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If you’re an active person, you might not think you’re at risk for joint problems other than those caused by a too-intense workout, say, or an exhausting weekend of packing and moving. While acute injuries to joints can happen, persistent joint pain may have medical causes that you need to look into.
“Any nagging joint pain that lasts for more than a few days should be evaluated by a doctor, especially if it isn’t clearly coming from an obvious injury or overuse,” says rheumatologist Arthur Mandelin, MD, PhD, assistant professor of medicine at Northwestern University’s Feinberg School of Medicine.
For most pain that comes on suddenly, Dr. Mandelin says it’s appropriate to wait a few days to see if it will go away on its own. Of course, if you prefer to have it checked out right away, call your primary care physician. But “any joint pain that severely prevents normal functioning shouldn’t be ignored,” Dr. Mandelin says. Be on the lookout for these joint pain red flags:
If you feel stiff when you get out of bed, hear cracking or clicking sounds, and have more pain after you use the joint, you could have osteoarthritis (OA), a wear and tear on the joints. “Osteoarthritis can be painful because the cartilage, which normally provides a smooth gliding surface and acts as a cushion between the bones, is worn away,” says Shing Law, BA, BM, BCh, a rheumatology fellow at Boston University Medical Center.
Although osteoarthritis is often caused by use, Dr. Mandelin says that’s not the only factor. “We now believe that the problem lies in cartilage biology,” he says. “People who suffer from OA may have a problem with cartilage maintenance and/or repair, which makes them more susceptible over the decades to all of life’s little mechanical stresses.”
But osteoarthritis is not a reason to stop working out—in fact, exercise and weight loss are among the most effective treatments. Physical therapy, medications, and (as a last resort) surgery are also options.
Unlike osteoarthritis pain, rheumatoid arthritis pain actually gets better after you use your joints. “To differentiate, rheumatoid patients typically have worse symptoms first thing in the morning that get better with activity; osteoarthritis patients typically are worse with activity,” says rheumatologist Karmela Kim Chan, MD, of the Hospital for Special Surgery in New York City. RA is not an overuse problem; rather rheumatoid arthritis is an inflammatory autoimmune condition in which the body mistakenly attacks its own joints.
“Because they are inflamed, RA joints typically get warm, swollen, and maybe even red,” Dr. Mandelin says. The “warm-up” period in the morning for RA may last as long as an hour or more. Although there’s no cure for rheumatoid arthritis, medications can slow the progression of the disease to prevent bone damage.
If you have the skin condition psoriasis (its hallmark symptoms are red, scaly patches), that may provide a clue that your joint pain is actually psoriatic arthritis, says Dr. Chan. However in some cases, “psoriatic arthritis may come before the development of skin psoriasis, so it is important to find out whether there is a family history of psoriasis,” Dr. Law says.
Psoriatic arthritis symptoms can mimic RA joint pain by affecting multiple small joints, or it might only affect one or two. “There are five different subtypes of PsA so it’s not possible to give a single scenario of what PsA is like, but the most common form of PsA is quite similar from the patient’s perspective to RA,” Dr. Mandelin says. “Thus, many patients experience warm, swollen, red, tender joints that are worst first thing in the morning and better as the day goes on.” Similarly to RA, treating psoriatic arthritis with medication aims to shut down the inflammatory response.
If you’ve got sudden joint pain along with a fever and chills, call your doctor; you may need to head to the emergency room. “Unlike RA, septic arthritis is often limited to just one joint,” Dr. Chan says. “It is usually excruciatingly painful, with heat and redness of the involved joint, and the range of motion of the joint is severely limited.”
In the case of septic arthritis, says Dr. Mandelin, the body’s inflammatory response is correctly attacking an outside invader: a bacterial infection. Treatment involves antibiotics and a procedure to drain the joint. Risk factors for septic arthritis may include a previous skin injury or joint surgery, says Dr. Law. “This condition is a medical emergency because if left untreated, it could lead to complications such as complete destruction of the joint—or even death,” he says.
If you have sudden pain in your big toe, you might have gout, which occurs due to a buildup of a waste product called uric acid. “Gout pain is believed to be among the worst pain a human can experience,” says Dr. Mandelin. “The affected joint becomes swollen, red, and usually very warm to the touch. People often become unable to walk because the pain is so severe, and they frequently find they cannot even tolerate wearing a sock or putting their feet under the weight of the bedsheets.” The gout flare will get better without treatment, says Dr. Chan, but medication and diet can prevent it from happening again.
If you have debilitating discomfort all over your body, you may have fibromyalgia. With fibro, “pain is not limited to the joints; rather, there is pain involving muscles as well as joints,” says Dr. Chan. “Patients are frequently tired all the time because they have non-restorative sleep, and get something called ‘fibro fog,’ which causes an inability to concentrate or memory issues.” Most fibromyalgia sufferers are women; many also have migraines or symptoms of irritable bowel syndrome.
