcoidosis (Löfgren's syndrome):Sarcoidosis is a rare inflammatory disease of unknown origin that can affect the entire body. One form of the disease is Löfgren's syndrome (acute sarcoidosis). It occurs mainly in young women and presents with the following symptoms: inflammation, joint pain (especially in the ankles), acute inflammation of the subcutaneous fatty tissue (erythema nodosum), swelling of the lung lymph nodes (bronchial lymphadenopathy) and weight loss.
Systemic lupus erythematosus (SLE):It is a rare autoimmune disease that mainly affects women, often causing joint pain and inflammation. But there are perhaps many other different symptoms as well, such as a butterfly-shaped rash on the face, pleurisy, pericarditis, inflammation of the kidneys or brain, loss of appetite, and weight loss. Therefore, lupus erythematosus in medicine is called "chameleon".
Joint bleeding in violation of coagulation.In rare cases of hemophilia, there is a hereditary predisposition to uncontrollable bleeding after trauma or, in severe cases, even for no apparent reason. Especially often there is bleeding in the muscles and joints. Joint bleeding can cause joint pain and permanent joint damage if left untreated. In addition to haemophilia, other bleeding disorders can also lead to joint bleeding and joint pain, such as bleeding disorders due to an overdose of anticoagulants.

When should you see a doctor?

Joint pain sometimes goes away on its own or can be relieved with simple home remedies. But watch out for the following symptoms:

Joint pain that restricts movement of the joint.
Fever.
Redness of the skin in the area of the sore joint.
Swelling of the joint.

If joint-related symptoms (joint pain with reduced mobility, redness, swelling) persist for three days or more, get worse or spread to other joints, you should definitely see a doctor.

What does the doctor do?

To clarify the cause of the joint pain, the doctor will first ask the patient about his medical history (medical history). For example, when and where joint pain occurs and if there are other disorders (accompanying symptoms such as fever or joint swelling).

Accurate description of joint pain

This information is very important in diagnosing joint pain - the more accurately a patient can describe joint pain, the sooner a doctor can narrow down the number of possible causes. For example, an acute attack of gout is thought to cause pain in only one joint. In rheumatoid arthritis, on the other hand, arthralgias are observed in various joints. Furthermore, the localization (localization) of joint pain is indicative: if the patient feels pain in the wrist and pain in the base and middle joints of the fingers, it is very likely that rheumatoid arthritis is present. If, on the other hand, joint pain affects the base of the thumb and knuckles, the suspicion is in the direction of osteoarthritis.

Scan (palpation)

Regardless of where the joint pain occurs, the doctor should clarify the question: Does the joint itself really hurt, or is the alleged joint pain coming from an area close to the adjacent joints or bones? In some cases, the doctor can find the answer to this question simply by palpating the painful area. However, additional examinations, such as x-rays or ultrasounds, are most often needed.

Further research on joint pain

Such tests can help identify the cause of pain if joint pain occurs directly in the joint:

Orthopedic examination:If the joint pain is caused by wear and tear (arthritis), bursitis, rheumatism, or an acute attack of gout, you can find relevant information during an orthopedic exam.
Dermatological examination:Skin exams help identify suspected psoriatic arthritis or sarcoidosis as possible causes of joint pain.
Blood analysis:blood tests are helpful in identifying various causes of joint pain, such as bacterial arthritis or Lyme disease. Sometimes specific measurements, such as blood clotting, are needed in a blood test if joint bleeding (due to a clotting disorder) can cause joint pain. If rheumatoid arthritis is the cause of joint pain, then in the blood, first of all, rheumatoid factor and other signs of inflammation are determined, which are crucial. And if gout or an acute attack of gout is suspected, the focus is on the level of uric acid in the blood.
Ultrasound examinations:Ultrasonography (sonography) is indicated when bursitis, gout, or systemic lupus erythematosus is suspected as causes of joint pain.
X-ray:the x-ray shows signs of joint wear (arthritis), rheumatoid arthritis, and ankylosing spondylitis.
Joint puncture:If doctors suspect bacterial joint inflammation is the cause of joint pain, they will take a sample of joint fluid (joint puncture). A bacterial culture is performed from this sample: if bacteria grow from the joint sample, this indicates bacterial inflammation of the joint.

It is not always possible to identify a disease or a pathological change in the tissue as the cause of joint pain. Doctors speak of "joint sensitivity". If the cause of the joint pain is found, the doctor can initiate appropriate treatment and treat the underlying condition with medication or surgery.

You can do it yourself

General advice for joint pain

Lose excess weight. Any extra kilograms are an unnecessary additional load on the joints and contribute to their wear, which inevitably leads to joint pain.
Make sure you get enough rest after training.
Do resistance exercises regularly to strengthen your muscles and joint cartilage. For example, swimming and cycling are suitable for joint training. Regular strength training (such as weight lifting, jump rope) is also recommended to strengthen bones. Consult an experienced trainer or sports doctor to determine the correct dose and develop a well-balanced exercise program that strengthens all muscles equally.
Avoid one-sided loads such as carrying heavy shoulder bags.
According to Jacobson, it is necessary to reduce mental stress through, for example, autogenic training or progressive muscle relaxation. Emotional pressure also puts pressure on the joints, shoulders, and bones.
Joint pain and other joint ailments are treated in traditional Chinese medicine with acupuncture. Consult an experienced therapist.

