diease

Joint Pain


OVERVIEW OF Joint Pain :

Joints are the connections between the two bones. When they becomes injured this might result in the joint pains


EPIDEMIOLOGY :

It is more common among the old age group of above 65 years.I t is more common in women when compared to men.


CAUSES :

Joint pain can be caused by:

bursitis, or inflammation of the cushioning pads around joints

lupus

gout

certain infectious diseases, such as mumps, influenza, and hepatitis

chondromalacia of the patella, or a breakdown of the cartilage in the kneecap

an injury

tendinitis, or inflammation of the tendon

an infection of the bone or joint

overuse of a joint

cancer

fibromyalgia

osteoporosis

sarcoidosis

rickets


PATHOPHYSIOLOGY :

The joint pain afffcets single joints or multiple joints.

Type of joint pain( the major cause of the joint pain):

1.Rheumatoid arthritis:

 It is a chronic inflammatory condition of the joints.initially the synovial memebrane becomes swollen due to the predisposing factor and losses its smoothness and it ends in thickening of the embrane.Blood flow to the site is increased and depositions of fibers and white blood cells happen giving rise to the formation of pannus(a mass formed from fibres) which reduces the gap between two joints resulting in stiffness of the joints.sometimes the joint bone is exposed.

2.Osteoarthritis:

It ocuurs mainly in cartilages.Inspite of greater number of inflammatory cells taking the reactions osteoarthritis mainly depends upon the chondrocytes(termed as cartilage producing cells).The main problem is the cartilages rejunuvate and new cells are formed but the new cells undergoes death very soon.The degeneration of the chondrocytes continues.In the end cartilages crack and small pieces come out of the fluid and thus the synovial fluid starts to flow away from the joints.Resulting in bony outgrowth and the tissue expands.

3.Juvenile idiopathic arthritis:

Chronic joint inflammation and occurs before the age of 16.itincludes:

  • Systemic-onset JIA
  • Persistent or extended oligoarthritis
  • Rheumatoid factor (RF)–positive polyarthritis
  • Rheumatoid factor (RF)-negative polyarthritis
  • Enthesitis-related arthritis
  • Psoriatic juvenile idiopathic arthritis
  • Undifferentiated arthritis

4.Seronegative spondylo arthropathies: it is immune mediated and infkammmation is caused by an unknown antigen

  • Ankylosing spondyloarthritis
  • Reactive arthritis
  • Reiter syndrome
  • Enteritis-associated arthritis
  • Psoriatic arthritis
  • Arthritis associated with inflammatory bowel disease

5.nfectious arthritis:

It is also termed as septic arthritis.micro organisms enter the joint space and infect the articular spaces.it includes,

  • Bacterial arthritis
  • Tuberculous arthritis
  • Lyme arthritis
  • Viral arthritis
  • Fungal arthritis

6.Crystal induced arthritis:

Crystals include monosodium urate as in gout,disodium phosphoglycerate as in pseudo gout,calcium phosphate .these are termed as exogenous crstals.Endogenous crystals include corticosteroid crystals,polyethylene,methylacrylate and talcum.deposition of these crystals occurs in spaces between the articular joint.

  • Gout and gouty arthritis
  • Calcium pyrophosphate crystal deposition disease (pseudo-gout)

 

Bursitis:

Bursae are fluid-filled sacs found about your joints. They surround the areas where tendons, skin, and muscle tissues meet  bones. The lubrication they add helps reduce friction during movement of the joint.Bursitis is an inflammation of your bursae. Inflamed bursae cause pain and discomfort in the affected location. They also limit the ways you can move your joints.

 

Traumatic arthritis:

Traumatic or post-traumatic arthritis is joint inflammation due to injury. The trauma may affect the entire joint or just parts of its like the cartilage or bone. It may be caused by a fall, sporting injury like a kick, motor vehicle accident, assault, bullet or knife wound and so on.

 

Gout:

It is termed as the deposition of the urate crystals in the joints that interrupts the normal activity of the human being affected with the gout. The term pseudogout is used to describe the deposition of the calcium pyrophosphate crystals at the joints.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Joint stiffness

Pain during movement of the joints

Malaise and fatigue

Weight loss

Rashes

Muscle ache and pain

Tenderness

Numbness and tingling

Reduced range of motions


DIAGNOSTIC :

Laboratory test:

Analysis of different types of body fluid is indicated.Fluids include blood,urine and joint fluids.

