What might be causing my joint soreness?

Does movement make it worse?

Ordinary wear often hurts more during walking, stairs, gripping, or reaching, and the ache may settle during rest before returning with the same motion. An old injury can make a busy day harder.

The sore place isn’t always where the trouble begins; hip trouble may be felt near your knee, while neck trouble may reach your arm. A careful exam checks nearby areas too.

Morning timing also helps. Brief stiffness that eases as you move often goes with ordinary wear, while longer stiffness in several joints deserves a doctor’s attention.

What doesn’t sound like ordinary wear?

Long morning stiffness, swollen knuckles, and several sore joints may mean inflammation, which is irritation and swelling driven by the body’s defense system. Your doctor can work out what is causing it.

Strong pain that starts suddenly with heat or redness needs prompt care. Infection inside a joint is one possible cause, even when there’s no fever, and it can’t wait.

An X-ray may help when the result could change your care, but it can also show old changes that aren’t causing today’s soreness. Your doctor compares the X-ray with your exam and symptoms.

This page can help you describe the ache, but it can’t diagnose it. A visit is worthwhile when the timing or swelling concerns you, and you’re not wasting anyone’s time by asking.

Sources

1. A EULAR task force of 18 rheumatologists, 3 health professionals, 2 patients and a methodologist defined which joint symptoms, in the absence of any visible swelling, should make a clinician suspect that inflammatory arthritis is coming. Seven parameters survived: symptom duration under one year, symptoms in the knuckle (metacarpophalangeal) joints, morning stiffness lasting 60 minutes or more, symptoms worst in the early morning, a first-degree relative with rheumatoid arthritis, difficulty making a fist, and a positive squeeze test of the knuckles. The combination identified at-risk patients with an area under the ROC curve of 0.92 (95% CI 0.87-0.96).

   van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJJ, et al. — EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis.. Annals of the Rheumatic Diseases, 2017. DOI: 10.1136/annrheumdis-2016-209846.

2. A systematic review of 33 studies reporting CT or MRI findings in 3,110 people with NO symptoms found that degenerative changes are close to universal with age. Disc degeneration was present in 37% of 20-year-olds and 96% of 80-year-olds; disc bulge in 30% at 20 and 84% at 80; disc protrusion in 29% at 20 and 43% at 80. The authors concluded that many imaging-based degenerative features are likely part of normal ageing and unassociated with pain.

   Brinjikji W, Luetmer PH, Comstock B, et al. — Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.. American Journal of Neuroradiology, 2015. DOI: 10.3174/ajnr.A4173.

3. In a structured review of 14 studies covering 6,242 patients with an acutely painful swollen joint (653 with confirmed septic arthritis), no single symptom rules the diagnosis in or out: joint pain was present in 85%, a history of joint swelling in 78%, and fever in only 57%. The most powerful bedside data came from aspirating the joint - the summary likelihood ratio rose with the synovial fluid white cell count, from 0.32 below 25,000/microL to 2.9 at 25,000 or more, 7.7 above 50,000 and 28.0 above 100,000.

   Margaretten ME, Kohlwes J, Moore D, Bent S — Does this adult patient have septic arthritis?. JAMA, 2007. DOI: 10.1001/jama.297.13.1478.

4. A systematic review of 78 prospective primary care cohort studies involving more than 48,000 participants with musculoskeletal conditions identified five factors that predict a worse outcome regardless of which body part hurts: widespread pain, high functional disability, somatisation, high pain intensity and previous episodes of pain. Consistent evidence also showed that use of pain medication was NOT associated with outcome.

   Artus M, Campbell P, Mallen CD, Dunn KM, van der Windt DAW — Generic prognostic factors for musculoskeletal pain in primary care: a systematic review.. BMJ Open, 2017. DOI: 10.1136/bmjopen-2016-012901.