Stiff, swollen and painful joints that get worse over time are a sign of osteoarthritis (OA), the most common type of arthritis. It's a wear and tear degenerative disease associated with getting older, but also injuries and other conditions, including gout.
Other causes of joint pain include sports injuries, general sprains and strains, fractures, overuse, knee cartilage problems, rheumatoid arthritis (RA) a frozen or unstable shoulder, and bleeding into joint spaces caused by torn ligaments.
OA is caused by cartilage, the tough connective tissue which acts as a shock absorber to your joints, wearing thinner and breaking down, causing friction and pain in the joints.
In RA the body produces antibodies which attack the lining of the joints (more specifically the synovial lining) leading to pain and inflammation in affected areas.
Gout is the result of too much uric acid building up in the body and sodium urate crystals being deposited in the joints and growing in the cartilage (the 'shock absorber' lining of joints) and other joint soft tissue.
Sprains and strains are caused by awkward movements, doing more activity than normal and overuse. Fractures may develop following falls or impact.
OA symptoms can include joint pain, swelling and stiffness. Your joints may also creak and crunch as you move and feel stiff in the morning, but this will ease by moving around within 30 minutes of getting up. Your knees, hips and hands are the joints where you are most likely to experience pain first.
Typical symptoms of RA include pain, swelling and stiffness in the joints. The small joints of the hands and feet are usually the first joints to be affected. Stiffness is worse first thing in the morning and after resting, and takes longer than 30 minutes to wear off. Extreme tiredness and fatigue is another symptom. Symptoms are usually, but not always, symmetrical (affecting both sides of the body).
Gout crystals grow most frequently in the toe, finger, ankle, knee and elbow joints. Crystals can affect any joint, though. When they move into the joint cavity this triggers a gout attack – causing inflammation and pain in the soft lining of the joint.
Joint pain is diagnosed by your doctor asking for a history of your symptoms and an examination. The next step may involve X-rays, ultrasound, CT or MRI scan – depending what your symptoms suggest. Your GP might also run blood tests for inflammatory markers and other signs of disease.
Who gets joint pain?
The short answer is everyone at some point – as we are all prone to injury, overuse of joints and awkward movements.
Arthritis joint pain caused by OA affects one in three people over 45. Being overweight makes it more likely you will get OA.
RA affects roughly two to three times as many women as men, and the peak age for starting with symptoms is in your 30s and 40s, however it can affect any age.
Gout mainly affects men over 30 and post-menopausal women. It's become a lot more common in recent years and this is thought to be due to rising levels of obesity.
Treatment for a sprain or strain should include resting and elevating the joint, applying ice and taking non-steroidal anti-inflammatory drugs (NSAIDs). If it doesn't settle you may need physiotherapy.
Milder OA pain and joint stiffness improves with regular exercise, particularly strengthening exercises and aerobic fitness. Losing weight if you're overweight can also ease symptoms as it takes pressure off the joints.
Regular paracetamol and/or NSAIDs cream or gel (for knee or hand OA) can also help. Oral NSAIDs including ibuprofen, diclofenac or ibuprofen, or COX-2 selective NSAIDs such as celecoxib are the next step.
Some research has found supplements may help in OA, including glucosamine and chondroitin, which both have anti-inflammatory effects. A 2016 study by King George's Medical University in Lucknow, India, also found patients with OA of the knee who took turmeric extract compared to a placebo, had significant improvement.
Treatments for RA include disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, which help reduce inflammation and prevent joint damage. Biological or biologic medicines, mimic substances found in the body such as antibodies and enzymes, and work by blocking chemicals involved in inflammation are the next option.
The omega 3 fatty acids in fish oils and fish oils supplements have also been found to help RA symptoms.
Gout treatments include NSAIDs and a drug called colchicine or steroids, as well as resting and elevating the affected area, applying ice and trying to avoid knocking it. The drugs allopurinol and febuxostat both reduce levels of uric acid to help prevent attacks coming back. Cherry and cherry extract intake was associated with a 35 per cent reduction in recurrent gout attacks in those with the condition in one study. When cherry intake was combined with taking allopurinol, it reduced attacks by 75 per cent.