Muscle and joint pain

Myalgia and arthralgia are pains in muscles and joints, these two painful conditions often accompany each other, despite the fact that they develop in completely different tissues in structure. Often the nature of the pain is so vague and undefined that the patient points to the joint, but in fact it is the inflamed muscle that hurts.

Quite recently, a definition appeared in medical terminology that is most suitable for describing simultaneous pain in muscles and joints - myoarthralgia, there are also more deeply studied nosologies with similar clinical picture - rheumatoid arthritis (RA), rheumatic polymyalgia. These diseases include all signs, symptoms, conditions related to the musculoskeletal system and muscles.

In the 21st century, several completely unique areas of medical specialization have also emerged, including myology, so muscle pain should be treated by a specialist - a myologist, but there are only a few such doctors in the world, so myoarthralgia is still treated by rheumatologists.

The combination of pain in muscles and joints is considered to be a fairly common phenomenon; according to statistics, 90% of patients with rheumatism present precisely such complaints. In case of joint diseases, damage to the skeletal muscles surrounding the joint is inevitable. Following the pathology of bone tissue, muscle tissue also changes, causing pain, deformation, and sometimes joint contracture. All this complicates diagnostics and timely recognition of the underlying cause of the condition, since it is often the muscle symptom that debuts first and prevails. This is due to the physiological and anatomical connection of skeletal muscles, ligaments, tendons, and joints. There is another etiological version. Currently, some progressive specialists consider rheumatic pain as a symptom complex, in the pathogenesis of which muscles play the main role; modern scientists believe that their damage leads to joint pathology and manifests itself as myoarthralgia.

[ 1 ], [ 2 ], [ 3 ]

Causes of Muscle and Joint Pain

The true causes of muscle and joint pain still remain a diagnostic mystery, since both myalgia and arthralgia are symptom complexes of unclear etiology. Modern microbiologists have identified several types of infections - provocative agents of all types of rheumatoid arthritis, which is considered the main disease with myoarthralgia clinical picture. Factors causing acute polyarthritis, monoarthritis, polyarthritis and generalized myalgia primarily belong to the autoimmune, secondarily - to the viral and bacterial categories, and only 15-20% of them can be considered traumatic.

The following causes of pain in muscles and joints are distinguished:

• Autoimmune pathologies – RA (rheumatoid arthritis), scleroderma and its types, all types of rheumatism, systemic lupus erythematosus.
• Metabolic disorders in the tissues of the skeletal system, cartilage – gout, osteoarthritis, osteoporosis.
• Traumatic damage to a joint or muscle – sprains, blows, fractures, bruises and ruptures of the synovial sac (bursa). Any, even the weakest blow to the muscle will inevitably lead to minor trauma to the joint due to the single blood supply system.
• Viral diseases – acute respiratory viral infections, flu, TORCH infections. Hyperthermia (high temperature) leads to the spread of the virus through the bloodstream, when it is able to penetrate muscle tissue and even reach the joint. Retroviruses, Epstein-Barr virus, herpes virus, rubella, cytomegalovirus, mycoplasma, rubella virus are especially dangerous.
• Hypertonicity and pain in joints and muscles due to physical overexertion and training.
• Osteochondrosis, deforming articular osteochondrosis.
• Neurological pathologies (muscle compression neuropathy, nerve entrapment).
• Joint ganglia (synovial bursa cysts).
• Congenital anomalies of the musculoskeletal system (achondroplasia, congenital hip dislocations).
• Physiological conditions that provoke transient arthralgia and myalgia, such as pregnancy.

Rheumatologists pay special attention to the Epstein-Barr virus, since its elevated titers are found in 85-90% of patients suffering from RA (rheumatoid arthritis). This is a polyclonal cellular virus that activates the pathological synthesis of antigens, as a result of which the immune system becomes tolerant to external and internal harmful pathogens, and eventually a systemic, chronic inflammatory process develops. Also dangerous are DNA-containing parvoviruses, retroviruses, mycobacteria, which provoke diseases, in the clinic of which pain in muscles and joints is noted.

Why do muscles and joints hurt?

