Arthralgia

Arthralgia - What is Arthralgia?

The term arthralgia literally means joint pain. It is a combination of two Greek words – Arthro – joint and algos – pain.

There are several reasons why joints can be painful. It could be due to:-

  • injury
  • infection
  • immune disorders
  • allergic reactions
  • degenerative diseases

However, according to the Medical Subject Headings created by the United States National Library of Medicine, the term “arthralgia” should not be generalized to all conditions and should be reserved for the cases where there are no inflammatory pathologies affecting the joints. Where there is presence of inflammation, the condition should be termed arthritis.

Types and pathologies of arthralgia

Despite the convention Inflammatory arthralgia is commonly used to describe inflammatory joint pain. Many of these individuals may be actually suffering from osteoarthritis.

Osteoarthritis is a degenerative joint disease that is the commonest form of arthritis. In this condition there is loss of the cushion like cartilage that is placed between the ends of the bones at the joints to allow for smooth and painful movements.

Prevalence of osteoarthritis rises with age. With continued use the cartilage may be irritated and this may lead to pain and swelling. With progressive loss of the cartilage the ends of the bones undergo friction leading to loss of joint mobility as well.

Pain from osteoarthritis is worse after activity and at the end of the day. There is presence of stiffness in the morning or after inactivity that lasts for a few minutes.

Those with inflammatory arthralgia have a typically different presentation. The stiffness in these cases tends to last more than an hour.

Unlike osteoarthritis that affects joints on one side of the body and usually affected major weight bearing joints like the knees, hips, ankles etc., inflammatory arthralgias affect smaller joints of the hands and feet more commonly and joints on both sides of the body usually are involved.

The redness, swelling and warmth near the joint is seen more prominently with osteoarthritis than inflammatory arthralgias.

Autoimmune conditions that are responsible for inflammatory arthralgias include rheumatoid arthritis, scleroderma, systemic lupus erythematosus, Sjögren’s disease and mixed connective tissue disease.

In these conditions the body’s immune system perceives the joint and its proteins as foreign and attacks them causing severe joint damage. These are progressive conditions that eventually lead to tissue damage and fibrous scarring over the joints and severe loss of mobility.

Arthralgia Treatments

Arthralgia or joint pain is a symptom of an underlying disease rather than a disease in itself that can be treated. The management of arthralgia thus depends on the cause, type and severity of the condition.

Therapy goals

The therapy goals include:-

  • Management according to the cause of the arthralgia rather than the symptoms of pain alone.
  • More than one therapy alternative may be tried to treat the underlying cause as suitable for the patient.
  • Most arthritis causing arthralgia is not curable. Realistic therapy goals help reduce frustration.
  • The main therapy goals are to improve joint function and relieve pain in order to improve the quality of life of the patient.
  • There should be a follow up and feedback on treatment from the patient. This is considered as valuable in diagnosis and management.

Treatment modalities

Treatment modalities of arthralgia include: –

  • Rest
  • Pain relief using medications - analgesics or pain relievers are drugs including Acetaminophen (Paracetamol), Ibuprofen, Diclofenac etc. They belong to the class Non steroidal anti-inflammatory drugs or NSAIDs.

Pain relievers may be applied locally over the joint as creams, ointments and sprays or may be taken as pills.

These NSAIDs have a dual action of relieving pain as well as reducing inflammatory changes. However long term use of these agents are not recommended as they may carry the risk of severe side effects including gastric ulcers, kidney damage, heart disease etc.

Another class of pain relievers are opioids that do not have any effect on inflammation but are better pain relievers.

Long term use of these agents is also not recommended as they may lead to a risk of dependence and abuse apart from several other side effects.