Imaging:

Xrays-bone can show damage to cartilage,bone damage and bone spurs.but xray fails to show any arthritic damage

Computerized tomography:it shows cross sectional views of internal structures.

Magnetic resonance imaging:

Cross section studies of soft tissues such as cartilage ,tendons and ligaments are obtained.

Ultrasound:

Soft tissue image,cartilage and fluid structure are obtained.

Arthroscopy:It is an 3D device used to visualize the joint images.

 


TREATMENT AND PROGNOSIS :

      Treatment options varies from indivduals.The main treatments include physiotherapy.diet control,joint replacement therapy,and certain medications to get relieve from symptoms.

 

Physical therapy:

Physical exercises provides greater releif from pain in arthritis and it also increases the flexibility of the joints to certain degrees.

Patients suffering from joint pain can benefit from both physical as well as occupational therapy. In joint pain the joints become stiff and the range of movement are limited to the extent.. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteojoint pain of the knee. Exercises mostly focuses on the flexibility and strength of the joints.  Occupational therapy can provide assistance with activities.

They are various treatment options available for the treatment of joint pain and medications which has lower side effects are selected as the first choice of treatment in joint pain.

Depending on the type of joint pain, the medications that are given may be different. For example, the first-line treatment for osteojoint pain is acetaminophen (paracetamol) while for inflammatory joint pain it involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Opioids and NSAIDs may be less well tolerated. However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteojoint pain, intra-articular corticosteroid injections may also be considered.[54]

The drugs to treat rheumatoid joint pain (RA) range from corticosteroids to monoclonal antibodies given intravenously. Due to the autoimmune nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called disease-modifying antirheumatic drugs (DMARDs). Treatment with DMARDs is designed to slow down the progression of RA by initiating an adaptive immune response, in part by CD4+ T helper (Th) cells, specifically Th17 cells. Th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17).

Surgery:

Orthroscopic surgery for joint pain does not provide much effect.

Adaptive aids:

People with hand joint pain can have trouble with simple activities daily doing  tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. Adaptive aids or assistanve aids are available in the market  to assist the patient and simplyfing those task to them. but they are generally more costly than conventional products with the same function. It is now possible to 3D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help joint pain patients and the vast majority of those with joint pain need and use them.

Alternative medicine

Further research is required to determine if TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION(TENS) for knee osteojoint pain is effective for controlling pain.

Low level laser therapy may be considered for relief of pain and stiffness associated with joint pain. Evidence of benefit is tentative.

Pulsed electromagnetic field therapy (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteojoint pain. The FDA has not approved PEMFT for the treatment of joint pain. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.

Surgery:

Orthroscopic surgery for joint pain does not provide much effect.

Adaptive aids:

People with hand joint pain can have trouble with simple activities daily doing  tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. Adaptive aids or assistanve aids are available in the market  to assist the patient and simplyfing those task to them. but they are generally more costly than conventional products with the same function. It is now possible to 3D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help joint pain patients and the vast majority of those with joint pain need and use them.

Alternative medicine

Further research is required to determine if TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION(TENS) for knee osteojoint pain is effective for controlling pain.

Low level laser therapy may be considered for relief of pain and stiffness associated with joint pain. Evidence of benefit is tentative.

Pulsed electromagnetic field therapy (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteojoint pain. The FDA has not approved PEMFT for the treatment of joint pain. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.

 

Orthroscopic surgery for joint pain does not provide much effect.

Adaptive aids:

People with hand joint pain can have trouble with simple activities daily doing  tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. Adaptive aids or assistanve aids are available in the market  to assist the patient and simplyfing those task to them. but they are generally more costly than conventional products with the same function. It is now possible to 3D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help joint pain patients and the vast majority of those with joint pain need and use them.

Alternative medicine

Further research is required to determine if TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION(TENS) for knee osteojoint pain is effective for controlling pain.

Low level laser therapy:  may be considered for relief of pain and stiffness associated with joint pain. Evidence of benefit is tentative.

Pulsed electromagnetic field therapy (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteojoint pain. The FDA has not approved PEMFT for the treatment of joint pain. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.


PROGNOSIS :

The recovery depends upon the causative factor of the disease. But the prognosis is good at the early stages.


PREVENTION :

 

Reduce the body weight

do stretch execises

Eat fish or twice a week-since fish contains omega 3 fatty acids which can reduce inflammation in the bone.

Exercise regularly

Protect the joints and avoid joint injuries.