What is Joint Pain?
Joint pain is a symptom experienced by many Japanese people at some point in their lives, with dozens of underlying causes. These range from simple muscle fatigue to conditions requiring early treatment such as rheumatoid arthritis, osteoarthritis, gout, and infectious arthritis. Accurate diagnosis is therefore crucial.
At our clinic, we evaluate the involvement of systemic diseases from an internal medicine perspective. If the problem is confined to a single joint, we coordinate with orthopedics; if it's a systemic inflammatory disease, we refer to a rheumatologist.
Don't dismiss it as just "old age"
Many joint conditions can be significantly improved with treatment. Early treatment for rheumatoid arthritis can prevent joint destruction, and gout attacks can be controlled with medication. Don't leave it untreated, thinking "it will get better eventually." Let's find out the cause.
Main Causes of Joint Pain
Inflammatory (Requires Early Treatment)
| Condition | Characteristics | Commonly Affected Areas |
|---|---|---|
| Rheumatoid Arthritis (RA) | Morning stiffness (over 1 hour), symmetrical, multiple joints | Fingers, wrists, toes |
| Gout Attack | Sudden severe pain, redness, warmth, night to early morning onset | Most commonly base of big toe |
| Pseudogout | Elderly, calcium pyrophosphate deposition | Knees, wrists |
| Polymyalgia Rheumatica | Over 50 years old, morning stiffness in both shoulders and hips | Shoulders, hip joints |
| Reactive Arthritis | Arthritis after infection | Large joints of lower limbs |
| Infectious Arthritis | High fever, severe local inflammation, urgent | Single joint |
| Psoriatic Arthritis | Psoriasis + arthritis, enthesitis of finger tendons | Fingers, toes, spine |
| Ankylosing Spondylitis | Young males, lower back pain, morning stiffness | Sacroiliac joints, spine |
| SLE (Systemic Lupus Erythematosus) | Young females, arthritis + rash, systemic symptoms | Multiple joints |
Non-Inflammatory (Degenerative/Overuse)
| Condition | Characteristics | Commonly Affected Areas |
|---|---|---|
| Osteoarthritis | Aging, obesity, overuse, stiffness lasts less than 30 minutes | Knees, hips, finger DIP joints |
| Tenosynovitis | Overuse, local tenderness | Wrists, thumb (De Quervain's) |
| Muscle/Tendon Enthesitis | Repetitive movements | Elbow (tennis elbow), heel (Achilles tendon) |
| Fracture/Sprain/Dislocation | Trauma | Injured area |
| Trigger Finger | Inability to bend and straighten finger | Fingers |
Other/Systemic
- Fibromyalgia (widespread body pain)
- Thyroid dysfunction (joint pain, stiffness)
- Hematologic disorders (bone pain from leukemia, etc.)
- Bone metastases from malignant tumors
- Drug-induced arthralgia (statins, aromatase inhibitors, etc.)
Narrowing Down the Cause from Joint Pain Characteristics
Location of Pain
| Area | Suspected Condition |
|---|---|
| Single joint (1 location) | Gout, infectious, trauma, pseudogout |
| Multiple joints, symmetrical | Rheumatoid arthritis, SLE, drug-induced |
| Finger DIP (fingertip) | Osteoarthritis (Heberden's nodes) |
| Finger PIP/MCP (proximal) | Rheumatoid arthritis |
| Base of big toe | Gout |
| Large joints (knees, hips) | Osteoarthritis |
| Spine, sacroiliac joints | Ankylosing spondylitis, degenerative spondylosis |
Duration of Stiffness
- Morning stiffness lasting over 1 hour: Suspect rheumatoid arthritis, polymyalgia rheumatica
- Improves within 30 minutes: Osteoarthritis
- Worsens with use: Overuse, degenerative
- Worsens with rest: Inflammatory conditions
Associated Symptoms
- Fever → Infectious arthritis, SLE, rheumatic fever
- Rash → SLE, psoriatic arthritis, post-viral infection
- Oral ulcers → Behçet's disease
- Eye symptoms (uveitis) → Ankylosing spondylitis, juvenile rheumatoid arthritis
- Numbness in fingers → Carpal tunnel syndrome, cervical spondylosis
- Lightning-like joint pain → Gout
About Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease that causes inflammation and destruction of joints, affecting an estimated 600,000 to 1 million people in Japan. It is more common in women aged 30-50, and early treatment can prevent joint destruction in this era.
Typical Symptoms of Rheumatoid Arthritis
- Morning stiffness (usually over 1 hour)
- Pain and swelling in multiple joints such as fingers, wrists, and toes
- Symmetrical presentation
- Fatigue, low-grade fever, weight loss
- Joint deformity as it progresses (swan neck deformity, etc.)
Diagnosis and Treatment
- Blood tests: RF (rheumatoid factor), anti-CCP antibodies, CRP, ESR
- Imaging: X-ray, joint ultrasound, MRI
- Treatment: Methotrexate (MTX) is the first choice; if ineffective, biologics (TNF inhibitors, IL-6 inhibitors, etc.) or JAK inhibitors are used.
- Early treatment: Starting treatment within 6 months of onset significantly changes the prognosis.
Our Clinic's Role
Our clinic performs initial evaluation (blood tests, imaging assessment) and initial treatment. After a definitive diagnosis, we collaborate with a rheumatologist for ongoing management. We can also manage the patient's condition and monitor side effects after starting methotrexate.
About Osteoarthritis
This is the most common joint disease, caused by the wearing down of articular cartilage due to aging and overuse. It is estimated that over half of people aged 60 and above have some degree of change.
