Joint pain
Almost everyone has sore joints at some point. What matters is something else: the same phrase, "my joints hurt", covers situations of wildly different…
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Medicines commonly prescribed for Joint pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Viatris Pharmaceuticals S.L.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mg/5mlActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: GEL, 11.6 mg diethylamine diclofenac/gActive substance: diclofenacManufacturer: Haleon Spain S.A.Prescription not required
Almost everyone has sore joints at some point. What matters is something else: the same phrase, "my joints hurt", covers situations of wildly different urgency — an overloaded knee, an inflammatory disease that has to be treated within the first few months, and an infection inside a joint where the clock runs in hours. This page is about telling them apart. If the only thing hurting is one knee, that has its own set of causes and its own page on knee pain; come back here if several joints are involved, or if the knee has been joined by morning stiffness, swelling or a temperature.
Is it really the joint?
The first thing worth settling is whether the joint itself is the problem. Very often the pain comes from what sits beside it: a tendon, where that tendon attaches to bone, a bursa, a muscle. Those are managed differently.
When the joint itself is affected, it hurts to move it in any direction, including when somebody else moves the limb and you stay relaxed; it may be swollen all round and warm to the touch. When the trouble is in the surrounding tissue, the pain is pinpoint, you can put a finger on it, it appears with one particular movement and when a specific muscle tightens, and in every other direction the joint moves freely.
There is a third possibility: referred pain. A shoulder can hurt because of the neck, and a hip or a knee because of the lower back, with the joint itself entirely healthy. The clue is pain that runs in a band, travels down the limb, comes with numbness or pins and needles, and changes with the position of your back and neck rather than with load on the joint.
Inflammation or wear: the main fork in the road
This is the most useful distinction in the whole subject, and the one people most often skip. Mechanical pain and inflammatory pain behave differently, and what you do next depends on which you have.
Mechanical pain — osteoarthritis being the standard example — gets worse with use and towards the end of the day, settles with rest, and comes with brief morning stiffness: five or ten minutes, a quarter of an hour at most, gone after a few movements. It does not usually wake you at night. Any swelling is slight and not warm.
Inflammatory pain does the opposite: morning stiffness lasts more than half an hour and often an hour or more; movement eases it while rest and long sitting make it worse; the joint is swollen, warm and sometimes red; the pain wakes you in the second half of the night. Tiredness, a slight temperature and weight loss often come with it.
The difference is practical, not academic. Mechanical pain is sensibly managed with movement, unloading and pain relief. Inflammatory pain is not cured by rubbing something on it and does not go away by itself: behind it stand rheumatoid arthritis, psoriatic arthritis, the spondyloarthritides, gout and systemic disease. Timing counts here: inflammatory arthritis caught in the first months lets the joints be saved, while a year lost turns into damage that cannot be undone. So more than half an hour of morning stiffness plus a swollen joint is a reason to book an appointment, not to visit the pharmacy.
One joint or many
The second question that narrows things down sharply is how many joints are involved, and which ones.
- One joint, acutely: injury, gout, pseudogout, bleeding into the joint, infection. Sudden night pain in the big toe with purple swelling and unbearable tenderness to touch is a very characteristic picture of gout.
- One joint, long term: osteoarthritis, cartilage or meniscal damage, an old injury and, rarely, chronic infection or a tumour.
- Several large joints, one after another: reactive arthritis one to four weeks after a bowel or genitourinary infection, and viral arthritis.
- Many small joints, symmetrically: rheumatoid arthritis begins in the hands and feet, the same on both sides, with marked morning stiffness. Viral infections give a similar picture but clear within weeks.
- Joints together with back pain: inflammatory low back pain in a young person, worse at rest and eased by movement, is spondyloarthritis, not a "pulled back".
- Stiffness in the shoulders and hips in an older person without the joints themselves swelling: this can be polymyalgia rheumatica.
If the only item on that list that applies to you is the knee, read the page on knee pain: it covers the mechanism of injury, locking, meniscal tears and pain beneath the kneecap in younger people.
When help is needed straight away
One hot, red, swollen joint together with fever and shivering is a joint infection, and the clock runs in hours. Pus destroys cartilage irreversibly within days, so that joint is examined and aspirated the same day and treated in hospital. Do not wait for morning, do not apply heat, do not take "something for the inflammation": a painkiller will bring the temperature down and soften the picture while the disease carries on. Be especially wary if the joint is an artificial one, if there has been a recent injury or an injection into the joint, if you take medicines that suppress the immune system, or if you have diabetes. Gout looks almost the same and the two cannot be told apart by eye, so it is treated as infection until proved otherwise.