“The mechanisms of pain in fibromyalgia are poorly understood but may be due to overly sensitive nerves,” says Dr. Law. Diagnosis of fibro is not easy, but excluding other diseases as well as comparing symptoms to a fibro checklist can help in pinpointing it, says Dr. Mandelin. Treatment focuses on pain management, and includes exercise and optimizing healthy sleep and mood, Dr. Law says.
Most fibromyalgia sufferers
are also women; many also have migraines or irritable bowel syndrome.
Another autoimmune condition that can cause joint pain is lupus, which sometimes presents with a butterfly-shaped rash across the face. “Lupus happens when there’s an inappropriate immune response in which the body directs against its own tissues,” Dr. Mandelin says. “Lupus can be difficult to diagnose and treat in some cases because it does not affect all patients in the same way.”
Lupus patients may have inflammatory joints similar to those in rheumatoid arthritis, but may also have all-over pain as with fibromyalgia, says Dr. Chan. Besides the joints, lupus can also attack your skin, kidneys, blood cells, brain, heart, or lungs. Once lupus is identified through tests, exams, and symptom checks, medications and lifestyle modifications to avoid triggers, such as staying out of the sun, can help.
If your joint pain feels more like numbness, tingling, or burning in your hand and wrist, it may not really be joint pain at all. “Classic carpal tunnel causes neuropathic pain in the thumb, index, middle finger and part of the ring finger,” Dr. Chan says. “It is caused by the median nerve getting compressed by the connective tissue that typically holds it in place.”
Anatomic differences in people, repeated hand use, or the way you use your hand and wrist can contribute to its development. “Carpal tunnel is treatable especially if it’s caught early—very early carpal tunnel responds to splinting,” Dr. Chan says. “Mild to moderate disease can be treated with steroid injections.” Severe cases of carpal tunnel, though, may require surgery.
Think back—could you have been bitten by a tick? You might not have even known, but if your knee joint has swollen up, you could have untreated Lyme disease. “Lyme arthritis presents with a swollen joint—usually a knee—and typically the swelling is much worse than the pain,” Dr. Chan says. Also look for the classic “bulls-eye” rash. Fortunately, Lyme disease, even at a later stage, can be treated with antibiotics. Steroids and sometimes other medications that treat RA can also be used, Dr. Chan says. “Inevitably it gets better with little residual damage,” she says.
The bacterial infection that causes the sexually transmitted infection gonorrhea, if untreated, can travel through the blood and infect other areas of the body. When it attacks the joints, it’s called gonococcal arthritis. It’s characterized by stiffness, swelling, and tenderness upon movement, most commonly in the wrists, fingers, ankles, or toes.
“Women are often asymptomatic or symptoms are more subtle, so they may not associate joint pain with [gonorrhea] infection,” says Damian P. Alagia, III, MD, medical director of woman’s health for Quest Diagnostics. “Considering recent sexual activity may provide the best insight into whether there was exposure to gonorrhea.” Other gonorrhea symptoms include fever, burning during urination, or a skin rash. The infection can be cleared up with antibiotics, but if not treated can lead to joint damage.
If you have an underactive thyroid (known as hypothyroidism), which causes your metabolism to slow, you may feel joint pain—but the condition itself might not be the direct reason for it. Hashimoto’s thyroiditis, the autoimmune disease that causes most cases of hypothyroidism, often occurs alongside other autoimmune conditions that cause joint pain.
“Most endocrinologists believe that many people with hypothyroidism suffer from joint pain; however most thyroidologists in the field do not believe that hypothyroidism itself is responsible for the joint pain,” says Noah A. Bloomgarden, MD, an endocrinologist in the Department of Endocrinology, Diabetes, and Metabolism at Montefiore Health System. “Joint pain may be a sign of an underlying susceptibility to other rheumatologic or autoimmune diseases.”
Other symptoms of hypothyroidism include fatigue, constipation, dry skin, and feeling cold. The disease is fortunately easily diagnosed with a blood test and treated with thyroid medication. But if you are diagnosed with hypothyroidism and have joint pain, talk to your doctor about whether you could have another condition as well.
If you notice you have joint pain in one specific bone region (like your leg or arm) that’s getting worse and worse, it’s worth a call to your doctor. Though rare, such pain is associated with bone cancer, as tumors can cause joint discomfort. Swelling may also be present. In addition, bone cancer can make fractures more common, so if you’re having pain and then have a fracture in that area, your doctor may want to do blood tests, imaging, or a biopsy to rule it out. Although joint pain is more often caused by other conditions, such as arthritis, it’s best to be aware of all the possibilities and bring them up with your doctor if you’re concerned.
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