Arthralgia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: John Fani Srour, M.D.

Overview

Arthralgia (from Greek arthro-, joint + -algos, pain) literally means joint pain; it is a symptom of injury, infection, illnesses in particular arthritis or an allergic reaction to medication. According to MeSH, the term arthralgia should only be used when the condition is non-inflammatory, and the term arthritis should be used when the condition is inflammatory.

Causes

The causes of arthralgia are varied and range from, a joints perspective, degenerative and destructive processes such as osteoarthritis and sports injuries to inflammation of tissues surrounding the joints (e.g. bursitis, a painful inflammation of bursa, fluid filled sacks around the joints).

Common Causes

• Behcet's disease
• Chikungunya virus
• Crohn's disease
• Dengue fever
• Gout
• Osteoarthritis
• Rheumatoid arthritis
• Rheumatic fever
• Ross river virus
• Lupus erythematosus
• Tenosynovitis
• Ulcerative colitis
• Medication like terconazole

Causes by Organ System

Cardiovascular	Dressler's syndrome
Chemical / poisoning	No underlying causes
Dermatologic	Blau syndrome, Ehlers-Danlos syndrome, Erythema elevatum diutinum, Lepromatous leprosy, Lipoid dermatoarthritis, Lupus erythematosus, Lyme disease, Mixed connective tissue disease, scleroderma, PAPA syndrome, Pyoderma gangrenosum, Rheumatic Fever, Scleroderma,syphilis, Sweet's disease, Systemic sclerosis, Erythema nodosum, Psoriasis
Drug Side Effect	Acitretin, Artemether/lumefantrine, Asenapine maleate, hyaluronic acid, Bismuth, Carbimazole, Carfilzomib, Cefadroxil, Cidofovir, Clomifene, Ciprofloxacin, caspofungin acetate, Cefaclor, Cyanocobalamin, Deferiprone, Efavirenz, Enzalutamide, Eribulin, Ethambutol, Exemestane, Fluorosis, Goserelin, Gemifloxacin mesylate, Indinavir, Interferon gamma, Isotretinoin, Ivacaftor, Ixabepilone, Letrozole, Methimazole,Mianserin, Mifepristone, Minocycline hydrochloride, mirtazapine, Nabilone, Natalizumab, nefazodone, Nalidixic acid, Nateglinide, Norfloxacin, Omalizumab, Paclitaxel, Pantoprazole, Pentamidine Isethionate, Pergolide, Pertuzumab, Pirfenidone, Plerixafor, Propylthiouracil, Pyrazinamide, Potassium iodide, Quinupristin dalfopristin, Rasagiline, Rifaximin, Ropinirole, Riluzole,Sertraline, Siltuximab, Sorafenib, Sulfasalazine, Sunitinib, Tiagabine, Tenofovir, Teriparatide, Trastuzumab, Valacyclovir, Vilazodone, Zanamivir, Zotepine, Zonisamide
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, Obesity, Avascular necrosis, Secondary hyperparathyroidism
Environmental	Metal fume fever, pneumoconiosis
Gastroenterologic	Coeliac disease, Crohn's disease, Hepatitis A, B, C, Ulcerative Colitis, Whipple disease, Wilson's disease, Autoimmune Hepatitis, Celiac Sprue
Genetic	Ankylosing spondylitis, Celiac Sprue, Gaucher's disease, Hereditary multiple exostoses, Legg-Calve-Perthes syndrome, Limb-girdle muscular dystrophy, Marfan syndrome, Noonan's Syndrome, Recessive Multiple Epiphyseal Dysplasia, Muscular dystrophy
Hematologic	Haemochromatosis, Haemophilia type A, Henoch-Schönlein purpura, Acute myeloid leukemia, Acute promyelocytic leukemia, Leukemia, Thrombotic thrombocytopenic purpura
Iatrogenic	*Arthrofibrosis
Infectious Disease	Atypical pneumonia, Borrelia burgdorferi, Lyme Disease, Chikungunya virus, Coccidioidomycosis lung infection, Community-acquired pneumonia Hepatitis A; B; C, Lepromatous leprosy, Lyme disease, Malaria, Mayaro virus fever, Mycoplasma pneumoniae, O'nyong-nyong fever, Parvovirus B19 infection, Pharyngitis, Rat bite fever, Rheumatic Fever, Ross River virus, Rubella, syphilis, Semliki forest fever, Serum sickness, Toxic shock syndrome, Trichinosis, West Nile fever, Whipple disease,Barmah Forest virus, Chlamydia trachomatis, Dengue fever, Ebola, Gonorrhea, Relapsing fever, Rocky Mountain spotted fever, Tuberculosis, Tularemia, Yellow fever, Yersinia enterocolitica Infection, Yersinia pseudotuberculosis, Zika fever
Musculoskeletal / Ortho	Blau syndrome, Borrelia burgdorferi, Fibromyalgia, Gout, congenital hip dysplasia, Hypertrophic pulmonary osteoarthropathy, Jacobs arthropathy-camptodactyly syndrome, Juvenile idiopathic arthritis, Lipoid dermatoarthritis, Lupus erythematosus, Lyme disease, Mixed connective tissue disease, Multiple epiphyseal dysplasia, Osteoarthritis, Osteochondritis dissecans, Paget's disease of bone, Palindromic rheumatism, PAPA syndrome, Pigmented villonodular synovitis, Polyarteritis nodosa, Polychondritis, Relapsing, Progressive pseudorheumatoid dysplasia, Pseudogout, Recurrent hereditary polyserositis, Rheumatoid arthritis, Scleroderma, Sclerosing osteomyelitis of Garre, Sjögren's syndrome, Still's Disease, Synovial chondromatosis, Systemic sclerosis, Takayasu's arteritis, gout,Adhesive capsulitis of shoulder, Ankylosing spondylitis, Arthrofibrosis, Avascular necrosis, Baker's cyst, Bursitis,Erythema nodosum, Marfan syndrome, Osteoporosis, Piriformis syndrome, Plantar fasciitis, Retropatellar Pain Syndrome,Muscular dystrophy, Scoliosis, Slipped Upper Femoral Epiphysis, Spondylitis, Spondylolisthesis, Spondylosis,Subacromial bursitis, Symphysis pubis dysfunction, Tennis elbow, Tenosynovitis
Neurologic	Neuropathic joint disease, Poliomyelitis
Nutritional / Metabolic	Obesity
Obstetric/Gynecologic	No underlying causes
Oncologic	Acute lymphoblastic leukemia, Multiple myeloma, Pigmented villonodular synovitis, Acute myeloid leukemia, Acute promyelocytic leukemia, Giant cell tumor of bone, Hereditary multiple exostoses, Hurler syndrome, Leukemia, Soft tissue sarcoma
Ophthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Atypical pneumonia, Caplan's disease, Coccidioidomycosis lung infection, Community-acquired pneumonia,Mycoplasma pneumoniae, pneumoconiosis
Renal / Electrolyte	Renal osteodystrophy
Rheum / Immune / Allergy	Behcet's disease, Caplan's disease, Coeliac disease, Crohn's disease, Dressler's syndrome, Erythema elevatum diutinum, Hypothyroidism, Juvenile chronic arthritis, Lupus erythematosus, Mixed connective tissue disease, Polyarteritis nodosa, Polychondritis, Relapsing Pyoderma gangrenosum, Rheumatic Fever, Rheumatoid arthritis, Sarcoidosis, Scleroderma , Serum sickness,Sjögren's syndrome, Still's Disease, Systemic sclerosis, Takayasu's arteritis, Takayasu's arteritis, Wegener's granulomatosis, Ankylosing spondylitis, Autoimmune Hepatitis, Celiac Sprue, Erythema nodosum, Familial Mediterranean fever, Iliotibial band syndrome
Sexual	No underlying causes
Trauma	Bursitis, Complex regional pain syndrome, Diastasis symphysis pubis, Golfer's elbow, Slipped Upper Femoral Epiphysis, Tennis elbow
Urologic	No underlying causes
Miscellaneous	Complex regional pain syndrome, Familial Mediterranean fever, Kikuchi disease