One of the reasons why muscles and joints hurt may be a little-studied disease – fibromyalgia. Often, its symptoms “imitate” typical joint pain of rheumatic origin.

Fibromyalgia is a systemic, chronic disease of unclear etiology, which is definitely not related to inflammatory or autoimmune pathologies. The diagnosis of diffuse muscle pain, which often spreads to the joints, is confirmed if the patient presents similar complaints for 3 months and the possible disease does not respond to treatment with anti-inflammatory, analgesic and antirheumatic drugs. In addition, fibromyalgia is characterized by certain trigger points in which pain is localized. These points are identified by palpation and physical examination. The symptoms also include complaints of specific morning weakness, stiffness, numbness in the limbs, transient but systematic diffuse pain in the back, neck, arms, lower back, and calf muscles. The clinical picture of fibromyalgia is very similar to the manifestations of rheumatism; often a person is treated for it and cannot understand why muscles and joints hurt, despite various therapeutic methods, including folk ones.

This concerns, first of all, self-medication, which is often present in our lives. No competent doctor will diagnose a rheumatic disease without examination, and in the case of fibromyalgic syndrome, studies do not determine the parameters of inflammation and other signs of rheumatic pathologies in joints, bone and muscle tissue.

Also, the answer to the question "why do joints and muscles hurt at the same time" can be elementary overstrain, when constant muscle tone provokes autonomous development of spontaneous pain symptom. Pathogenetically, this process looks simplified as follows: tension - hypertonicity - spasm - sensation of pain - new spasm and consolidation of hypertonicity. Such an abnormal muscle "corset" does not contribute to normal nutrition of bone and cartilaginous tissue of the joint, myogenic ischemia, microcirculation disorder, tissue acidosis, accumulation of cell decay products, joint inflammation develop.

Why do joints and muscles hurt?

The human body includes more than 600 types of muscle tissue, each of which in turn performs important functions, including providing motor, ligamentous function of joints. All muscles consist of many thousands of tiny thin muscle fibers. Any abnormal process in muscles, in their tissue can provoke pain symptoms. Among those who studied the relationship between muscle and joint diseases and pain, was the great Greek physician, Hippocrates, who was the first to find out why joints and muscles hurt. Several thousand years ago, he described an acute inflammatory process in the joints and called it "arthritis".

Despite such a long history, doctors still cannot identify specific causes that explain the etiology of arthritis, but it has been established that muscle and joint dysfunction is provoked in the following way:

• Changes (systemic or situational, temporary) in the contractile function of muscles, skeletal muscles.
• Long-term hypertonicity contributes to the development of local compactions in muscle tissue and disruption of joint nutrition.

In turn, overexertion, hypertonicity, muscle hardening, and joint pain can be caused by the following factors:

• Various types of posture disorders that cause joint deformations and provoke muscle pain. This category also includes professional disorders – constant sitting work, wearing specific shoes (high heels), which violate all the laws of anatomically acceptable biomechanics.
• Autoimmune diseases, often genetically determined.
• All types of rheumatism, rheumatoid arthritis, rheumatic polymyalgia.
• Osteochondrosis is a degenerative process that gradually deforms the spine, therefore activating compensatory overload of both muscles and joints.
• Pathological deformation of the spine.
• Forced prolonged stay in a horizontal position in chronically ill patients, people with severe injuries.
• Joint stiffness and myalgia can be caused by intense training and physical overload.
• Trauma, regardless of its severity, is in any case accompanied by microdamage to muscle tissue, disruption of microcirculation and nutrition of joints and muscles.
• Endocrine diseases.
• Vascular pathologies that provoke atrophy of muscle and bone tissue.

In short, it is quite difficult to determine why muscles and joints hurt; the accuracy and speed of diagnosis and the effectiveness of treatment are directly related to the timely visit of the sick person to the doctor.

When all your muscles and joints hurt?

As a rule, diffuse pain indicates either the degree of neglect of the pathological process, or certain diseases for which such a symptom is characteristic.

