Joint pain causes are many, and treatments vary depending on the cause. For a lot of people, it’s due to some kind of arthritis (joint inflammation). For others, such as those with fibromyalgia or an underactive thyroid, pain occurs with no underlying damage or inflammation.
Joint pain may range from a mild ache to a severe, burning, or sharp sensation in one or several joints. In some instances, joint pain is associated with other symptoms, like joint swelling and stiffness, red and warm skin, and whole-body symptoms like fatigue, weight loss, or fever.
Illustration by Alexandra Gordon, Verywell
In cases of arthritis-related joint pain, inflammation and/or damage within the joint space is responsible for the pain. Several types of arthritis exist and their causes differ.
Osteoarthritis (OA) is the most common form of arthritis.1 OA develops as a result of the breakdown of cartilage (which serves as a cushion between the bones of a joint) often due to aging. This type of arthritis tends to affect the knees, hips, neck, lower back, and fingers.
The pain of OA—which often progresses from a sharp, intermittent pain to a constant aching—worsens with movement and eases with rest.2 Joint stiffness and a restricted range of motion are also characteristic of OA joint pain.
While classic OA is actually a non-inflammatory arthritis, an aggressive subtype of OA, called erosive osteoarthritis, is inflammatory. Erosive OA is most common in postmenopausal women and causes a gradual onset of joint aches, stiffness, and swelling in multiple finger joints.3
Common Osteoarthritis Symptoms
Gout is a type of inflammatory arthritis that occurs in some people with high levels of uric acid in their blood. As the uric acid builds up, it may form crystals in certain joint spaces, like the big toe, ankle, or knee.
A classic gout attack refers to a sudden episode of severe, often burning joint pain that usually occurs in one joint (for example, the big toe). The joint pain of a gout attack is often extreme and associated with redness, swelling, and warmth of the joint. Without treatment, an acute flare can take anywhere from three days to two weeks to resolve on its own.4
The “why” behind gout joint pain is attributed to the rapid, inflammatory response of the body’s immune system as it tries to digest the unwanted and foreign crystals.
Symptoms of Gout
Pseudogout, also known as calcium pyrophosphate deposition disease (CPPD), is a type of inflammatory arthritis that occurs as a result of calcium crystal buildup in certain joints, most commonly the knee, wrists, shoulders, ankles, feet, and elbows.
Like gout, the pain of an acute pseudogout joint attack is sudden, severe, and associated with other symptoms like joint swelling and warmth. Unlike gout, the attacks of pseudogout may last longer before remitting.5
Gout vs. Pseudogout
With septic arthritis, a joint becomes infected, most commonly with a bacteria and rarely with a fungus (for example, Candida) or mycobacteria (such as tuberculosis).
Septic arthritis tends to affect a single joint, usually the knee, ankle, wrist, or hip. The affected joint is swollen, warm, and stiff, and a fever is also present.
In most cases, septic arthritis is caused by a bacterial infection in the blood that then travels to the joint space.6 Less commonly, joint surgery or trauma (for example, a tick bite) may be the culprit.
Several different viruses may cause arthritis. The most common ones include hepatitis B and C, parvovirus B19, and HIV, as well as alphaviruses (transmitted by mosquitoes) like the Chikungunya virus (CHIKV).7
Rheumatoid arthritis (RA) is a chronic autoimmune disease that develops gradually over a period of weeks to months. While the disease predominantly affects the joints, early symptoms may not involve them, but instead include:
Numbness and tingling in the hands
When the joints become affected, which is a gradual process, small joints on the same side of the body—such as those in the fingers and toes—tend to be affected first. Eventually, other joints like the wrists, elbows, hips, and spine follow suit.
The joint(s) also tend to become stiff, warm, red, and swollen. Unlike osteoarthritis, the stiffness of joint pain in RA tends to be worse in the morning (lasting for more than an hour) and improve with movement.8
Spondyloarthritis is a family of inflammatory rheumatic diseases that includes four conditions.
