Joint Pain

Joint pain vs joint inflammation

Joint pain is a symptom. It can happen with or without visible inflammation. When a joint is also swollen, warm and stiff, doctors call it arthritis or synovitis, covered on joint inflammation. Many common causes of joint pain, such as tendinitis, bursitis and early osteoarthritis, cause pain without much swelling. For the disease group itself, see arthritis.

Pain can also seem to come from a joint but actually arise nearby: from a tendon, bursa, ligament, muscle, bone or a pinched nerve. Shoulder pain from the neck and knee pain from the hip are classic examples.

Causes of joint pain in one joint

Causes of pain in many joints

Short-lived (under 6 weeks)

• Viral arthritis: joint pain, sometimes swelling, during or after viral infections such as parvovirus B19, hepatitis B, rubella, COVID-19 and chikungunya. It usually settles within weeks.
• Flu and other infections: generalized aching with fever.
• Reactive arthritis: after gut or genital infections.
• Serum sickness and medicine reactions.

Persistent (over 6 weeks)

• Rheumatoid arthritis: small joints of both hands and feet, swelling, long morning stiffness, fatigue.
• Psoriatic arthritis: with psoriasis or nail changes, swollen fingers or toes.
• Lupus: joint pain with rash, mouth ulcers, hair loss, fatigue, mostly in women 15 to 45.
• Polymyalgia rheumatica: over 50, aching and stiffness of shoulders and hips.
• Generalized osteoarthritis: hands, knees, hips and spine.
• Fibromyalgia: widespread pain felt in and around joints, with fatigue and poor sleep, but no joint damage or swelling.
• Joint hypermobility: very flexible joints that ache and sometimes partly dislocate, often in younger women.
• Thyroid disease, vitamin D deficiency and hemochromatosis (iron overload).
• Medicines: aromatase inhibitors for breast cancer, some cholesterol and diabetes medicines, and fluoroquinolone antibiotics (tendon pain).

Joint pain with fatigue

Joint pain plus tiredness is common in autoimmune conditions (rheumatoid arthritis, lupus, Sjogren's), viral illnesses, fibromyalgia, hypothyroidism, anemia, depression and Lyme disease. A doctor will usually check blood counts, inflammation markers, thyroid function and autoantibodies.

How doctors diagnose the cause

Your doctor will ask:

• Which joints hurt, and is it one side or both?
• Did it start suddenly or gradually? After an injury?
• Is there swelling, redness or warmth?
• How long is morning stiffness?
• Any fever, rash, eye problems, diarrhea, urinary symptoms, tick bites or recent infections?
• Family history of arthritis, psoriasis or gout?

Then they examine each joint and the surrounding tissues. Depending on findings, tests include:

• Blood tests: CRP, ESR, blood count, rheumatoid factor, anti-CCP, ANA, uric acid, thyroid, vitamin D, hepatitis and parvovirus serology
• Joint aspiration: for a swollen joint, to check for crystals and infection
• Imaging: X-ray for arthritis and fractures, ultrasound for fluid and tendons, MRI for soft tissue injuries

Joint pain relief and home treatment

• Adjust, don't stop: reduce the activity that hurts but keep moving. Prolonged rest weakens supporting muscles.
• Ice for 15 to 20 minutes after an injury or flare. Heat for stiffness and chronic aching.
• Exercise: strengthening the muscles around the joint is the best long-term treatment for knee and hip pain. Low-impact options include walking, swimming, cycling and water aerobics.
• Weight loss reduces knee and hip load.
• Pain relief: topical NSAID gel for knees and hands, acetaminophen (paracetamol), or oral ibuprofen or naproxen at the label dose. Avoid NSAIDs with kidney disease, stomach ulcers, heart failure or blood thinners.
• Supports: knee braces, insoles, wrist splints, a cane in the hand opposite a painful hip or knee.
• Physical therapy: for tailored exercise, manual therapy and advice.

Medical treatment depends on the cause, from steroid injections to disease-modifying medicines or surgery.

Supplements such as glucosamine and chondroitin have inconsistent evidence. Turmeric and fish oil may modestly help some people. Check with a pharmacist for interactions, especially with blood thinners.

Frequently asked questions

What causes joint pain all over the body?

Pain in many joints is commonly caused by viral infections, rheumatoid arthritis, lupus, psoriatic arthritis, polymyalgia rheumatica, fibromyalgia, widespread osteoarthritis and hypermobility. Thyroid problems, vitamin D deficiency and some medicines can also cause it. Blood tests usually help narrow down the cause.

When should I worry about joint pain?

Get urgent care for a hot, swollen joint with fever, a deformed joint after injury, or being unable to bear weight. See a doctor if pain lasts more than a few weeks, comes with swelling or long morning stiffness, affects several joints, or comes with rash, fever or weight loss.

Can a virus cause joint pain?

Yes. Many viruses, including flu, COVID-19, parvovirus B19, hepatitis B and C, rubella and chikungunya, cause joint pain and sometimes swelling. Viral joint pain usually settles within a few weeks, though some, like chikungunya, can last months.

Is joint pain a sign of arthritis?

It can be, but not always. Joint pain can also come from tendinitis, bursitis, injuries, viral infections and fibromyalgia. Arthritis is more likely if the joint is swollen, stiff in the morning for more than 30 minutes, or has been painful for more than 6 weeks.

What is the best painkiller for joint pain?

It depends on the cause and your health. Topical NSAID gels work well for knees and hands with few side effects. Oral NSAIDs such as ibuprofen relieve pain and inflammation but carry stomach, kidney and heart risks. Acetaminophen is gentler but less effective for arthritis. Ask a pharmacist which suits you.