All muscles and joints hurt - this is a sign of the following pathologies:

1. Rheumatic polymyalgia. The disease is rarely diagnosed, on average one patient per thousand who seek rheumatic complaints. Most often, rheumatic polymyalgia affects women over 50-55 years of age, representatives of the stronger sex and young people, children suffer from this disease very rarely. As in the case of other rheumatic types, the etiology of RP is not fully understood, but statistical data allow us to talk about psychogenic factors in combination with autoimmune pathological processes. Clinical manifestations are non-specific, patients complain of "all muscles and joints hurt." During physical examination, the localization of pain is specified, most often pain and stiffness are expressed in the hips and shoulder joints. X-ray does not reveal deformation, degeneration of the spine, joints, rather rheumatic polymyalgia refers to inflammatory diseases. The main leading diagnostic criteria are muscle weakness (hips, buttocks, arms) and symmetry of symptoms, but initially, before the development of such atrophy, RP manifests itself with transient painful polymyalgia. The pain may intensify in the morning during the first attempts to make a movement, at night or at rest the pain subsides. The list of symptoms of RP includes elevated body temperature, weight loss, and depressive state.
2. Fibromyalgia is a disease of unknown etiology, which most often affects muscle tissue, but diffuse pain can also be felt in the joints. Characteristic clinical criteria are certain trigger zones in which diffuse musculoskeletal pain is localized. Painful sensations are accompanied by stiffness, joint stiffness in the morning, weakness, decreased activity. Although the muscles are the primary source of pain, they do not become inflamed in the same way as the joints, there is no irreversible damage or destruction, which allows us to differentiate fibromyalgia from various rheumatological pathologies.

When do joints and muscles in the arms hurt?

Myoarthralgia of the upper limbs can develop first in the area of large joints, such as:

• Shoulder joint.
• Elbow joint.
• Wrist joint.
• Joint of the wrist.
• Joints of the fingers.

In addition, the joints and muscles of the hands hurt due to damage, inflammation or injury to the periarticular, periarticular tissues, which primarily include the tendon-ligament apparatus, as well as bursae, fascia and muscles.

The reason why myoarthralgia develops in the hands may be the following:

• Tendonitis.
• Tendinitis.
• Myotendinitis.
• Bursitis (inflammation of the synovial sac of the joint).
• Ligamentitis (an inflammatory process in the ligament, with reflected pain in the muscles and joints).
• Enthesitis (an inflammatory process in the area where the joint and tendon attach).
• Fibrositis.
• Fibromyalgia.

What diseases cause pain in the joints and then in the arm muscles:

• Rheumatoid arthritis is the most common disease.
• Osteoarthritis.
• Brachial plexitis.
• Neuralgic amyotrophy.
• Injuries to the joints of the hand.
• Gout.
• Arthritis.
• Psoriatic arthropathy.
• Polyarthritis (pain in five joints of the hands at once).
• Carpal tunnel syndrome.

How to determine where the root cause is with movement tests?

Movement and pain	What gets damaged, gets inflamed
Moving the arm back and to the side	Shoulder joint capsule compression syndrome, subacromial impingement syndrome
The hand is raised upward as much as possible	Injury to the acromioclavicular joint
External rotation of the arm (combing)	Inflammation or injury of the tendon of the infraspinatus muscle, teres minor muscle
Internal rotation, when pain occurs when moving the arm back	Inflammation or injury of the subscapularis tendon
Pain when bending the arm at the elbow and supination when lifting weights	Damage, inflammation of the biceps tendon of the shoulder girdle
Almost all hand movements are impaired	Chronic inflammation, damage to the capsule of the shoulder joint or the joint itself
Pain in joints, shoulder muscles, arm at rest	Possibly - plexitis, all types of compressions included in the thoracic outlet syndrome - scalene muscle syndrome, costoclavicular syndrome, cervical rib syndrome and others

In addition, myoarthralgia, that is, a combination of pain in the joints and muscles, is often a symptom of traumatic injuries - sprains, bruises, ligament ruptures. Such conditions can clinically manifest as a classic joint syndrome, but have a very specific cause - trauma. Damage to muscle-tendon structures is inevitably accompanied by painful sensations both in the periarticular tissues and partially in the joints that they surround.

