Joint pain

and Sabine Schrör, medical journalist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Joint pain is common. Almost half (45 percent) of all people over the age of 45 suffer from painful joints. The knee joints are most commonly affected. Usually signs of wear and tear trigger the pain; doctors then speak of osteoarthritis. Inflamed (arthritis) or injured joints are also often associated with painful symptoms. But there are many other possible causes of joint pain. Here you can read everything you need to know about the causes and treatment of joint pain.

Brief overview

Description: Joint pain can be very different, e.g. affect only a single joint or several joints, only small joints (e.g. on the fingers) or large joints (such as the hip joint). They can be acute or chronic. Sometimes they only occur at rest (pain at rest) or at night (night pain).
Causes: e.g. joint wear and tear (osteoarthritis), bursitis (bursitis), bacterial joint inflammation (bacterial arthritis), rheumatoid arthritis, rheumatoid fever, gout, accompanying inflammation of the joints during and after infections (such as borreliosis), reactive arthritis (Reiter's disease), psoriasis (psoriasis) Arthritis), ankylosing spondylitis, sarcoid, systemic lupus erythematosus, joint bleeding in coagulation disorders.
When to the doctor With restricted mobility of the painful joint, fever, reddened skin over the painful joint, swollen joint.
Diagnostics: taking the medical history (anamnesis), palpation of the painful joints, possibly further examinations such as orthopedic examination, dermatological examination, blood examination, ultrasound, x-ray, joint puncture.
What you can do yourself: e.g. reduce excess weight, avoid one-sided stress, joint-friendly endurance training (such as swimming, cycling), moist and cooling compresses or the application of heat, finger exercises in warmed sand (for osteoarthritis in the fingers), medicinal plants (e.g. as tea or ointment ), essential oils (for massages).

Joint pain: description

Joint pain can manifest itself in a variety of ways. Different criteria help to describe the complaints more precisely.

Classification according to the onset of joint pain

Acute joint pain sets in within hours.
Subacute joint pain becomes noticeable within days.
Chronic joint pain lasts for weeks or months.

Classification according to the number of joints affected

Monoarticular joint pain affects only one joint.
Oligoarticular joint pain extends to two to four joints.
Polyarticular joint pain affects more than four joints.

Classification according to the pain rhythm

Resting pain
Night pain

Morning stiffness of the joints

Classification according to the distribution pattern

Joint pain in the small joints (such as wrists, finger joints)
Joint pain in the large joints (for example, knee and hip joints)
Joint pain in the end joints of the fingers

Classification according to the pain intensity

The patient can assess the pain intensity on a scale from 0 (no pain) to 10 (unbearable, maximum pain).

Joint pain: Joints affected particularly often

Which joints are most often affected by joint pain depends largely on the cause of the pain. Some examples:

Wear and tear (osteoarthritis) is the main cause of joint pain. It mainly affects those joints that are heavily stressed throughout their life. These are the knee, hip and ankle joints. Osteoarthritis can also occur in all other joints.

Rheumatoid arthritis is another common cause of joint pain. The painful joint inflammation mainly affects the wrist and finger joints. Knee, elbow and shoulder pain as well as pain in the metatarsophalangeal joints are also common in rheumatoid arthritis.

In the case of an acute gout attack, the joints in the legs usually hurt, mainly in the metatarsophalangeal joint of the big toe. But ankle and knee joints can also be affected.

A bursitis (bursitis) can mainly cause hip, elbow, knee and shoulder pain.

Joint pain: causes and symptoms

Joint pain can have very different causes. The most important are:

Joint wear (osteoarthritis of the joints)

Osteoarthritis is the most common joint disease. In principle, it can occur in all joints. The cartilage layer on the joint surfaces is increasingly destroyed - the adjacent bone areas change, the affected joint becomes less mobile. It becomes inflamed, swollen, and hurts.

Excessive joint wear usually occurs when the affected joints have been overloaded for a long time. Sometimes osteoarthritis is also the result of an accident, ligament damage or a congenital weakness or malformation of joints. Most wrist, hip and knee pain is due to osteoarthritis.

Inflammation of the bursitis (bursitis)

Bursae are found between bones and tissue in places that are exposed to particularly high levels of stress (e.g. in the joints). They act as an organic insulating material - they cushion pressure and thus protect the bones. Bursae consist of a cavity filled with synovial fluid. Inflammatory or mechanical irritation (for example in the case of sports injuries) can inflame the bursae and cause pain in the region concerned.

Elbow pain is often caused by inflamed bursae in the elbow joint. Shoulder pain is often based on inflamed or calcified bursae in the shoulder region. Knee pain is often caused by inflamed bursae in the knee joint and hip pain from inflamed bursae on the large roll mound (protruding bone on the upper outside of the thigh).