Ankylosing Spondylitis (AS)
Ankylosing spondylitis is an axial spondyloarthropathy, meaning it mainly affects the back and neck and the sacroiliac joints (which connect the spine to the pelvis).
The joint pain of AS tends to begin in early adulthood before the age of 45, come on gradually, and improve with activity (similar to RA).9 Morning stiffness that lasts longer than 30 minutes is also common in AS.
Up to 30% of people with psoriasis—a chronic skin condition characterized by patches of thickened skin covered by silvery scales—have psoriatic arthritis.10
It most commonly affects the end joints of the fingers and toes, causing a throbbing pain, along with stiffness and swelling. Other symptoms may include swollen fingers and toes that look like sausages, and nail problems (for example, pitted nail beds).
Interestingly, the severity of a person’s psoriasis does not correlate with the severity of their arthritis. And in about 15% of people, joint pain shows up before the psoriasis appears.11
Reactive arthritis is characterized by the development of joint pain and swelling one to six weeks after an infection in the urinary tract, genitals, or intestines.12
Specific bacterial organisms linked to the development of reactive arthritis include:
Typical joints involved in reactive arthritis are the knee, ankle, and foot.
Arthritis Associated With Inflammatory Bowel Disease (IBD)
Throbbing joint pain and swelling, especially in larger joints like the knees and hips, may occur in people with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. The arthritis tends to be more active when bowel symptoms are flaring.13
The Link Between Arthritis and IBD
Systemic Lupus Erythematosus
Joint inflammation, especially of the knees, wrists, and finger joints, is common in systemic lupus erythematosus (SLE)—a chronic, autoimmune disease that can affect nearly every organ in the body.
Like RA, the same joints on the same side of the body tend to be affected in SLE. However, unlike RA, the morning stiffness does not last as long (minutes for SLE versus over an hour for RA). The joint pain also tends to be short-lived and migratory, moving from one joint to another within a 24-hour period.14
Could It Be Lupus?
Polymyalgia rheumatica (PMR) is an inflammatory joint disease that causes significant muscle and joints aches and stiffness in the shoulders, neck, and hips. Joint swelling and tenderness may also occur in the wrists and fingers, although it is usually mild. The feet and ankles are never affected, and the disease almost exclusively affects people over the age of 50.15
Interestingly, PMR is associated with another rheumatic condition called giant cell (temporal) arteritis, which is an inflammatory blood vessel disease that causes inflammation in the arteries of the head and scalp.
Other Systemic Rheumatic Diseases
Though it may be hard to believe, the above list is not exhaustive of all the different causes of arthritis. Other less common systemic (whole-body) illnesses may cause arthritis, a few examples being:
Familial Mediterranea fever
Numerous conditions may cause joint pain that is not related to an underlying disease or inflammatory process within the joint.
The predominant symptoms of fibromyalgia, a chronic pain condition, are widespread muscle tenderness, nerve-related pain, crippling fatigue, and cognitive dysfunction dubbed “fibro fog.” Some people with this illness have joint aches and, sometimes, minor joint swelling. However, doctors generally don’t find any serious inflammation on physical exam or inflammatory markers via blood tests.16
The pain of fibromyalgia is related to dysfunction of the nervous system and hypersensitivity in the nerves. Rather than being linked to specific areas of the body, fibromyalgia pain is more likely to move around from place to place.
Extensive List of Fibromyalgia Symptoms
Hemarthrosis occurs when you have bleeding into a joint. It may be due to a number of reasons, including trauma, a bleeding disorder like hemophilia, a postsurgical complication, or tumor growth like a synovial hemangioma.
