Joint Pain: Causes, Treatments, and Recovery Options

Joint pain

I previously sought medical attention for my joint inflammation during my first visit, where it was determined that I had hyperuricemia.
The physician likely prescribed pain relief and anti-inflammatory medication, but after taking it repeatedly for a while, the pain subsided.
The pain typically originates from my wrists and ankles, and sometimes, during inflammation, I am unable to move them properly.
Occasionally, if I accidentally move them, I hear a cracking sound in the joints (which doesn't hurt at the moment, but they return to their original state and can swell and hurt even when not in motion).
After some time, other joints rarely exhibit such symptoms (though they still occur).
For my right hand, as long as I avoid improper twisting or exertion (I have a good understanding of which angles to avoid), the main issue lies in my wrist, extending to a large bony prominence on the front of my hand.
This area often becomes inflamed and swollen, making it difficult to make a fist and keep my palm parallel to the table (which is painful).
However, there are still times when I experience inflammation symptoms.
Later, I underwent an MRI at the hospital, and the physician determined that I had ligament damage in my hand that required immobilization for self-repair.
After some time, when I returned for further inflammation, the physician diagnosed me with tendinitis and prescribed similar pain relief and anti-inflammatory medications (which I inquired about).
What kind of condition do I have? What treatments are necessary for recovery? Is complete healing possible? These symptoms have persisted since around 2006, and I have not yet recovered...

A-Ting, 10~19 year old female. Ask Date: 2012/01/29

Dr. Xu Zhiqin reply Orthopedics

1.
Based on the symptoms you described, it indeed appears to be gout, which is a metabolic disorder caused by the accumulation of uric acid crystals in the soft tissues surrounding the joints, leading to acute symptoms such as redness, swelling, heat, and pain due to white blood cell phagocytosis.
This is one of the most painful conditions I have personally experienced; although I only had pain and mild fever during my episodes (which is considered atypical gout), the pain was so intense that even looking at it hurt (this is a genuine statement, not a joke).

2.
Could you please confirm your uric acid levels? If they are elevated, it can serve as a diagnostic criterion (of course, there are exceptions; for instance, my uric acid level was only 4.8, yet I had an atypical attack due to frequent beer consumption).

3.
This condition is a metabolic disease (which cannot be completely cured) and can recur with slight dietary indiscretion.
There is a hereditary tendency for this disease.

4.
I recommend that after each episode, you undergo treatment to relieve symptoms and then take uric acid-lowering medication for several months to potentially reduce the frequency of recurrences (provided that your uric acid levels are elevated).

5.
Prevention is more important than treatment for this condition; therefore, in addition to monitoring your diet, please drink plenty of water (it's better to drink during the day, as excessive nighttime drinking can affect sleep due to increased urination).
During periods of remission, engage in more physical activity to promote sweating, which can help increase the excretion of uric acid through urine and sweat.

6.
Magnetic resonance imaging (MRI) can diagnose tendinitis, as uric acid most commonly deposits in tendons, causing inflammation.
The situation is akin to trying to clean a rope soaked in concentrated lime; it is very difficult to clean thoroughly.

7.
I hope the above responses meet your needs.
Regarding dietary advice, I suggest that the next time you visit a doctor, you request a gout diet plan, which will provide detailed information.

8.
Wishing you a prosperous New Year, and I hope this information is helpful to you.
Goodbye, Hsu Chih-Chin, 2012/01/31 PM 1:00.

Reply Date: 2012/01/29

More Info

Joint pain can be a complex issue, often stemming from various underlying causes, including inflammation, injury, or chronic conditions such as gout or arthritis. In your case, it appears that you have been experiencing recurrent episodes of pain and inflammation in your joints, particularly in your wrists and ankles, which may be linked to hyperuricemia (high uric acid levels) and tendonitis.

Understanding Your Condition
1. Hyperuricemia and Gout: Hyperuricemia occurs when there is an excess of uric acid in the blood, which can lead to the formation of urate crystals in the joints, causing gout. Gout typically presents as sudden, severe pain, redness, and swelling in the affected joint, often the big toe, but it can also affect other joints, including the wrists and ankles. The intermittent nature of your pain, along with the swelling and tenderness, suggests that gout could be a contributing factor.

2. Tendinitis: The pain you describe in your wrist, particularly around the area of the bone prominence, may indicate tendinitis, which is inflammation of the tendons. This condition can occur due to repetitive motion or overuse, leading to pain, swelling, and difficulty in movement. The fact that you experience pain when attempting to grip or extend your wrist suggests that the tendons in that area may be irritated or damaged.

3. Joint Instability: The "cracking" or "popping" sounds you hear when moving your joints could be due to various factors, including joint instability or the movement of tendons over bony structures. While this is often benign, it can sometimes indicate underlying issues that need to be addressed.

Treatment Options
1. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to manage pain and inflammation. However, long-term use should be monitored by a healthcare provider to avoid potential side effects. If you have been relying on over-the-counter pain relievers like aspirin without relief, it may be beneficial to discuss alternative medications with your doctor, such as ibuprofen or naproxen.

2. Physical Therapy: Engaging in physical therapy can be highly beneficial for joint pain and tendinitis. A physical therapist can design a personalized exercise program to strengthen the muscles around the affected joints, improve flexibility, and reduce the risk of further injury. They may also employ modalities such as ultrasound or electrical stimulation to alleviate pain.

3. Rest and Activity Modification: It’s crucial to rest the affected joints and avoid activities that exacerbate the pain. Learning to modify your movements and avoid positions that trigger discomfort can help manage symptoms.

4. Corticosteroid Injections: In cases where inflammation is severe and does not respond to oral medications, corticosteroid injections may be considered to provide rapid relief.

5. Lifestyle Changes: Dietary modifications can also play a significant role in managing hyperuricemia. Reducing the intake of purine-rich foods (such as red meat, shellfish, and alcohol) can help lower uric acid levels. Staying well-hydrated and maintaining a healthy weight are also important.

6. Surgery: In rare cases, if conservative treatments fail and there is significant damage to the tendons or joints, surgical intervention may be necessary to repair the affected structures.

Prognosis
The prognosis for joint pain and related conditions varies widely depending on the underlying cause and the effectiveness of the treatment plan. Many individuals experience significant improvement with appropriate management, including medication, physical therapy, and lifestyle changes. However, chronic conditions like gout or tendinitis may require ongoing management to prevent flare-ups and maintain joint function.

Conclusion
It is essential to work closely with your healthcare provider to develop a comprehensive treatment plan tailored to your specific needs. Regular follow-ups and open communication about your symptoms and treatment responses will help ensure the best possible outcome. If you have not already done so, consider seeking a referral to a rheumatologist or an orthopedic specialist who can provide further evaluation and management options for your joint pain.

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