Pain in muscles and joints

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

More recently, in medical terminology appeared the definition most suitable for describing simultaneous pain in muscles and joints - myoartralgia, there are also more deeply studied nosologies with a similar clinic - rheumatoid arthritis (RA), rheumatic polymyalgia. It is these diseases that include all the signs, symptoms, conditions relating to the musculoskeletal system and muscles.

In the 21st century, a number of completely unique directions also appeared in the medical specialties, including myology, thus, the pain specialist should work as a muscle specialist, but there are no such physicians in the world, so rheumatologists still treat myoarthralgia.

The combination of the pain symptom in the muscles and joints is considered quite common, according to statistics, 90% of patients with rheumatism make just such complaints. When joint diseases inevitably defeat the surrounding joint of skeletal muscles. Following the pathology of bone tissue, muscle tissue also changes, causing pain, deformity, and sometimes contracture of the joint. All this complicates the diagnosis and timely recognition of the root cause of the condition, since often the first to debut and predominate is the muscle symptom. This is due to the physiological and anatomical connection of skeletal muscles, ligaments, tendons and joints. There is another etiologic version. Currently, some progressive specialists consider rheumatic pains as a symptom complex, in the pathogenesis of which the main role is played by muscles, modern scientists believe that their defeat leads to joint pathology and manifests as myoarthralgia.

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Causes of pain in muscles and joints

The true causes of pain in the muscles and joints are still a diagnostic mystery, since both myalgia and arthralgia belong to the symptom-complex 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 the clinic of myoarthralgia. The factors that cause acute polyarthritis, monoarthritis, polyarthritis and generalized myalgia are primarily related to 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 stand out: 

• Autoimmune pathologies - RA (rheumatoid arthritis), scleroderma and its types, all kinds of rheumatism, systemic lupus erythematosus.
• Disturbance of metabolism in the tissues of the bone system, cartilage - gout, osteoarthritis, osteoporosis.
• Traumatic affection of the joint or muscle - stretching, bumps, fractures, bruises and ruptures of the synovial bag (bursa). Any, even the weakest blow to the muscle will inevitably lead to a small traumatization of the joint due to a unified system of blood supply.
• Viral diseases - ARVI, influenza, TORCH-infection. Hyperthermia (high temperature) leads to the spread of the virus through the bloodstream, when it is able to penetrate into the muscle tissue and even reach the joint. Especially dangerous are retroviruses, Epstein-Barr virus, herpes virus, rubella, cytomegalovirus, mycoplasma, rubella virus.
• Hypertonus and pain in the joints, muscles with physical overstrain, training.
• Osteochondrosis, deforming articular osteochondrosis.
• Neurological pathologies (muscle-compression neuropathy, nerve impairment).
• Ganglion joints (cysts synovial bag).
• Congenital anomalies of the structure of the musculoskeletal system (achondroplasia, congenital dislocations of the hips).
• Physiological conditions that provoke transient arthralgia and myalgia, for example, pregnancy.

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

Why do muscles and joints ache?

One of the reasons why muscles and joints ache, there may be a little studied disease - fibromyalgia. Often it is her symptoms that "mimic" the typical joint pain of rheumatic origin.

Fibromyalgia is a systemic, chronic disease of unclear etiology that does not unambiguously refer to inflammatory or autoimmune pathologies. The diagnosis of diffuse muscular pain, which often spreads to the joints area, is confirmed, provided that the patient makes such complaints within 3 months and the possible disease can not be cured by anti-inflammatory, analgesic and antirheumatic drugs. In addition, for fibromyalgia specific trigger points in which pain is localized. These hons are revealed by means of palpation, physical examination. Symptoms include complaints of specific morning weakness, stiffness, numbness of the limbs, transitory, but systematic diffuse pain in the back, neck, arms, lower back, calf muscles. The clinic of fibromyalgia is very similar to the manifestations of rheumatism, often a person is treated for it and can not understand why muscles and joints ache, despite various therapeutic methods, including folk.

This applies, first of all, to self-treatment, which is often present in our lives. No competent doctor will diagnose 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 the joints, bone and muscle tissue.

Also, the answer to the question "why joints and muscles ache at the same time" can be an elementary overstrain, when the constant tone of muscle tissue provokes autonomic development of the spontaneous pain symptom. Pathogenetically, this process looks simplistic: tension - hypertonus - spasm - sensation of pain - a new spasm and fixation of hypertonia. Such anomalous muscle corset does not promote normal nutrition of bone and cartilaginous joint tissue, myogenic ischemia develops, microcirculation is disturbed, tissue acidosis, accumulation of cell decay products, inflammation of the joint.