Why do joints and leg muscles hurt?

What causes myoarthralgia in the legs?

If your joints and leg muscles hurt, the following provoking factors and diseases can be assumed:

• Neuralgia, neuritis.
• Degenerative processes in the spine.
• Radiculopathy.
• Rheumatoid arthritis.
• Bursitis.
• Myotendinitis.
• Fasciitis.
• Myoenteritis, paratenonitis.
• Injuries, bruises.
• Vascular pathologies – atherosclerosis, varicose veins, thrombophlebitis, lymphostasis, endarteritis.
• Hypertonicity from overload (training, strength activities).
• Crush syndrome.
• Fibromyalgia.
• Gout.

It should be noted that the joints and muscles of the legs often hurt during an inflammatory process in the periarticular tissues, that is, the symptom itself does not relate to the joint, but is subjectively felt in it as repercussion (reflected).

The cause of pain in periarticular tissues may be the following rheumatic pathologies:

1. Periarthritis of the hip joints, when the tendons of the gluteal muscles and simultaneously the synovial bag of the hip joint become inflamed. The combination of pain in the joint and muscles increases with any movement, especially when walking, and passes at rest.
2. Periarthritis of the knee, when pain develops in the area of the inner surface of the joint. The symptom increases when walking, in motion, and gradually subsides at rest.
3. Baker's cyst or bursitis of the popliteal zone, the disease is a continuation of almost any deformation of the knee joint. The cyst, descending to the back of the shin, provokes muscle pain (in the calf muscle), in the joint it hurts at the same time due to the inflammatory nature.
4. Aponeurosis, tendinitis of the heel tendon, bursitis of the heel bone - these conditions are characterized by severe pain localized at the site of inflammation or damage.
5. Fibromyalgia is a chronic musculoskeletal pain of unknown etiology, often subjectively affecting the joints.

Symptoms of Muscle and Joint Pain

Clinically, the painful sensations of myarthralgia are related to the symptoms of rheumatoid arthritis, since this disease demonstrates a combination of pain in the joints and muscles. Symptoms of pain in the muscles and joints may depend on the localization of the sensation, and what pain symptom was first - muscle or joint. For the diagnosis of myoarthralgic symptoms, an accurate description of the pain from the patient is very important, therefore, as an introduction, we will provide a list of some parameters proposed in the international classification of pain:

1. Clinical course by time, duration:

• Acute and short-term pain (shooting pain, lumbago).
• Acute and recurrent pain.
• Chronic long-term pain.
• Chronic, constant, unrelenting pain.
• Progressive pain.
• Non-progressive pain.

2. Definition of myoarthralgia depending on the type of disorder:

• An epicritic pain symptom that develops due to a violation of the integrity of barrier tissues, in this case, the joint capsule. Epicritical pain is a signal of damage and violation of differentiation, isolation of internal structures. Pain of this type is felt in a specific place, it is easy to recognize and differentiate, it is usually acute, short-term and not too intense.
• Protopathic symptom is a pain signal of oxidative dysfunction in tissues, and in this case – in muscles. The pain is aching, dull, perceived as diffuse, diffuse, poorly differentiated and defined in terms of localization.

A specific symptom of rheumatoid arthritis is myalgia, in addition to the characteristic pain in the joints, almost all patients complain of muscle pain. The statistics are as follows:

• 82-90% of RA patients complain of pain in the muscles and joints (leg and arm muscles, less often in the muscles surrounding the hip joint).
• 58-60% of patients note the onset of pain in the joints, and then, against the background of arthralgia, pain in muscle tissue appears.
• 31-35% complain of simultaneous pain - myoarthralgia.
• 35-40% of patients with rheumatoid arthritis suffer from morning stiffness in both muscles and joints.
• 45-50% of patients have clinically pronounced weakness and atony of skeletal muscles.
• Progressive muscle wasting in RA is observed in 80% of patients.

