joint pain
Introduction
Introduction to joint pain Joint pain is mainly caused by arthritis or joint disease. Joint pain involves a wide range and a wide variety, so the differential diagnosis of joint pain is crucial. Joint pain is a category of limb pain, limb swelling, pain, phlegm and gout in Chinese medicine. Another joint pain can be found in "Lingshu·Hundred Diseases": "The six limbs are not able to pass the limbs, the limbs are painful, and the lumbar spine is strong." Common systemic symptoms are fatigue, general malaise, myalgia and low fever. A small number of patients may have moderate fever. basic knowledge Probability ratio: Susceptible people: all types of people are morbid people Mode of infection: non-infectious Complications: pneumonia, urinary tract infection in the elderly
Cause
Cause of joint pain
1. Periarticular ligament injury The knee joint ligament has relatively poor stability when the knee joint is slightly flexed. If the external force suddenly causes valgus or varus, it may cause damage to the medial or lateral collateral ligament. The patient has a clear history of trauma, knee pain, swelling, ecchymosis, and limited mobility.
2. Cartilage damage is mainly the meniscus injury of the knee joint. When the knee joint is slightly flexed, if the knee is suddenly over-extended or knee-extended, such as kicking a soccer ball, the movement of bending the calf and kicking the ball, there is May cause a meniscus tear. Meniscus injury has a significant knee tear, followed by joint pain, limited mobility, walking claudication, and joint movements.
3. Joint synovitis Due to trauma or excessive strain and other factors, a large amount of fluid will be produced after the joint synovial membrane is damaged, which will increase the pressure in the joint, causing joint pain, swelling, tenderness, and the sound of rubbing and bun. For example, when the knee joint is extremely stretched, especially when there is a certain resistance to knee extension exercise, the pain in the lower part of the tibia will be aggravated. In the case of passive extreme flexion, the pain is also significantly increased.
4. Autoimmune diseases Diseases Immune system diseases such as lupus erythematosus and psoriasis can also invade the joints, which depends on blood tests to assist in diagnosis.
5. Child growth pain These patients are mainly children in the growing period, and boys are more common. The pain site is common in the knee joint, hip joint, and the like. This situation is a normal physiological phenomenon that occurs during the growth and development of children. Because the growth of children's bones is relatively fast, the periosteum and local muscle growth and development are not coordinated, causing discomfort and joint pain. It has also been suggested that this pain is caused by a low toxicity infection.
6. Traumatic joint pain due to an accident or accident, the joints of the shoulders, wrists, knees, ankles and other parts of the joints in the absence of fractures and other serious trauma (such as soft tissue injury, fracture dislocation, etc.) and joint pain.
7. Septic arthritis has a history of infection of other parts of the body or a history of local trauma. The painful joints may be swollen, and the parts may not be obvious, but there are elevated body temperature, joint pain, inactivity, elevated blood levels, etc. phenomenon.
8. The age of onset of osteoarthritis osteoarthritis is mostly after 40 years of age. Joint pain is heavier in the morning and lighter during the day and night. Bone hyperplasia at the joint site and spur rubbing around the tissue can cause joint pain.
9. Osteoporosis Older women have multiple joint pains and feel particularly weak. They can't walk with heavy weight. If other diseases are excluded, they may have osteoporosis.
10. Rheumatoid arthritis and rheumatoid arthritis occur mostly in women between the ages of 20 and 45. Rheumatoid arthritis is often a migratory pain (the position of pain is uncertain). Pain, swelling, and stiffness often occur in the wrist, and the sensitivity and swelling of the joints occur simultaneously. Symptoms (such as wrists and knees) ).
11. Gouty arthritis Gout pain is common in the thumb and the first metatarsophalangeal joint (outside of the thumb). Mainly due to the consumption of seafood and drinking, which is induced by metabolic disorders in the body. In the acute phase, the patient is locally swollen and painful and unbearable; in the chronic phase, the patient may have pain, joint deformation and the like.
