Common causes

There are many conceivable causes for joint pain. However, it is very difficult to distinguish all causes exactly from each other. The following is an overview of particularly common causes and their therapies: The so-called arthrosis is a wear and tear of the joints, which exceeds the usual level of age.

Joints begin to show signs of wear and tear around the age of 30, depending on risk factors such as stress or overweight. Arthrosis usually manifests itself in pain between the ages of 50 and 60, so that about 2/3 of those over 65 suffer from arthrosis. The causes of this wear and tear are risk factors such as smoking, overweight, incorrect weight bearing, joint malpositions as a result of injuries and inflammation (e.g. arthritis).

But genetic predispositions also play a role in the development of osteoarthritis. Women are also more frequently affected than men. As the joint cartilage perishes and the joint surfaces become uneven, the affected joints can grind and become very painful.

Often the large joints, such as the knee or hip joint, are affected. The freedom of movement is then restricted. As the disease progresses, everyday activities such as climbing stairs become increasingly difficult and the joints also hurt when resting.

The affected joints may be reddened and swollen during the acute attack. The therapeutic approaches are very diverse and include both conservative and surgical approaches. The aim is to achieve a large degree of freedom from pain and more freedom of movement.

Analgesic and anti-inflammatory drugs can be used. In addition, exercises to strengthen the joints help. Finally, there are surgical approaches ranging from arthroscopy, cartilage transplants to joint prostheses.

With gout, the concentration of uric acid in the blood is increased. Uric acid is a metabolic waste product, which, if the concentration is too high, is deposited in the form of uric acid crystals mainly in the metatarsophalangeal joint of the big toe, but also in other joints. In an acute attack of gout, this causes severe pain, swelling, redness and fever.

The acute attack of gout manifests itself mainly after rich, meaty meals or alcohol consumption. The therapy is based on anti-inflammatory drugs such as indomethacin, a low-meat diet, abstinence from alcohol and drugs that lower the uric acid level, such as uricosurics and allopurinol (the latter not in acute attacks). The term arthritis generally refers to inflammatory joint diseases.

It is to be distinguished from arthrosis, which is the wear and tear of the joints. Arthritis is usually characterized by the typical inflammatory signs of swelling, redness, overheating and pain. There are different forms of arthritis, which can be roughly divided into infectious and non-infectious arthritis: Infectious arthritis: A purulent bacterial arthritis (infectious arthritis) is a very severe damage to the joint, which is a highly acute event.

Surgical treatment with additional antibiosis is usually performed to kill the pathogens.Such a bacterial joint inflammation usually develops at the bottom of an injury, but can also have endogenous causes. The terms pyarthros and joint empyema are used as synonyms for purulent arthritis. Arthritis with non-infectious cause: There are various forms of non-infectious arthritis.

The most important are rheumatoid arthritis, psoriatic arthritis and gout. Rheumatoid arthritis, which is an autoimmune disease, can manifest itself at a very young age and is determined by blood tests, tissue samples taken from the joint and imaging procedures such as bone scintigraphy. It is the most common inflammatory joint disease and manifests itself, for example, in joint pain in the fingers, morning stiffness in the finger and wrist joints and swelling of the joints.

Psoriatic arthritis occurs in the context of psoriasis and is characterized by an asymmetrical affection of the joints (joints on one side are affected), as well as the so-called ray infestation. In the case of navicular disease, for example, all joints of a finger are affected. The joint complaints can occur before the skin complaints of psoriasis, which makes the diagnosis considerably more difficult.

(gout arthritis, see above). Bekhterev’s disease is a chronic rheumatic inflammation, which mainly affects the spine and other large joints. Typical symptoms are pain in the back, knees, hips and heels.

The soles of the feet can also be inflamed. These diseases include Crohn’s disease and ulcerative colitis. What they have in common is that they cause inflammation in various areas of the gastrointestinal tract.

Approximately one quarter of patients suffer from arthritis as part of such a disease, and about 15% from inflammation of the intestinal and sacrum (sacroileitis). This is also known as enteropathic arthropathy. In addition to various complaints of the digestive tract such as diarrhea or constipation, those affected then suffer from joint pain.

Newly occurring joint pain in the context of a chronic inflammatory bowel disease indicates an acute flare-up of Crohn’s disease or ulcerative colitis. Lyme borreliosis: Borrelia are the pathogens that are transmitted from ticks to humans. Lyme disease progresses in different stages and shows symptoms such as reddening of the skin, tiredness, fever and also joint pain.