Symptoms of muscle and joint pain are characterized by moderate intensity, but they are usually persistent and recurring. The intensity of pain can change during the day depending on the position of the body, the temperature factor and methods of pain relief. In general, the symptoms of myoarthralgia can be divided into two types - inflammatory and mechanical:

• Myoarthralgia of inflammatory etiology is most often observed in cases of chronic arthritis. The pain intensifies at night and early in the morning, accompanied by morning stiffness and rigidity. The pain gradually passes after warming up the muscles and joints.
• Myoarthralgia of mechanical etiology is pain caused by degenerative processes in the joints, more often with osteoarthrosis. The pain intensifies in the evening and subsides in the morning. Also, the pain symptom can develop due to physical stress, load, the pain goes away at rest.

Hip muscle pain

The hip joint is considered one of the most vulnerable to various injuries of both degenerative and inflammatory nature. Pathology that provokes pain in the muscles of the hip joint can be localized in the joint itself, but also in the tissues surrounding it. Most often, the pain symptom in this area is provoked by such factors, diseases that relate to pathologies of the skeletal system:

• Traumatic injury to a joint, accompanied by pain in muscle tissue.
• Trauma of periarticular tissues.
• OA – osteoarthritis.
• Rheumatoid arthritis.
• Perthes disease is a dissecting osteochondropathy of the femoral head, most often diagnosed in children.
• Tuberculous coxitis.
• Osteomyelitis.

In such cases, pain in the hip area begins in the joint and then moves to the muscles. However, there are also periarticular diseases in which pain in the muscles of the hip joint is an independent symptom:

Disease	Symptoms
Bursitis of the iliopectineal bursa	Swelling and pain in the inner thigh, lower abdomen in the groin area, pain radiating to the thigh muscles when walking, squatting
Inflammatory process in the greater trochanter bag of the hip bone	The inflammation is a consequence of osteoarthritis, the pain is localized in the area of the greater trochanter and radiates to the thigh muscles
Trochanteric bursitis, trochanteric enthesitis	The pain develops in the lying position, the patient cannot turn on his side, pain in the thigh muscles appears when abducting the hip
Adductor Tendinitis	A typical sports injury, pain is localized in the groin area, intensifies in the muscles of the thigh, leg when abducting the hip joint.
Inflammation of the sciatic bursa, sciatic bursitis	Pain in the gluteal muscles develops when squatting, if a person sits on a hard surface, the symptom intensifies when bending the hip
Periformis syndrome, piriformis syndrome	Hip joint muscle pain is localized in the buttock or lumbar muscles, it can also develop in the sacroiliac joint, in the muscles of the back of the thigh. The pain intensifies at night, when getting out of bed or from a sitting position

Pain in the muscles of the elbow joint

The movement of the elbow joint is controlled by the following muscles, in which pain may develop:

• Triceps muscle – extends the elbow (supination).
• The medial brachialis and biceps brachii muscles flex the elbow (pronation).

Pain in the muscles of the elbow joint may not be associated with pathological processes. Thus, those who are intensely involved in fitness, developing muscles, may experience incomplete supination (extension) of the elbow due to hypertonicity of the flexors of the forearm, which is accompanied by a transient pain symptom.

Those people who, on the contrary, do not pay any attention to strengthening muscle tissue, may experience pain in the elbow muscles during pronation (flexion) up to excessive hyperextension due to weak muscles.

There are many reasons why elbow joint muscle pain occurs, some of them are related to physiological, reversible factors, others are associated with pathological processes, most often in the joint itself. To clarify the diagnosis of the disease, in addition to general clinical studies, functional tests are carried out to determine the position of the elbow joint, the nature of pain during the test. If the flexion of the sore elbow becomes constant (compensatory slight bend in any position of the body), this indicates the accumulation of exudate due to thickening, inflammation of the synovial membrane, degeneration of the joint. When the elbow hurts, but bends with difficulty, it is easier for a person to keep his hand straight, this may indicate true muscle pathologies of the elbow - myositis, polymyositis and other diseases of muscle tissue.

