Generality
Arthralgia is the term by which doctors indicate the presence of pain in one or more joints.
The main causes of arthralgia are arthritis, the phenomenon of joint distortion, the phenomenon of joint dislocation, hypothyroidism and malignant bone cancer.
The presence of other associated symptoms depends on the triggering causes.
In order to plan a suitable and effective arthralgia treatment, doctors must know precisely the factors that triggered the onset of joint pain.
Arthralgia and arthritis are not synonymous, but indicate two different medical conditions.
Short review of the joints
The joints are anatomical structures, sometimes complex, which put two or more bones in mutual contact. In the human skeleton, they are 360 and perform functions of support, mobility and protection.
According to the most common anatomical view, there would be three main categories of joints:
- Fibrous joints (or synarthrosis ). They generally lack mobility and the constituent bones are held together by fibrous tissue. Typical examples of synarthrosis are the joints between the bones of the skull.
- Cartilaginous joints (or amphiarthrosis ). They have poor mobility and the constituent bones are joined by cartilage. Classic examples of amphiarthrosis are the joints that connect the vertebrae of the spine.
- Synovial joints (or diarthrosis ). They are highly mobile and include various components, including: the articular surfaces and the cartilage that covers them, the joint capsule, the synovial membrane, the synovial bags and a series of ligaments and tendons.
Typical examples of diarthrosis are the joints of the shoulder, knee, hip, wrist and ankle.
What is arthralgia?
Arthralgia is the medical term that indicates the presence of more or less intense pain in a joint.
Many doctors are keen to stress that this word is not synonymous with arthritis, as so many people believe. In fact, while the word arthritis designates a degenerative medical condition of an inflammatory nature that affects the joints, the word arthralgia is limited to signaling a painful sensation - therefore in fact a symptom - at the joint level. The confusion between the two terms arises from the fact that arthritis is one of the most known and widespread causes of joint pain, namely arthralgia. In reality, arthralgia can be a consequence of many other situations, not only inflammatory (such as arthritis), but also non-inflammatory.
Arthritis sufferers always complain of arthralgia; however, those who complain of arthralgia do not always suffer from arthritis.
Other ways to distinguish arthralgia from arthritis
Some doctors distinguish arthralgia from arthritis, defining the first as "joint pain or discomfort without swelling" and the second as "joint inflammation causing pain and swelling".
Experts who do not agree with this distinction state that there are cases of arthralgia characterized by swelling, even though they are not related to arthritis.
Origin of the name
The word arthralgia derives from the union of two Greek words, arthron ( ἄρθρον ) and algos ( ἄλγος ). The word " arthron " means "joint" or "articulation", while the word " algos " means "pain". Thus, the literal meaning of arthralgia is "pain in a joint".
Causes
The main causes of arthralgia are:
- Arthritis in all its forms. The most famous forms of arthritis are: arthrosis (or osteoarthritis ), rheumatoid arthritis, gout, reactive arthritis, psoriatic arthritis, systemic lupus erythematosus and ankylosing spondylitis ;
- Episodes of joint distortion (eg, knee sprains, ankle sprain, etc.) and episodes of joint dislocation (eg, shoulder dislocation).
Both distortions and dislocations involve joint damage, which can be more or less extended depending on the circumstances; this damage triggers inflammatory processes;
- Episodes of tendinitis affecting the tendons of the large joints, such as the knee (tendinitis in the knee), the wrist (tendonitis in the wrist), the shoulder (tendonitis of the shoulder) or the ankle-foot complex (tendonitis in the foot). In the medical field, tendonitis is the inflammation of a tendon;
- Hypothyroidism . It is the morbid state deriving from the inability of the thyroid gland to synthesize a quantity of hormones adapted to the needs of the entire organism;
- Malignant bone cancer .
What are the causes of arthritis?
Arthritis can be:
- A possible long-term complication of a serious joint injury. For example, a severe knee injury dramatically increases the risk of developing gonarthrosis (or osteoarthritis of the knee) in old age;
- A consequence of obesity. Obesity is an important risk factor for osteoarthritis, the most widespread form of arthritis in the general population;
- A consequence of advanced age. Among its various effects, aging also determines the degeneration of the articular cartilages, which act as protective pads for the bones involved in the joints. With the degeneration of articular cartilages, the aforementioned bones rub against each other, triggering inflammatory processes;
- The outcome of a malfunction of the immune system. This is the case, for example, of rheumatoid arthritis (the second most common form of arthritis), systemic lupus erythematosus, reactive arthritis or psoriatic arthritis;
- The result of an infection. The most emblematic case is septic arthritis;
- The outcome of an alteration of the metabolism. The classic example of arthritis dependent on metabolic causes is gout.
Symptoms and complications
The pain that characterizes arthralgia is often associated with other symptoms, all of which are clearly related to the joint or painful joints.
Of varying intensity depending on the case, the symptoms in question generally consist of:
- Joint stiffness ;
- Skin redness ;
- Reduced joint mobility ;
- Swelling, whose presence is usually due to the presence of liquid inside the joint.
The most common anatomical sites of arthralgia are: the knee, the ankle, the shoulder, the elbow and the wrist.
What is the symptomatology of arthritis?
