Brief overview
- Causes: Joint wear and tear, bursitis, joint inflammation, rheumatic fever, gout, psoriasis, ankylosing spondylitis, sarcoidosis, lupus erythematosus, joint bleeding, among others.
- Treatment: Appropriate treatment of the cause, possibly painkillers, rarely surgery; reduce excess weight, avoid one-sided stress, exercise, cooling or warming, medicinal plants.
- When to see a doctor? In case of limited mobility of the painful joint, fever, reddened skin over the painful joint, swollen joint.
- Diagnosis: medical history, palpation of the painful joint, possibly further examinations such as orthopedic examination, dermatological examination, blood test, ultrasound, X-ray, joint puncture.
Joint pain: Causes
There are a number of possible causes of joint pain (arthralgias). An immediate trigger is trauma, i.e. injuries such as bruises, sprains or fractures. In addition, there are various diseases that can cause joint pain.
Joint pain due to wear and tear and overuse
Prolonged stress or accidents can also irritate structures surrounding the joint. These include bursae and tendons. When they become inflamed, the joint in question hurts. Inflammation of the bursa (bursitis) usually occurs in the elbow, knee and hip. Inflamed tendon sheaths (tendovaginitis) are common in the wrist.
Infections
Some people experience joint pain when they come down with a flu-like viral infection or the “real” flu. Other infectious diseases also cause painful joints. These include travel illnesses such as Chikungunya fever, in which pain in almost all joints can last for a long time.
If a joint becomes inflamed because of bacteria (bacterial arthritis) it also hurts a lot. Typically, the joint also swells and is reddened. The bacteria enter the joint through the blood, through injuries or during surgery.
Joint pain after an infectious disease
Days to weeks after a bacterial infection of the intestines or urethra, joints can also become inflamed. Doctors refer to this as reactive arthritis. The leg joints are particularly frequently affected (e.g. the knee). The joint pain may also move from one joint to the next.
Rheumatic fever, on the other hand, is a disease that occurs a few weeks after a streptococcal infection. A typical symptom is joint pain, especially in the large joints. Other organs such as the heart can also suffer from this secondary disease.
Chronic inflammatory diseases with joint pain
There are some diseases in which the immune system is misdirected and attacks own tissue. Particularly well known is dierheumatoid arthritis. This chronic inflammation of joints gradually destroys joints and causes swelling and pain.
But there are other inflammatory diseases that affect the joints:
- Bekhterev’s disease: This chronic inflammatory disease primarily affects the joints between the pelvis and sacrum and the spine. The onset of joint pain is usually dull and gradual.
- Sarcoidosis: In this inflammatory disease, the joints may also hurt. In the acute special form of Löfgren’s syndrome, this is particularly the ankle joints.
- Systemic lupus erythematosus (SLE): Almost all people with this autoimmune disease suffer from joint pain. The exact cause is not known.
- Polymyalgia rheumatica: In this autoimmune disease, the medium-sized joints such as the wrist suffer in particular.
Since it is a chronic inflammation, sufferers usually also have recurrent or chronic joint pain. However, the joints can also hurt permanently or repeatedly due to other causes. This is especially true if the underlying disease is not treated.
Other causes of joint pain
An attack of gout causes sudden and severe pain in, for example, the base joint of the big toe, the ankle, the knee, or the joints of the hands and fingers. The joint pain often starts at night.
If blood clotting is impaired, bleeding can occur in the joints and cause pain. Such painful joint bleeding occurs, for example, in people with hemophilia.
Some medications can also trigger joint pain as a side effect. These sometimes include certain antibiotics (especially fluoroquinolones) or cancer drugs (e.g. anastrozole).
Joint pain at night
Nocturnal joint pain can be particularly distressing: it disturbs sleep and in some cases significantly impairs quality of life. Here are some typical conditions where joints (also) hurt at night.
- Rheumatoid arthritis: The inflammation in the body can increase during sleep and is more likely to hurt.
- Osteoarthritis: advanced osteoarthritis hurts at rest and therefore also at night. This is especially true if the joint cartilage has been stressed during the day.
- Gout: The body breaks down uric acid, which accumulates in the form of crystals in the joints and causes pain. This happens mainly at night and after meat-heavy meals or a lot of alcohol.
- Bechterew’s disease: The joint pain in the spine tends to start at night and eventually wakes the affected person up. Movement then usually improves the symptoms.
Sometimes the joint pain also gets worse at night. This is due, for example, to the fact that the affected person comes to rest and then perceives the pain more strongly. An unfavorable sleeping position can also worsen joint pain at night.
Wandering joint pain
In many diseases with joint pain, not only one but several joints are affected. Sometimes sufferers also report that the pain “wanders” or “jumps” from one joint to the next. This is typical in the following conditions:
- Reactive arthritis (such as after gonorrhea): In this secondary condition after urethritis or enteritis, the pain travels between a few joints, usually in the legs.
- Rheumatic fever: wandering joint pain is also typical for this complication of a streptococcal infection.
- Lyme arthritis (Lyme disease): Joints inflamed by Borrelia bacteria may alternately ache.
Every person experiences joint pain differently. Depending on the cause, there are typical courses, but the type, intensity and duration of the pain vary greatly from person to person.
What helps against joint pain?
The doctor treats the cause of the joint pain and also prescribes painkillers. Typically, these are painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac. Patients may also receive injections of anesthetics or “cortisone” into the painful joint.
Treatment of the cause varies greatly. In rheumatoid arthritis, doctors prescribe drugs that slow down the immune system. In the case of severe joint wear (osteoarthritis), surgery is often necessary to insert an artificial joint. In gout, on the other hand, medications help lower uric acid in the blood.