Elbow muscle pain. Diseases of the musculoskeletal system:

• Epicondylitis of the joint. A degenerative inflammatory process in the muscles and tendons surrounding the elbow joint. Most often, epicondylitis is typical for musicians, tennis players, and those whose professional activities involve constant hand movements. Symptoms: pain appears under load, mainly when rotating or supinating (extending) the arm. Passive movements of this kind performed by a doctor with the patient's arm do not cause pain, which allows for the rapid exclusion of arthrosis or arthritis of the joint.
• Elbow myotendinitis is an inflammatory process in the tendon, gradually spreading to the muscle tissue of the forearm. The causes of myotendinitis are also associated with professional activity, performing rhythmic, monotonous movements of the hand. In addition, provoking factors can be rheumatic diseases, injuries, sprains, gout. Symptoms - myotendinitis caused by rheumatism is characterized by constant pain, even at rest. Other types of tendinitis are characterized by pain when performing active movements with painlessness of passive movements. Hyperemia of the skin is possible, a characteristic "crunch" sound during movement.
• Pinched ulnar nerve - cubital tunnel syndrome. In essence, this is traumatic ischemia of the ulnar nerve caused by a blow. Such sensations are familiar to many who have hit the corner of the elbow. If such an injury occurs during a fall (a strong blow) or is repeated with enviable consistency, the ulnar nerve, passing through the injured canal, is compressed. The cause may be not only an injury, but also professional activity - drivers (constant switching of levers, workers operating machines in factories, etc. Symptoms of chronic trauma - numbness of the hand, little finger and ring finger, pain gradually increases. The blow provokes a feeling of shooting pain (Tinel's symptom). The ulnar nerve innervates the flexor of the wrist, fingers, palmar muscles, that is, the pain most often "shoots" into the hand.
• Eosinophilic diffuse fasciitis of the elbow is a systemic fibrous disease of the fascia, connective tissues, as well as subcutaneous tissue, and adjacent muscles. Diffuse fasciitis is considered a type of scleroderma, therefore, its etiology has not been sufficiently studied and clarified. Symptoms are gradual compaction of the dermis, subcutaneous tissue, soft tissues, which provokes a noticeable limitation of elbow joint mobility, contracture, flesh to flexion contracture of the fingers. A specific sign is spontaneous muscle pain in areas of compacted tissue, uneven "orange" skin.
• Bursitis is an inflammation of the synovial bag of the elbow process (bursa), most often of traumatic origin. Symptoms are an increase in the bursa, swelling, puffiness, pain, but without limiting the range of motion. Progressive inflammation, purulent, phlegmon can provoke symptoms similar to those of myositis.

Reflected pain in the muscles of the elbow joint can also be caused by osteochondrosis of the cervical spine; in this case, the symptoms are localized throughout the forearm in the biceps muscle.

Diagnosis of pain in muscles and joints

Muscle and joint pain are not considered independent diseases in medicine, rather they are complex, multi-component symptoms. Considering that arthralgia and myalgia almost always “coexist”, it can be extremely difficult to determine the root cause of the pain.

Diagnosis of muscle and joint pain depends on the accuracy of identifying the anamnestic and clinical characteristics of the symptom, when and under what circumstances it develops, as well as on a set of physical examinations. As a rule, diagnosis of combined pain (joint and muscle) is the prerogative of a rheumatologist. In order to differentiate possible pathological causes, a whole diagnostic complex is prescribed, the main indicator of which is a standard clinical and biochemical analysis of blood serum, as well as serological reactions. To confirm or exclude the suspected diagnosis, radiography, tomography, podography, ultrasound of the joints, arthrography are prescribed, and punctures are possible to collect intra-articular fluid for microbiological and cytological examination.

Diagnosis of muscle and joint pain in more detail:

1. Basic analytical blood tests that are not specific but provide direction in diagnostic searches for the root cause of the symptom and show the degree of activity of the process. ESR, protein metabolism, acidic enzyme content (proteinases, phosphatase, cathepsins, deoxyribonuclease) indicators make it possible to search for the onset of symptoms in Bechterew's disease, rheumatism, polyarthritis. These pathologies are manifested by combined myalgic and arthralgic symptoms:

