Joint Pain Causes and Treatment Options

Joint pain has many causes, including many types of arthritis (e.g., osteoarthritis, rheumatoid arthritis, gout) and some that aren't arthritis-related (e.g., fibromyalgia, thyroid disease, Lyme disease, depression).

Joint pain can feel different depending on the cause. It might feel like a sudden, sharp pain. You might notice stiffness, burning, or a dull ache.

With so many causes, the reason for your joint pain can be hard to diagnose. And until you know the cause, you won't know the best way to treat it. A major feature that determines the treatment is whether your joint pain involves inflammation.

This article walks you through many common causes of joint pain, how they're diagnosed and treated, and when you need to see a healthcare provider.

Arthritis-Related Causes

In arthritis, inflammation and/or joint damage is responsible for the pain. Arthritis comes in many forms with different causes.

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. It results from the breakdown of cartilage due to aging or injury.

Cartilage is a flexible tissue that cushions the ends of bones so they glide smoothly against each other inside your joints. When the cartilage wears away, the bones start grinding against each other, causing pain.

OA can affect any joint but it's most common in the:

• Neck
• Fingers
• Lower back
• Hips
• Knees

The pain of OA gets worse with movement and better with rest. It often starts with sharp, intermittent pain and then grows into a constant ache. Joint stiffness and a limited range of motion are common.

Classic OA is considered non-inflammatory because the damage isn't caused by inflammation. However, inflammation may be a symptom of OA.

But an aggressive subtype of OA—called erosive osteoarthritis—is inflammatory. Erosive OA is most common in people who've gone through menopause. Symptoms include:

• Gradual-onset joint pain
• Stiffness
• Swelling in multiple finger joints

Gout

Gout is a type of inflammatory arthritis caused by high levels of uric acid in the blood. Uric acid can build up and form crystals inside your joints.

When the immune system tries to destroy them, it leads to inflammation and pain. (Inflammation is a normal and necessary part of the immune response.)

Common joints for gout are:

• Big toe
• Ankle
• Knee

A classic gout attack involves sudden, severe, often burning joint pain. It's usually in just one joint. Joints may be:

• Discolored (red or pink in light skin, purplish or darker in dark skin)
• Warm
• Swollen

Without treatment, an acute flare may last up to two weeks.

Pseudogout

Pseudogout is a type of inflammatory arthritis. It's caused by calcium crystals building up in the joints, especially the:

• Shoulders
• Elbows
• Wrists
• Knees
• Ankles
• Feet

Pseudogout feels much like gout, but the attacks may last longer.

Septic Arthritis

Septic arthritis is caused by an infection inside a joint, most often due to bacteria. In rare cases, it may be a fungus (like Candida) or mycobacteria (like tuberculosis).

Septic arthritis tends to affect a single joint. It's usually a:

• Wrist
• Hip
• Knee
• Ankle

The affected joint gets swollen, warm, and stiff. You'll also have a fever.

The infection usually starts in the blood, then moves into the joint. Less often, joint surgery or something like a tick bite may be the culprit.

Viral Arthritis

Several viruses may cause viral arthritis. The most common ones include:

• Hepatitis B and C
• Parvovirus B19
• HIV
• Mosquito-borne viruses like the Chikungunya virus (CHIKV)

Viral arthritis lasts for a short time. Then most people are symptom-free. But some viruses leave behind pain that lingers for months or years.

