Arthralgia refers to pain in one or more joints. It may occur in the absence of objective signs of inflammation or structural damage, or it may be associated with underlying joint or systemic disease. The severity and pattern of arthralgia provide important diagnostic clues.

Pathophysiology

Joint pain arises from irritation or injury of nociceptors in the synovium, cartilage, periarticular ligaments, tendons, or surrounding muscles. In inflammatory conditions, immune-mediated synovial inflammation triggers pain and stiffness. In degenerative disorders, mechanical wear and tear of cartilage and bone stimulate nociceptors. Systemic autoimmune diseases may cause widespread arthralgia due to circulating immune complexes and inflammatory cytokines.

Etiology and Associated Features

History and Physical Examination

History:

• Onset, duration, location, and symmetry of joint pain.

• Aggravating and relieving factors (activity, rest, medications).

• Associated systemic symptoms: fever, rash, fatigue, morning stiffness, swelling.

• Family or personal history of autoimmune disease.

Physical examination:

• Inspect joints for swelling, erythema, deformity, and atrophy.

• Palpate for tenderness, warmth, or effusion.

• Assess range of motion and functional limitations.

• Examine other systems (skin, eyes, mucous membranes) for systemic disease clues.

Diagnostic Approach

• Laboratory tests: CBC, ESR, CRP, rheumatoid factor, anti-CCP, ANA, uric acid.

• Imaging: X-ray, ultrasound, or MRI for joint damage, effusions, or crystal deposits.

• Synovial fluid analysis: In suspected crystal-induced or infectious arthritis.

• Specialized tests: HLA-B27 for spondyloarthropathies, serologies for infections.

Management

Patient counseling

• Educate patients about the underlying cause and chronicity of arthralgia.

• Encourage joint-protection strategies and physical activity appropriate to condition.

• Discuss weight management and lifestyle modifications for degenerative joint disease.

• Explain the importance of medication adherence for autoimmune or inflammatory causes.

• Advise when to seek urgent care: acute monoarticular swelling with fever may indicate infection.

Pediatric considerations

• Juvenile idiopathic arthritis is a common cause of chronic arthralgia in children.

• Pain may be intermittent, with morning stiffness or joint swelling.

• Growth and developmental milestones should be monitored.

Geriatric considerations

• Osteoarthritis and degenerative joint disease are more prevalent in older adults.

• Polypharmacy may contribute to joint pain (statins, diuretics).

• Functional assessment and fall risk evaluation are important.

Key points

• Arthralgia is a symptom, not a diagnosis; careful evaluation is required to identify underlying causes.

• Patterns of joint involvement, systemic features, and laboratory/imaging findings guide diagnosis.

• Management depends on etiology and may include pharmacologic, physical, and lifestyle interventions.

References

1. Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR. Kelley and Firestein’s Textbook of Rheumatology. 10th ed. Philadelphia: Elsevier; 2017.

2. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology. 6th ed. Philadelphia: Elsevier; 2015.

3. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 8th ed. Maryland Heights, MO: Mosby Elsevier; 2019.

4. Buttaro TM, Sandberg-Cook J, Bailey PP. Primary Care: A Collaborative Practice. 6th ed. St. Louis, MO: Mosby Elsevier; 2018.