• Blood analysis serves as an indicator of the ESR level as a parameter of the inflammatory process. An increased level of erythrocyte sedimentation rate (ESR) with normal leukocyte limits is always evidence of rheumatic damage. If leukocytes are also increased, this may be a sign of a focal infectious process in the spine or joints. •
• A biochemical blood test for myalgia and arthralgia is an indicator of CRP - reactive protein. Biochemistry also reveals a DFA test, a definilamine reaction that determines the quantity and quality of DNA - deoxyribonucleic acid as one of the indicators of the type of rheumatic disease. The analysis shows the presence of fibrinogen, cholesterol, AST and ALT-ferase, seroglycoids and many other elements

2. Immunological tests help to identify many diseases of the musculoskeletal system at an early stage, for example, Bechterew's disease, rheumatoid arthritis, infectious bacterial inflammation (streptococcal infection), and so on:

• If the Valera-Rose reaction is positive, the doctor continues diagnostics in the direction of the rheumatoid factor. Its indicator is also the presence of an antiglobulin body in the blood serum.
• The ASL-O test, a blood reaction with antistreptolysin, shows the immune response to a suspected streptococcal infection (infectious inflammation of the joints, infectious polyarthritis).
• The HLA system is an indicator of the early stage of Bechterew's disease, when HLA complexes are detected in the blood (in cell membranes).
• Determining the rate of inhibition of the movement (migration) of leukocytes helps to identify rheumatoid arthritis and other types of rheumatism.

3. A synovial fluid puncture is necessary in case of combined symptoms – pain in joints and muscles to determine the type of joint damage – degenerative, traumatic or inflammatory. The puncture involves immunobiological and histochemical studies of the exudate of the synovial membrane of the joint.
4. If pathological diseases of the spine or skeletal system are suspected, X-rays are mandatory, which are an important differential diagnostic method. X-rays help to identify the severity of the disease, the stage of the process and to build treatment prospects, including prognosis.
5. Tomography is needed to clarify the localization of suspected focal inflammations, deformations, as a rule, in the spine. Also, diagnostics of pain in muscles and joints in the spinal column area involves myelography - a contrast method of examining the spine.
6. Angiography is needed to determine the extent of suspected atherosclerotic changes in the vascular system, which primarily provoke muscle pain.

In addition, the patient may be prescribed the following tests:

• Phlebography, including intraosseous.
• Arthroscopy for joint diseases, especially knee diseases.
• Contrast arthrography.
• Contrasting discography.
• Biopsy.
• Radionuclide scanning.

It is obvious that the examination methods mainly concern bone tissue, joints, and the spine, which is due to more precise, specific indicators, in contrast to the methods that reveal muscle pain. To clarify the nature of myalgia, its type, which is combined with joint pain, methods are used (major and minor criteria of myofascial pain, a map of trigger points in fibromyalgia, tests, palpation and stimulation algometry, radiothermometry), recommended by the International Pain Association.

[ 4 ], [ 5 ]

Treatment of muscle and joint pain

Therapeutic measures directly depend on the severity of the symptom and the underlying cause, i.e. the disease identified. Treatment of muscle and joint pain is always comprehensive, since pain is localized in tissues of different structure and histology. Since the combination of myalgia and arthralgia is most typical for rheumatoid arthritis and osteoarthrosis, treatment consists of curating these diseases. Pain can begin both in the joint itself and in the periarticular tissues, in this case in the muscles, respectively, the pain symptom is the leading parameter in the choice of drugs and methods for treating pain. It should be noted that therapy for such combined clinical manifestations always requires a long, sometimes months-long course. Since the causes that provoke myoarthralgia are diverse, treatment involves the use of drugs from many pharmacological groups, often with contraindications and complications. In this regard, there are unspoken rules in rheumatology:

1. First of all, relieve the symptom.
2. The effect of pain relief should be as rapid as possible.
3. The pain-relieving drug must be as safe as possible.

Treatment of myoarthralgia can be divided into the following stages:

1. Symptomatic treatment:

• Nonsteroidal anti-inflammatory drugs.
• Steroid anti-inflammatory drugs.
• Analgesics in any form available and appropriate to the symptom.