ARTHRITIS TYPE	COMMON JOINTS	CHRONIC OR ACUTE	DISTINGUISHING FEATURES
Osteoarthritis	Knees Hips Neck Low back Fingers	Chronic	Worse with movement Better with rest
Erosive osteoarthritis	Fingers	Chronic	Aggressive Gradual onset
Gout	Big toe Ankle Knee	Chronic, acute flares	Uric acid crystals Sudden, severe pain One joint
Pseudogout	Knee Wrist Shoulder Ankle Foot Elbow	Chronic, acute flares	Calcium crystals Sudden, severe pain One joint
Septic arthritis	Knee Ankle Wrist Hip	Acute	Joint infection Fever
Viral arthritis	Usually 5 or more joints	Acute	Pain may linger after the infection is gone
Rheumatoid arthritis	Wrists Elbows Hips Neck	Chronic, acute flares	Better with movement Worse with rest
Ankylosing spondylitis	Back Neck SI joints	Chronic, acute flares	Better with movement Worse with rest
Psoriatic arthritis	Fingers Toes	Chronic, acute flares	Psoriasis plaques Nail symptoms
Reactive arthritis	Knees Ankles Feet	Acute	Follows infections
IBD Associated	Knees Hips	Chronic, acute flares	More active during IBD flare
Lupus	Knees Wrists Finger joints	Chronic, acute flares	Moves from one joint to another
Polymyalgia rheumatica	Shoulders Neck Hips	Chronic, acute flares	Never affects feet, ankles

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that develops gradually. RA predominantly affects the joints. Early symptoms may include:

• Fatigue
• Muscle pain
• Low-grade fever
• Weight loss
• Numbness and tingling in the hands

RA then progresses to the joints. It most often starts in the fingers and toes on one side of the body. Then other joints follow. The likely ones are:

• Neck
• Wrists
• Hips
• Elbows

The joint(s) also tend to be stiff, warm, discolored, and swollen. Unlike OA, RA pain tends to improve with movement. It's often worse in the morning and the heightened pain lasts for more than an hour.

Spondyloarthritis

Spondyloarthritis is a family of inflammatory rheumatic diseases. It includes four conditions.

Ankylosing Spondylitis (AS)

Ankylosing spondylitis is an axial spondyloarthropathy. That means it mainly affects the axial skeleton (the spine and other bones of the central core). Common sites include the:

• Neck
• Back
• Sacroiliac (SI) joints at the base of the spine

The joint pain of AS tends to come on gradually and to begin before age 45. Symptoms tend to improve with activity (similar to RA). Morning stiffness that lasts longer than 30 minutes is common in AS.

Psoriatic Arthritis

Psoriasis is an autoimmune skin disease. It causes patches of thick skin covered in silvery scales.

Up to 30% of people with psoriasis develop psoriatic arthritis. It most commonly affects the end joints of the fingers and toes. It causes:

• Throbbing pain
• Stiffness
• Swelling
• Nail problems like pitted nail beds

In about 15% of people, joint pain shows up before psoriasis appears.

Reactive Arthritis

Reactive arthritis shows up within six weeks after an infection in the urinary tract, genitals, or intestines. It causes joint pain and swelling.

Bacteria linked to reactive arthritis include:

• Salmonella
• Campylobacter
• Shigella
• Yersinia
• Chlamydia

Typical joints are the knee, ankle, and foot.

Arthritis Associated With Inflammatory Bowel Disease (IBD)

Some people with inflammatory bowel disease (IBD) develop a type of arthritis. It tends to be more active when bowel symptoms flare.

IBD includes Crohn's disease and ulcerative colitis.

Arthritis associated with IBD causes throbbing joint pain and swelling. It's more common in larger joints like the knees and hips.

Systemic Lupus Erythematosus

Joint inflammation is common in systemic lupus erythematosus (lupus or SLE). That's a chronic autoimmune disease that can affect nearly every organ in the body.

Lupus especially hits the:

• Knees
• Wrists
• Finger joints

It tends to affect joints on the same side of the body. Mornings often bring stiffness but it generally lasts for just a few minutes.

Joint pain also tends to be short-lived. It may move from one joint to another throughout the day.

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory joint disease. It causes:

• Significant muscle and joint aches
• Stiffness in the shoulders, neck, and hips
• Sometimes, mild swelling and tenderness in the wrists and fingers

The feet and ankles are never affected. And the disease almost exclusively affects people over 50.

PMR is associated with an inflammatory blood-vessel disease called giant cell (temporal) arteritis. It causes inflammation in the arteries of the head and scalp.

