Arthralgia

Risk: Arthralgia is a common symptom that affects virtually everyone at some point during life and occurs in women more often than men.

Incidence and Prevalence: The exact incidence is not known because, as a symptom, arthralgia accompanies a broad range of disparate conditions. The prevalence of arthralgia increases with age.

History: The individual may complain of pain in one or multiple joints. Helpful information about the pain includes the time of day it occurs; what makes it worse or better; and the presence of any other symptoms such as fever, sore throat, fatigue, joint swelling, or a general feeling of poor health (malaise). A complete history of prior and current illnesses, injuries, and medications is needed to help diagnose the underlying condition.

Physical exam: The exam helps determine if the pain comes from the joint itself or is referred from nerve root impingement in the spine, nerve entrapment in the limb, or other pathology in the same extremity. For example, a hip problem may manifest as knee pain. If pain comes from the joint itself, there may be joint tenderness, warmth, swelling, or redness. Joint range of motion is measured, with attention to whether the movement is painful or not and whether it is smooth or accompanied by a crackling sound (crepitus) or catch. The individual may appear acutely or chronically ill. Overall health status will be evaluated with a complete physical examination.

Tests: Laboratory tests include erythrocyte sedimentation rate (ESR or sed rate), rheumatoid factor (RF), a complete blood count with hemoglobin, hematocrit, red blood cell (RBC), and white blood cell (WBC) counts, uric acid levels, and antinuclear antibodies. A complete blood chemistry panel may be done to evaluate health status. Joint fluid may be analyzed for the presence of crystals, bacteria, blood, and inflammatory cells. X-rays of affected joints may detect fracture, tumor, joint space narrowing, pockets of fluid in the bone just under the cartilage (subchondral cysts), joint surface erosions, soft tissue calcifications, bone spurs at joint edges (marginal osteophytes), or other abnormalities. MRI or CT scans, ultrasound, arthrography or arthroscopy, synovial biopsy, bone scanning, bone biopsy may also be indicated. Electrodiagnostic testing such as electromyography or nerve conduction studies may be warranted if referred pain is suspected.

Rehabilitation for arthralgia aims to improve function, decrease pain, and preserve joint integrity. Although the type of treatment depends on the underlying cause, rehabilitation often includes occupational and physical therapy. The therapist may need to modify treatment according to the cause and severity of the arthralgia, which joint is affected, and whether surgery on the joint was required.

Therapy will include a program that combines stretching and strengthening exercises. Stretching exercises will preserve and/or improve joint range of motion, and the strengthening program will train the muscles in order to improve the functional capacity of the involved joints. The individual can progress through stretching and strengthening exercise programs depending on pain tolerance and physical ability (Suomi). Pain control can be achieved by use of modalities including cold, heat, and electric stimulation. All exercises are aimed at restoring full function.

Orthotics may be useful in reducing the biomechanical stress on involved joints and must be evaluated individually. An occupational therapist may educate individuals in joint protection techniques to improve daily living performance as well as in the use of adaptive devices to promote independence and safety.