These can also occur months after the infection and subside with time. The knee and elbow joints are particularly affected. Others: Joint pain can also occur after hepatitis, scarlet fever, mumps, rubella, tuberculosis, flu and other infectious diseases.

Iron storage disease – Hemochromatosis: This storage disease causes an abnormal deposition of iron in the body. It can be either acquired or hereditary. In addition to organ damage such as fibrosis (connective tissue remodelling) of the pancreas and liver, and heart failure, iron storage disease leads to pseudo-gout (see below) in the joints.
Here, a low-iron diet is very important, but drug therapy is also essential.
Fat metabolism disorders: Lipometabolic disorders include both hypertriglyceridemia and hypercholesterolemia. Both metabolic disorders can lead to joint effusions, pain, overheating and swelling. The course of the pain is more severe in hypercholesterolemia.

Chondrocalcinosis (pseudo-gout) is a deposit of special calcium compounds (calcium pyrophoshate) in the cartilage.

This causes damage to the menisci, intervertebral discs and the joint cartilage of the small and large joints. A pseudo-gout resembles gout in its symptoms and leads to severe pain and restricted mobility. It is more common in other diseases such as diabetes mellitus, hemochromatosis and hyperparathyroidism.

Blood diseases can also affect the joints. Hemophilia (disease of the hemophiliac) can cause extensive internal bleeding, either spontaneously or after slight injury, which can also occur in joints (hemarthros) and muscles. The consequences are severe pain, swelling and, over time, deformities.

Therapy with anticoagulant drugs (anticoagulants) can also very rarely lead to joint bleeding. Sarcoidosis is a systemic autoimmune disease that can affect almost any organ, but prefers the lungs. It leads to so-called granulomatous deposits.

A special form is the Löfgren’s syndrome, which mainly affects young women.It is characterized by the triad of arthritis, a skin rash (erythema nodosum) and an infestation of special lymph nodes of the lung (bihilary lymphadenopathy). The therapy is symptomatic and is carried out with anti-inflammatory and pain-relieving medication. Chronic fatigue syndrome is a paralyzing mental and physical state of exhaustion, which shows further characteristic symptoms.

These include headache, neck, muscle and joint pain, as well as insomnia and concentration problems. Reiter’s syndrome, also called Reiter’s disease, is a special form of Reactive Arthritis and occurs after gastrointestinal and urogenital infections. The main symptoms are arthritis, inflammation of the urethra (urethritis) and conjunctivitis.

Reactive arthritis is generally simply an inflammation of the joints, which occurs after infection with various pathogens. Mostly the large joints, such as the knees, are affected. Fibromyalgia is a chronic, currently incurable, disease that causes a wide range of symptoms.

The main symptoms are chronic pain in various parts of the body, fatigue and sleep disorders. The pain mainly affects the muscles and joints of the back, chest, neck, arms and legs. It is important to distinguish fibromyalgia from rheumatoid arthritis by differential diagnosis.

Systemic lupus is an extremely rare disease that mainly affects women. It causes various different symptoms, which include joint pain. It is an autoimmune disease.

Joint pain typically occurs in the context of a flu-like infection (cold). They are even more severe in the context of influenza. This pain is triggered by the messenger substances that the immune system sends out while it is fighting the infection.

These messenger substances lead to a lowered pain threshold. If the pain persists even after the cold has healed, a doctor should be consulted. Joint pain occurring days to a few weeks after infection can be a sign of Reactive Arthritis.

In the context of a rheumatic disease, the joint pain may be accompanied by general weakness and slight fever. Fever can also be a sign of infectious joint inflammation. Bacterial joint inflammation often develops in the hip or knee joint.

The bacteria can enter the joint from outside, e.g. during arthroscopy, or via the blood. Bacterial Lyme borreliosis transmitted by ticks can also manifest itself as joint pain with fever. If joint pain occurs after the consumption of alcohol, it can be an acute attack of gout.

With gout, the concentration of uric acid in the blood is increased. As a result, uric acid crystals are deposited in the joints and thus lead to pain. The metatarsophalangeal joint of the big toe is particularly often affected.

However, it can also lead to inflammation of the knee, finger joints, elbow joint, ankle joint or similar. Just like meat consumption, alcohol leads to increased uric acid concentrations in the blood. There are also many other diseases that can cause joint pain. Further causes are scleroderma, various vasculitides (vascular inflammations), rheumatic fever, Sjögren’s syndrome and many more.