Other Systemic Rheumatic Diseases

Other systemic (whole-body) conditions may cause arthritis, too. They include:

• Systemic sclerosis: Involves the abnormal growth of connective tissues.
• Sarcoidosis: Produces lumps of cells (granulomas) in organs and tissues, especially the lungs.
• Familial Mediterranean fever: Rare genetic disorder that causes recurrent bouts of fever, abdominal pain, lung inflammation, and swollen joints.

Non-Arthritis Causes

Many other conditions cause joint pain that's not related to joint disease or inflammation.

Fibromyalgia

Fibromyalgia is a chronic pain condition involving nervous system dysfunction and hypersensitive nerves.

Fibromyalgia pain usually moves around the body. It can affect joints, muscles, and connective tissues. Nerves may cause shooting, zinging, or tingling pain.

Other symptoms include crippling fatigue and cognitive dysfunction ("fibro fog"). Some people with this illness have joint aches and minor swelling.

However, exams and tests don't generally find any serious inflammation or joint damage.

NAME OF CONDITION	COMMON JOINTS	CHRONIC OR ACUTE	DISTINGUISHING FEATURES
Fibromyalgia	Any	Chronic, acute flares	Moves around the body Fatigue Fibro fog
Hemoarthrosis	Any	Acute	Bleeding into a joint May resolve without treatment
Hypothyroidism	Any	Chronic	Fatigue Weight gain Cold intolerance
Lyme disease	Knee Shoulder Ankle Elbow Jaw Wrist Hip	Acute, can become chronic	Bacteria transmitted through tick bites
Depression	Any	Either	Loss of interest Sleep problems Feeling hopeless

Hemarthrosis

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
• Tumor growth like a synovial (joint lining) hemangioma

Blood can damage the cartilage inside your joints. Symptoms include:

• Joint pain and stiffness
• Swelling
• Bruising
• Redness and warmth

It can take weeks or months to go away on its own. Treatment helps prevent pain and disability.

Hypothyroidism

Hypothyroidism involves an underactive thyroid gland. The most common cause is Hashimoto's thyroiditis, an autoimmune disease in which your body attacks your thyroid gland.

The thyroid is responsible for keeping numerous hormones in balance. When they're out of balance, a lot of things can go wrong. Symptoms of hypothyroidism include:

• Joint aches
• Stiffness
• Fatigue
• Weight gain
• Constipation
• Cold intolerance
• Hair loss
  

Lyme Disease

Lyme disease is transmitted via tick bites. Lyme bacteria in your joint tissue causes inflammation and pain known as Lyme arthritis.

The main symptom is swelling of one or more of the joints. Common sites include:

• Jaw
• Shoulder
• Elbow
• Wrist
• Hip
• Knee
• Ankle

Depression

It may seem odd, but unexplained joint pain is a primary physical symptom of depression. Other common symptoms include:

• A loss of interest in pleasurable activities
• Appetite changes
• Sleep disturbances
• Difficulty concentrating
• Feelings of hopelessness and/or guilt

When to See a Healthcare Provider

New joint pain is a reason to see your healthcare provider. Also, make an appointment if you have a pain condition but:

• Have pain in a new area
• Develop a markedly different type of pain
• Have new symptoms along with the pain

Many people with one pain condition go on to develop another. For example, it's common for someone with RA or lupus to eventually develop secondary fibromyalgia.

Diagnosis

Healthcare providers have myriad tools for diagnosing the cause of your back joint pain. They include:

• A thorough medical history
• A comprehensive physical examination
• Blood tests
• Imaging tests
• A joint aspiration procedure
• In rare cases, a biopsy (tissue sample)

The specific tests you'll get depend on your symptoms.

Medical History

The first step in the diagnostic process is a medical history. That includes the details of your joint pain, such as:

• Where does it hurt?
• How intense is it?
• Is it worse at certain times of day? After rest or certain activities?
• What makes it better and worse?

Your healthcare provider will also ask whether you have a family history of joint pain. That's because some conditions (like psoriatic arthritis) tend to run in families.

