Managing joint pain
JOINT pain is common in society and may affect the quality of life of an individual. It may present with burning or throbbing pain and is almost always associated with stiffness. The commonly affected joints are usually weightbearing joints such as the hips, knees, and ankles and usually worsen with activity. Certain diseases may also affect other joints such as the hands, feet or spine.
According to consultant orthopaedic surgeon Dr Ruzaimi Md Yusoff at MSU Medical Centre, “There are several identified risk factors with regard to joint pain. Those who have previous injuries to a joint, have previously overused a particular joint, history of arthritis, are overweight and ageing are among the people with common risk factors associated with joint pain.”
He adds that symptoms of joint pain range from mild to disabling and some of these symptoms require urgent attention and immediate consultation with medical practitioners. These symptoms include swelling, a stiff or enlarged joint, numbness noisy joints, painful movement, difficulty in bending or straightening the joint, loss of motion and a red and hot and swollen joint.
The most common causes of joint pain include osteoarthritis, rheumatoid arthritis, gout, bursitis, a viral infection, trauma to the joints and tendinitis.
Osteoarthritis is the most common joint pain managed in orthopaedic clinics. Osteoarthritis is typically diagnosed based on clinical and radiographic evidence as there are no specific laboratory abnormalities associated with osteoarthritis. Methods used to diagnose osteoarthritis include:
l Plain radiography: It is the imaging method of choice because it is more cost-effective and can be obtained more readily and quickly. Radiographs can depict joint-space loss, as well as subchondral bony sclerosis and cyst formation.
l Magnetic resonance imaging (MRI): It is not necessary in most patients with osteoarthritis, unless additional pathology amenable to surgical repair is suspected. Pathology that can be seen on MRI includes joint narrowing, subchondral osseous changes, and osteophytes. Unlike radiography, MRI can directly visualise articular cartilage and other joint tissues (e.g., meniscus, tendon, muscle, or effusion).
l Computed tomography (CT):
Rarely used in the diagnosis of primary osteoarthritis. However, it may be used in the diagnosis of secondary causes of osteoarthritis such as malalignment of the patellofemoral joint or of the foot and ankle joints.
“Symptoms of joint pain range from mild to disabling and some of these symptoms require urgent attention and immediate consultation with medical practitioners.”
l Ultrasonography: It currently has no role in the routine clinical assessment of the patient with osteoarthritis. However, it is being investigated as a tool for monitoring cartilage degeneration, and it can be used for guided injections of joints not easily accessed without imaging.
Optimally, patients should receive a combination of nonpharmacologic and pharmacologic treatment.
Nonpharmacologic interventions include educating patients, simple at-home treatments such as applying a heating pad or ice on the affected area, losing weight, exercising, physical or occupational therapy and unloading in certain joints with the use of supportive aids.
Pharmacologic agents used in the treatment of osteoarthritis include paracetamol nonsteroidal antiinflammatory drugs, calcium channel blockers or COX-2 inhibitor combination, intraarticular corticosteroids, intraarticular sodium hyaluronate, opioids, muscle relaxants and nutraceuticals.
Surgical procedures for osteoarthritis may be considered if the osteoarthritis fails to respond to a medical management plan. These include:
l Arthroscopy: Indicated for the removal of meniscal tears and loose bodies; less predictable arthroscopic procedures include debridement of loose articular cartilage with a microfracture technique and cartilaginous implants in areas of eburnated subchondral bone.
l Osteotomy: Used in active patients younger than 60 years who have a malaligned hip or knee joint and want to continue with reasonable physical activity.
l Arthroplasty: Performed if all other modalities are ineffective and the osteotomy is not appropriate or if a patient cannot perform activities of daily livings (ADLS) despite maximal therapy. This procedure alleviates pain and may improve function.
There are also several methods to prevent osteoarthritis, these include:
l Exercising: Regular lowimpact exercises such as strength training and stretching can help to slow down the progression of osteoarthritis.
l Maintaining an ideal body weight: Overweight patients who have early signs of osteoarthritis or who are at high risk should be encouraged to lose weight. Losing weight can help to reduce pain and increase joint motions.
l Resting: Exercise can help to maintain healthy joints but overuse of the joints will increase the risk of developing osteoarthritis. Therefore, if the joint becomes swollen or painful, it should not be used for 12 to 24 hours to reduce the risk of developing osteoarthritis in the future.
l Acknowledging occupational risks: Jobs that require repetitive kneeling, twisting, lifting and walking may have impact on joints. It is important to work according to the designated standard operating procedures to maintain healthy joints.