Why do joints and muscles ache?

The human body includes more than 600 types of muscle tissue, each of which in turn performs important functions, including the provision of motor, ligamentous function of the joints. All the muscles are made up of thousands of tiny thin muscle fibers. Any abnormal process in the muscles, in their tissues can provoke pain symptoms. Among those who studied the relationship of musculo-articular diseases and pain, was the great Greek healer, Hippocrates, who first discovered why joints and muscles ache. Several millennia ago, he described the acute inflammatory process in the joints and called it "arthritis."

Despite such a long history, doctors still can not identify specific reasons explaining the etiology of arthritis, but it is established that the disruption of the muscles and joints is provoked in this way:

• Changes (systemic or situational, temporary) of the contractile function of muscles, skeletal musculature.
• Prolonged hypertonus promotes the development of local seals in the muscle tissue, disruption of joint nutrition.

In turn, overstrain, hypertonia, muscle tightening, joint pain can be caused by the following factors:

• Various types of violation of the body's posture, which cause joint deformities, provoke pain in the muscles. This category includes professional violations - the constant work of sitting, wearing specific footwear (high heels), violating all the laws of anatomically acceptable biomechanics.
• Autoimmune diseases, often genetically conditioned.
• All kinds of rheumatism, rheumatoid arthritis, rheumatic polymyalgia.
• Osteochondrosis is a degenerative process, gradually deforming the spine, therefore, activating compensatory overload of both muscles and joints.
• Pathological deformation of the spine.
• Forced long stay in a horizontal position in chronically ill patients, people with severe injuries.
• Stiffness of the joints, myalgia can provoke increased training, physical overload.
• Trauma, regardless of the degree of severity in any case, is accompanied by microdamages of muscle tissue, a violation of microcirculation and nutrition of the joints, muscles.
• Endocrine diseases.
• Vascular pathologies, which cause atrophy of the muscular and bone tissue.

In a word, it is rather difficult to determine why the muscles and joints ache, the accuracy and speed of diagnosis, the effectiveness of the treatment are directly related to the timely treatment of the sick person to the doctor.

When all the muscles and joints ache?

As a rule, diffuse pains testify either to the degree of neglect of the pathological process, or about certain diseases for which such a symptom is inherent.

All the muscles and joints ache is a sign of such pathologies:

1. Rheumatic polymyalgia. The disease is rarely diagnosed, on average one patient per thousand of rheumatic patients who have complained with complaints. Most often rheumatic polymyalgia affects women aged after 50-55 years, representatives of the stronger sex and young people, children are ill with this disease very rarely. As in the case of other rheumatic species, the etiology of the RP is not fully understood, however, statistical data allow us to speak of psychogenic factors combined with autoimmune pathological processes. Clinical manifestations are nonspecific, patients complain "all muscles and joints ache." In physical examinations, the localization of pain is concretized, 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 (thighs, buttocks, hands) and symmetry of signs, but initially, before the development of such atrophy, the RP manifests by transient pain polymyalgia. Pain can intensify in the morning with the first attempts to make movement, at night or at rest the pain subsides. The list of symptoms of RP includes elevated body temperature, weight loss, depressive state.
2. Fibromyalgia is a disease of unexplained etiology, in which muscle tissue most often suffers, but diffuse pain can also be felt in the joints. Typical clinical criteria are certain trigger zones in which diffuse bone-muscle pain is localized. Painful sensations are accompanied by stiffness, stiffness of the joints in the morning, weakness, decreased activity. Muscles, although they are the primary source of pain, do not inflame as well as joints, there are no irreversible damage and destruction, which makes it possible to differentiate fibromyalgia from a variety of rheumatological pathologies.

When joints and arm muscles ache?

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

• Shoulder joint.
• Elbow joint.
• Wrist joint.
• The joint of the brush.
• Joints of fingers.

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

The reason why myoarthralgia develops in the hands may be as follows:

• Tendovaginitis.
• Tendonitis.
• Myotendinitis.
• Bursitis (inflammation of the synovial bitch of the joint).
• Ligamentitis (an inflammatory process in a ligament, with reflected pain in the muscles and joints).
• Entezit (inflammatory process in the joint and tendon attachment zone).
• Fibrositis.
• Fibromyalgia.

