Painful joints……could it be something more than ‘wear and tear’?

Painful joints……could it be something more than ‘wear and tear’?


Osteoarthritis (OA) is often thought of as a classic age-related disorder. Many reference this condition as a chronic degenerative disease described as having the prominent feature of the loss of joint cartilage. This is frequently called ‘wear and tear,’ affecting patients aged 40 and older.

Although age is a risk factor for OA, it does not directly cause it. Yes, age is the single greatest risk factor for OA, but not all older adults develop OA, and not all joints within the human body are affected equally. Important risk factors for osteoarthritis include obesity, joint injury, anatomical abnormalities, and genetics. Common joints involved are those joints that are most frequently used, which include the hips, knees, spine, and hands. There is no cure for the disease, and the focus remains on slowing the progression of the disease with exercise, weight management, anti-inflammatory +/- pain-relief medication, or surgical interventions, which sometimes include joint replacement surgery.


Whilst joint pain is often attributed to OA, sometimes the cause can be more serious conditions called ‘inflammatory arthritis’. This refers to a group of diseases caused by an overactive immune system that attacks the body and can present in a similar way to OA, particularly at the start when symptoms may include joint pain, swelling, and stiffness. Why exactly the immune system attacks the body is unknown, but what is known is that the immune system does not know when to stop, continuing to attack itself, causing continued inflammation, thereby known as an autoimmune disease. Auto refers to self and immune because the immune system can no longer distinguish itself from foreign such as viruses or bacteria. Inflammatory arthritis is often a systemic disease, meaning it can affect many joints and other organs, such as the heart, lungs, eyes, tendons, and skin. Examples of the different types of inflammatory arthritis include rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, and lupus. Recognition is important as left unchecked, inflammatory arthritis can become progressive.


Although the cause of joint pains can be diagnosed by a doctor’s clinical examination, sometimes further investigations are needed to confirm the diagnosis of OA or inflammatory arthritis. These investigations can include blood tests, scans such as x-rays, ultrasound or MRI scans, or sometimes taking a sample of joint fluid for testing.

Fortunately, treatments, including modern disease-modifying drugs, can limit or even halt the progression of the disease and the joint damage caused by inflammatory arthritis. Treatments are overseen by specialists called Rheumatologists, who are medical doctors with special training in the care of people with joint and autoimmune diseases. The key is early recognition of the possibility of inflammatory arthritis and referral to a specialist who can diagnose and manage the condition to prevent permanent joint damage and disability.




Author: Dr Amit Pasan, Virtual GP, Teladoc Health UK


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