What Is Rest Pain?

Arthritis or arthropathy involves a wide range of diseases, with a wide variety of etiology, and common clinical symptoms can manifest arthralgia. Arthritis caused by any cause can usually be cured or relieved if timely medical treatment is provided.

Basic Information

English name

arthralgia

Visiting department

orthopedics

Common locations

joint

Common causes

Ligament damage, cartilage damage, joint synovitis, autoimmune diseases, trauma, osteoarthritis, osteoporosis, etc.

Common symptoms

joint pain

Causes of joint pain and common diseases

Ligament injury

Periarticular ligament damage The stability of knee ligaments is relatively poor when the knee joint is slightly flexed. If external force suddenly causes valgus or varus at this time, it may cause medial or lateral collateral ligament damage. The patient has a clear history of trauma, knee pain, swelling, ecchymosis, and restricted movement.

Cartilage injury

It is mainly the meniscus injury of the knee joint. When the knee joint is slightly flexed, if the knee is excessively extended internally or externally, it may cause meniscal tear. Meniscus injuries will have a noticeable tear in the knee, followed by joint pain, limited mobility, lameness during walking, and bounces when the joints move.

3. Joint synovitis

After the joint synovium is damaged due to trauma or excessive strain, a large amount of fluid will be produced, which will increase the pressure in the joint, causing joint pain, swelling, tenderness, and frictional noise. For example, when the knee is actively straightened, especially when the knee is stretched with a certain amount of resistance, the pain in the lower part of the sacrum will increase. Pain can also increase significantly during passive extreme flexion.

4. Diseases of the autoimmune system

Immune system diseases such as lupus erythematosus and psoriasis can also invade joints and cause swelling and pain.

5. Growth pain in children

These patients are mainly children in the growing season, more common in boys. Pain is common in the knee and hip joints. This condition is a normal physiological phenomenon that occurs during the growth and development of children.

6. Traumatic joint pain

Due to some kind of accident or accident, the joints in the shoulder, wrist, knee, ankle and other parts have suffered trauma (such as soft tissue injury, fracture dislocation, etc.) without serious fractures and other joints causing joint pain.

7. Purulent arthritis

There is a history of infection in other parts of the body or a history of local trauma. Painful joints may be swollen, and the depth may or may not be obvious, but there are symptoms such as increased body temperature, joint pain, inability to move, and increased blood.

8. Osteoarthritis

Osteoarthritis occurs mostly after the age of 40 years. Joint pain is more severe in the morning and lighter in the day and night. Bone hyperplasia at the joint site and bone spurs rubbing the surrounding tissue can cause joint pain.

9. Osteoporosis

Elderly women have pain in multiple joints throughout the body and feel particularly weak. They cannot walk with weights. If other diseases are ruled out, they may have osteoporosis. 10. Rheumatoid and rheumatoid arthritis mostly occur in women aged 20 to 45 years. Rheumatoid arthritis is often a migratory pain. Pain, swelling, and stiffness often occur in the wrist, and joint sensitivity and swelling and pain occur simultaneously, and they occur symmetrically.

11. Gouty arthritis

Gout pain is common in the thumb and the first metatarsophalangeal joint (outside of the thumb). Mainly due to consumption of seafood and alcohol to induce purine metabolism disorders in the body.

12. strain

The pain caused, due to the relatively large amount of joint activity, leads to strain on the soft tissues such as the muscles around the joint, and then causes pain. Common shoulder inflammation, tennis elbow, etc. are common.

13. Tumor-induced pain

Local tumors in the joints are also one of the important factors that cause joint pain. They are more common in children and the elderly during growth and development. If there is joint swelling and pain, the pain is more severe at night than during the day, and taking analgesics is not effective. You should go to the hospital for further examination to rule out joint tumors.

Joint pain examination

Medical history

In the diagnosis of joint pain, it is important to first ask for a detailed medical history.

2. Physical examination

Joint pain should undergo a comprehensive and detailed physical examination. Check the joint for redness, swelling, venous bulge, sinus tract, scar, muscle atrophy, deformity, etc. Palpate to see if the sides are symmetrical, equal length, and if there is joint fluid. Such as the knee joint floating body test, is a common method to check joint effusion. Gait is also an important manifestation of joint disorders, such as lameness, duck gait, jumping gait, sluggish and paralytic gait, spastic gait, etc .; some joint lesions may pop when joints move.

3. Laboratory inspection

(1) There are many methods for checking rheumatoid factor (RE) , but the basic principles are the same. Except for systemic lupus erythematosus, the positive rates of other joint diseases and joint lesions were lower (<50%).

