Orthopedics-Online

Pain in the joints

introduction

Sore joints can be very uncomfortable for those affected.
Everyday movements become a burden and ordinary loads can often only be carried out with pain.

The causes of the complaints can be varied and caused by banal reasons as well as by chronic diseases.

Distinction

There is either a mono- or polyarticular joint involvement.

Joint pain can be grouped according to various criteria.
One distinguishes acute, subacute and chronic joint painwhere acute joint pain develops suddenly, subacute joint pain worsens over a few days, and chronic joint pain persists for weeks or months.

There is also a distinction between one mono- and one polyarticular infestationi.e. whether only one or several joints are affected.

Depending on the cause, there can be typical differences.

In addition, the pain can be further classified, depending on whether it is consistently strong over the long term, gets stronger over time or disappears in the meantime and only ever occurs intermittently.

Also the Pain quality can be groundbreaking, i.e. whether the pain is more likely, for example stabbing or dull is.

The Pain intensity is usually done by the doctor on one Scale from 1 to 10 he asks.
In the case of joint pain, however, it is often the case that the perceived severity of the pain does not necessarily correlate with the extent of the joint damage.

Below are some conditions that can be associated with joint pain.

arthrosis

The arthrosis refers to wear-related joint wear.
In Germany this disease occurs particularly frequently on Knee joint because this is exposed to special loads.

About 2/3 of all people over 65 years of age are affected by the disease, although the severity can be very different and not all those affected experience symptoms.

One distinguishes one primary from one secondary osteoarthritis.
The primary osteoarthritis is one Cartilage defect based on which no precise cause can be assigned.

The secondary osteoarthritis arises through Improper loading, overload, previous Inflammation of the joint (arthritis) or certain metabolic diseases.
The pain typically occurs during exercise. Especially the tarnishing after long periods of sitting is described as painful by those affected.
In the course of osteoarthritis, it can Deformity of the affected joints and to Joint effusions come.

therapy
Arthrosis is initially treated by means of anti-inflammatory drugs and intensive physiotherapyto improve mobility.
Painkiller can be used to alleviate symptoms.

If conservative measures do not help, there are some alternative methods that can be used.
There is, for example, the possibility of so-called Chondroprotectives injected into the joint.
Chondroprotectives are drugs that are supposed to protect the cartilage from further degradation.

Healthy cartilage can also be removed from a less stressed cartilage zone of the joint and transplanted to the main stress points (so-called autotransplantation).

A similar method is that Chondrocyte transplant, in which some cartilage cells are removed from the healthy cartilage. These are grown for a few weeks and then attached to the damaged cartilage.
By forming new cartilage, these transplanted cells can compensate for the damage to some extent.

Alternatively come operational procedures in question, especially if the osteoarthritis is more advanced.
The joint can either be replaced by a Endoprosthesis be replaced (e.g. artificial knee joint) or stiffened become (Arthrodesis).

An endoprosthesis is a long-term solution, but the joint usually loosens after about 10 years again and then has to be operated again. For this reason, one would like to avoid inserting an endoprosthesis before the age of 60.
The follow-up operations are usually much more complicated than the first operation, as increasingly bone substance is lost and the bone due to aging processes and osteoporotic changes is less resilient.

In the Arthrodesis (Joint stiffening) the corresponding joint is e.g. fixed in one position by screws or wires and can then no longer be moved.
This is mostly lasting freedom from pain achieved, but this procedure also works with one complete loss of function in the affected joint.

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Rheumatic diseases

Rheumatic diseases typically lead to joint pain of various types.

Rheumatoid arthritis is the most common inflammatory joint disease.
It affects women particularly often and can develop between the 35 and 45 years of age form.

The pain typically begins in the finger and toe joints, whereby the end joints, in contrast to the joints near the trunk, are not affected.

Patients often complain of morning stiffness in the joints, which is just beginning after about 30 minutes improves.
In addition, there is often swelling, overheating and reddening of the joints.
The disease usually runs in episodes, with one episode between a week and a few months can last.
As the disease progresses, more and more joints may be affected, typically symmetrically on both sides.

therapy
There are currently various options for treating rheumatoid arthritis.
Initially, conservative treatment with pain relievers and anti-inflammatory drugs is tried.

Some special medicines, such as Methotrexate are initially used with preference.
If these measures cannot improve the symptoms, alternative therapy concepts can be used.

This includes the operational procedures, which are delayed as long as possible.
As with osteoarthritis, joint stiffening (Arthrodesis) or a joint replacement with an endoprosthesis.

