Joint pain: causes and which doctor to see

Why joints hurt

Doctors divide the causes of joint pain into mechanical and inflammatory.

Mechanical causes come from load and wear on the tissues:

• osteoarthritis, when the cartilage gradually thins, most often in the knees, hips and hands, mainly in people over 45;
• overuse after a long walk, work done squatting or new training, which inflames tendons and bursae (the fluid-filled sacs around joints);
• injuries: sprained ligaments, a damaged meniscus, the after-effects of old fractures.

Inflammatory causes all fall under arthritis:

• rheumatoid arthritis, which is more common in women and usually affects the small joints of the hands and feet on both sides;
• gout, with sudden attacks of severe pain, most often at the base of the big toe;
• psoriatic arthritis in people with psoriasis: sometimes the joints start hurting before the rash appears, and a whole finger or toe can swell up “like a sausage”;
• reactive arthritis after a bowel or genitourinary infection;
• lupus and other systemic diseases, in which the skin, kidneys or other organs are affected along with the joints.

How to tell inflammatory pain from mechanical pain

Signs of inflammation:

• morning stiffness that lasts more than 30 minutes;
• a joint that swells without an injury and feels warm to the touch;
• pain at rest and at night that eases once you get moving;
• swelling and pain in the small joints of the fingers or toes on both sides;
• lower back pain that started before age 40, has lasted more than 3 months, gets worse with rest and at night, and eases with movement;
• tiredness, a long-lasting low-grade fever, weight loss, a rash, or dry eyes and mouth along with joint pain.

Mechanical pain, as in osteoarthritis, gets worse with walking, on stairs or towards evening and eases with rest. Stiffness after sleep or a long time sitting is short, up to half an hour. The joint may creak and, over the years, become thicker. In people aged 45 and over with this kind of pain, the doctor can often diagnose osteoarthritis from the symptoms and an exam, without X-rays.

These signs help you get your bearings, but mixed cases happen too: osteoarthritis sometimes flares up with swelling, and arthritis can start slowly.

Which doctor to see when your joints hurt

A rheumatologist treats inflammatory and systemic joint diseases: rheumatoid, psoriatic and reactive arthritis, gout and lupus. They also treat osteoarthritis when it can be managed without surgery. If you have signs of inflammation, see a rheumatologist as soon as you can. The European Alliance of Associations for Rheumatology (EULAR) recommends that anyone with swollen joints is seen by a rheumatologist, ideally within 6 weeks of the first symptoms: the earlier arthritis treatment starts, the less chance the joints have to be damaged.

An orthopedic and trauma doctor is the one to see after an injury, for damaged ligaments and menisci, deformities, and when osteoarthritis has destroyed a joint and surgery may be needed. Viva Clinic in Slavuta also has an orthopedic and trauma doctor.

Start with a family doctor or internist when it’s not clear who to see. They will examine your joints, order basic tests and refer you to the right specialist. If you have signed a declaration with a Viva Clinic family doctor, a complete blood count with differential and a urinalysis are free with that doctor’s referral.

A Viva Clinic rheumatologist in Slavuta sees patients at 27a Sobornosti St or 3 Danyla Halytskoho St (the exact address is confirmed when you book). The consultation is paid, and you don’t need a referral. You can book by phone or on Viber.

Which tests are ordered for joint pain

Blood tests help find inflammation and its cause. These include a complete blood count, ESR and C-reactive protein, uric acid, rheumatoid factor, anti-CCP antibodies and antinuclear antibodies. Normal results don’t rule out arthritis, and rheumatoid factor can be found in healthy people, so the doctor reads the results together with the exam. A complete blood count is done at Viva Clinic’s Diagnost-Lab laboratory at 32 Sobornosti St; ask about the other tests when you book.

A joint ultrasound shows fluid in the joint and inflammation of the joint lining and tendons, and in gout, crystal deposits as well. At Viva Clinic it’s done at the polyclinic at 27a Sobornosti St, and no preparation is needed.

An X-ray shows the bones: a narrowed joint space in osteoarthritis, erosions in long-standing arthritis. If the doctor suspects rheumatoid arthritis, they usually order X-rays of the hands and feet. If you need an X-ray, MRI or CT scan, the doctor will give you a referral and tell you where to have it done.

When to see a doctor the same day

See a doctor the same day if:

• a joint suddenly becomes hot, red and swollen, especially with a fever or chills: this can be a joint infection, which damages the joint quickly;
• joint pain comes with a rash and a high fever.

Call an ambulance on 103 if a hot joint comes with a high fever, severe weakness or confusion. You also need an ambulance if an arm or leg suddenly goes numb, weak, cold or pale. If a rash appears with a fever, press a clear glass against it: spots that don’t fade under the glass are another reason to call 103. After an injury, if you can’t stand on your leg, the limb looks deformed or the swelling grows fast, go to a trauma unit (travmpunkt), where they can take an X-ray, or call an ambulance.

Don’t mask the pain with painkillers for weeks. Taken for a long time, anti-inflammatory painkillers can cause a stomach ulcer or bleeding, harm the kidneys and raise blood pressure. While they dull the pain, the inflammation keeps damaging the joint. If the pain doesn’t go away within a few days or keeps coming back, see a doctor: they should choose the medicine and the dose.