12. Pain caused by strain due to the relatively large amount of activity in the joints, resulting in muscle strains such as muscles around the joints, and then cause pain, common with frozen shoulder, tennis elbow and so on.
13. Tumor-induced pain Localized tumors in joints are also an important factor in joint pain, which is more common in children and the elderly during growth and development. If there is swelling and pain in the joints, the pain is more severe in the evening than in the daytime. If the painkilling drug is invalid, there is no reasonable reason to explain it. You should go to the hospital for further examination to rule out the joint tumor.
Prevention
Joint pain prevention
Joint pain is the main symptom of patients with rheumatoid arthritis, and it is also one of the symptoms that make patients suffer. After joint pain, patients should pay attention to the following aspects:
(1) Joint Brake: In the acute phase, the joint should be placed in a resting position to reduce exercise.
(2) Partial massage: After the joint pain has been alleviated, the massage around the joint can be made.
(3) Joint gymnastics practice: practice different joint gymnastics for each different joint, 30 minutes each time, 2-3 times a day.
(4) Joint medicine smoked: Formulated drugs for joint fumigation, the water temperature should be kept at about 50 °C, once a day for 20 minutes each time.
(5) Joint warm water bath: Soak the diseased joint or the whole limb in warm water for about 20 minutes, once a day.
(6) Joint health moxibustion: Select 2-3 acupuncture points commonly used around the affected part, and use moxibustion for moxibustion, usually once a day, once every 20 minutes.
Complication
Joint pain complications Complications Pneumonia elderly urinary tract infection
(1) Pneumonia: Due to decreased immunity and bacterial infection, patients often have pneumonia.
(2) urinary tract infection: patients with rheumatoid arthritis are often prone to urinary tract infection if they do not pay attention to their daily life or suffer from a cold.
(3) Cushing's syndrome: If patients use hormones for too long, they often suffer from Cushing's syndrome due to inhibition of adrenal function in the body. Common symptoms include full moon face, buffalo back, and weight gain.
(4) Oral ulcers: Patients with rheumatoid arthritis often experience oral ulcers after taking immunosuppressive agents. In addition, there may be adverse reactions such as nausea and vomiting, anorexia, rash, and loss of taste.
(5) Infectious diseases: Patients have been suffering from this disease for too long, and their autoimmune function has declined. When certain infectious diseases are prevalent in society, they are more susceptible to infection than normal people.
Symptom
Symptoms of joint pain Common symptoms: redness and swelling of the back of the hands, feet, redness, swelling, heat, pain, unexplained, fever, joint pain, persistent pain
1. Reactive arthritis
1. General symptoms: Common systemic symptoms are fatigue, general malaise, myalgia and low fever. A small number of patients may have moderate fever.
2. Joint symptoms: The main manifestation of reactive arthritis is joint involvement, which varies in severity. Lighter can only feel joint pain, and severe cases have obvious polyarthritis, and even limited activity. Typical manifestations are progressive aggravation of asymmetry in single joints or oligoarthritis, and the most common joint involvement in the lower extremities, such as the knee, ankle, and hip joints. Shoulder, elbow, wrist and small joints of the hands and feet can also be affected. Local redness, pain, increased skin temperature, or erythema of the skin. The salami toe of the small joints is more common. In some patients, lower back and ankle pain may occur.
3. Tendonitis: Tendonitis is one of the common symptoms of reactive arthritis. It is manifested as pain and tenderness of the tendon at the point of attachment of the bone. It is most susceptible to Achilles tendon, plantar tendon, tendon attachment point and paravertebral column. In severe cases, activity may be limited or muscle atrophy may occur due to local pain.
4. Skin mucosa: Skin mucosal lesions are more common in reactive arthritis. The most characteristic manifestation is purulent keratosis of the skin of the palms and soles of the feet. This skin damage, as well as nail roughness, thickening, etc., which occurs in some patients, can be similar to psoriasis skin manifestations. Mainly seen in sexual arthritis after sexual intercourse such as gonococcal infection, other types of reactive arthritis are rare, the reason is not clear.
