Chronic Joint Pain: Causes and Recommended Tests

Joint pain

Hello Doctor: I have had a back injury for over ten years.
Now, in addition to the soreness in my back, I frequently experience pain in my joints, such as my knees and ankles, even though I have never had any previous injuries to those joints.
I am unsure why this is happening.
The pain has persisted for several years, and my uric acid levels have been normal upon testing.
What other reasons could there be for this? If I need to undergo further examinations, what should I get checked? Thank you.

kim, 40~49 year old female. Ask Date: 2001/03/26

Dr. Shi Guozheng reply Orthopedics

The most likely cause of joint pain is injury, followed by overuse.
Additionally, it is important to consider whether the pain is due to joint degeneration, rheumatoid arthritis, or gout.
The differential diagnosis of joint pain can be quite challenging.
In addition to a physical examination, the physician may consider blood tests or X-ray imaging.
If necessary, special tests such as MRI may also be performed.
However, it is essential for the physician to make a personal diagnosis to determine the necessity of these tests, so it is not possible to provide a definitive answer regarding which tests should be conducted.
It is best to consult a physician for an accurate assessment.

Reply Date: 2001/03/26

More Info

Chronic joint pain can be a complex issue, especially when it has persisted for several years without a clear diagnosis. Based on your description, it seems that you are experiencing pain in your joints, particularly in your knees and ankles, which may be related to a previous injury to your lower back. Here’s a breakdown of potential causes and recommended tests to help you understand your condition better.

Possible Causes of Chronic Joint Pain
1. Osteoarthritis: This is a degenerative joint disease that can occur due to wear and tear on the joints over time. It can lead to pain, stiffness, and swelling. Given that you have a history of back injury, it’s possible that altered biomechanics could have contributed to the development of osteoarthritis in your knees and ankles.

2. Rheumatoid Arthritis: This is an autoimmune condition that can cause chronic inflammation in the joints. It often affects multiple joints and can lead to pain and swelling. While you mentioned that your uric acid levels are normal, rheumatoid arthritis is not related to uric acid levels.

3. Tendinitis or Bursitis: These conditions involve inflammation of the tendons or bursae (small fluid-filled sacs that cushion joints). They can result from repetitive use or strain, which might be exacerbated by your previous back injury.

4. Fibromyalgia: This is a condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. It can sometimes be associated with chronic pain in the joints.

5. Referred Pain: Sometimes, pain in the joints can be referred from other areas of the body, such as the back. If your lower back injury has led to nerve irritation or muscle imbalances, it could manifest as joint pain in your legs.

6. Other Conditions: Conditions such as lupus, psoriatic arthritis, or even infections can lead to joint pain. It’s essential to rule these out through appropriate testing.

Recommended Tests
To better understand the cause of your chronic joint pain, the following tests may be helpful:
1. X-rays: These can help identify any degenerative changes in the joints, such as osteoarthritis or other structural issues.

2. MRI: This imaging test provides a more detailed view of the soft tissues, including cartilage, tendons, and ligaments, which can help diagnose conditions like tendinitis or tears.

3. Blood Tests: While you have already checked your uric acid levels, additional blood tests can help rule out autoimmune conditions. Tests for rheumatoid factor, anti-CCP antibodies, and inflammatory markers (like ESR or CRP) can provide valuable information.

4. Joint Aspiration: If there is swelling in the joints, a doctor may perform a joint aspiration to analyze the synovial fluid for signs of infection, crystals, or other abnormalities.

5. Physical Examination: A thorough physical examination by a healthcare provider can help assess your range of motion, joint stability, and any signs of inflammation.

Conclusion
Chronic joint pain can stem from various causes, and it’s essential to approach it systematically. Given your history of back injury and the persistence of your symptoms, I recommend consulting with a rheumatologist or an orthopedic specialist who can guide you through the necessary tests and develop a tailored treatment plan. Treatment may include physical therapy, medications for pain relief and inflammation, and lifestyle modifications to improve joint function and reduce discomfort.
In the meantime, consider keeping a pain diary to track your symptoms, activities, and any potential triggers, which can be helpful for your healthcare provider in diagnosing and managing your condition.

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