At what diseases arises in the joints, and then in the muscles of the hands:

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

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

Movement and pain	What is damaged, inflamed
Putting your arm back, aside	Syndrome of compression of the capsule of the shoulder joint, subacromial impi -ment syndrome
The arm rises as much as possible	Damage to the clavicle-acromial joint
External rotation of the hand (combing)	Inflammation or damage to the tendon of the subaccess, small round muscle
Internal rotation, when pain occurs when the hand is pulled back	Inflammation or injury of the tendon of the scapula muscle
Pain when flexing the arm at the elbow and supination when lifting the gravity	Damage, inflammation of the tendon of the biceps muscle of the shoulder girdle
Almost all hand movements are disrupted	Chronic inflammation, defeat of the capsule of the shoulder joint or the joint itself
Pain in the joints, shoulder muscles, in the hand at rest	Probably - plexitis, all kinds of compression included in the syndrome of the chest exit - a syndrome of staircase, bone-cystic syndrome, cervical rib syndrome and others

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

Why do joints and leg muscles ache?

What are the causes of myoarthralgia in the legs?

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

• Neuralgia, neuritis.
• Degenerative processes in the spine.
• Radiculopathy.
• Rheumatoid arthritis.
• Bursitis.
• Myotendinitis.
• Fasciitis.
• Myoenesis, paratenonitis.
• Injuries, bruises.
• Vascular pathologies - atherosclerosis, varicose veins, thrombophlebitis, lymphostasis, endarteritis.
• Hypertonus from overload (training, power activities).
• Crash syndrome.
• Fibromyalgia.
• Gout.

It should be noted that the joints and leg muscles ache often in the inflammatory process in the periarticular tissues, that is, the symptom itself does not refer to the joint, but is subjectively felt in it as a repercussion (reflected).

The cause of pain in periarticular tissues can be such pathologies of the rheumatic category:

1. Periarthritis of the hip joints, when the tendons of the buttock muscle and the synovial bag of the femoral joint are inflamed. The combination of pain in the joint and muscles is enhanced with any movement, especially when walking and passes at rest.
2. Periarthritis of the knee, when the pain develops in the inner surface area of the statute. The symptom grows when walking, moving, at rest, it gradually subsides.
3. Baker's cyst or bunion of the popliteal zone, the disease is a continuation of almost any deformity of the knee joint. The cyst, sinking to the back of the shin, provokes muscle pain (in the calf muscle), the joint hurts simultaneously due to its inflammatory nature.
4. Aponeurosis, tendonitis of the tendon of the heel, bursitis of the calcaneus - these conditions are characterized by severe pain localized at the site of inflammation, damage.
5. Fibromyalgia is a chronic musculo-skeletal pain of an unclear etiology, often with subjective sensations affecting the joints.

Symptoms of pain in muscles and joints

Clinically painful myartralgia relate to the symptoms of rheumatoid arthritis, as this disease shows 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 the first - the muscle or joint. For the diagnosis of myoarthralgic symptoms, it is very important to have an accurate description, a description of pain from the patient, so as a guide we will list a few parameters proposed in the international pain classification:

1. Clinical course over time, duration:

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

2. The definition of myoarthralgia depending on the type of disorder:

• Epicritic pain symptom, which develops due to violation of the integrity of barrier tissues, in this case - the articular bag. Epicritic pain is a signal of damage and violation of differentiation, isolation of internal structures. Pain of this type is felt in a particular 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 muscle. 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 muscles of the hands, less often in the muscles surrounding the hip joint).
• 58-60% of patients note the onset of pain in the joints, and then arthralgia pains in the muscle tissue.
• 31-35% complain of simultaneous pain - myoartrilgia.
• 35-40% of patients with rheumatoid arthritis suffer from morning stiffness simultaneously in muscles and joints.
• 45-50% of patients have clinically pronounced weakness, atony of skeletal muscles.
• Progressive muscle tissue hypotrophy in RA is noted in 80% of patients.