Be sure to tell your healthcare provider if any of the following apply to you:

• Recent fever
• Unusual symptoms, like fatigue or unexplained weight loss
• Recent trauma
• Recent surgery
• Recent viral infection

Before your appointment, think about all of these things so you can provide helpful information.

How Symptoms Help

Details about your pain can help narrow down possible diagnoses. For example, if sudden, severe pain hits one joint at a time, it may be:

• Gout
• Pseudogout
• Bacterial infection

Mild, achy pain that comes on gradually and affects more than one joint could be:

• Rheumatoid arthritis
• A type of spondylitis
• Lupus

Joint pain of osteoarthritis improves with rest and worsens with activity. Arthritis due to RA is worse with rest and improves with activity.

Being thorough at that first appointment can help you get to the right tests, and the right treatments, faster.

Physical Examination

During the physical exam, your healthcare provider will press on the painful joints. They're looking for:

• Warmth
• Swelling
• Tenderness

These are signs of inflammation. They'll also move your joints around to check for a limited range of motion or crepitus (popping and grinding).

They'll note whether your pain is symmetrical (in the same joint on both sides) or asymmetrical. Lastly, they'll look for various clues such as:

• Plaques (seen in psoriatic arthritis)
• Heberden and Bouchard's nodes (distinctive finger swelling in osteoarthritis)
• Tophi (crystalline deposits like those seen in gout)
• Rheumatoid nodules (bumps under the skin seen in RA)
• Tender points (pain in 18 specific places, sometimes used to diagnose fibromyalgia)
• Enlarged thyroid gland (goiter, seen in hypothyroidism)

Exam findings may lead to a clear diagnosis. But much of the time, more work is needed.

Labs and Tests

Blood tests are necessary for diagnosing many systemic (body-wide) causes of joint pain. They may include:

• Complete blood count (CBC): Identifies infections and blood-based problems.
• Erythrocyte sedimentation rate (ESR or sed rate): Checks for inflammatory markers.
• C-reactive protein (CRP): Checks for inflammatory markers.
• Rheumatoid factor: An antibody present in RA, Sjögren's disease, and other autoimmune diseases.
• Anti-citrullinated protein antibody (anti-CCP): A peptide seen in autoimmune diseases.
• Uric acid level: Checks for the possibility of gout.
• Anti-nuclear antibody (ANA): Can indicate certain autoimmune diseases.
• Kidney and liver function tests: May be abnormal in inflammatory arthritis.
• Hepatitis B and C tests: Joint pain is a common symptom of these infections.
• Parvovirus test: Joint pain is a common symptom of this infection.

If they suspect autoimmune disease, your provider may order tests for certain antibodies. Those are your immune system's "attack" cells.

If they suspect fibromyalgia, you may be given questionnaires to fill out. These are measurements of pain, other symptoms, and their impact on you.

Imaging

Imaging tests can help confirm or rule out a diagnosis. For example, an X-ray may reveal:

• Osteophytes (bony growths common in OA)
• Joint space narrowing (see in OA)
• Erosions (craters in the bone seen in inflammatory arthritis)

Other imaging tests may provide more information about a joint and its surrounding tissues. Common ones include:

• Ultrasound
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan

Procedures

A few procedures can help confirm a diagnosis.

Joint Aspiration and Synovial Fluid Analysis

With joint aspiration, a needle is used to remove fluid from inside the synovium (joint lining). The fluid is then analyzed under a microscope. This can help diagnose:

• Gout
• Septic arthritis

Synovial Biopsy

If your healthcare provider suspects tuberculosis or fungal infection, they may perform a synovial biopsy.

This involves removing a small tissue sample from the synovium. The tissue is then examined in the lab.

Differential Diagnoses

Sometimes, what's perceived as joint pain comes from a non-joint related condition. These may include:

• Tendonitis
• Muscle strain
• Bone fracture
• Rarely, a bone tumor

These causes are typically easy for your health team to rule out.