(2) Lupus erythematosus cell test is a kind of phagocytic cells that have taken up degenerate nucleus. About 80% of patients with systemic lupus erythematosus can be found, and 18% of rheumatoid arthritis patients can see lupus erythematosus cells. Chronic active hepatitis, drug allergy, progressive systemic sclerosis, nodular polyarteritis, and dermatomycosis are sometimes seen with lupus erythematosus cells.

(3) Erythrocyte sedimentation rate Erythrocyte sedimentation is the simplest and most important detection method for measuring various rheumatic and inflammatory diseases. Increased erythrocyte sedimentation rate can be seen in various diseases such as acute rheumatic fever, acute infection, active tuberculosis, rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, and malignant tumors.

(4) Anti-streptolysin "O" test, such as the anti-streptolysin "O" titer is higher than 500U, indicating that the patient has been infected with hemolytic streptococcus recently, and is often used to help diagnose rheumatic fever.

(5) C-reactive protein Elevated C-reactive protein in blood is often used to understand the activities of acute rheumatic fever and rheumatoid arthritis.

(6) Anti-nuclear antibodies This test is often used for the diagnosis of connective tissue disease, especially in systemic lupus erythematosus, with the highest antibody titer and positive rate, and the most specific diagnosis.

(7) Immune globulin and complement can be used to observe the status of immune function, and it is helpful to the diagnosis of connective tissue diseases such as liver disease, autoimmune disease, chronic bacterial, viral and parasitic infections, and tumors.

(8) Detection of HLA-B27 HIA-B27-positive patients are most commonly seen in ankylosing spondylitis, with a positive rate of 86% to 96%.

(9) Determination of uric acid and uric acid in blood.

(10) Synovial fluid examination Acute inflammation of synovial fluid, showing sparse flocculent protein clots. The number of leukocytes in degenerative joint disease is (0 to 1) / L, and rheumatoid arthritis is (3 to 15) x 10, or even more.

4. Arthroscopy

Arthroscopy is a new surgical technique that has been widely used in knee, shoulder, elbow, hip, and ankle joints, and can even be used for inspection and treatment of wrist and interphalangeal joints. The arthroscopy technique has less damage and quicker recovery, and can directly observe the structural changes in the joint with the naked eye, which is more accurate than imaging examination.

5. Imaging examination

X-ray film is one of the conventional examination methods for joint diseases. It mainly looks at changes in bone quality, especially for bone tumors at the joint site, bone destruction, deformity, and swelling of joint exudates, which has obvious diagnostic significance. CT and MRI are also methods for examining joint lesions.

Differential diagnosis of joint pain

Pain characteristics

(1) Fast, slow and occult.

(2) The front, back, medial, lateral, and non-positioned parts.

(3) Persistent pain and intermittent pain.

(4) Severity (degree).

(5) Factors that worsen or alleviate dull pain, tingling pain, rest pain, exercise pain, and nocturnal pain.

(6) Whether you can continue to move or bear weight after an acute injury or have to stop moving due to pain.

2. Mechanical symptoms

(1) Interlocking meniscus ruptures and free body.

(2) Burst acoustic ligament damage.

(3) The cracking of the meniscus.

(4) Soft knee instability (sacral subluxation, ligament tear, meniscus rupture).

3. Swelling and effusion

(1) Acute (within 2 hours), large amount, and high tension: torn ligaments or intra-articular fractures (hematomas).

(2) Chronic (24-36 hours), mild to moderate: meniscus injury or ligament injury.

(3) Recurrence after activity: meniscus injury.

Joint pain treatment principles

1. Non-hormonal anti-inflammatory drugs

Anti-inflammatory and analgesic effects are achieved mainly by inhibiting the synthesis of prostaglandins. Such drugs can still increase lysosomal membrane stability and reduce enzyme release. But such drugs can only reduce symptoms and cannot control the development of the condition. Such drugs are: indomethacin; aspirin; indomethacin; ibuprofen; naproxen; flufenamic acid.

2. Relief drugs

Can affect the disease's immune response pathological process. Such drugs are: gold salts; penicillamine; chloroquine and its derivatives; levamisole and the like.

3. Adrenal glucocorticoids

Application indications are: When conventional treatment is not effective, it can be combined with first- and second-line drugs. Severe extra-articular complications, such as pericarditis, pleurisy, vasculitis, and iridocyclitis.

4. Immunosuppressive

Also known as "third-line" drugs. It can be applied to those who do not respond to first-line or second-line drug treatment or have severe reactions. Such drugs are: cyclosporin; sulfasalazine cyclophosphamide; azathioprine; methotrexate and so on.

5. Molecular immunity

Such drugs are: gamma interferon; specific antibodies (McAb) and so on.

6. Other

For joint pain caused by degenerative changes, physical therapy and taking painkillers can alleviate the pain temporarily, but they cannot change the fundamental problem of cartilage loss.