Symptoms of pain in muscles and joints are characterized by moderate intensity, but they are usually persistent, relapsing. The intensity of pain can vary throughout the day, depending on the position of the body, the temperature factor and ways to get rid of pain. In general, the symptoms of myoartrality can be divided into two types: inflammatory and mechanical:

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

Pain in the muscles of the hip joint

The hip joint is considered one of the most vulnerable to various injuries, both degenerative and inflammatory. The 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 are related to pathologies of the bone system:

• Traumatic injury of the joint, accompanied by pain in the muscle tissue.
• Injury of periarticular tissues.
• OA - osteoarthritis.
• Rheumatoid arthritis.
• Perthes disease - dissecting osteochondropathy of the femoral head, more often diagnosed in children.
• Tuberculosis coke.
• Osteomyelitis.

In such cases, the pain in the hip region begins at 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 iliac crest synovia	Puffiness and pain in the inner thigh area, in the lower abdomen in the groin area, the pain radiates to the femoral muscles during walking, squats
Inflammatory process in a bag of a large trochanter of the hip bones	Inflammation is a consequence of osteoarthritis, pain is localized in the zone of the large trochanter and radiates into the muscles of the thigh
Spiny bursitis, entheitis of spit	The pain develops in the prone position, the patient can not turn on his side, the pain in the femoral muscles appears with the hip
Tendonitis of adductor femoral muscle	A typical sports injury, pain is localized in the groin area, is amplified in the muscles of the hip, legs when hip joint is being withdrawn.
Inflammation of the sciatic bag, sciatic bursitis	The pain in the gluteal muscles develops when squatting, if a person sits on a hard surface, the symptom is strengthened by flexing the hip
Periformis syndrome, pear-shaped muscle syndrome	Pain in the muscles of the hip joint is localized in the buttock or lumbar muscles, and it can also develop in the area of the sacroiliac joint, in the muscles of the posterior region of the hip. Pain is worse at night, when getting up from bed or sitting

Pain in the muscles of the elbow joint

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

• The triceps muscle extends the elbow (supination).
• The inner humeral and biceps muscles - bend the elbow (pronation).

Pain in the muscles of the elbow joint may not be associated with pathological processes. So those who are intensely engaged in fitness, develops muscles, may experience incomplete supination (extension) of the elbow due to hypertonic flexion of the forearm, which is accompanied by a transient pain symptom.

Those people who, on the contrary, completely do not pay attention to strengthening the muscle tissue, can feel pain in the muscles of the elbow during pronation (flexion), up to excessive overdistension due to the weakness of the musculature.

The reasons for pain in the muscles of the elbow joint are numerous, some of them refer 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 performed that determine the position of the elbow joint, the nature of pain during the test. If the flexion of the elbow becomes constant (compensatory light 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 man to hold his hand straightened, this may indicate the true muscular abnormalities of the elbow-myositis, polymyositis and other diseases of muscle tissue.

Pain in the muscles of the elbow. Diseases of the musculoskeletal system:

• Epicondylitis of the joint. Degenerative process of inflammatory nature in the muscles, tendons, surrounding the elbow joint. Most often the epicondylitis is peculiar to musicians, tennis players, those whose professional activity is associated with constant movements of hands. Symptoms - pain occurs when the load, mainly during rotation or supination (extension) of the hand. Passive movements of this kind, performed by a doctor with a patient's arm, do not cause pain, which allows quickly to exclude arthrosis or arthritis of the joint.
• Myotendinitis of the elbow is an inflammatory process in the tendon that gradually spreads to the muscular tissue of the forearm. The causes of myotendinitis are also associated with professional activities, performing rhythmic, monotonous hand movements. 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 painless passive movements. Possible hyperemia of the skin, a characteristic sound of "crunching" in motion.
• Injury of the ulnar nerve is a syndrome of the cubital canal. In fact, this is a traumatic ulnar nerve ischemia caused by a stroke. Such feelings are familiar to many who hit the corner of the elbow. If such a trauma is made during a fall (a strong blow) or repeated with enviable constancy, the ulnar nerve passing through the canal is squeezed. The reason can be not only trauma, but also professional activity - drivers (constant shifting of levers, workers, machine controllers at factories, etc. Symptoms of chronic trauma - numbness of the hand, little finger and ring finger, pain gradually builds in. The blow provokes a feeling of shooting pain (the symptom of Tinel.) The ulnar nerve innervates the flexor of the hand, fingers, palmar muscles, that is, the pain most often "shoots" into the wrist.
• Eosinophilic diffuse fasciitis of the elbow is a systemic fibrous disease of the fascia, connective tissues, as well as subcutaneous tissue adjacent to the muscle. Diffuse fasciitis is considered one of the types of scleroderma, therefore, its etiology is not well understood and is not specified. Symptoms - gradual consolidation of the dermis, subcutaneous tissue, soft tissues, which provokes a noticeable restriction of mobility of the elbow joint, contracture, flesh to the flexion contracture of the fingers. A specific symptom is spontaneous muscular pain in areas of densifying tissue, uneven orange skin.
• Bursitis - inflammation of the synovial bag of the elbow process, (bursa), most often of traumatic origin. Symptoms - an increase in bursa, swelling, swelling, pain, but without the limitations of the volume of movements. Progressing inflammation, purulent, phlegmon can provoke a symptomatology similar to those of myositis.