Bacterial inflammation of the joint (bacterial arthritis)

Bacterial joint inflammation mainly affects the knee and hip joints. The bacteria either reach the joint via the blood or directly infect the joint (either through injuries or operations on the joint or through diagnostic injections into the joint). Possible indications of a bacterial joint inflammation are intense knee or hip pain and fever. In addition, the joint area is swollen, reddened and locally overheated.

Borreliosis (Lyme arthritis)

The joint pain in Lyme disease is also based on a bacterial joint inflammation. This is triggered by certain bacteria (Borrelia burgdorferi) that are transmitted to humans by ticks. Typical symptoms such as tiredness, fever, reddened skin and joint pain appear around four weeks later.

Concomitant joint inflammation during and after infections

Joint pain caused by inflammation can also occur during and after general infectious diseases such as hepatitis (inflammation of the liver), rubella, mumps, chickenpox, scarlet fever, tuberculosis, flu and inflammatory bowel diseases (Crohn's disease, ulcerative colitis). The large joints (hips, knees and ankles) are mainly affected. The symptoms subside spontaneously.

Joint inflammation in reactive arthritis

Reactive arthritis, formerly also called Reiter's disease, is a rare rheumatic disease. Symptoms include painful joint inflammation, urethritis and conjunctivitis.

Joint inflammation in psoriasis (psoriatic arthritis)

Psoriasis can be accompanied by inflammation-related joint pain. Sometimes the joint pain also precedes the skin disease: Then the joint pain occurs first and the scaly skin changes develop later. Psoriatic arthritis can be the cause of pain, especially if the finger and toe joints and / or the spine are painful.

Joint inflammation in ankylosing spondylitis

Bechterew's disease is a chronic rheumatic inflammation. It mainly affects the spine, but can also spread to the large joints. Ankylosing spondylitis can therefore be the cause of knee, hip and heel pain and / or pain in the ankle.

Gout or an acute attack of gout

In gout, the uric acid concentration in the blood is increased. The excess uric acid crystals are deposited in the joints, among other things - this leads to an acute gout attack with severe joint pain, swollen and reddened joints. The metatarsophalangeal joint of the big toe is usually affected. But also knee and wrist pain as well as pain in the finger joints or the upper ankle joint can be the basis of an acute gout attack.

Rheumatoid arthritis

Rheumatoid arthritis is the most common inflammatory joint disease. It usually progresses chronically and gradually destroys the joints. Typical of this disease are painful, morning-stiff fingers and wrists, joint swelling and the inability to make a fist.

Rheumatic fever

This inflammatory disease is caused by certain bacteria (streptococci) days to weeks after a nasopharynx infection that was not treated with antibiotics. Children are particularly affected by it. In addition to joint pain, possible symptoms include skin symptoms, inflammation of the heart (carditis) and sudden, involuntary and uncontrolled movements (chorea minor).

Inflammation of the joints with sarcoid (Löfgren's syndrome)

Sarcoid is a rare inflammatory disease of unknown origin that can affect the whole body. Löfgren's syndrome (acute sarcoid) is a special form of the disease. It mainly affects younger women. Symptoms include joint pain (especially in the ankle area), acute inflammation of the subcutaneous fat (erythema nodosum), swelling of the lymph nodes in the lungs (biliary lymphadenopathy) and weight loss.

Systemic lupus erythematosus (SLE, butterfly lichen)

This rare autoimmune disease mainly develops in women. It often causes joint pain and inflammation. Many other symptoms can also occur, such as a butterfly-shaped rash on the face, pleurisy, pericardium, kidney or encephalitis, as well as anorexia and weight loss. Lupus erythematosus is therefore also called the “chameleon” of medicine.

Joint bleeding in coagulation disorders

People with the rare bleeding disease (haemophilia) tend to bleed insatiable - both after injuries, but also spontaneously without an external cause. The bleeding occurs particularly in the muscles and joints. The joint bleeding can cause pain and, if left untreated, cause lasting damage to the joint.

In addition to haemophilia, other coagulation disorders can lead to joint bleeding and pain. This can happen, for example, if someone takes an overdose of anticoagulants.

A disease or a pathological tissue change is not always responsible for joint pain. Doctors then speak of "joint sensitivity".

Joint pain: when should you see a doctor?

Joint pain sometimes goes away on its own or can be relieved with simple home remedies. However, caution is advised with the following symptoms:

Joint pain that restricts the mobility of the joint
fever
reddened skin over the painful joint
swollen joint

If these symptoms persist for more than three days, worsen, or spread to other joints, you should definitely consult a doctor!

Joint pain: what does the doctor do?

First, the doctor will ask you about your medical history (anamnesis). For example, when and where the joint pain occurs and whether you suffer from other symptoms (such as fever or joint swelling).