Some patients with reactive arthritis may have whirlpool balanitis, cystitis and prostatitis, which are characterized by frequent symptoms such as urinary frequency, urgency, dysuria and hematuria. There are still cervicitis and salpingitis in women.
Nodular erythema is only seen in some patients, mainly Yersinia infection. Clinical studies have found that the expression of HLA-B27 may be unrelated to the occurrence of nodular erythema.
Oral ulcers are another common manifestation of reactive arthritis, mostly superficial painless small ulcers, which can occur in the ankle, tongue, lips and buccal mucosa.
5. Intestinal lesions: Intestinal infection is one of the predisposing factors of reactive arthritis. Patients may have a history of diarrhea from a few days to several weeks before onset, and some cases have intestinal symptoms in the presence of arthritis. Colonoscopy revealed intestinal mucosal congestion, erosion, or ulcerative colitis and Crohn's disease-like appearance. In this stage, the patient's stool culture was mostly free of bacterial growth.
6. Urinary tract manifestations: Patients may have symptoms of urinary tract infections such as frequent urination, urgency, and dysuria, and occur mostly before arthritis. However, many patients may have no apparent symptoms.
7. Eye damage: Eye damage is common in reactive arthritis. Moreover, it can be the first symptom of the disease. Patients may have conjunctivitis, scleritis, keratitis, and even corneal ulcers. In addition, there may be endophthalmitis such as iritis and iridocyclitis. Therefore, it can show signs of photophobia, tearing, eye pain, and internal eye involvement. Patients with eye damage should undergo routine eye examinations and appropriate local treatments, such as cortisone eye drops, dilated eyes, etc., to avoid permanent eye damage.
8. Visceral involvement: Reactive arthritis can cause heart block, aortic regurgitation, central nervous system involvement and exudative pleurisy. There have been cases of heart block in patients with reactive arthritis and the installation of pacemakers. Individual patients may have proteinuria and microscopic hematuria during the course of the disease. However, there is generally no serious kidney damage.
2. Rheumatoid arthritis
1. Pain: There is local pain in the early stage of the disease, especially during the active period, accompanied by tenderness and tenderness. This is the earliest appearance and the most sensitive sign of the patient.
2. Stiffness: The affected joints are stiff, especially when starting activities in the morning, but after a period of activity, it will gradually improve.
3. Swelling: The soft tissue around the affected joint is diffusely swollen, and the surface temperature is slightly higher than the normal joint.
4. Malformation: In the later cases, the metacarpophalangeal joint flexion and ulnar deviation are generally present; if it occurs on the toes, the appearance of the claw-toe deformity appears.
5. Subcutaneous nodules: 30% to 40% of patients may have subcutaneous nodules, which helps to diagnose the disease. Pathological examination of subcutaneous nodules can be used to assist in diagnosis.
6. Increased body temperature: Some patients in the acute phase may have fever, mostly low fever below 38 °C.
Three. Shoulder inflammation
The neck and shoulders continue to be painful, and the upper limbs of the affected side are raised, rotated, and swinged back and forth. When the wind encounters cold, there is heavy pain.
Joint dislocation
(1) There is a history of obvious trauma.
(2) The clinical manifestations are joint pain and swelling, deformity, elastic fixation and joint stenosis, and the resulting dysfunction.
(3) X-ray examination can clearly identify the location, extent, direction and presence or absence of fracture and displacement.
5. Gouty arthritis
The incidence of middle-aged men is significantly higher than that of women. The onset is rapid and can wake up at night. Often infringe one joint first, mostly in the first metatarsophalangeal joint, followed by the instep, heel and ankle joint. The joints are locally swollen, the skin is dark red, the tenderness is obvious, and the activity is not dare. There may be systemic reactions such as fever (38 to 39 ° C), headache, palpitations and anorexia during an acute attack. About 1 week after the acute attack, the symptoms gradually disappeared and the joints returned to normal.
