How To Manage A Painful Joint-Part 2

By: David Ravech

If the pain is judged as coming from the joint in question then certain decisions have to be made as to the causes of this. Inflammatory arthritis is the first category to be considered, with inflammatory changes affecting the the synovial membranes and the entheses, the junctions between the bones and the ligaments and tendons. Non-inflammatory arthritis involves changes in the structure and function of the joint, occurring as damage to the menisci or the articular cartilage lining the joint or secondary to changes in the joint which can be from a variety of causes.

There can be significant knee pain without any discernible pathology perhaps due to clinical changes not yet presenting in early disease or in pain conditions such as fibromyalgia. Two or more types of disorder can occur within one joint at the same time and an inflammatory arthritis can lead to the joint becoming less stable and more damaged. One of the main symptoms of such joint disorders is pain and with inflammatory causes pain is present with the joint moving or at rest and usually worse at the start of the movement. With non-inflammatory arthritic changes the pain is usually better when resting and worse with movement.

If the vertebral column or the large joints suffer from significant degenerative changes they may give pain when resting and at night, disturbing sleep. It is less easy to localise accurately the pain from larger joints as compared to smaller ones, with the hip being an example of how pain can be referred to several areas including the fronts of thighs, the groin, the side of the hip and the buttock. Patients perceive difficulty moving a joint, especially when just getting going, as stiffness and this symptom is usually better once the joint has got going and worse again after a rest period. Normal joint stiffness lasts 10-15 minutes but inflammatory stiffness may be for an hour or longer.

There are several changes which can occur in a joint to make it swell. If the joint is affected by non-inflammatory arthritis then bony growths form at the margins of the joints and the end of the fingers or the knees become knobbly joints. Or an effusion, a collection of fluid within a joint capsule, can form secondary to inflammatory disease and can be drawn off by injecting the joint. It is common for an affected joint to show a degree of loss of movement either because the soft tissues have tightened up, the joint is damaged anatomically or by restriction from pain and inflammation.

Getting dressed, looking after oneself and mobility such as walking and stairs are some of the activities of daily living which can be affected by arthritic disease. Loss of bulk and power in the muscles can explain at least some of functional loss and if pain and weakness occur in a joint then a muscular or neurological pathology is unlikely. Having problems with stable gait, getting up from a chair or the floor and holding things can all be interfered with by the weakness. Feeling unwell and suffering fatigue occurs in systemic arthritic conditions as the whole body is affected. Arthritic symptoms can come on slowly or fast, with rapid onset due to infection, crystal arthritis and traumatic events.

It is more typical for symptoms to develop over a period of weeks or months, and this commonly occurs in rheumatoid arthritis and osteoarthritis, the two most common types. Acute occurs for less than six weeks, sub-acute from six to twelve weeks and chronic if lasting more than twelve weeks. Joint inflammation can persist in affected joints as new joints are affected or episodic occurrence of joint symptoms with pain free periods between such as gout. The number of joints affected also varies, with monoarthritis affected a single joint, oligoarthritis involving two to four and polyarthritis affecting five or more.

Non-symmetrical and symmetrical joint patterns of involvement can occur. SLE and rheumatoid arthritis tend to affect the same joints on each side of the body in a symmetrical pattern while psoriatic arthritis and reactive arthritis involve different joints on each side of the body, the asymmetrical pattern. Joints may be involved in different patterns also, for example distal finger joints in osteoarthritis and psoriatic arthritis but not in rheumatoid arthritis.

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Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, musculo-skeletal conditions, neck pain, injury management and physiotherapists in Newcastle. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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