In addition, the joints can also be removed without replacement; this is often used on the small toe joints.

In the early stages of the disease, a synovectomy can have a positive effect on the course of the disease.
The so-called synovia, the mucous membrane of the joint capsule, which is the origin of the inflammatory process, is removed.
If this is removed early, a decrease in the inflammation and an improvement in the symptoms can usually be observed.

gout

The gout is a disease that is going through Deposition of uric acid crystals excels in various tissues and joints.

Possible causes are e.g. a Renal dysfunction or one Disturbance in purine metabolismwhich increases the level of uric acid in the patient's blood.
When the blood is oversaturated, the excess uric acid eventually precipitates in the form of crystals.

There are mostly men affected by the disease, which usually spreads between the 40th and 60th year of life manifested.

Gout progresses in phases and, if left untreated, leads to long-term damage to joints and cartilage, as well as to Kidney failure.

Typical symptoms of gout are sudden, very severe pain in the affected joints that in addition swollen and extremely reddened and overheated are.

In principle, any joint can be affected, but the acute attack of gout very often occurs in the base joint of the big toe.
In contrast to rheumatoid arthritis the end joints of the fingers and toes can also be affected. Such an attack lasts if left untreated about 2-3 weeks.

The gout can be from the acute in a chronic form in which the attacks are then less violent, but the disease has already led to significant damage and functional impairments.

therapy
In gout, the diet should be adapted to the disease. High levels of uric acid in the blood should be avoided.
Basically, one is recommended protein-rich diet with increased intake of unsaturated fatty acids.

Animal products, especially meat, sausage and fish, should be avoided as far as possible, as these contribute to an increase in the uric acid level in the blood.

A acute gout attack is particular with anti-inflammatory drugs (NSAIDs), whereby the inflammation process is slowed down and the pain is relieved.

With chronic gout, certain medicines come, like Urikosurika and Uricostatics, for use.
Uricosurics reduce the Reabsorption of uric acid in the kidney, which causes more uric acid to be excreted in the urine.
Uricostatic drugs attack the Uric acid metabolism and inhibit the enzyme (Xanthine oxidase), which forms uric acid. This lowers the uric acid levels in the blood.

Reactive arthritis

The reactive arthritis refers to inflammation of the joints after a previous immune reaction of the body to a certain stimulus.
Such a stimulus can, for example previous bacterial infection, but also one vaccination or similar be.

At the Reiter's disease joint inflammation occurs after bacterial intestinal or urinary tract infection.
There are mostly young men between that 20 and 30 years of age affected that in addition to the joint inflammation one Urethritis (Urethritis) and a Conjunctivitis / inflammation of the skin of the eye (Conjunctivitis / uveitis) can develop.

The combination of these symptoms is also known as Equestrian triad.
These are preferred in reactive arthritis Knee- and the Ankle joint affected, but in principle any joint can be affected.

The joints are common swollen and overheated, often it comes to strong Joint effusions.

It is believed that the previous reaction of the body to the bacterial infection, a kind of Autoimmune disease which then acts against the body's own tissues.

therapy
There are mostly anti-inflammatory drugs in conjunction with a cooling of the affected joint.

Since in reactive arthritis no pathogen can usually be detected, there is one antibiotic therapy not useful.
With chronic course can Immunosuppressants are given.

Psoriatic arthritis

The psoriasis (psoriasis) can also affect the joints and cause an inflammatory change in these joints. This is then referred to as Psoriatic arthritis.

In principle, all joints can be affected, but mostly the end and middle joints of the hands and feet, as well as the knee or ankle joint and joints of the spine.

In contrast to rheumatoid arthritis this is usually the infestation asymmetricali.e. the joint involvement is not equally pronounced on both sides of the body.
Typically, all joints of a single finger can be affected (Dactylitis, "infestation in the beam").

In the long run it can become a significant deformation of the joints come that with Pain and Function losses goes hand in hand.

alcohol, Obesity and Smoke have a negative impact on psoriatic arthritis.

With treatment of the underlying disease, the intensity and frequency of joint complaints usually also decrease.
For example, anti-inflammatory drugs (NSAIDs) and Methotrexate.

Overload / incorrect load

In general, joint pain can always be caused by a mere excessive or incorrect load.

Throwing sports and tennis, golf and hockey are particularly stressful Shoulder-, Poor- and Wrists, during sports with a high proportion of running, as well as start and stop movements, especially the Knee- and Ankle joints burden.

Sports accidents can damage the ligaments, bony structures and cartilage parts of the joints, which can subsequently cause severe discomfort.
Of course, other traumas can also cause the pain.