Since October 2004, when the International Academy of Pain (IASP) designated the third Monday of October as “Global Day Against Pain”, the annual release of the theme of the year has become the most important event in the global pain medicine community. The theme of this year’s analgesic day is Pain in the joints, and on the occasion of World Pain Day, pain experts will bring you to know about joint pain.
1.What is joint pain?
Joint pain is the most common symptom of joint disease, and there are many causes of joint pain. In terms of causes, it can be divided into primary and secondary. Primary osteoarthritis pain, mostly occurs after middle age, caused by degeneration of joint cartilage. It is the most common type of joint pain in the elderly, and it occurs in joints that carry a lot of weight and movement. Secondary arthralgia includes: traumatic, congenital, infectious, and related diseases causing bone and joint pain.
According to the course of the disease, arthralgia can be divided into acute and chronic. Acute arthralgia is dominated by inflammatory reactions in the joints and their surrounding tissues, while chronic arthralgia is dominated by hypertrophy of the joint capsule and osteophytes.
2.Which diseases are likely to cause arthralgia.
(1) Degenerative arthritis: also known as osteoarthritis, is the most common joint pain, common in women, mostly in obese elderly people, knee pain is most common. Early manifestations are pain in the diseased joints when walking, standing for a long time and weather changes, relieved after rest, often accompanied by joint effusion, increased skin temperature, pain at the edges of the joints; advanced pain in the diseased joints worsens, the joints have a sense of friction, a ringing sound when moving, patients often limp, seriously affecting patients’ lives.
(2) Rheumatoid arthritis: Most of the disease starts from one joint, with the first pain in the interphalangeal joints of the fingers. It can involve all the joints in the body, often symmetrically distributed, with limited movement and stiffness of the diseased joints, which is heavy in the morning, also known as morning stiffness; it can be accompanied by generalized fever, and the joints often appear stiff and deformed in the late stage.
(3) Rheumatoid arthritis: the onset of the disease is rapid, often after streptococcal infection, with knee, ankle, shoulder and hip joints being the most common. The diseased joints appear red, swollen, hot and painful, wandering, swelling is short and disappears quickly, leaving no joint stiffness and deformity changes.
(4) Gout: The pain is often acute after drinking alcohol, exertion or high purine diet, the local skin is red, swollen and hot, and the patient often wakes up at night with pain.
(5) Tuberculous arthritis: It is most common in children and adolescents, with the spine being the most common, followed by the hip and knee joints. During the active period, there is often fatigue and low fever, night sweats and loss of appetite; the pain of the diseased joint increases after activity, and sinus tracts may be formed next to the joint, and secretions are often seen;
(6) Septic arthritis: the onset of the disease is rapid, with obvious symptoms of systemic toxicity, early chills, chills and high fever, with body temperature up to 39℃ or more; the diseased joints are red, swollen and painful, and patients often feel persistent pain in the diseased joints, with serious dysfunction and severe pain caused by activities in all directions;
(7) Bone and joint tumors: all kinds of benign and malignant tumors of bone can cause joint pain and joint movement disorders.
(8) Traumatic arthralgia: Pain, swelling and dysfunction of damaged joints often occur immediately after trauma, such as ankle sprains. Chronic traumatic arthritis has a clear history of trauma, such as meniscal injury; recurrent arthralgia, often triggered by excessive activity and weight bearing and cold weather stimuli, is relieved by medication and physical therapy;
(9) Metabolic bone disease: osteoporosis, diabetes mellitus, hyperparathyroidism and other causes of vitamin D deficiency caused by osteochondrosis osteoarthropathy.
3, osteoarthritis “five fears”
In summary, the following five things are most likely to cause osteoarthritis
(1) Age: joint pain fears “old”. With the aging of the body, the repeated use of the knee joint can stimulate inflammatory changes in the cartilage. In addition, the decrease in mucopolysaccharide content in cartilage in old age, the loss of chondroitin sulfate in the matrix and the decrease in toughness make it vulnerable to mechanical injury and degenerative changes.
(2) Environmental factors, joint pain is afraid of “cold”. Because for people with bad joints, cold can aggravate the condition, which is mainly related to poor blood circulation. In the summer in the air conditioning room, but also to protect the knee.
(3) joint strain: joint pain afraid of “damage”. Long-term fixed work posture, poor posture will damage the joints, resulting in joint pain.
(4) Obesity: joint pain fears “fat”. Obese weight increases the load on the joints and leads to changes in the biomechanics of the joints due to changes in posture and gait. The incidence of osteoarthritis in obese people is 2.63 times that of the normal population.
(5) Inappropriate exercise or excessive activity: bone and joint fear “diligence”. The joints are used too hard, which can easily lead to mechanical wear and tear and damage to cartilage, resulting in osteoarthritis and joint pain. Climbing, climbing and other sports can be harmful to the joints. Some studies have shown that the incidence of knee pain and osteoarthritis of the knee are higher among residents of buildings without elevators than among residents of bungalows.
