The most common joint disease is arthritis which affects more than 22% of adults in the United States.

What is a Joint?

A joint is a part of the body where two or more bones come together to allow movement. The ends of the bones are coated in cartilage to cushion the joint and prevent friction as the bones move against one another. Joints are held together and supported by tough bands of connective tissue called ligaments. A membrane called the joint capsule encloses the whole joint system and contains synovial fluid which lubricates the joint and provides extra cushioning against impact.

Muscles attach to bones with bands of connective tissue called tendons and create movement at each joint. When tendons and ligaments lie close to the bone, tiny fluid-filled sacs called bursae sit between the connective tissue and bone to reduce friction and irritation.

Summary: Joints are areas in the body where two bones come together to allow movement. Joints also contain cartilage, ligaments, bursae, muscles, tendons, synovial fluid, and a joint capsule.

Common Joint Conditions

There are a variety of conditions that affect different tissue types that make up a joint. The most common joint condition is arthritis which mainly affects joint cartilage, but arthritis can also target the joint capsule and bones that make up the joint. Joint conditions can also affect the bursa and ligaments surrounding the joint.

Arthritis

Arthritis is the most common joint condition and occurs in over 22% of American adults. Arthritis is a general term for a large group of conditions that affect joint cartilage and involve inflammation of the joint. There are over 100 types of arthritis that all share the same symptoms of pain, stiffness, and swelling in the joint. Anyone can live with arthritis independent of age, race, and sex though it is more common among women. Arthritis tends to happen more often in older age, though it can affect people of all ages including children.

The most common forms of arthritis are outlined below.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It is caused by wear and tear of the joint and most commonly affects the weight-bearing joints of the hands, knee, hip, and spine. The cartilage coating the end of the bones that form the joint starts to break down due to degenerative changes and the underlying bone structurally changes. These changes happen slowly and tend to get worse over time. Symptoms of osteoarthritis involve pain, stiffness, swelling, and decreased range of motion at the affected joint. Conservative treatment options include bracing, offloading with an assistive device, physical therapy, and medication. Surgical options include arthroscopy and joint replacement (1).

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune condition that damages the lining of the joint capsule (called the synovium) and causes inflammation. The joints most often affected by rheumatoid arthritis include the small joints of the hands, wrists, and knees. Symptoms of rheumatoid arthritis tend to be symmetrical so if a joint is affected on one side of the body, the same joint is likely also affected on the other. Signs and symptoms include those similar to other forms of arthritis including pain, swelling, and stiffness, but rheumatoid arthritis can also include systemic symptoms of fatigue, weight loss, fever, and weakness. Treatment options include medication management, diet, physical therapy, and exercise.

Psoriatic Arthritis

Psoriatic arthritis is an autoimmune condition that is associated with psoriasis, which is a chronic skin disease causing red, scaly rashes on the skin. About 1 in 3 people who have psoriasis will eventually develop psoriatic arthritis (2). The joints most commonly affected in psoriatic arthritis include fingers, wrists, ankles, and knees. Along with the common symptoms of arthritis involving pain and stiffness of the joints, psoriatic arthritis can also involve cracking and pitting of the nails and irritation of the eyes. Treatment options are the same as with rheumatoid arthritis including medication management, diet, physical therapy, and exercise.

Gout

Gout is a common form of inflammatory arthritis that typically causes significant pain, swelling, and redness at the joint of the big toe. Gout tends to come in flares that start suddenly and may last for several days or weeks, followed by long periods of remission. Gout usually only occurs in one joint at a time. Gout is controlled through medication management and a diet that minimizes purines found in red meat, alcohol, and certain types of fish.

Septic Arthritis

Septic arthritis is an infection in the joint fluid and other tissues of the joint which tends to affect children more than adults. Causes of septic arthritis include infection, surgery, or injury. The infection reaches the joint through the bloodstream. Symptoms include fever, joint pain, and joint swelling which most often affects the knee, hip, shoulder, wrist, and finger. Septic arthritis is treated with antibiotics and joint fluid drainage.

Ankylosing Spondylitis

Ankylosing spondylitis is a type of Spondyloarthritis that primarily affects the spine, though other joints such as the shoulders and hips may be involved. It causes inflammation in the spinal joints that can lead to severe pain and in more advanced cases, sections of the spine may become fused together. Ankylosing spondylitis is managed with medication, diet, physical therapy, and exercise.

Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis is an autoimmune disease that affects children under the age of 16 years and causes joint inflammation, swelling, pain, and difficulty performing daily activities. Some types of juvenile arthritis have few or no joint symptoms and only affect other body tissues such as the skin and internal organs, though this is less common. The joints most commonly affected are the hands, knees, ankles, elbows, and wrists. Juvenile idiopathic arthritis is managed with medication, exercise, physical therapy, and in rare cases surgery.

Lupus (SLE)

Lupus is an autoimmune condition that causes inflammation that affects multiple organs in the body. In addition to causing joint symptoms, it can affect the skin, kidneys, lungs, heart, and brain. A hallmark symptom of lupus is a butterfly-shaped rash that occurs across the nose and the cheeks, though rashes may develop on any part of the body that is exposed to the sun. Other symptoms aside from muscle and joint pain include hair loss, fever, kidney problems, mouth sores, blood clotting, and fatigue. Lupus is primarily treated with medication.

