The adult human body contains 206 bones and over 300 joints, which connect bones and provide stability, cushioning, and frictionless movement. Ligaments are tissues around joints that provide additional support, while tendons are tissues that connect muscles to bones.
Arthritis occurs when joints become inflamed or worn out. There are many different types of arthritis, which are typically classified as noninflammatory (the result of wear and tear, as in osteoarthritis) or inflammatory (the result of immune cells attacking joints, as in rheumatoid arthritis and lupus).
“Myalgia” is the medical term for muscle pain. Think how impressed your friends will be when you walk out of the locker room and confidently declare that you need some ice because “that game really gave me myalgias.” These too can result from overuse, autoimmune disease, and many other problems.
So is your joint or muscle pain a sign of worse things to come? Could it be from a tick bite you got last summer? Or is it a sign you’re just getting old? Should you pop some pain relievers or call up your doctor for some X-rays?
Take a Chill Pill
You’re training for an Iron Man competition and experience pain in your joints or muscles. We recommend an active lifestyle that includes regular exercise—ideally at least twenty to thirty minutes per day—but don’t go crazy and overdo it. Make sure you gradually work yourself up to any big challenge. Stretch before and after your workouts, and if you notice pain after exercising, first try basic measures like icing, massaging, and resting the affected joints. If you’re still suffering, you can pop some nonsteroidal anti-inflammatory drugs, or NSAIDs. The most popular NSAIDs are ibuprofen/Advil/Motrin and naproxen/Aleve/Naprosyn. Of note, NSAIDs can cause problems in people with kidney or heart disease. If you have severe pain, difficulty with movement, or persistent pain despite rest and medications, call your doctor. You could have a more serious condition, known as rhabdomyolysis, in which muscle tissue actually breaks down after very intense exercise.
Your fingers or toes change color when they’re cold or you’re stressed. You may have Raynaud’s phenomenon. In this fairly common condition, which affects one in twenty people, both cold temperatures and emotional stress make the blood vessels in your hands become so narrow that your fingers turn white and then blue. In some cases, you may also experience pain. Symptoms can occur in the toes, ears, nose, and even nipples too.
If you get an attack, try to warm up the affected area. At other times, focus on prevention by avoiding cold temperatures (such as reaching into freezers), wearing warm gloves (possibly with hot packs inside), not smoking, and minimizing medications that shrink blood vessels. The major medications to look out for include decongestants (phenylephrine, pseudoephedrine), migraine medications (triptans, caffeine), and stimulants (methylphenidate/Ritalin).
Although Raynaud’s phenomenon is usually not a big deal, it can sometimes be associated with an autoimmune condition like lupus or scleroderma. Mention it at your next doctor’s appointment, as you may need additional tests.
If your symptoms are really bothersome and can’t be prevented, your doctor may prescribe a calcium channel blocker, a medication that helps keep vessels open. If your fingers stay blue and painful for more than thirty minutes, you may have a different kind of blockage in your blood vessels and should get to an urgent care center or E.R.
Make an Appointment
You twisted or injured a joint, which then became swollen and painful. If the pain is tolerable and the joint can be easily moved, you may simply have a strained ligament. You can try to wait and see if your symptoms improve with RICE: rest, ice, compression (tightly wrap the injured area with a bandage), and elevation. If your symptoms persist for more than one or two days, see your doctor for a detailed physical examination. If the pain is severe, the joint can’t move normally (or support your weight), or you have loss of sensation near the injury, you probably have a more serious problem, like a fracture, torn ligament, or ruptured tendon. If you can’t get a same-day appointment with your doctor, go to the E.R. for a complete examination and some X-rays.
You’re over sixty and have had months or even years of pain in one or two joints. Wisdom comes with age, but unfortunately so too does osteoarthritis, or OA. This condition is especially common after age sixty and results from cumulative wear and tear on joints. Those most likely to be affected are the knees, hips, hands, and spine. The pain typically gets worse with activity and improves with rest.
If you frequently use certain joints in repetitive movements (you’re an athlete or dancer), you may experience OA at an even younger age. Extra weight also stresses load-bearing joints (like your knees and hips) and accelerates damage to joints.
Your doctor will order an X-ray (and possibly MRI) of the affected joints. The initial therapies usually include medicated creams (containing NSAIDs), physical therapy, and exercise. Your doctor or physical therapist may also recommend a splint or brace to help stabilize and strengthen your joint. Some people swear by capsaicin cream, which contains hot chili pepper oils and can numb pain (but also causes stinging when first applied). Weight loss can also reduce joint stress and improve pain.