Go to an emergency department or call an ambulance on the single European number 112 if:
- the joint is hot, red and swollen and you have a temperature or shivering;
- after a fall or a blow the joint has changed shape, sits at an unnatural angle or cannot take any weight;
- the joint swelled up within an hour of the injury;
- below the joint the limb has gone numb, pale or cold;
- you take anticoagulants and the joint has swelled and bruised rapidly.
What should not be put off
See a doctor within the next few days if:
- joint pain comes with a rash, fever and weight loss — that combination occurs in systemic disease and needs investigating rather than watching;
- your joints are stiff in the morning for more than half an hour and this has gone on for more than two or three weeks;
- a joint is clearly swollen and you do not know why;
- the pain started after a tick bite, a bowel infection or a sexually transmitted infection;
- in an older person, pain in the shoulders and hips is joined by headache at the temples, tenderness of the scalp, jaw pain on chewing or disturbed vision: this may be temporal arteritis, seen urgently because it threatens sight;
- joint pain appears in a child and lasts more than a few days, particularly if the child is limping, has a temperature or looks unwell.
What it most often turns out to be
- Osteoarthritis, the commonest cause from the forties and fifties onwards. It affects knees, hips, hands and the base of the thumb: pain on loading, brief stiffness, gradual loss of movement.
- Rheumatoid arthritis, treated with drugs that alter the course of the disease; the earlier that starts, the better the outcome.
- Gout and pseudogout, crystals deposited in the joint. The attack builds over hours and settles within days, but it recurs and steadily damages the joint.
- Psoriatic arthritis. Worth considering if there is psoriasis (sometimes only on the scalp or in skin folds) or nail changes; inflammation of a whole finger and heel pain are typical.
- Viral arthritis. Plenty of ordinary infections produce aching and even swollen joints; they clear in two to six weeks.
- Tendonitis and bursitis, inflammation of a tendon or a bursa from overuse: it hurts beside the joint rather than in it.
- Other illnesses and medicines. Aching joints occur with thyroid disease and vitamin D deficiency, and also with statins, aromatase inhibitors and on withdrawal of steroids.
- Fibromyalgia, widespread pain in the muscles and around the joints without swelling, with disturbed sleep and fatigue. The joints are not damaged and the treatment is entirely different.
What you can do yourself
- Keep moving. Complete rest harms a joint: without movement the cartilage is nourished less well, muscles weaken, and the pain ends up worse. Load is modified, not abolished — walking, swimming, cycling, movement within the range that does not hurt.
- A fresh injury is managed for the first day or two with rest and cold: an ice pack through a cloth rather than on bare skin, for fifteen to twenty minutes.
- Pain relief: paracetamol, and non-steroidal anti-inflammatories by mouth or as a gel. Agree the choice and the dose with a doctor or pharmacist, particularly if you have stomach, kidney or heart problems or take other medicines. Reaching for painkillers week after week is a sign that you need a diagnosis, not another packet.
- Losing weight makes a marked difference to knees and hips: every extra kilogram is multiplied several times over with each step.
- Heat helps stiffness, cold helps swelling and local warmth. The rule is simple: a hot, red joint is not warmed further.
- Comfortable shoes and a stick held in the opposite hand unload a painful joint more than you would expect.
What is not worth doing: putting up with it for months in the hope it passes; heating a joint that is already hot; taking steroids on your own initiative; and above all, writing off inflammatory pain as age. Age does not explain a swollen joint or an hour of morning stiffness.
How a doctor looks for the cause
The conversation counts for more here than people expect: the doctor wants to know which joints hurt, whether symmetrically, how long the stiffness lasts, what happened in the month or two beforehand, whether there is psoriasis, inflammatory bowel disease or rheumatic illness in the family, and what medicines you take. Then they examine the joints for swelling, warmth and restricted movement, and check skin, nails, eyes and spine.
Of the tests, a blood count with inflammatory markers is the usual starting point, with uric acid, rheumatoid factor and antibodies to cyclic citrullinated peptide added as the situation requires. Ultrasound shows fluid in the joint and inflammation of the lining well; an X-ray shows the changes of osteoarthritis and of advanced arthritis; not everyone needs a scan. For a single acutely inflamed joint the decisive test is aspiration and analysis of the fluid: it answers both questions at once, infection or crystals. If inflammatory arthritis is suspected the doctor refers you to a rheumatologist, and that referral is not left to sit.
Online consultation
Much of this work is done by listening, which is what makes an online consultation useful at the very earliest stage. The Oladoctor doctor will ask how long the morning stiffness lasts, whether movement eases things, which joints are involved and what happened in the preceding weeks, and from those answers will say whether the picture looks mechanical or inflammatory. They will explain which tests are worth doing, help you read results and images you already have, and advise whether a rheumatologist is needed. And they will spell out the situations in which the conversation should stop and you should go to hospital: a hot, swollen joint with a temperature cannot wait.
This material is for information only and does not replace medical advice.
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