Commonly Affected Areas and Characteristics
| Area | Name/Characteristics |
|---|---|
| Knee Joint (Knee Osteoarthritis) | Most frequent, pain when standing up or using stairs |
| Hip Joint (Hip Osteoarthritis) | Pain in the groin and anterior thigh |
| Fingers (DIP joints) | Heberden's nodes |
| Fingers (PIP joints) | Bouchard's nodes |
| Thumb CM joint | Pain and deformity at the base of the thumb |
| Spine | Degenerative spondylosis, lumbar spondylosis |
Treatment Options
- Weight loss, muscle strengthening, exercise therapy
- Acetaminophen, NSAIDs
- Topical NSAIDs (fewer side effects)
- Intra-articular hyaluronic acid injection
- Intra-articular steroid injection (avoid frequent use)
- Severe cases may require artificial joint replacement (referral to orthopedics)
About Gout
For details, please refer to the "Gout/Hyperuricemia" page. The following is an overview:
- Sudden severe pain, redness, and warmth at the base of the big toe
- Onset during the night to early morning
- Urate crystals deposited in the joint
- During an attack: NSAIDs, colchicine
- Chronic phase: Febuxostat, allopurinol to keep uric acid levels below 6.0 mg/dL
Consult us for these symptoms
- Joint pain that lasts for more than 2 weeks
- Morning stiffness that lasts for more than 30 minutes
- Pain in multiple joints, symmetrically
- Joint swelling and warmth
- Accompanied by fever
- Accompanied by unexplained weight loss or fatigue
- Accompanied by rash, oral ulcers, or eye symptoms
- Sudden, severe joint pain (suspected gout attack)
- Knee pain when climbing stairs or standing up
- Stiffness or pain in the fingers
Consultation and Examination at Our Clinic
Medical Interview
- Location, number, and symmetry of painful joints
- Onset, duration, and daily fluctuations
- Duration of morning stiffness
- Presence of trauma
- Fever, rash, systemic symptoms
- Past medical history, family history (rheumatoid arthritis, psoriasis, etc.)
- Current medications
Tests
| Test | Purpose |
|---|---|
| Blood tests (CRP, ESR) | Presence of inflammation |
| Rheumatoid-related (RF, anti-CCP antibodies) | Screening for rheumatoid arthritis |
| Uric acid level | Gout evaluation |
| Antinuclear antibody | Screening for collagen diseases |
| Liver and kidney function | Reference for medication selection |
| Chest X-ray | Extra-articular findings, general condition |
| Joint X-ray | Evaluation of bone destruction and deformity |
When Referral is Necessary
- Ongoing treatment after definitive diagnosis of rheumatoid arthritis → Rheumatologist
- MRI, joint ultrasound, synovial fluid analysis → Orthopedics
- Indication for artificial joint replacement → Orthopedics
- Collagen diseases, SLE → Rheumatologist specializing in collagen diseases
- Suspected infectious arthritis → Emergency consultation (Orthopedics, Infectious Diseases)
Self-Care You Can Do at Home
For Acute Pain
- Rest (avoid using the affected area)
- Cooling (if there is inflammation or warmth)
- Over-the-counter pain relievers (NSAIDs, acetaminophen)
- Topical pain relievers (patches, gels)
- Joint protection with supporters or braces
For Chronic Management
- Moderate exercise (walking, water walking, stretching)
- Strength training (strengthening muscles that support the joints)
- Weight loss (1 kg weight loss = 3 kg reduction in knee burden)
- Heat therapy (warm chronic conditions)
- Movements that place less strain on the joints
- Appropriate shoes and insoles
Nutrition
- Seafood (omega-3 fatty acids)
- Vegetables and fruits (antioxidants)
- Calcium and Vitamin D (bone health)
- Maintain appropriate weight
- For gout prevention, limit purines and alcohol
Frequently Asked Questions
Should I go to orthopedics or internal medicine?
For single-joint injuries or mechanical pain, orthopedics is suitable. If you have pain in multiple joints or systemic symptoms, it is recommended to first rule out systemic diseases at internal medicine (our clinic). Please feel free to consult us if you are unsure.
Can rheumatoid arthritis be completely cured?
While "complete cure" is difficult, we aim for remission (a state with almost no symptoms). With appropriate early use of methotrexate and, if necessary, biologics, many people can now prevent joint destruction.
I was advised to have artificial joint surgery for knee osteoarthritis. Are there other options?
Non-surgical options include weight loss, muscle training, NSAIDs, hyaluronic acid injections, and braces. The decision depends on the severity of symptoms and their impact on daily life. Often, conservative treatment is tried first before rushing to surgery.
What is Heberden's nodes?
This is a type of osteoarthritis affecting the fingertips (DIP joints), common in women over 40. Bony lumps form on the fingertips, causing pain and deformity. It is thought to be related to changes in female hormones.
Is exercise bad for my joints?
Appropriate exercise actually protects your joints. When muscle strength declines, the burden on joints increases, worsening pain. Joint-friendly exercises such as water walking, cycling, and stretching are recommended.
Features of Our Clinic's Joint Pain Treatment
- Evaluation of systemic diseases as an internal medicine clinic (rheumatoid arthritis, collagen diseases, thyroid, etc.)
- Same-day testing for RF, anti-CCP antibodies, uric acid levels, antinuclear antibodies
- X-ray evaluation of osteoarthritis
- Prescription of NSAIDs, acetaminophen, and topical medications
- Ongoing management of rheumatoid arthritis in collaboration with specialists
- Referral to specialized institutions for orthopedic procedures (intra-articular injections, surgery)
- Management of hyperuricemia and gout
- No appointment necessary, walk-ins welcome / Open daily 9 am - 9 pm / 1-minute walk from Jujo Station
Early Diagnosis is Key to Treatment
Joint pain treatment varies greatly depending on the cause. Don't just stick on a patch and self-diagnose; finding out the cause early will protect your joint health in the long run.