Treatment

Treatments for joint pain depend on the diagnosis. Options include:

• Self-care
• Medication
• Physical therapy
• Complementary and alternative treatments
• Less often, surgery

Self-Care Strategies

Simple things you can try at home, before or after a diagnosis, include:

• Ice or heat
• Topical pain relievers
• Gentle stretching
• Rest
• Supportive wraps

You can take good care of your joint(s) and yourself by:

• Staying up-to-date on vaccinations and regular check-ups
• Educating yourself about your diagnosis
• Doing aerobic and strengthening exercises regularly
• Eating a nutrient-rich diet
• Losing extra weight

You may want to try an anti-inflammatory diet. Some illnesses, such as gout, may be improved with specific dietary changes.

Be sure to involve your healthcare practitioner in any lifestyle change you make.

Medication

Several different medications can ease joint pain. The specific type depends on your diagnosis. Some possible medications are:

• A topical or oral (by mouth) nonsteroidal anti-inflammatory drug (NSAID)
• Other painkillers (acetaminophen, opioids)
• Topical capsaicin
  
• Steroid joint injections
• Hyaluronic acid injections

Medications for autoimmune diseases change how your immune system works. These include:

• Disease-modifying anti-rheumatic drugs (DMARDs): Methotrexate, Plaquenil (hydroxychloroquine), Xeljanz (tofacitinib citrate)
• Biologics: Enbrel (etanercept), Humira (adalimumab), Orencia (abatacept), Rituxan (rituximab)

Fibromyalgia and depression are often treated with drugs that alter brain chemistry. These include:

• Cymbalta (duloxetine)
• Savella (milnacipran)
• Lexapro (escitalopram)
• Elavil (amitriptyline)

Fibromyalgia is also treated with anti-seizure medications:

• Lyrica (pregabalin)
• Neurontin (gabapentin)

Other conditions require specific treatments.

• Hypothyroidism is treated with replacement thyroid hormones.
• Some drugs help with gout by preventing uric acid crystal formation.
• For septic arthritis, intravenous (through a vein) antibiotics are typical.

Physical Therapy

Physical therapy for joint pain focuses on:

• Maintaining (or regaining) joint function and range of motion
• Strengthening muscles surrounding the joint
• Minimizing joint stiffness and pain

Depending on your condition, your physical therapist may recommend a walking aid, brace, or splint.

For fibromyalgia, a supervised physical exercise program is especially important. It can help manage symptoms like muscle and joint, fatigue, and anxiety.

Complementary and Alternative Medicine

Several mind-body therapies can alleviate joint pain. They can be used alone (alternative) or along with other treatments (complementary). Some of these include:

• Tai chi
• Yoga
• Acupuncture
• Biofeedback
• Nutritional supplements

Your healthcare provider can help you decide which approaches may be helpful or harmful to you.

Surgery

Surgery is generally reserved for advanced cases of joint pain. This may include knee or hip OA that hasn't responded to less invasive treatments.

An osteotomy is sometimes a good option. It involves cutting and reshaping bones to ease pressure on a joint. That may delay the need for a joint replacement.

Good osteotomy candidates are:

• Young
• Active
• Have one-sided knee or hip problems

In severe cases, total joint replacement may be necessary.

Summary

Many conditions cause joint pain. Some are chronic (long-lasting). Others may be temporary. They may run their course without treatment or only clear up with the right treatments.

Some joint-pain causes just affect the joints. Others are systemic conditions with many other symptoms.

New joint pain, or a new type of joint pain, are reasons to see a healthcare provider. To diagnose the problem, they'll use your medical history, a physical exam, and possibly blood tests, imaging, and special procedures.

Treatment depends on the diagnosis. Medication, physical therapy, and sometimes surgery are standard. You may also benefit from lifestyle changes, self-care strategies, and complementary therapies.

A Word From Verywell

Pain is your body's way of telling you something is wrong. Joint pain is a clear signal but it can be hard to figure out where it's coming from.

The diagnostic process can take time and lead to a lot of frustration. Hang in there, though. Once the cause is found, you can start on the right treatments.

And that's what it takes to tackle your pain, quiet your symptoms, and improve your quality of life.