Joint Pain (Arthritis)

What is Joint pain?

Joint pain or arthritis is defined as an acute or chronic joint inflammation that often co-exists with pain and structural damage. The disorder must be differentiated from arthralgia which is the localised pain in a joint regardless of its origin. There are many types of arthritis defined clinically, the most common being osteoarthritis or degenerative arthritis which is non-inflammatory arthritis.

Osteoarthritis is the most prevalent type of arthritis amongst all. Between 19% and 30% of adults over the age of 45 years have knee osteoarthritis. Also, Rheumatoid arthritis is typically seen in early adulthood, with a disease prevalence of 5% in women over the age of 65 years. The incidence of gout (inflammatory arthritis) is more than 45 per 100,000.

Causes

The aetiology of arthritis varies with the type and contributory factors.

• Osteoarthritis: Contributory factors include advancing age, female sex, joint trauma, and obesity. It is characterised by a degenerative cascade of progressive cartilage loss which leads to bone damage.
• Rheumatoid factors (RA): It is an autoimmune disorder caused by an interplay of genetic factors especially HLADRB1 and environmental factors leading to degradation of cartilage and, eventually the bone is preceded by endothelial cell activation and synovial cell hyperplasia.
• Gout: The prolonged hyperuricemia leads to uric acid deposition in joints, which then leads to joint inflammation. Male sex, advancing age, chronic kidney disease, alcoholism, and certain drugs such as the diuretics are additional risk factors for hyperuricemia and gout.
• Septic arthritis: Factors like immunodeficiency, advancing age, diabetes mellitus, prosthetic joints, rheumatoid arthritis, and intravenous drug abusers are at a higher risk of developing the infection. It is typically an inflammatory response to a mono-bacterial infection.

Sign and symptoms

The most common presentation is pain, swelling, loss of function, stiffness, joint deformity, weakness, and joint instability. Pain from arthritis is usually worse by activities and at the end of the day. Morning stiffness lasting more than 45 minutes is typically associated with inflammatory arthritis.

Physical examination is an essential part of the diagnosis and in evaluating the type of arthritis. Inflammatory arthritis is associated with tenderness, swelling, effusion, erythema and warmth. Non inflammatory arthritis (osteoarthritis) may be associated with tenderness, swelling and effusion but erythema may be absent. Assessment of the following points of the affected joint or joints helps in clinching the diagnosis-

• Onset
• Number of joints involved
• Symmetry
• Distribution
• Pattern

Diagnosis

Laboratory and radiographic evaluation can assist in the diagnosis and grading of the severity of an arthritic condition. An elevation in markers of inflammation (ESR and CRP), Serum uric acid , Antibodies like Anti-citrullinated peptide antibodies and Anti-Nuclear antibodies can be detected. Synovial fluid examination and Plain radiographs are also advised.

General management

The management includes both the pharmacological and non-pharmacological interventions. Non-pharmacologic treatments include specific exercises, physical therapy, bracing, acupuncture, and weight reduction. Symptomatic relief is provided by pharmacotherapy.

Warning: Above information provided is an overview of the disease, we strongly recommend a doctor's consultation to prevent further advancement of disease and/or development of complications.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.