Causes in Alphabetical Order

Acitretin Acute lymphoblastic leukemia Acromegaly Acute myeloid leukemia Acute promyelocytic leukemia Adhesive capsulitis of shoulder Alkhurma virus Ankylosing spondylitis Arthrofibrosis Artemether/lumefantrine Atypical pneumonia Autoimmune Hepatitis Avascular necrosis Baker's cyst Barmah Forest virus Behcet's disease Bismuth Blau syndrome (granulomatous arthritis, iritis, and skin rash) Borrelia burgdorferi (Lyme Disease) Bruton's agammaglobulinemia Buprenorphine/Naloxone Bursitis Caplan's disease (rheumatoid arthritis and pneumoconiosis) Carbimazole Cefadroxil Celiac Sprue Chikungunya virus Chlamydia trachomatis Chronic fatigue syndrome Cidofovir Ciprofloxacin (Quinolone-induced cartilage toxicity in children) Coccidioidomycosis lung infection Coeliac disease Community-acquired pneumonia Complex regional pain syndrome Crohn's disease Cryoglobulinaemia Cyanocobalamin Decompression sickness Deferiprone Dengue fever Diffuse idiopathic skeletal hyperostosis Diastasis symphysis pubis Dressler's syndrome Ebola Efavirenz Ehlers-Danlos syndrome Emtricitabine Eribulin Erythema nodosum Erythema elevatum diutinum (is a rare type of leukocytoclastic vasculitis characterized by red, purple, brown, or yellow papules, plaques, or nodules) Exemestane Familial Mediterranean fever Farber's disease Fibromyalgia Fluorosis Fracture of bone Gamekeeper's thumb Gaucher's disease Giant cell tumor of bone Gluten-sensitive enteropathy associated conditions Golfer's elbow Gonorrhea Gout Graft versus host disease Haemochromatosis Haemophilia type A Henoch-Schönlein purpura Hepatitis A, B, C Hereditary multiple exostoses Hip dysplasia, congenital HPV Vaccine (Gardasil) Hurler syndrome Hyperimmunoglobulinemia D and periodic fever syndrome ( attacks of fever, arthralgia, skin lesions, and diarrhea) Hypertrophic pulmonary osteoarthropathy Hypothyroidism Iliotibial band syndrome Indinavir Infliximab Interferon gamma Interstitial nephritis Ivacaftor Isotretinoin Ixabepilone Jacobs arthropathy-camptodactyly syndrome Janumet (sitagliptin and metformin) Juvenile chronic arthritis Kawasaki disease Kikuchi disease Kniest dysplasia Legg-Calve-Perthes syndrome Lepromatous leprosy Leukemia Ligamentous laxity Limb-girdle muscular dystrophy Lipoid dermatoarthritis Lupus erythematosus Lyme disease Malaria Marfan syndrome Mayaro virus fever Metal fume fever Methimazole Mianserin (antidepressant, also mirtazapine and nefazodone are associated with arthralgia) Mifepristone Mixed connective tissue disease Morphoea/scleroderma

