Some Causes and Features of Pain in More Than One Joint
Cause | Common Features* | Tests† |
|---|---|---|
Disorders usually causing symmetric joint pain | ||
Joints not inflamed Chronic widespread pain and tenderness of muscles (that may involve joints and/or the back) Fatigue Sometimes irritable bowel syndrome or sleep disturbances Usually chronic, often affecting women Often depression or other mood disorders | Sometimes testing unnecessary | |
Infectious arthritis caused by viruses | Joint pain with or without inflammation, typically developing over hours or days Other symptoms of viral infection (for example, hepatitis B may cause jaundice, hepatitis C may cause purple blotches on legs, and HIV causes swollen lymph nodes) | Analysis of joint fluid Blood tests to identify the virus (most often hepatitis C or B or parvovirus) |
Chronic,‡ symmetric joint inflammation during childhood Lower back pain Swollen glands throughout the body or episodes of fever An enlarged liver and spleen Excess fluid around the heart or lungs Rash or eye pain and redness | Blood tests for autoantibodies§ | |
Other diseases that cause joint inflammation (such as Sjögren syndrome and systemic sclerosis) | Pain in many joints with or without mild swelling | Blood tests for autoantibodies§ |
Chronic,‡ symmetric inflammation of small and large joints Fatigue and morning stiffness Eventually, deformity of joints (particularly the knuckles and wrist joints) Sometimes hard swellings under the skin and carpal tunnel syndrome More common among young adults but can affect people aged 60 or older | X-rays Blood tests for autoantibodies§ | |
Serum sickness (a reaction by the immune system against large amounts of foreign proteins in the bloodstream) | Pain and inflammation in several joints Fever, rash, and swollen glands In people known to have been exposed to foreign proteins (for example, from a blood transfusion) up to 21 days before the start of symptoms | Sometimes blood tests |
Syndromes that cause unusual joint flexibility (such as Ehlers-Danlos syndrome) | Usually pain in many joints Joint inflammation very uncommon Increased looseness (laxity) of skin In people known to have a history of recurring joint dislocations or misalignment In people known to have affected family members | Sometimes genetic testing |
Systemic lupus erythematosus and other, less common, autoimmune diseases (for example, autoimmune myositis, Sjögren syndrome, and vasculitis such as immunoglobulin─A associated vasculitis) | Joint pain‡ with or without inflammation that can occur when the disorder flares up Other symptoms depending on specific autoimmune disease, such as skin changes; abdominal pain; muscle soreness; kidney disease; fluid around the lungs, heart, or other organs (serositis); or dry eyes and dry mouth | Blood tests for various autoantibodies§ Sometimes biopsy of skin, kidney, or other involved organs Analysis of urine |
Disorders usually causing asymmetric joint pain | ||
Involvement of the large joints Lower back pain in most people Eye redness and pain (iritis) Achilles tendinitis Leakage of blood back through the aortic valve (aortic insufficiency) | X-rays Sometimes CT or MRI | |
Chronic‡ or recurrent mouth and genital ulcers Sometimes eye pain and redness Often begins in the 20s Usually in parts of Asia and the middle east (relatively rare in the United States) | Sometimes testing unnecessary | |
Gout and related disorders (for example, calcium pyrophosphate arthritis ) | Sudden and severe pain, warmth, and swelling (particularly in the big toe or knee, but can be almost any joint) Sometimes fever Often only one joint affected, but sometimes many | Tests of joint fluid |
Infective endocarditis (infection of the lining of the heart and usually also of the heart valves) | Joint pain and swelling Fever, night sweats, rash, weight loss, and heart murmur are common | Blood tests Echocardiography |
Chronic pain, most often in the knees and hips and small joints in the fingers, which may also be enlarged and slightly deformed No redness Often back and neck pain | X-rays | |
Psoriasis (sometimes with few or no skin lesions) Sometimes chronic,‡ symmetric inflammation of joints Chronic deformities of fingers, toes, and nails Tendinitis Eye redness and pain | X-rays | |
Reactive arthritis and enteropathic arthritis | Sudden pain, usually involving the large joints of the legs or feet, often 1 to 3 weeks after an infection of the gastrointestinal tract (such as gastroenteritis) or genitourinary tract (such as urethritis) Sometimes involvement of the spine | Tests for sexually transmitted infections |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† X-rays are often unnecessary. If fluid is in the joint, the fluid often needs to be removed for testing. | ||
‡ Symptoms may begin suddenly, but the disorder is typically chronic or comes and goes. | ||
§ Autoantibodies are antibodies directed against a person's own tissues. Examples include antinuclear antibodies, anti–double-stranded DNA, anticyclic citrullinated peptide, and rheumatoid factor. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||