The most common cause of hypothyroidism—an underactive thyroid gland—is Hashimoto’s thyroiditis, which is when your body’s immune system launches an attack on your thyroid.17 Hypothyroidism may cause numerous symptoms, including:
How to Tell if You Are Hypothyroid
You may be surprised to learn that unexplained aches and pains, including joint pain, are a primary physical manifestation of depression.18 Other common symptoms of depression include a loss of interest in pleasurable activities, a change in appetite, sleep disturbances, difficulty concentrating, and feelings of hopelessness and/or guilt.
Depression’s Connection to Chronic Pain
When to See a Doctor
New joint pain is a reason to see your doctor. If you have a pain condition but are experiencing pain in a new area or a markedly different type of pain, be sure to get an appointment.
Many people with one pain condition go on to develop another. For example, it’s common for someone with rheumatoid arthritis or lupus to eventually develop secondary fibromyalgia.
Seek urgent medical attention if your joint pain is severe or you have any of the following additional symptoms:
Unexplained weight loss
Inability to function in daily life due to your joint problem
Hot or significantly swollen joint
Sudden numbness or burning and/or muscle weakness
A thorough medical history is often key to diagnosing the cause of your joint pain. It helps to be as detailed as possible when having this conversation with your doctor.
Along with this, your doctor will conduct a comprehensive physical examination and, in some cases, blood tests, imaging tests, and a joint aspiration procedure. In rare cases, a biopsy (a tissue sample) is needed.
In order to sort out your diagnosis, your primary care doctor may start by inquiring about the precise characteristics of your joint pain:
Where exactly does it occur?
How intense is the joint pain?
Does it occur at certain times of day? After certain activities or periods of rest?
What worsens or improves your joint pain?
These details can be telling and help narrow down possible diagnoses.
For example, arthritis related to gout, pseudogout, or a bacterial infection tends to affect one joint at a time, come on suddenly, and be severe. On the other hand, pain related to arthritis from a systemic disease, like a spondyloarthropathy or RA, tends to be mild and achy, come on gradually, and affect more than one joint at a time.
While the joint pain of osteoarthritis improves with rest and worsens with activity, arthritis due to a systemic connective tissue disease, like rheumatoid arthritis, is worse with rest (often in the morning) and improved with activity.
Your doctor will also ask whether you have a family history of joint pain, especially since certain conditions (such as psoriatic arthritis) tend to run in families.19
Be sure to tell your doctor if any of the following apply to you:
Unusual symptoms, like fatigue or unexplained weight loss
Recent viral infection
When examining your joints, your doctor will press on the painful joints feeling for warmth, swelling, and tenderness (signs of inflammation). They will move your joints around to see if there is any restricted range of motion or crepitus (a popping sound heard in OA), and chart the distribution of your joint pain to determine if it’s symmetric (affecting matching joints, like both knees) or asymmetric (affecting joints unevenly, like one knee but not the other).
Lastly, they’ll give you a complete physical examination, looking for various clues such as:
Plaques (seen in psoriatic arthritis)
Heberden and Bouchard’s nodes (seen in osteoarthritis)
Tophi (seen in gout)
Rheumatoid nodules (seen in rheumatoid arthritis)
Tender points (seen in fibromyalgia)
Enlarged thyroid gland (hypothyroidism)
Labs and Tests
Often, a diagnosis can be made from a medical history and physical examination alone (as in the case of OA). In some instances, though, such as when a systemic disease is suspected, testing may be necessary.
Depending on what your doctor discovers during your medical history and exam, they may order various blood tests. For example, if they suspect rheumatoid arthritis, they’ll test your levels of anti-citrullinated protein antibody (anti-CCP).
Other potential blood tests include:
Complete blood count (CBC)
Kidney and liver function tests
Inflammatory markers: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Uric acid level
Anti-nuclear antibody (ANA)
Hepatitis B and C tests
Imaging tests can be helpful in the diagnostic process, either by supporting or confirming a diagnosis.
For example, an X-ray may reveal osteophytes (bony growths) and joint space narrowing—both classic signs of osteoarthritis. An X-ray can also reveal subtle signs of inflammatory arthritis, like erosions (craters in the bone that occur as a result of joint damage).
