Chronic joint pain is a common symptom. If severe, it can affect daily life. Patients who buy painkillers on their own may develop complications such as stomach ulcers and kidney disease. Therefore, patients should understand the causes and receive proper treatment from specialists to regain quality of life and stop the progression of the disease and complications caused by improper self-care.
Causes of Chronic Joint Pain
Chronic joint pain can be divided into two main types as follows:
- Joint pain from overuse causing injury or structural support problems (mechanical joint pain), such as osteoarthritis, which is common in the elderly or overweight individuals. Patients experience pain when standing or walking for a long time. The pain improves with rest, there may be joint noises during movement, and there is no pain or only slight stiffness after waking up.
- Joint pain from inflammation (inflammatory joint pain), which includes several diseases. This type of joint pain is usually worse after waking up in the morning. Some people experience joint pain severe enough to wake them at night. Morning stiffness can last for hours, but during joint movement, most patients experience less pain and stiffness.
How Many Types of Arthritis Are There?
Many people often think arthritis is rheumatoid arthritis, but in fact, there are many other diseases that cause joint inflammation as follows:
- Rheumatoid Arthritis
- Spondyloarthropathy, although back and neck pain are common symptoms, patients with this disease can have inflammation in other joints besides the spine, such as knees, ankles, finger joints, and toe joints. This group includes 4 subtypes:
- Ankylosing Spondylitis
- Psoriatic Arthritis
- Reactive Arthritis, which is related to previous infections
- Arthritis associated with Inflammatory Bowel Disease
- Palindromic Rheumatism, which causes chronic joint pain but each episode resolves quickly within hours or days
- Connective Tissue Disease-related arthritis, including SLE, scleroderma, and myositis, which can cause inflammation in multiple organs, with arthritis being one of the symptoms
- Systemic Vasculitis-related arthritis, where joint pain is one of the symptoms. This disease is rare and sometimes difficult to diagnose
- Gout and Pseudogout, which cause intermittent joint pain and inflammation, usually affecting only 1-2 joints at a time
There are also other types of arthritis, but they are rare and will not be discussed here.
How Is Arthritis Diagnosed?
Diagnosing arthritis requires multiple factors, including detailed history taking and physical examination, along with blood tests for specific antibodies related to the disease and joint X-rays. The pattern of joint damage seen on X-rays usually differs among types of arthritis.
Often, arthritis is complex and a definitive diagnosis can be difficult, especially if patients see a doctor early or if symptoms are incomplete, or if blood tests do not show specific antibodies or inflammatory markers, such as rheumatoid arthritis with negative rheumatoid factor, or psoriatic arthritis where joint inflammation precedes the skin rash for a long time.
In such cases, continuous monitoring is necessary. Therefore, patients suspected of having arthritis are advised to see a specialist for evaluation and to differentiate from other diseases with similar symptoms.
How Is Arthritis Treated?
Arthritis is caused by an overactive immune system leading to inflammation of the joints and other organs. Therefore, treatment involves medications to modulate and/or suppress the immune system.
Initially, doctors may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac, Ibuprofen, Naproxen, Arcoxia, or Celebrex. However, long-term use of these drugs may cause stomach ulcers or kidney disease. Therefore, these medications should be taken under medical supervision and are usually used to relieve joint pain in the early stages.
Sometimes, doctors may prescribe steroids to treat arthritis if symptoms are severe. However, long-term steroid use can cause many side effects.
Therefore, long-term arthritis treatment requires other medications to modulate and/or suppress the immune system. These include Methotrexate, Sulfasalazine, Leflunomide, Hydroxychloroquine or Chloroquine, among others. The choice of medication depends on the doctor’s judgment, considering the type and severity of arthritis. Patients on these drugs need regular blood tests to monitor blood counts and liver and kidney function.
Additionally, there are biologic agents that specifically target inflammatory substances in the blood. These are mostly injectable drugs such as Infliximab, Golimumab, Etanercept, Tocilizumab, Secukinumab, etc. There is one oral drug called Tofacitinib. These drugs are more effective than the previously mentioned oral medications and are usually used in patients who do not respond adequately to standard treatments.
How Should Arthritis Patients Take Care of Themselves?
Patients should exercise regularly, maintain a healthy weight, and get enough rest. They should also consume foods high in calcium because arthritis patients are at higher risk of osteoporosis than the general population. Intake of starches, sugars, and high-fat foods should be limited as they may lead to diabetes and high blood lipids. In the long term, arthritis patients have a higher risk of coronary artery disease.
Moreover, patients on immunosuppressive drugs are at risk of severe infections. Therefore, they should eat thoroughly cooked and clean food, avoid raw or undercooked food, avoid close contact with infectious patients, wear masks in crowded places or hospitals, wash hands frequently, and if possible, get vaccinated against influenza and pneumonia.
