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Pain in one joint
Last reviewed: 06.07.2025
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Monoarticular pain may be caused by joint disorders, be referred, or develop with damage to periarticular structures (e.g., bursitis or tendovaginitis). Pain caused by damage to intraarticular structures is more often observed in inflammatory arthritis, but may also be non-inflammatory (e.g., osteoarthrosis, intraarticular disorders).
Acute monoarticular pain requires urgent diagnostics, since in some cases, particularly in infectious (septic) and microcrystalline arthritis, it is necessary to immediately initiate adequate therapy. Both of these situations are accompanied by inflammation and can lead to intra-articular hemorrhages. Microcrystalline arthritis is most often caused by deposits of monosodium urate (in gout) or calcium pyrophosphate (in pseudogout). Also, acute damage to one joint can be the initial manifestation of psoriatic arthritis or various inflammatory polyarthritis. Less common causes of monoarthritis are osteomyelitis of the bones that form the joint, aseptic necrosis of the latter, foreign bodies, hemarthrosis (for example, in hemophilia or coagulopathy), tumors.
[ Diagnosis of pain in one joint
It is necessary to determine which structures (articular or periarticular) are the cause of the symptoms and whether inflammation is present. If inflammation is present or the diagnosis is unclear, an assessment for the presence of polyarticular symptoms and systemic manifestations is necessary along with an examination of all joints.
History. Severe joint pain that develops over several hours suggests microcrystalline (or, less commonly, infectious) arthritis. If there is a history of episodes of microcrystalline arthritis accompanied by similar clinical symptoms, a relapse of this condition should be assumed. Risk factors for gout include male gender, older age, and the use of diuretics and other drugs that increase the concentration of uric acid in the blood. Risk factors for infectious arthritis include immunosuppressive and corticosteroid therapy, diabetes mellitus, intravenous administration, including drugs, extra-articular foci of infection, a history of tick bites or residence in an area endemic for Lyme disease, a history of intra-articular glucocorticosteroid injections, and the installation of joint endoprostheses. The presence of urethritis may indicate reactive arthritis or gonococcal infection, but it should be borne in mind that gonococcal arthritis is often not accompanied by clinical manifestations of urethritis.
Pain at rest or when starting to move the joint suggests an inflammatory nature of arthritis, while pain that increases with movement and disappears at rest is characteristic of mechanical damage (e.g., osteoarthrosis). Gradual increase in pain is often observed in rheumatoid or non-infectious arthritis, but can also occur in specific infectious arthritis (e.g., tuberculous or fungal).
Physical examination. Pain that increases with passive motion of another structure (e.g., knee pain that increases with passive hip rotation) suggests referred pain. Pain that is greater with active than with passive motion may indicate tendinitis or bursitis; joint inflammation usually limits both active and passive motion. Tenderness or swelling on only one side of a joint suggests extra-articular disease (i.e., ligaments, tendons, or bursae); conversely, pain on multiple sides suggests intra-articular disease.
Localized temperature and erythema of the skin indicate inflammation, but erythema may often be absent. Although gout can affect several joints at once, acute arthritis of the metatarsophalangeal joint of the big toe is especially characteristic.
Laboratory and instrumental studies. Bursitis and tendinitis can often be diagnosed without additional studies. In cases of severe or unexplained acute monoarthritis accompanied by tissue edema, synovial fluid analysis is necessary; arthrocentesis with aspiration of the contents of the joint capsule confirms the presence of effusion and is necessary for specific diagnostics (for example, isolating a culture of microorganisms from synovial fluid in infectious arthritis). On the contrary, detection of crystals in synovial fluid confirms the diagnosis of microcrystalline arthritis, but does not exclude concomitant infection. X-ray diagnostics is usually performed if there is a suspicion of anatomical bone disorders (in fractures and infections), calcium pyrophosphate deposits (in chondrocalcinosis) or periarticular tissue calcifications. Other research methods are auxiliary, and the need for them depends on the suspected diagnosis. Studies of ESR, antinuclear antibodies, and rheumatoid factor are useful if there is a suspicion of the development of non-infectious inflammatory arthritis.
Treatment of pain in one joint
Treatment should be aimed at the underlying causes of arthritis. Symptomatic therapy of joint inflammation is usually carried out using NSAIDs. Joint immobilization with a splint, longuette or supporting bandage (for example, a sling bandage for shoulder joint damage) can also help reduce the severity of pain. Thermal procedures can lead to a decrease in spasm of periarticular muscles, while cold can have an analgesic effect in inflammatory arthritis.