4.How to diagnose osteoarthritis?
If we experience joint pain, swelling, difficulty in standing up, painful stairs, joint deformity and other signs and symptoms in our daily life, we should be highly suspicious if we have osteoarthritis and go to the relevant hospital specialist for a clear diagnosis, which often requires the following tests.
(1) Laboratory tests
Routine blood count, sedimentation, C-reactive protein, rheumatoid factor, streptococcal antibody (anti-o), antinuclear antibody, immunoglobulin assay, lupus cell assay, complement assay, etc.
(2) Joint fluid examination
Osteoarthritis with synovitis may result in increased joint fluid. The joint fluid on puncture is clear and clarified, yellowish, with normal or reduced viscosity and mild or moderate increase in leukocytes. It helps to identify septic or certain secondary arthritis
(3) Imaging tests, including X-ray, CT, MRI
X-ray is the most commonly used imaging technique for bone and joint examination, which is valuable in showing joint space narrowing, joint surface sclerosis and deformation, marginal osteophytes and bone bridges, subsurface cystic changes, intra-articular free bodies, calcification, bone destruction and osteoporosis, etc. CT is mainly used for bone and joint space display, three-dimensional reconstruction, etc. MRI can be used for examination of arbitrary sections and can show various soft tissue structures in the joint, such as tendons. MRI can show various soft tissue structures, such as tendons, ligaments, articular cartilage and synovial membranes, and can show signal changes in the bone marrow.
5.Treatment of osteoarthritis.
It mainly includes non-drug treatment, drug treatment, joint cavity injection treatment, arthroscopic treatment, joint replacement treatment, etc.
Non-pharmacological treatment of osteoarthritis of joints includes health education of patients, self-training, weight loss, aerobics, joint training, occupational therapy and joint protection, and auxiliary facilities for daily life.
Pharmacological treatment includes oral and topical creams for treatment. For most patients with osteoarthritis, mild to moderate pain can be controlled by taking pain medications. These include mainly various non-steroidal anti-inflammatory drugs (NSAIDs) such as selective COX-2 inhibitors (celecoxib, etoricoxib, etc.) and central analgesic drugs such as tramadol hydrochloride. Glucosamine and chondroitin sulfate are also frequently used clinically to treat osteoarthritis, both of which enhance the absorption of nutrients into joint cartilage and maintain joint toughness and flexibility. Topical medications include patches and topical applications, which have the advantages of precise efficacy and low systemic reactions.
Intra-articular injection therapy: This is also a treatment method that can relieve joint pain symptoms. It is important to note that intra-articular injection therapy is an invasive operation and should be performed in a regular hospital to ensure medical safety and to avoid medically induced joint infections.
Physical therapy: Physical therapy can relieve pain and muscle spasm, help improve blood circulation, and reduce swelling. Hot compresses, preferably moist heat, can be applied. Hot air baths and hot spring baths can also be applied. Ultrashort wave, microwave and iontophoresis are effective in relieving pain and inflammation. It is worth mentioning that the new technology of shock wave treatment carried out in our department in recent years has powerful anti-inflammatory and pain relieving effects, relieving muscle spasm and improving joint mobility, with precise and rapid efficacy, which is welcomed by patients with bone and joint pain, and is especially suitable for elderly patients who cannot have joint cavity injection due to multiple diseases. This technique is a physical therapy with almost no adverse effects and is therefore known as a green treatment for diseases such as osteoarthritis.
Surgery: If the symptoms of osteoarthritis are very serious, if medication is not effective, and if it affects the patient’s daily life, surgical intervention should be considered. Depending on the condition, arthroscopic surgery or knee joint replacement surgery can be performed.
6.How to prevent and treat bone and joint pain?
For patients with joint pain, it is especially important to protect the joints in daily life.
(1) First of all, “reduce the load” of the joints by losing weight or using a support bureau, etc.
(2) Keep the knee joint “warm”
(3) Use the knee properly. Less climbing or no climbing, less stairs, more elevators; try to wear soft-soled shoes, avoid wearing high heels; work to avoid long squatting, long standing; travel, avoid long distance; sports, avoid strenuous excessive sports, such as soccer, basketball, etc., to prevent joint strain, trauma, accelerate joint degeneration.
(4) “Charge” for the joints. Eat a diet rich in protein, calcium and collagen, such as milk, dairy products, black fungus, fish and shrimp, to provide nutrients for the health of the knee joint.
(5) Refuel the joint. Intra-articular sodium glass injection can play a role in lubricating the joint, reducing cartilage wear, eliminating inflammation and reducing pain.
(6) Proper exercise. Focus on increasing the stability of the muscles and ligaments around the knee joint, choose appropriate sports, such as swimming and walking, and appropriate functional exercise can enhance the tension of ligaments and muscles and joint stability, reducing the incidence of arthritis.
(7) Early diagnosis, early treatment. Early osteoarthritis of the knee can often be controlled by simple treatment, so do not tolerate pain without treatment, delaying the condition and losing the best opportunity for treatment.