Exact description of the joint pain

The more precisely you can describe your joint pain, the better the doctor can narrow down the possible causes. An acute attack of gout, for example, is likely to be the cause of pain if the joint pain only occurs in one joint. In rheumatoid arthritis, on the other hand, the joint pain manifests itself in several joints.

The location (localization) of the joint pain is also revealing: If you have wrist pain or pain in the metacarpophalangeal and median joints, you probably have rheumatoid arthritis. On the other hand, if the joint pain affects the metatarsophalangeal joint of the thumb and the end joints of the fingers, osteoarthritis is more likely.

Palpation

No matter where the joint pain occurs - the doctor must clarify whether the pain really originates from the joints, from areas close to the joint or from the neighboring bones. Sometimes he can find this out by palpating the painful region. However, further examinations such as X-rays or ultrasound are often necessary.

Further examinations for joint pain

Orthopedic examination: If it is suspected that the joint pain is caused by wear and tear (osteoarthritis), bursitis, rheumatic fever or an acute gout attack, an orthopedic examination can provide certainty.

Dermatological Exam: Skin exams will help identify psoriatic arthritis or sarcoid as a possible cause of the joint pain.
Blood tests: Using blood samples, various triggers can be detected, for example bacterial joint inflammation or borreliosis. The doctor can also detect impaired blood clotting in a blood count. The rheumatoid factor and other signs of inflammation in the blood provide information about a possibly existing rheumatoid arthritis. If gout is suspected, the focus is on the uric acid level in the blood.
Ultrasound examination: It is helpful if bursitis, gout or systemic lupus erythematosus could trigger the joint pain.
X-ray: X-rays show signs of joint wear (osteoarthritis), rheumatoid arthritis and ankylosing spondylitis.
Joint puncture: If the doctor suspects a bacterial joint inflammation, he takes a sample of the joint fluid (joint puncture) and creates a bacterial culture with it: If bacteria can be grown from it, this speaks for a bacterial joint inflammation.

Once the cause of the joint pain is found, the doctor can initiate appropriate treatment. Rheumatoid arthritis, for example, is treated with various drugs. Medicines can also relieve the symptoms of joint wear (osteoarthritis). In advanced cases, an operation can also be useful (insertion of an artificial joint).

Joint pain: you can do it yourself

General tips for joint pain

Lose excess weight. Every excess kilo puts additional strain on the joints - they wear out faster, which inevitably leads to joint pain.
Exercise regularly to strengthen muscles and articular cartilage. Swimming and cycling, for example, are particularly gentle on the joints.
Regular strength training (such as weight lifting and jumping rope) is also recommended. Let an experienced trainer or sports doctor develop a balanced exercise program that strengthens all muscles equally.
Take enough breaks from exercising.
Avoid one-sided loads such as carrying heavy shoulder bags.
Reduce psychological stress - emotional stress can also manifest itself in the form of joint pain. You should therefore ensure a balance, for example through autogenic training or progressive muscle relaxation according to Jacobson.
Have sore joints treated with acupuncture.

Tips for joint wear (osteoarthritis)

How you can help yourself with osteoarthritis depends in part on whether you are currently experiencing a flare-up of inflammation (activated osteoarthritis) or not (non-activated osteoarthritis).

Tips for activated osteoarthritis

Under "activated osteoarthritis" doctors understand a current severe joint inflammation with joint pain, swelling and redness. In this case, you should rest the affected joint (bed rest). Position it so that the associated muscles are relaxed. Moist and cooling compresses (for example quark compresses or quark compresses) can also relieve joint pain.

Medicinal plants can support the effects of the anti-inflammatory and pain-relieving drugs that you receive from your doctor. Arnica, for example, is well suited (as a tea for compresses or as an ointment or gel for rubbing the joints). There are also anti-inflammatory and pain reliever preparations based on willow bark as well as combination preparations with oils from the leaves of rosemary and eucalyptus. In addition, cooling peppermint oil can have an analgesic effect.

Tips for non-activated osteoarthritis

If the pain, redness and swelling have subsided, one speaks of non-activated osteoarthritis. Then it is a matter of preventing the joint pain from reactivating. Sufficient sleep on an orthopedic mattress helps relax the muscles and relieve the spine and joints.

If osteoarthritis is not activated, a tea made from devil's claw root is also recommended: Pour two cups of boiling water over a tablespoon of the powdered root and let the tea steep for eight hours. Before serving, briefly boil the drink and then strain it. You drink the tea over a period of three days. It takes about three weeks to take effect.

If you have non-activated osteoarthritis, you can also prepare a tea mixture of currant leaves, willow bark, nettle, field horsetail and meadowsweet flowers (20 g each). Take two teaspoons of this mixture and pour a cup of boiling water over it. Let cook for half an hour and then strain. Drink five to six cups of this tea throughout the day. It has an anti-inflammatory effect and relieves joint pain.