In addition to causing the same symptoms as arthralgia, arthritis can cause:
- The deformation of the joints involved . The articular deformations known as varus and valgus are often due to forms of arthritis (eg: gonarthrosis is a risk factor of the so-called varus knee and valgus knee);
- The formation of bone spurs (or osteophytes) . Better known as osteophytosis, this process consists in the development, on the sides of the affected joints, of small projections or swellings of bone nature, which experts call spurs or osteophytes.
The best known examples of bone spurs are the so-called Heberden nodules, which are located on the distal interphalangeal joints of the hands.
- Degeneration of articular cartilage . This is irreversible damage, for which at present there is no cure capable of restoring the original situation.
When the degeneration of the articular cartilage is particularly deep, the mobility of the affected joints is reduced so markedly that they are almost immobile;
- The emission of abnormal noises at each movement of the affected joint . The noises resemble crackles or creaking noises.
Complications of arthralgia
If not treated properly, some forms of arthralgia - specifically those sustained by important causes - may involve:
- Unbearable joint pain;
- Disability;
- Inability to perform normal daily activities (climbing stairs, lifting weights, washing dishes, cutting food, getting out of the car, etc.).
When should I go to the doctor?
If the pain in a joint lasts for several days and if this pain is accompanied by other symptoms (eg: joint stiffness, skin redness at the level of the painful joint, etc.), it is good practice to contact your doctor to undergo an accurate physical examination.
The prescription of further diagnostic tests, in addition to the physical examination, depends on what emerges from the latter.
Arthralgia represents an urgency when the pain is very intense and is associated with: obvious swelling, severe stiffness and immobility or semi-immobility of the joint or joints involved.
Diagnosis
Diagnosing arthralgia is easy and requires a quick physical examination. On the contrary, diagnosing arthralgia and its causes is complex or, better, more complex, and requires the use of:
- The anamnesis, that is the patient's clinical history;
- Imaging tests, such as nuclear magnetic resonance, radiography or, more rarely, CT;
- Blood tests, which also include the ESR (erythrocyte sedimentation rate) and the quantification of the C-reactive protein ;
- The anti-citrulline antibody test and the Reuma test (or rheumatoid factor test ). These two diagnostic tests are essential to identify a pathology such as rheumatoid arthritis;
- Laboratory analysis of any abnormal fluid present at the joint level;
- A biopsy of joint tissues ;
- Exploratory arthroscopy .
Therapy
The treatment of arthralgia involves a therapy aimed at treating the triggering cause ( causal therapy ) and a therapy focused on alleviating the symptomatology ( symptomatic therapy ).
Causal therapy
Causal therapy is essential to recover from arthralgia; acting on the triggering causes, in fact, is the only way to hope for the definitive resolution of joint pain and other associated symptoms.
All this explains the need of doctors, in the course of diagnosis, to find out what causes arthralgia.
Causal therapy varies depending on the trigger and based on its severity.
To understand what has been said, think of two situations: arthralgia due to a slight distortion and arthralgia dependent on a severe distortion. In the first case, causal therapy involves, of course, resting the painful joint and, in some situations, physiotherapy ; in the second case, instead, causal therapy involves reparative surgical intervention against joint damage resulting from the distortion phenomenon, followed by a precise rehabilitation program .
CAUSAL THERAPY OF ARTHROSIS AND RHEUMATOID ARTHRITIS
Currently, there are no causal therapies for osteoarthritis and rheumatoid arthritis.
Therefore, the progress of these two degenerative conditions is irreversible and the damage they cause is incurable.
Symptomatic therapy
Symptomatic treatments for arthralgia include:
- The application of ice on the painful and swollen area . The use of ice has a pain-relieving and anti-inflammatory power, which many people underestimate.
Normally, in the presence of pain in a joint (especially if there is a trauma at the origin), doctors recommend applying ice 4-5 times a day, for at least 15-20 minutes.
- The compression bandage of the joint . Specifically indicated in the presence of sprained or dislocated arthralgia, the compression bandage counteracts swelling and, in the case where the lower limbs (eg knee or ankle) are affected, reduces the sense of instability;
- The elevation of the limb presenting the damaged joint . By minimizing the flow of blood to the damaged area, elevation is an effective remedy for pain and swelling.
It is especially important when arthralgia affects the lower limbs;
- The administration of a NSAID (eg: ibuprofen) against inflammation and pain . Doctors indicate the use of NSAIDs when arthralgia has an inflammatory origin. The anti-inflammatory action of these drugs reduces pain;
- Injection in the corticosteroid joint . Corticosteroids are powerful anti-inflammatories, which doctors use only when NSAIDs and other inflammation remedies are ineffective. As with NSAIDs, the anti-inflammatory action reduces pain;
- The administration of symptomatic drugs for arthritis . For example, in the presence of rheumatoid arthritis, doctors prescribe so-called DMARDs.
Alternative therapies
For the treatment of some forms of arthralgia, alternative therapies are also available, such as for example massotherapy and acupuncture .
Please note : alternative therapies should not replace causal therapy and symptomatic therapy.
Prognosis
The prognosis in case of arthralgia depends mainly on the severity of the triggering cause and its curability: certainly arthralgia due to a slight distortion has a better prognosis than arthralgia dependent on an incurable disease such as osteoarthritis.
Another important factor affecting the prognosis of arthralgia is the timeliness of diagnosis and treatment.