Lyme Disease

Lyme disease is a bacterial infection that is transmitted from insect bites, most commonly ticks. Acute Lyme disease causes symptoms such as rash, fever, headache, and fatigue. If not treated, Lyme disease can become chronic and the infection can spread to your joints, heart, and nervous system. Chronic Lyme disease has varied symptoms with the most common being joint pain, fatigue, inflammation, headaches, and muscle aches. Lyme disease is treated with antibiotics successfully in the acute stage. In chronic Lyme disease, a holistic approach is most often needed including lifestyle and dietary changes (3). Lyme disease is easiest to treat in the first 30 days after exposure so early treatment is key for resolving symptoms.

Bursitis

Bursitis is a painful condition that affects the small fluid-filled sacs called bursae that cushion the bones, tendons, and muscles near the joints. Bursitis occurs when the bursa becomes inflamed due to repetitive activities or overuse. The most common location for bursitis is the shoulder, elbow, and hip. Bursitis is treated with anti-inflammatory medications, activity modification, and cortisone injection.

Dislocation

Dislocations happen when one of the bones that make up a joint is pushed out of place due to trauma or sports injury. Dislocations also cause injury to muscles, nerves, tendons, and blood vessels that surround the joint. The most common joints to be dislocated are fingers, shoulders, knees, elbows, hips, and jaws. Symptoms include pain, swelling, bruising, visible deformity, and being unable to move the joint. Dislocations require a healthcare provider to relocate the joint. Imaging such as x-ray, MRI, or CT scan might be needed to assess damage to the surrounding area after a dislocation. Treatment after a dislocation usually requires immobilization, rest, pain medication, and physical therapy.

Hypermobility

Joint hypermobility is common and means that the joints can move beyond the normal range of motion. In most people, joint hypermobility does not cause pain or medical issues. Though for some people, hypermobility can cause joint pain, ligament injuries, and fatigue. This is termed joint hypermobility syndrome and is a genetic connective tissue disorder that involves extreme flexibility along with pain. Joint hypermobility syndrome is treated with strengthening exercises to protect the joints, physical therapy, bracing and orthotics, and pain medication.

Symptoms

Symptoms of joint disease vary based on the specific condition and joint disease affects each person differently. Though the most common symptoms among joint diseases are:

Joint pain with movement or weight bearing
Stiffness most noticeable upon waking up or after inactivity
Tenderness to pressure at the joint
Loss of flexibility and inability to move the joint through its full range of motion
A grating sensation or noise when moving the joint
Bone spurs which feel like lumps around the affected joint
Swelling around the affected joint

Causes

The most common cause of joint disease is overuse which can damage the soft tissues of the joint. Overuse injuries happen with repetitive activities or overtraining. The most common overuse injuries that affect joints include bursitis and osteoarthritis.

Sudden injuries and trauma can also cause joint disorders. These usually result from accidents or sports injuries. Traumatic joint injuries include dislocations and can lead to a higher risk of developing arthritis in the future.

Genetics can also increase your risk of developing different types of arthritis including rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis and osteoarthritis.

Infections can also cause joint disease. If an infection spreads to your joints it is called septic arthritis. Certain insects can cause bacterial infections which affect the joints as well, the most common being Lyme disease.

Summary: Joint diseases can be caused by overuse, trauma, genetics, and infections.

Risk Factors

There are several factors that increase the risk of developing joint diseases. The most common are the following:

Older age: risk of developing osteoarthritis increases with older age
Sex: women are more likely to develop osteoarthritis, rheumatoid arthritis, lupus, and hypermobility. Males are more likely to develop gout and ankylosing spondylitis.
Obesity: extra weight puts more stress on the joints and can cause arthritis and exacerbate other joint conditions.
Sports: exposure to sports puts you at a higher risk of joint injuries including dislocation and other injuries to the joints that can increase your risk of developing osteoarthritis.
Genetics: inflammatory types of arthritis and osteoarthritis have been shown to have a genetic cause.

Diagnosis

Diagnosis of joint disease starts with a detailed medical history of symptoms, family history, medications, co-morbidities, and activity levels. Next the doctor will perform a physical examination including range of motion, strength, observation of inflammation and tenderness, and watching you perform certain activities such as walking and transferring out of a chair.

After the physical examination your doctor may want to take additional tests. These may include lab tests such as blood work, urine tests, and joint aspiration (looking at the fluid creating swelling inside the joint). These tests can point to certain joint diseases such as gout, lupus, infection, and inflammatory arthritis.

Your doctor may also order imaging tests such as x-ray, MRI, CT scan, or ultrasound. These will allow your doctor to view any damage to the joint that has occurred and diagnose joint diseases such as osteoarthritis, dislocation, bursitis, and ankylosing spondylitis.

Summary: Joint diseases are diagnosed with a combination of medical history, physical examination, labratory tests, and imaging.

Treatment Options

Treatment options will vary based on the specific joint disease, though will likely involve a combination of the following:

Medications: types of medications used to treat joint diseases include anti-inflammatories, steroids, biologics, disease-modifying anti-rheumatic drugs (DMARDs), and pain killers.
Physical therapy: physical therapists can help to improve range of motion and strength to offload the affected joints. Physical therapy can also help teach you how to modify your activities to cause less pain.
Assistive devices and bracing: certain types of braces or using assistive devices such as a cane can help to offload the affected joint.
Surgery: if conservative treatments do not improve symptoms, doctors might suggest surgery such as arthroscopy, joint replacement, or joint fusion.

Conclusion

Joints are areas in the body where two bones come together and can be injured with overuse, sports, or trauma. The most common joint disorder is osteoarthritis, though there are other types of inflammatory arthritis that can affect the joints as well. Risk factors for joint disease include age, sex, obesity, participation in sports, and genetics. Joint disorders are diagnosed with a combination of medical history, physical examination, laboratory findings, and imaging tests. Treatment for joint disorders includes medications, physical therapy, assistive devices, and surgery.

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