Multiple epiphyseal dysplasia: Recessive multiple epiphyseal dysplasia Multiple myeloma Muscular dystrophy Mycoplasma pneumoniae Nabilone Nalidixic acid Natalizumab Nateglinide Neuropathic joint disease Noonan's Syndrome Norfloxacin Obesity O'nyong-nyong fever Osteoarthritis Osteochondritis dissecans Osteoporosis Otospondylomegaepiphyseal dysplasia Paclitaxel Paget's disease of bone Palindromic rheumatism (idiopathic, periodic arthritis marked by multiple and recurrent attacks affecting one to a few joints, with tissue inflammation around or adjacent to them) Pantoprazole PAPA syndrome ( Pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome) Parvovirus B19 infection Pergolide Pharyngitis Pigmented villonodular synovitis Pituitary tumour (*Acromegaly, growth hormone secreting tumor) Pirfenidone Piriformis syndrome Plantar fasciitis Plerixafor pneumoconiosis Poliomyelitis Polyarteritis nodosa Polychondritis, Relapsing Progressive pseudorheumatoid dysplasia Propylthiouracil Psoriasis Pyoderma gangrenosum Pyrazinamide Pyrophosphate arthropathy (Pseudogout) Rat bite fever (Streptobacillus moniliformis or Spirillum minus) Reactive arthritis Recessive multiple epiphyseal dysplasia Recurrent hereditary polyserositis Relapsing fever Renal osteodystrophy Retropatellar Pain Syndrome Rheumatic Fever Rheumatoid arthritis Rocky Mountain spotted fever Ross River virus Rubella Sarcoidosis Scleroderma Scoliosis Secondary hyperparathyroidism Sclerosing osteomyelitis of Garre Secondary syphilis Semliki forest fever Serum sickness Sickle cell disease Siltuximab Sjögren's syndrome Slipped Upper Femoral Epiphysis Soft tissue sarcoma Sorafenib Spondylitis Spondylolisthesis Spondylosis Stickler syndrome Still's Disease, Juvenile-Onset Subacromial bursitis Sunitinib Sweet's disease Symphysis pubis dysfunction Synovial chondromatosis Systemic sclerosis Takayasu's arteritis Tennis elbow Tenofovir disoproxil fumarate Tenosynovitis Teriparatide Tiagabine Thrombotic thrombocytopenic purpura Toxic shock syndrome Trastuzumab Trichinosis Tuberculosis Tularemia Ulcerative Colitis Urate crystal arthropathy (gout) Vilazodone Waldenström macroglobulinemia Wegener's granulomatosis West Nile fever Whipple disease Wilson's disease Wissler-Fanconi syndrome Yellow fever Yersinia enterocolitica Infection (Yersiniosis) Yersinia pseudotuberculosis Zanamivir Zika fever Zotepine

Diagnosis

History and Symptoms

Diagnosis involves interviewing the patient and performing physical exams. When attempting to establish the cause of the arthralgia, the emphasis is on the interview. The patient is asked questions intended to narrow the number of potential causes. Given the varied nature of these possible causes, the questions may strike the uninitiated as irrelevant. For example the patient may be asked about dry mouth, light sensitivity, rashes or a history of seizures. Answering yes or no to any of these questions limits the number of possible causes and guides the doctor toward the appropriate exams and lab tests.

Treatment

Medical Therapy

Treatment depends on specific underlying cause. The underlying cause will be treated first and foremost. The treatments may include immunosuppressants for immune system dysfunction, antibiotics when an infection is the cause, and discontinuing medication when an allergic reaction is the cause. When treating the primary cause, pain management may still play a role in treatment. The extent of its role varies depending on the specific cause of the arthralgia. Pain management may include stretching exercises, over the counter pain medications, prescription pain medication, or other treatments deemed appropriate for the symptoms.

Surgery

Joint replacement surgery is done for severely damaged joints.