Pain in one joint
Last reviewed: 23.04.2024
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Monoarticular pain can be caused by articular disorders, be reflected or develop with lesions of periarticular structures (for example, in bursitis or tendovaginitis). Pain caused by intraarticular lesions is more common in inflammatory arthritis, but may also be non-inflammatory (eg, in osteoarthritis, intraarticular disorders).
Acute monoarticular pain requires emergency diagnosis, since in some cases, in particular for infectious (septic) and microcrystalline arthritis, immediate initiation of adequate therapy is necessary. Both these situations are accompanied by inflammation and can lead to intra-articular hemorrhages. Microcrystalline arthritis is more often due to deposits of urate monosodium (for gout) or calcium pyrophosphate (for pseudogout). Also, an acute lesion of one joint may be the initial manifestation of psoriatic arthritis or various inflammatory polyarthritis. Less frequent causes of monoarthritis are osteomyelitis of the joints forming the joint, aseptic necrosis of the latter, foreign bodies, hemarthrosis (for example, in hemophilia or coagulopathy), tumors.
[Diagnosis of pain in one joint
It should be determined which structures (articular or periarticular) are the cause of the development of symptoms and whether there is inflammation. If the inflammation is present or the diagnosis is unclear, an assessment of the presence of the symptoms of polyarticular lesion and systemic manifestations along with the examination of all joints is necessary.
Anamnesis. The expressed articular pain developing within several hours, testifies to microcrystalline (or, more rare, infectious) arthritis. In the presence of an anamnesis episodes of microcrystalline arthritis, accompanied by a similar clinical symptomatology, we should assume a relapse of this condition. The risk factors for gout include male sex, old age, the use of diuretics and other drugs that increase the concentration of uric acid in the blood. Risk factors for infectious arthritis include ongoing immunosuppressive and corticosteroid therapy, diabetes mellitus, intravenous injections, including drugs, extra-articular foci of infection, bitten tick bites or living in an area endemic to Lyme disease, intraocular injections of glucocorticosteroids and arthroplasty of joints. 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 in rest or at the beginning of movements in the joint suggests the inflammatory nature of arthritis, while pain that increases during movement and disappears at rest is characteristic for its mechanical damage (for example, with osteoarthritis). A gradual increase in pain is often noted in rheumatoid or non-infectious arthritis, but may also occur with specific infectious arthritis (eg, tuberculosis or fungus).
Physical examination. Pain, which is strengthened by the passive movement of another structure (for example, pain in the knee joint with passive rotation of the thigh), involves reflected pain. Pain, the intensity of which is higher with active movements than with passive, may indicate tendonitis or bursitis; Inflammation in the joint usually limits both active and passive movements in it. Tenderness or puffiness only on one side of the joint indicates the defeat of extra-articular structures (ie, the localization of the pathological process in ligaments, tendons or articular bags); on the contrary, the presence of pain from different sides suggests intra-articular causes.
Local increase in temperature and the presence of erythema of the skin indicate inflammation, but erythema can often be absent. Despite the fact that several joints can be affected simultaneously with gout, especially acute arthritis of the metatarsophalangeal joint of the big toe is particularly characteristic for it.
Laboratory and instrumental research. Quite often, bursitis and tendonitis can be diagnosed without further research. With pronounced or unexplained acute monoarthritis occurring with edema of tissues, it is necessary to perform synovial fluid research; arthrocentesis with aspiration of the contents of the joint bag confirms the presence of effusion and is necessary for carrying out a specific diagnosis (for example, isolating the culture of microorganisms from the synovial fluid in infectious arthritis). On the contrary, the detection of crystals in the synovial fluid confirms the diagnosis of microcrystalline arthritis, but does not exclude the concomitant infection. X-ray diagnostics is usually performed with suspicion of anatomical bone disorders (fractures and infections), calcium accumulation of pyrophosphate (with chondrocalcinosis) or calcification of periarticular tissues. Other methods of investigation are auxiliary, and the need to carry them out depends on the expected diagnosis. Studies of ESR, antinuclear antibodies, rheumatoid factor are useful in the presence of suspected development of noninfectious inflammatory arthritis.
Treatment of pain in one joint
Treatment should be aimed at the causes underlying arthritis. Symptomatic therapy for joint inflammation is usually performed using NSAIDs. Immobilization of the joint with the help of a tire, longos or a supporting bandage (for example, a scarf in case of a shoulder joint injury) can also help reduce the severity of the pain syndrome. Thermal procedures can lead to a decrease in spasm of periarticular muscles, on the contrary, cold may have an analgesic effect in inflammatory arthritis.