Other imaging tests such as an ultrasound, magnetic resonance imaging (MRI), and a computed tomography (CT) scan may provide further information about a joint and its surrounding tissues.
A joint aspiration procedure (arthrocentesis) entails a doctor, often a rheumatologist, using a needle and syringe to remove fluid from inside the synovium (lining of the joints) of a painful and/or inflamed joint. The fluid can then be examined under a microscope.
Synovial fluid analysis is useful for diagnosing conditions like gout (presence of urate crystals) and septic arthritis (presence of a high white blood cell count).
Less commonly, a rheumatologist will remove a tissue sample of the lining of the synovium. This is called a synovial biopsy and can be useful for diagnosing septic arthritis due to tuberculosis or a fungus.
In some cases, you may need to see a specialist (or more than one) to get an official diagnosis.
Sometimes, what is perceived as joint pain is actually due to a non-joint related condition, like tendonitis, a muscle strain, or a bone fracture. While it’s rare, a bone tumor may even manifest as joint pain.
The good news is that an evaluation by a healthcare professional, along with imaging tests, can generally sort this out. For instance, an X-ray can diagnose a fracture.
Once you receive a diagnosis, you and your doctor can devise a treatment plan that includes medication along with self-care strategies, physical therapy, and less commonly, surgery. What’s recommend depends on the cause of your joint pain, as protocols differ.
A part of treating joint pain entails you taking an active role in your joint and overall health. Some self-care strategies to consider under the guidance of your doctor include:
Seeing your primary care doctor for vaccinations and regular health screenings (for example, for osteoporosis, cancer, and depression)
Educating yourself about your diagnosis
Engaging in daily exercise, both aerobic and strengthening
Losing weight if overweight or obese
10 Empowering Ways to Fight Arthritis
Several different medications are used to ease joint pain, depending on your underlying diagnosis. For example, with osteoarthritis, a number of different treatments may be used, including:
A topical or oral nonsteroidal anti-inflammatory drug (NSAID)
Steroid joint injections
Hyaluronic acid injections
In addition to pain medications, if you have a systemic disease, you may need to take a medication that alters how your immune system works—for instance, a tumor necrosis factor (TNF) inhibitor for ankylosing spondylitis and methotrexate for rheumatoid arthritis.
If you have been diagnosed with septic arthritis, you will need to take one or more antibiotics through a vein (intravenously).
Physical therapy for joint pain focuses on maintaining joint function and range of motion, strengthening muscles surrounding the joint, and minimizing joint stiffness and pain. Depending on your condition, your physical therapist may recommend a walking aid, brace, or splint to improve your functioning.
For people with fibromyalgia, a supervised physical exercise program is especially important for minimizing muscle and joint pain and easing other symptoms, like fatigue and anxiety.
Physical Therapy for Arthritis
Complementary and Alternative Medicine
Several mind-body therapies have been used, often in conjunction with medication and physical therapy, to alleviate joint pain.20 Some of these include:
In addition, while there was some hype about taking the dietary supplements glucosamine and chondroitin (or products that contain them, like Osteo Bi-Flex) for repairing the damaged cartilage of osteoarthritis, current scientific evidence is unfortunately not so supportive of this.21 That said, for some people, there may be a small pain-alleviating benefit to taking these supplements.
In the end, it’s best to talk with your doctor about whether these are right and safe for you.
Move Free Supplements: Do They Work?
Surgery is generally reserved for advanced cases of joint pain, such as knee or hip osteoarthritis that has not responded to conservative measures. In severe cases, total joint replacement may be necessary.
Alternatives to total knee or hip replacement include knee or hip osteotomy—surgeries that entail cutting and reshaping bones to ease pressure on the joint.
While an osteotomy may delay the need for a joint replacement for several years, only young, active adults with osteoarthritis limited to one side of the knee or people with certain hip conditions are generally candidates.