Joint pain has many causes, and the pattern tells them apart.
A joint is where two bones meet. Their ends are capped with smooth, slippery cartilage and wrapped in a thin lining that makes oil for the joint. Pain can come from the cartilage wearing thin, from the lining becoming inflamed, from crystals, or from an infection. Which joints hurt, how they feel in the morning, and whether they swell, point to which one it is.
In plain words.
Wear-and-tear arthritis (osteoarthritis) is the most common kind. It is most common in the knees, hips, lower back and the end joints of the fingers. It usually aches more with use and towards evening, and eases with rest. Morning stiffness lasts only a few minutes. Extra weight, past injuries and age make it more likely.
Inflammatory arthritis is different: the lining itself is inflamed. In rheumatoid arthritis the small joints of both hands and feet swell, and stiffness lasts more than half an hour after waking. It needs treatment early, because untreated it can damage the joints for good. Gout is a sudden, very painful, red, swollen joint, often the big toe, caused by uric acid crystals.
In India, joint pain that lingers for weeks or months after a chikungunya fever is also common. Other viral fevers, thyroid problems and low vitamin D can cause aches too. A single hot, swollen joint, with or without fever, is different again: it may be an infection inside the joint, which is an emergency.
Inside a knee
The bone ends are capped with smooth cartilage and sit in a sac of joint oil, so they glide over each other without touching.
The cartilage wears thin and rough, the gap narrows, and small spurs of new bone grow at the edges. The joint aches with use and creaks.
In rheumatoid arthritis or gout, the lining swells and fills the joint with extra fluid. The joint turns warm, puffy and stiff. Here the treatment is aimed at the inflammation, not the wear.
Go to hospital now if
- One joint suddenly hot, swollen and very painful for the first time, with or without fever, or you cannot move it at all: go to hospital now. An infection inside a joint can destroy it within days.
- After a fall or injury: the joint looks out of shape, or you cannot put weight on the leg: go to hospital now.
- Pain and swelling in one calf or thigh: go to hospital today. This can be a clot in a leg vein, not a joint problem.
- Leg swelling with sudden breathlessness or chest pain: call 112.
- Back pain with new weakness or numbness in the legs, numbness between the legs, or loss of control of urine or stools: go to hospital now.
- Joint pain with a spreading rash, high fever and feeling very unwell: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a week if
- Several small joints of the hands or feet are swollen, or morning stiffness lasts more than half an hour
- A joint swells up again and again
- Pain wakes you at night, or comes with weight loss or on-and-off fever
- Joint pain has lasted more than six weeks
- You have already needed painkillers most days for more than a week or two
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| ESR and CRP | Markers of inflammation. Raised in inflammatory arthritis; usually normal in wear-and-tear arthritis. |
| RA factor and anti-CCP | Antibodies seen in rheumatoid arthritis. Anti-CCP is the more reliable of the two; either can be positive in people who do not have it. |
| Uric acid | Helps when gout is suspected. A high value alone does not prove gout, and it can be normal during an attack. |
| X-ray of the joint | Shows narrowing and bone spurs of wear-and-tear arthritis. A knee X-ray is best taken standing. |
| Complete blood count (CBC), sugar, thyroid | Look for anaemia, infection and conditions that cause aches or make joints worse. |
| Joint fluid test | Fluid drawn from a swollen joint with a needle, in person. It is the surest way to find gout crystals or an infection. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Painkillers such as diclofenac, ibuprofen or nimesulide can harm the stomach and kidneys and raise blood pressure when taken for long. Use them only for short spells unless a doctor advises otherwise. Be wary of unlabelled powders and pills for joint pain: some have been found to hide steroids.
A video call can
- Work out the likely kind of arthritis from the pattern
- Decide which blood tests and X-rays are worth doing
- Read your reports and X-ray reports with you
- Plan safe pain relief, exercises and weight loss that ease the load on the knees
- Follow up on how treatment is working
Needs a visit in person
- Examining the joint: swelling, fluid and range of movement
- Drawing fluid from a swollen joint, or an injection into it
- Physiotherapy sessions to strengthen the muscles around the joint
- A surgeon’s opinion when a joint is badly worn
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759