General tips for osteoarthritis

Relaxation: Regular meditative relaxation methods such as progressive muscle relaxation or autogenic training can help if you often suffer from stress-related muscle tension.
Sport and exercise: Physical activity helps supply the articular cartilage with synovial fluid and nutrients. Swimming, cycling and water aerobics are particularly gentle on the joints. On the other hand, you should avoid jogging on hard asphalt. This is especially true if your knee or hip joints are already damaged by osteoarthritis. If you don't want to do without running, you should prefer soft forest floor and wear well-padded running shoes that cushion shocks. Better still, walk instead of jogging. Avoid sports with sudden changes of direction such as tennis and squash. These put a lot of strain on the joints and then quickly trigger joint pain.
No long standing or sitting: Avoid standing or sitting in an unchanged position for long periods.
Low in arachidonic acid: Eat a diet that is low in arachidonic acid. This omega-6 fatty acid can promote osteoarthritis-related joint inflammation. For example, arachidonic acid is found in fatty pork, egg yolks, lard, tuna, liver sausage, beef, and camembert.
a lot of omega-3: Consume omega-3 fatty acids regularly. They neutralize the arachidonic acid. Larger amounts are found in fish oil. Therefore, fish should be on your menu at least once a week.
Sufficient vitamin E: Make sure that you have an adequate supply of vitamin E. It is important for the "synovial fluid" and, thanks to its antioxidant effect, helps against inflammation. Vitamin E is found in vegetable oils, especially wheat germ, soy germ, and sunflower seed oils.
Warmth: Arthrosis-related joint pain and other joint complaints can be relieved by warmth, for example with the help of fango packs, mud, hay flower and rosemary baths.
Kneading: In the case of osteoarthritis of the finger joints, kneading clay or loam that is warm at the body can help relieve joint pain and swelling. Regular finger exercises in warmed sand are also highly recommended. This is particularly good for joint stiffness and joint pain in the morning.
Essential oils: Massage in essential oils of eucalyptus, juniper, rosemary, lavender, or lemon. This promotes blood circulation and thus helps fight joint inflammation. However, you must not apply the essential oils directly to the skin, but first dilute them in a carrier oil (e.g. almond oil or jojoba oil).
Irritation therapies: In the case of osteoarthritis, stimulation therapies that stimulate blood circulation, such as dry cupping or leech therapy, should help. The latter also has an anti-inflammatory effect.

Treatment of autologous blood is controversial, especially if the prepared fluid is injected into the joint (risk of infection!).

Tips for Rheumatoid Arthritis

Some tips for osteoarthritis can also help with rheumatoid arthritis. The recommendations on nutrition, the external use of arnica and the preparation of devil's claw root tea apply to both diseases. But there are other tips for rheumatic joint pain and other joint ailments:

Keep the joint flexible: In the case of minor symptoms (non-activated rheumatoid arthritis), you can keep the joint flexible with physiotherapy and massage.
Tea mixture for a flare-up of inflammation: During a flare-up of inflammation (activated rheumatoid arthritis), an anti-inflammatory tea mixture made from meadowsweet flowers, willow bark, goldenrod, currant and nettle herb (20 g each) can help. To do this, pour a tablespoon of the mixture over a cup of cold water and let it steep for an hour. Then heat until just before cooking (do not let it boil!) And remove from the stove immediately. Let it steep again for five to ten minutes, then strain. Drink three to four cups a day.
Bromelain: In acute joint inflammation, protein-degrading enzymes such as bromelain should help.
Tai Chi and Qi Gong: These holistic Chinese sports are highly recommended for rheumatic diseases such as rheumatoid arthritis. Research shows that they can have a positive effect on mobility, muscle strength, endurance, quality of life and mood of the patient.
Cold or warm: Joint pain caused by inflammation can be relieved by cold and warm - just test what is more comfortable for you. In general, cold is recommended for acute joint inflammation in order to stop the inflammation. In the case of chronic complaints, however, warmth is usually more pleasant. Warming baths (for example with hay flowers), mud packs or mud treatments are beneficial.
Herbal healing power to rub in: Creams and ointments with willow bark, rosemary or eucalyptus oil and peppermint oils also have anti-inflammatory and analgesic effects.
Ayurveda: Ayurveda therapists recommend cleansing cures (Panchakarma cures) for rheumatic diseases in order to remove waste products (ama) from the body. Ama accumulations are considered to be the cause of the disease according to this teaching. Indian frankincense (shallaki) and triphala (herbal mixture) are used for acute joint inflammation with joint pain. Both have strong anti-inflammatory effects.

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