General tips for joint pain
- Reduce any excess weight. Every excess kilo puts additional strain on the joints – they wear out faster, which then often leads to joint pain.
- Do regular endurance training to strengthen muscles and joint cartilage. Swimming and cycling, for example, are particularly easy on the joints.
- Regular strength training (such as weight lifting and jumping rope) is also recommended. Have a trainer or sports doctor draw up a balanced training program that strengthens all muscles equally.
- Take enough breaks when exercising.
- Avoid one-sided stress such as carrying heavy shoulder bags.
- Reduce mental stress: Mental stress may manifest itself in the form of joint pain. Therefore, make sure you find a balance, for example through autogenic training.
Herbal remedies for joint pain
In naturopathy, many plants are known to help with various forms of joint pain. Some of them are classified as traditional herbal medicines and are medically recognized against certain complaints.
Such medicinal plants for mild joint pain include:
- Willow bark
- Black currant leaves
- Nettle leaves and nettle herb
- quaking aspen (bark and leaves)
- Comfrey root
The medicinal plants can be used in the form of teas, compresses or ointments. There are also ready preparations, which can be bought in the pharmacy. They contain a defined amount of active ingredient and are sometimes officially approved as drops, capsules or tablets.
You can read more about this in our article “Medicinal plants for muscles and joints”.
Herbal remedies may also have side effects or be incompatible with other medications. Ask your health care provider or at your local pharmacy.
Alternative treatments for joint pain
Acupuncture, acupressure, chiropractic, or osteopathy help some people with joint pain. Studies show that acupuncture may relieve some of the pain of a worn knee or hip joint.
A summary of several studies showed that osteopathic treatments might also be effective for some musculoskeletal conditions. However, more studies are needed to make a firm statement.
Important: Chiropractic methods are not suitable for people with damaged or acutely inflamed joints. This also applies to people who have weakened bones, for example due to osteoporosis.
Alternative treatment approaches have their limitations and are not free of risks. In addition, the available studies are for individual conditions and not for joint pain in general. Talk to your health care provider about which approaches may or may not be appropriate in your personal case.
Homeopathy for joint pain without scientific evidence
In the teaching of homeopathy, there are also different approaches to joint pain. For example, Ledum (marsh brier) or Belladonna in the form of the typical dilutions or globules are remedies that homeopaths administer.
The concept of homeopathy and its effectiveness have not been proven by studies.
Forms of joint pain
Joint pain manifests itself in a wide variety of ways. Different criteria help to describe the complaints more precisely.
Classification according to the onset of joint pain
- Acute joint pain starts within hours.
- Chronic joint pain extends for weeks or months.
Classification according to the number of joints affected
- Monoarticular joint pain affects only one joint.
- Oligoarticular joint pain extends to two to four joints.
- Polyarticular joint pain affects more than four joints.
Classification according to the pain rhythm
- Pain at rest
- Night pain
- Morning stiffness of the joints
Classification according to the distribution pattern
- Joint pain in the small joints (such as wrists, finger joints)
- Joint pain in the large joints (for example, knee and hip joints)
- Joint pain in the finger end joints
Classification according to pain intensity
The patient describes the pain intensity using a scale from zero (no pain) to ten (unbearable, maximum pain).
When to see a doctor?
Joint pain sometimes disappears on its own or can be relieved with simple remedies. However, caution is advised with the following symptoms:
- joint pain that limits the mobility of the joint
- Fever
- Reddened skin over the painful joint
- Swollen joint
Diagnosis
First, the doctor asks about your medical history. He asks, for example, when and where the joint pain occurs and whether you suffer from other complaints (such as fever or joint swelling).
The more precisely you describe your joint pain, the better the doctor can narrow down the possible causes. An acute attack of gout, for example, is an obvious cause of pain if the joint pain only occurs in one joint. In rheumatoid arthritis, on the other hand, the joint pain appears in several joints.
The location (localization) of the joint pain is also revealing: if you have wrist pain or pain in the base and middle joints of your fingers, you probably have rheumatoid arthritis. If, on the other hand, the joint pain affects the metacarpophalangeal joint on the thumb and the finger end joints, it is more likely to be osteoarthritis.
Physical examination
Further examinations for joint pain
In order to track down the actual cause of joint pain, further examinations are often necessary. These include:
Dermatological examination: skin examinations help to identify psoriatic arthritis or sarcoidosis as a possible cause of the joint pain. Important: In this regard, there are cases in which the joints hurt but nothing can (yet) be seen on the skin.
Blood tests: Blood tests can be used to detect various triggers, such as bacterial joint inflammation or Lyme disease. The doctor also recognizes disturbed blood coagulation in the blood count. The rheumatoid factor and other inflammatory signs in the blood provide information about any rheumatoid arthritis that may be present. If gout is suspected, the focus is on the uric acid level in the blood.
Joints can also hurt without any changes in inflammation levels or other parameters in the blood. This can be the case with osteoarthritis, for example. It is even a condition for the diagnosis of fibromyalgia.
Ultrasound examination: It is helpful, for example, if bursitis, gout or systemic lupus erythematosus trigger the joint pain. Ultrasound often allows the physician to detect changes that are not yet visible in the X-ray image.
Magnetic resonance imaging (MRI): In some cases, doctors perform an MRI. It produces detailed images, especially of the soft tissue in and around the painful joint.
Joint puncture: If the doctor suspects a bacterial joint inflammation, for example, he or she takes a sample of the joint fluid (joint puncture) and uses it to create a bacterial culture. If bacteria can be cultivated from this, this indicates bacterial joint inflammation.