Reflex pain in the muscles of the elbow joint can be caused by osteochondrosis of the cervical spine, the symptomatology is then localized along the entire forearm in the biceps muscle.

Diagnosis of pain in muscles and joints

The pains in muscles and joints are not considered in medicine as independent diseases, rather they are complex, multicomponent symptoms. If we consider that arthralgia and myalgia are almost always "neighbors", then it is extremely difficult to determine the root cause of the pain sensation.

Diagnosis of pain in muscles and joints depends on the accuracy of the anamnestic and clinical characteristics of the symptom, on when and under what circumstances it develops, and also on the complex of physical investigations. As a rule, the diagnosis of combined pain (articular and muscular) is the prerogative of a rheumatologist. In order to differentiate possible pathological causes, a whole diagnostic complex is appointed, the main indicator of which is the standard clinical and biochemical analysis of blood serum, as well as serological reactions. To confirm or exclude the presumptive diagnosis, radiography, tomography, subgraphy, joint ultrasound, arthrography and puncture are possible for the extraction of intra-articular fluid for microbiological and cytological examination.

Diagnosis of pain in the muscles and joints in more detail:

1. Basic analytical blood tests that are not specific, but give direction in the diagnostic search for the root causes of the symptom and show the degree of activity of the process. Indicators of ESR, protein metabolism, content of acidic enzymes (proteinase, phosphatase, cathepsins, deoxyribonuclease) make it possible to search for the onset of symptoms in Bechterew's disease, rheumatism, polyarthritis. It is these pathologies that are manifested by combined myalgic and arthralgic symptoms:

• The blood test serves as an indicator of the level of ESR as a parameter of the inflammatory process. The increased level of erythrocyte sedimentation rate (ESR) at normal leukocyte boundaries is always evidence of rheumatic damage. If the white blood cell is also enlarged, this may be a sign of a focal infection process in the spine or joints. •
• Biochemical blood test for myalgia and arthralgia is an indicator of CRP-reactive protein. Also, biochemistry reveals a DFA-sample, a definilamine reaction determining the amount 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-feraza, seroglikoidov and many other elements

2. Immunological analyzes 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 the diagnosis in the direction of the rheumatoid factor. Also its indicator is the presence of an antiglobulin body in the blood serum.
• Sample ASL-O, the reaction of blood with antistreptolysin shows the reaction of immunity to an alleged 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).
• Determination of the rate of inhibition of migration (migration) of leukocytes promotes the detection of rheumatoid arthritis and other types of rheumatism.

3. The synovial fluid is necessary for combined symptoms - pain in the joints and muscles to determine the type of joint damage - degenerative, traumatic or inflammatory. Puncture presupposes immunobiological and histochemical studies of exudate of the synovial membrane of the joint.
4. When suspected of pathological diseases of the spine, the bone system is mandatory X-ray, which is an important differential diagnostic method. Radiography helps to identify the degree of severity of the disease, the stage of the process and build the prospects for treatment, including the prognosis.
5. Tomography is needed to clarify the localization of suspected focal inflammation, deformations, usually in the spine. Also, the diagnosis of pain in the muscles and joints in the vertebral column suggests myelography - a contrast method of spine examination.
6. Angiography is needed to determine the degree of putative atherosclerotic changes in the vascular system, which primarily provoke muscle pain.

In addition, the patient may be assigned to such studies as:

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

Obviously, mainly the methods of examination concern bone tissue, joints, spine, this is due to more accurate, specific indicators, in contrast to the methods that detect muscle pain. To clarify the nature of myalgia, its kind, which is combined with pain in the joints, methods are used (large and small criteria for myofascial pain, a map of trigger points for fibromyalgia, tests, palpation and stimulatory algometry, radiothermometry) recommended by the International Pain Association.