The intermittent period of the disease can last for several months or several years, but as the condition worsens, the intermittent period can be shorter and shorter, and corn granules with large corn granules can appear under the ear wheel, earlobe and joint skin. Can be induced by alcoholism, overeating, overwork or mental stress, some patients can be converted to chronic, severe joints due to destruction and rigidity.
Suppurative arthritis
1. Systemic symptoms: mainly manifested as acute onset, chills, chills, high fever, general discomfort, loss of appetite and other systemic toxemia symptoms, bloodline infections may have the corresponding symptoms and signs of the primary lesion, but sometimes the primary lesion Not clear. People with joint infection caused by direct pollution generally have a history of joint damage, joint puncture or joint surgery. The surrounding infection extends to the joints, and there is a pathological process of infection around the joint tissue.
2. Local symptoms: generally single joint disease, weight-bearing joints are susceptible, especially in the hip and knee joints, followed by the ankle, elbow, wrist and shoulder joints. Hand and foot facet joints are rare. Clinically, the main manifestations are severe pain in the affected joints, and the joint activities are obviously limited, and most of them are semi-flexed passive positions. Refuse to touch. If it is a baby patient, there is even a child who is afraid of the doctor touching and approaching the bed. Superficial joints have redness, swelling, heat and tenderness. Deep swelling may occur when the joint is involved, but redness and heat are not obvious.
3. Atypical manifestations: infants, elderly debilitated patients, and patients treated with immunosuppressive agents and glucocorticoids, when the joint purulent infection occurs, the systemic and local symptoms may not be significant, but the joint damage is not so light. When the diseased joint is complicated by purulent infection, the symptoms of suppurative inflammation can be confused with the symptoms of swelling, pain, and movement disorder caused by the original joint disease. Clinical symptoms are easily masked when deep joints such as ankle joints are infected. In the case of the above-mentioned atypical septic arthritis, it is necessary to pay attention to distinguish the subtle changes caused by suppurative infections, and through detailed examination, strive to make early diagnosis so as not to delay the treatment and lead to severe joint destruction and loss of exercise.
Examine
Joint pain examination
Anti-chain O, anti-streptolysin O, is an antibody found in the serum of humans infected with group A hemolytic streptococcus, and 80% of patients with rheumatoid arthritis have an increase in chain O, often above 1:800. After the condition is restored, the antibody can gradually decrease.
In addition to the increase in anti-chain O in patients with rheumatoid arthritis, laboratory tests can also find the following abnormalities:
(1) Peripheral blood leukocyte count increased, mostly above l0 × 109 / liter (that is, 10000 / cubic millimeter), the proportion of neutrophils also increased significantly, up to 80-90%, and some nuclear left shift phenomenon.
(2) ESR and C-reactive protein are elevated, erythrocyte sedimentation rate and C-reactive protein are usually indicators of various inflammations. In the acute phase of rheumatoid arthritis patients, erythrocyte sedimentation rate can reach 90 mm / h or more; C-reactive protein also At 30 mg / liter (30 g / ml) or more, after the acute period (about January to February) gradually returned to normal.
(3) joint fluid examination, often exudate, light white blood cell count can be close to normal, heavy up to 80 × l09 / liter (80000 / cubic millimeter) or more, mostly neutrophils, bacterial culture negative.
(4) Both rheumatoid factor and antinuclear antibody were negative.
Diagnosis
Diagnosis of joint pain
1, rheumatoid arthritis, for multiple symmetry refers to small arthritis and spondylitis.
2, migratory arthritis caused by sepsis, often have the symptoms of the original infection, blood and bone marrow culture is positive, and the intra-articular exudate has a purulent tendency, and pathogens can be found.
3, tuberculous arthritis, mostly involved in a single joint, occurs in the joints of frequently active hand rubbing or weight bearing.
4, tuberculosis infection allergic arthritis.
5, lymphoma and granuloma.
6, Lyme arthritis, an epidemic caused by ticks.