Joint treatment tips

If osteoarthritis, that is, a recent severe inflammation of the joints with pain, swelling and redness, is diagnosed, it is necessary to immobilize the affected joint (bed rest). Hold it so that the muscles associated with it are not strained. Indulge in wet, cold compresses (such as a quark wrap) to relieve joint discomfort. The effect of the anti-inflammatory and pain relieving drugs that you receive from the doctor can be enhanced with the help of medicinal plants. Arnica is suitable (as a decoction for compresses or as an ointment or gel for rubbing the joints). In addition, there are, for example, anti-inflammatory and analgesic preparations based on willow bark, as well as combined preparations with rosemary and eucalyptus oils. In addition, peppermint oil can relieve pain perception due to its cooling effect.
Once the joint pain, including redness and swelling, has subsided, the doctor talks about inactive osteoarthritis. At this stage of the disease, prevention of the resumption of active ailments on the joints is carried out. This is facilitated by adequate and healthy sleep on an orthopedic mattress, as the muscles relax well and the spine and joints rest.
Also, you should regularly use meditative relaxation techniques (such as gradual muscle relaxation, autogenic training) if you often suffer from muscle tension under stress.
Regular exercise and exercises that improve the supply of synovial fluid and nutrients to the joint cartilage. Useful sports are swimming, cycling and water aerobics. Conversely, running on hard pavement is not recommended, especially if osteoarthritis has already damaged the knee and hip joints. If possible, run on soft forest turf and wear sneakers with soft soles that provide a good effect. Even better, walk instead of jogging.
Avoid sports with sudden changes of direction (e. g. tennis, squash) as they are very stressful on the joints (e. g. knee) and quickly cause joint pain.
Try not to stand or sit in one position for a long time.
Follow a diet low in arachidonic acid. This omega-6 fatty acid plays a central role in inflammatory responses (such as arthritis-induced osteoarthritis). Arachidonic acid is found primarily in fatty pork, egg yolks, lard, tuna, liver, beef, and camembert.
Take omega-3 fatty acids regularly as they act as competing analogues of arachidonic acid in inflammatory responses. You can find more of these fatty acids in fish oils (eat fish at least once a week! ).
Make sure you are getting enough vitamin E, which is important for synovial fluid as it provides its antioxidant effect against inflammation. Vitamin E is found in vegetable oils, particularly in wheat, soy and sunflower germs.
Joint pains related to osteoarthritis and other joint ailments can often be relieved by the application of circulation-stimulating heat, such as sachets of mud, paraffin, senna, rosemary baths.
For osteoarthritis of the finger joints, kneading with warm clay or potting soil can help with joint pain and swelling. Regular finger exercises in the heated sand are also recommended. It is particularly suitable for morning stiffness and joint pain.
Massaging and rubbing with essential oils of eucalyptus, juniper, rosemary, lavender or lemon help improve blood circulation and thus fight joint inflammation.
For inactive osteoarthritis, devil's claw root tea is recommended: pour one tablespoon of coarsely ground root into two cups of boiling water and leave to infuse for eight hours. Boil before use, then strain, divide the prepared amount of tea into three portions and drink throughout the day. The effect of the devil's claw infusion appears around the third week of treatment.
For the treatment of inactive arthrosis we also recommend a blend of tea based on currant leaves, willow bark, nettle grass, horsetail and meadowsweet flowers (20 g of each component). Take two teaspoons of this mixture and pour a glass of boiling water, let it brew for half an hour, then strain. Drink 5-6 cups of this tea throughout the day. It has an anti-inflammatory and analgesic effect.
Also useful in treating arthritis irritation are dry cupping and leech therapy (including anti-inflammatory). Treatment with one's own blood is controversial, especially if the treated fluid is injected into the joint (risk of infection! ).

Tips for rheumatoid arthritis

Some osteoarthritis tips should also apply to people with rheumatoid arthritis. These include nutritional advice, recommendations for topical use of arnica, and devil's claw root. Additional tips that can help with rheumatoid joint pain and other joint problems:

During periods of mild discomfort (the inactive state of rheumatoid arthritis), you can use physical therapy and massage to keep your joints flexible.
During an aggravation of the inflammatory process (active rheumatoid arthritis), you can prepare an anti-inflammatory tea blend from meadowsweet, willow bark, goldenrod, currant grass and nettle (20 g of each herb). Pour a tablespoon of this mixture into a cup of cold water and leave for an hour. Then heat to a boil, but don't boil! Remove from the heat, let it rest for five to ten minutes, then strain. Drink three to four cups of this tea a day.
For acute joint inflammation, consuming protein-digesting enzymes, such as bromelain, should help.
Highly recommended for rheumatic diseases such as rheumatoid arthritis, tai chi and qigong. These are holistic Chinese forms of movement that can improve patients' mobility, muscle strength, stamina, quality of life and mood, according to studies. The effect, according to Chinese medicine, is that calm, fluid movements and breathing exercises release blockages in the body and cause life force (Qi) to flow. Slow exercises are also suitable for patients whose mobility is already limited due to joint pain and inflammation.
Inflammatory joint pain can be relieved with cold or hot treatments - try what works best for you. In general, cooling is recommended for acute joint inflammation to stop the inflammation. In chronic ailments, heat is generally more pleasant, such as warming baths (such as senna flowers), mud packs, or mud treatments.
Creams and ointments on medicinal plants also show anti-inflammatory and analgesic effects. These include ready-to-use preparations containing willow bark or rosemary and eucalyptus oils. Additionally, peppermint oil can relieve pain perception by irritating the cold receptors in the skin.
Ayurvedic therapists recommend cleansing procedures (panchakarma treatment) for rheumatic diseases to remove toxins (called ama) from the body. According to this teaching, the accumulation of ama is the cause of the disease. For acute inflammation of the joints with pain in the joints, Indian incense (shallaki) and triphala (herbal blend) are used. Both have strong anti-inflammatory effects.