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Treatment of pain in muscles and joints

Therapeutic measures directly depend on the severity of the symptom and on the underlying cause, that is, the detected disease. Treatment of pain in muscles and joints always goes complex, as pain sensations are localized in tissues that have different structures, histology. Since the combination of myalgia and arthralgia is most typical for rheumatoid arthritis and osteoarthritis, treatment consists in curating precisely 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 the treatment of pain. It should be noted that the therapy of such combined clinical manifestations always requires a long, sometimes multi-month course. Since the causes of myoartralgia are diverse, the treatment involves the use of drugs of many pharmacological groups, often having contraindications and complications. In this regard, in rheumatology there are unspoken rules:

1. First of all anesthetize the symptom.
2. The effect of anesthesia should be as fast as possible.
3. The drug for anesthesia should be as safe as possible.

Treatment of myoarthralgia can be divided into the following stages:

1. Symptomatic treatment:

• Nonsteroidal anti-inflammatory drugs.
• Steroidal anti-inflammatory drugs.
• Analgesics in any accessible and corresponding symptom form.

2. Basic therapy:

• Means that suppress the activity of immunity, immunosuppressants within 2-3 months, after that, with ineffectiveness drugs are canceled.
• Antibiotics can be prescribed for the inflammatory process of infectious etiology.
• May be appointed mielorelaksanty with hypertension syndrome muscles.

3. Additional methods:

• Acupuncture.
• Physiotherapeutic procedures - magnetic resonance, ultrasound therapy, balneotherapy.
• According to the indications, tricyclic or other antidepressants, antipsychotics, significantly altering sensations, perception of the pain symptom can be prescribed.
• Plasmophoresis.
• Lymphocytophore.
• Electrophoresis with dimethyl sulfoxide.
• Phonophoresis with hydrocortisone.
• Dietotherapy.
• Physiotherapy.
• Spa 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 himself, as 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 one year of complex, persistent treatment, more effective results are achieved after 1.5-3 years of treatment. Sometimes the course of taking medications can be lifelong, it all depends on the genesis of the pain syndrome.

Prevention of pain in muscles and joints

How to prevent diseases of muscles and joints? Both patients and doctors have been asking this question for many centuries. At the end of the XIX 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 load-rhythm ratio. In addition, the health of the muscular and articular tissues, as well as of the entire musculoskeletal system, is associated with a regular change in the types of human activity. Simplifying, we can say this:

• static overstrain, as well as excessive zeal in the training process, overloads - this is a direct path to arthralgia and myalgia.
• lack of exercise, as well as constant, monotonous performance of monotonous physical actions, this is a potential risk of developing pain in the muscle tissue and joints.

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

As for the alleged causes of combined muscular 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 such rules:

• It is reasonable to distribute the motor load, at regular stresses, regularly perform warm-ups.
• Avoid physical strain, especially when doing sports. Complexes of training exercises should be developed by specialists with deep knowledge of anatomy, skeletal muscle structure, musculoskeletal system.
• Avoid temperature provoking effects - supercooling and overheating.
• Timely identify and treat infectious diseases, sanitize inflammation, including in the nasopharynx and teeth.
• Regularly strengthen and temper the body, lead a healthy lifestyle.

Secondary prevention of pain in the muscles and joints is a set of measures to prevent relapses and complications after successful treatment: In this case, the following recommendations should be adhered to:

• Regularly perform complexes of therapeutic gymnastics.
• If the doctor prescribes a constant intake of medications, you should strictly follow his recommendations and not engage in self-medication.
• Observe a rheumatologist's diet, limiting salt, sugar, fats, spicy foods.
• Systematically undergo regular check-ups, examinations, especially before the period of possible complications.

Summarizing the rather difficult topic of pain in the muscles and joints, it can be concluded that the well-coordinated work of the musculature and the musculoskeletal system is inherent in the human organism by nature itself. Obviously, from the correct and natural functioning of these two systems depends almost the whole life of man, as an argument we again quote the statement of Ivan Mikhailovich Sechenov: "Does the girl hurry for the first date, does the soldier rise to attack, does the sonnet compose a poet, after all, all this comes down to one thing - to a rhythmic or disorganized muscle contraction. "Therefore, maintaining the tone, reasonable training of the muscular apparatus can provide joint health and painless motor activity, sufficient quality of life.