  • Physical and occupational therapy, monitored exercises and joint mobilization – exercises include stretching and strengthening exercises that increase muscle strength and maintain optimum joint mobility. This reduces and retards the progress of joint stiffness and immobility due to pain.
  • Antibiotics are prescribed in case of infected joints leading to arthralgia.
  • Corticosteroids are also used in many rheumatic and autoimmune conditions because they reduce swelling and block or slow down the immune system.
  • A major group of drugs include Disease-modifying antirheumatic drugs (DMARDs) and Biologic response modifiers. These agents are extensively used in rheumatoid arthritis and other inflammatory arthritis conditions.
  • Lifestyle changes like adopting a healthy diet, losing weight and maintaining a normal weight etc.
  • Hyaluronic acid substitutes and nutritional supplements like Calcium and Vitamin D supplements are used to prevent bone loss and Allopurinol is an enzyme inhibitor that is used in gout.
  • Alternative exercise therapies include water therapy and heat and cold fomentation therapy.
  • Use of medical devices such as splints, braces, crutches, wheelchairs etc. for improved mobility.
  • Surgical therapy for restoration of function, relieve pain and to introduce prosthetic joint replacements for better mobility.

Arthralgia Causes

There are several causes of joint pain that range from injuries, infections, inflammation to severe degenerative systemic or whole body disorders.

Some of the causes may be classified as:-

  1. Those leading to single joint pain or monoarticular pain
  2. Those leading to more than one joint pain or polyarticular pain
  3. Those leading to musculoskeletal emergencies mandating immediate attention
  4. Back pain
  5. Non-specific arthralgias or muscle pains

Causes of single joint affliction or pain

Pain in and around a single joint are commonly seen in the knees or shoulders. If the pain is in the joint there is tenderness and pain at the end of the maximum range of the movement in any direction. The range of movement thus is significantly reduced.

The pain may also involve structures around the joint. The joint affliction may be inflammatory or mechanical.

Inflammatory features include warmth, redness, swelling, pain and stiffness after prolonged inactivity in the joint. There is presence of morning stiffness as well.

Mechanical degeneration of a single joint is manifested by pain during activity, improvement with rest, locking or joint giving way during activity and absence of swelling, warmth and redness of the joint.

Some causes of single joint affliction include:-

  • Joint injuries
  • Joint infections or collection of pus in a joint usually following injuries and surgical complications
  • Rotator cuff syndrome
  • De Quervains tenosynovitis
  • Olecranon bursitis
  • Prepatellar, patella, anserine bursitis
  • Trochanteric bursitis
  • Plantar fasciitis
  • Achilles tendonitis

Causes of multiple joint affliction or pain

There are several non-inflammatory and inflammatory causes that may affect multiple joints. Common non-inflammatory conditions include osteoarthritis and fibromyalgia.

Other inflammatory causes include rheumatoid arthritis, reactive arthritis, psoriatic arthritis, gout, enteropathic arthropathy, polymyalgia rheumatic, systemic lupus erythematoses (SLE), etc.

Causes leading to musculoskeletal emergencies mandating immediate attention

The commonest emergencies include infections such as septic arthritis and osteomyelitis, injuries to the joint including fractures, dislocations, damage to the surrounding blood vessels and nerves due to injuries or cancers.

It is usually characterized by single affected joints with severe locking and pain that makes movement impossible. In case of infections there may be accompanying fever as well.

Causes of back pain

There are several causes that affect the back in general or the lower back particularly. It is the commonest musculoskeletal symptom by the population.

The condition may be transient and resolve in a few days or may be long standing with occasional flare-ups.

Apart from pain there may be affliction of the nerves as well leading to tingling, numbness in the lower limbs.

Some of the causes include repetitive strain injury, whiplash injury, sciatica, osteoporosis leading to vertebral fractures, slipped or bulging disc between two vertebral bodies etc.

Non-specific muscle pain and arthralgias

These may range from mild to severe leading to severe muscle pain, multiple areas of non specific pain, interference with sleep and performance, and commonly, chronic fatigue and depression. One of the common causes of this condition is fibromyalgia.