2. Basic therapy:

• Drugs that suppress immune activity, immunosuppressants for 2-3 months, after which, if ineffective, the drugs are discontinued.
• Antibiotics may be prescribed for inflammatory processes of infectious etiology.
• Muscle relaxants may be prescribed for hypertonicity syndrome.

3. Additional methods:

• Acupuncture.
• Physiotherapeutic procedures – magnetic resonance, ultrasound therapy, balneotherapy.
• According to indications, tricyclic or other antidepressants, neuroleptics, which significantly change the sensations and perception of pain symptoms, may be prescribed.
• Plasmapheresis.
• Lymphocytophoresis.
• Electrophoresis with dimethyl sulfoxide.
• Phonophoresis with hydrocortisone.
• Diet therapy.
• Physiotherapy exercises.
• Sanatorium and resort treatment.

Treatment of myalgia, arthralgia depends not only on medical recommendations and prescriptions, but also on the efforts, motivation and self-control of the patient, since the course of therapy can be very long and sometimes painful. According to statistics, about 55% of patients with such complaints significantly improve their quality of life after a year of complex, persistent treatment, more effective indicators are achieved after 1.5-3 years of treatment. Sometimes the course of medication can be lifelong, everything depends on the genesis of the pain syndrome.

Prevention of muscle and joint pain

How to prevent muscle and joint diseases? This question has been asked by both patients and doctors for many centuries. At the end of the 19th century, the great physiologist Sechenov studied the work of muscles in detail and came to the conclusion that the normal function of the muscular and articular apparatus is directly related to the load and rhythm of movements. Accordingly, according to the opinion of many followers of Sechenov's teaching, the prevention of pain in muscles and joints directly depends on the competent distribution of motor activity, the optimal ratio of load and rhythm. In addition, the health of muscle and joint tissue, as well as the entire musculoskeletal system, is associated with a regular change in types of human activity. To simplify, we can say this:

• Static overstrain, as well as excessive zeal in the training process, overloads are a direct path to arthralgia and myalgia.
• physical inactivity, as well as constant, monotonous performance of monotonous physical actions, are a potential risk for the development of pain in muscle tissue and joints.

Overload is fatigue, hypertonicity, inflammation, and inactivity is a gradual atrophic change in the structure of muscle fibers, and therefore, degeneration of the musculoskeletal system.

As for the supposed causes of combined muscle and joint pain, autoimmune rheumatoid diseases, standard recommendations for the prevention of pain symptoms have not yet been developed. However, practicing rheumatologists advise adhering to the following rules:

• It is reasonable to distribute the physical load; in case of static tension, regularly perform warm-ups.
• Avoid physical overexertion, especially when playing sports. Complexes of training exercises should be developed by specialists with deep knowledge of anatomy, the structure of skeletal muscles, and the musculoskeletal system.
• Avoid temperature-provoking effects - hypothermia and overheating.
• Timely detection and treatment of infectious diseases, sanitization of inflammation sites, including in the nasopharynx and teeth.
• Regularly strengthen and harden your body, lead a healthy lifestyle.

Secondary prevention of muscle and joint pain is a set of measures to prevent relapses and complications after successful treatment: In this case, it is necessary to adhere to the following recommendations:

• Perform therapeutic exercise routines regularly.
• If your doctor prescribes regular medication, you should strictly follow his recommendations and not self-medicate.
• Follow a diet prescribed by a rheumatologist that limits salt, sugar, fats, and spicy foods.
• Systematically undergo medical examinations and tests, especially before the period of possible complications.

Summarizing the rather difficult topic of muscle and joint pain, we can conclude that the coordinated work of the muscles and the musculoskeletal system is inherent in the human body by nature itself. It is obvious that practically the entire life of a person depends on the correct and natural functioning of these two systems, as an argument we again cite the statement of Ivan Mikhailovich Sechenov: "Whether a girl is in a hurry for a first date, whether a soldier is going to attack, whether a poet is composing sonnets, in the end, it all comes down to one thing - to rhythmic or disorganized muscle contraction." Therefore, maintaining tone, reasonable training of the muscular system can ensure healthy joints and painless motor activity, sufficient quality of life.