Noninflammatory Joint Pain:
Noninflammatory joint pain (no redness, no warmth, no swelling) of unknown etiology can be caused by a wide range of pathologic conditions. Fibromyalgia, leukemia, sexually transmitted infections, artificial sweeteners, 5 9 ” 6 1 Crohn’s disease (also known as regional enteritis), and infectious arthritis are all possible causes of joint pain.
|Noninflammatory joint pain|
When comparing joint pain associated with systemic versus musculoskeletal causes, one of the major differences is in the area of associated signs and symptoms. Joint pain of a systemic or visceral origin usually has additional signs or symptoms present. The client may not realize there is a connection, or the condition may not have progressed enough lor associated signs and symptoms to develop.
Therapist Evaluation for Joint Pain:
The therapist also evaluates joint pain over a 24-hour period. Joint pain from a systemic cause is more likely to be constant and present with all movements. This is in comparison to the client with osteoarthritis (OA), who often feels better after rest (though stiffness may remain). Morning joint pain associated with OA is less than joint pain at the end of the day after using the joint(s) all day.
The Pain Assessment Record Form includes an assessment of these differences across a 24-hour span as part of the “Pattern.”
- What kind of work do you do?
- Do you think your health problems are related to your work?
- Are your symptoms better or worse when you’re at home or at work?
- Follow up if worse at work: Do others at work have similar problems?
- Have you been exposed to dusts, fumes, chemicals, radiation, or loud noise?
- Follow up: It may be necessary to ask additional questions based on past history, symptoms, and risk factors present.
- Do you live near a hazardous waste site or any industrial facilities that give off chemical odors or fumes?
- Do you live in a home built more than 40 years ago? Have you done renovations or remodeling?
- Do you use pesticides in your home, on your garden, or on your pets?
- What is your source of drinking water?
- Chronology of jobs (type of industry, type of job, years worked)
- How new is the building you are working in?
- Exposure survey (protective equipment used, exposure to dust, radiation, chemicals, biologic hazards, physical hazards)
Drug induced Joint Pain:
Joint pain as an allergic response, sometimes referred to as “serum sickness” can occur up to 6 weeks after taking a prescription drug (especially antibiotics). Joint pain is also a potential side effect of statins (e.g., Lipitor, Zocor). These are cholesterol-lowering agents.
Likewise, delayed reactions can occur as a result of occupational or environmental chemical exposure. The alert therapist may recognize and report clues to help the client obtain a more accurate diagnosis.
Inflammatory Bowel Disease (IBD):
Ulcerative colitis (UC) and regional enteritis (Crohn’s disease; CD) are accompanied by an arthritic component and skin rash in about 25% of all people affected by this inflammatory bowel condition.
Systemic Causes of Joint Pain:
Infectious and noninfectious systemic causes of joint pain can include, but are not limited to
- Allergic reactions (e.g., medications such as antibiotics)
- Side effect of other medications such as statins, prolonged use of corticosteroids, aromatase inhibitors
- Delayed reaction to chemicals or environmental factors
- Sexually transmitted infections (STIs) (e.g., HIV, syphilis, chlamydia, gonorrhea)
- Infectious arthritis
- Infective endocarditis
- Recent dental surgery
- Lyme disease
- Rheumatoid arthritis
- Other autoimmune disorders (e.g., systemic lupus erythematosus, mixed connective tissue disease, scleroderma, polymyositis)
- Acute rheumatic fever
- Chronic liver disease (hepatic osteodystrophy affecting wrists and ankles; hepatitis causing arthralgias)
- Inflammatory bowel disease (e.g., Crohn’s disease or regional
- Anxiety or depression (major depressive disorder)
- Artificial sweeteners
Pain in Arthritis:
Joint pain (either inflammatory or noninflammatory) can be associated with a wide range of systemic causes including bacterial or viral infection, trauma, and sexually transmitted diseases.
Pain in Infectious Arthritis:
Joint pain can be a local response to an infection. Invading microorganisms cause inflammation of the synovial membrane with release of cytokines (e.g., tumor necrosis factor, interleukin-1) and proteases. The end result can be cartilage destruction even after eradicating the offending organism
Joint Pain Management:
Joint problems usually respond to medical treatment of the underlying bowel disease but in some cases require separate management.