If creams don’t work, you can try NSAID pills. (See here.) For people with continued pain, an injection of steroids (or other substances, like blood plasma) directly into the joint may also help. If you’re still suffering despite all of these measures, your only remaining hope may be joint replacement surgery.
You have multiple painful joints, which are usually at their worst when you first wake up in the morning. Your pain may be related to an autoimmune disease, which causes an inflammatory arthritis that gets worse with rest and improves with use. A common example is rheumatoid arthritis, or RA, which most often strikes women between the ages of forty and sixty. RA is typically symmetric, meaning it affects the same joints on both sides of the body (usually the hands and toes). It is sometimes associated with painless bumps around the elbow or forearm. Because RA is an autoimmune disease, it may also cause fever, weight loss, fatigue, eye redness/pain, and pain in the lining of the lungs and heart. Your doctor will perform blood tests and X-rays to make the diagnosis. If you’re diagnosed with RA, don’t panic: there are many medications that can dramatically improve your symptoms and slow down joint damage.
You also have itchy, scaly plaques on your elbows, knees, or scalp. One in three people with psoriasis (see here) also experiences inflammatory arthritis, related to abnormal targeting of joints by the immune system. (Interestingly, it’s even possible to have psoriatic arthritis without any skin lesions.) Another common issue is swelling and pain in the tendons and other tissues around joints, which causes your fingers or toes to look like sausages. Your doctor may recommend pain relievers or more powerful medications that partially suppress your body’s immune system and limit further joint damage.
You have fever, chills, headache, cough, and pain in many of your muscles and joints. You may have the flu (even if you got your flu shot this season). Most people recover within a week by resting, drinking plenty of fluids, and taking pain medications like acetaminophen/Tylenol. Your doctor may also prescribe an antiviral medication (oseltamivir/Tamiflu) if you’ve had symptoms for less than forty-eight hours. Be aware that the flu can cause serious, life-threatening complications, such as pneumonia, so if you’re feeling really terrible (high fevers, nonstop cough, and so on) and can’t get a same-day appointment, visit an urgent care center or E.R.
You also have bloody diarrhea and belly pain. You may have an autoimmune disease that affects both your intestines and your joints, such as celiac disease or inflammatory bowel disease (which includes Crohn’s disease and ulcerative colitis). In celiac disease, the joint pain usually goes away with a gluten-free diet. In inflammatory bowel disease, the pain often responds to medications that calm down the immune system.
You’re over fifty and wake up with pain and stiffness in both shoulders or hips. You may have a condition known as polymyalgia rheumatica, or PMR, which usually occurs in a person’s seventies (almost never before fifty) and is more common in women. In this condition, the immune system attacks the joints and muscles in the shoulders and hips, leading to pain and stiffness. For most people, symptoms improve dramatically after taking low-dose steroid pills. About one in five people with PMR have a related condition known as temporal arteritis, which causes problems with the arteries on the side of the face, resulting in headaches, scalp tenderness, jaw pain while chewing, and blurred vision. The vision problems can progress and become irreversible if the condition is not promptly treated with high-dose steroids.
Your cholesterol has been perfect ever since you started that new medicine, but now your muscles hurt. The statins are an extremely popular class of medication used to lower cholesterol and prevent conditions like heart attacks and stroke. The most popular ones are atorvastatin/Lipitor and rosuvastatin/Crestor. Although statin-related muscle pain is a hot topic, it occurs much less often than the statin naysayers claim. People who do experience pain tend to notice it most when rising from a chair, climbing stairs, or raising their arms above their head. The pain may actually be from other medical conditions (like thyroid disease or low vitamin D levels) or interactions between statins and other medications, such as colchicine (for gout), niacin and fibrates (also for cholesterol), cyclosporine (for suppressing the immune system), and steroids. Also note that grapefruit juice can increase blood levels of statins and cause muscle pain, but only if you regularly imbibe more than eight ounces per day. If you think your muscle pain is from your statin, speak to your doctor. Switching to another statin may be enough to fix the problem. Although statins do lower coenzyme Q10 (CoQ10) levels, there has been no compelling evidence that CoQ10 supplements prevent statin-associated muscle pain.
You’re taking antibiotics for a urine infection or diarrhea, and you have sudden pain and swelling in one joint. An antibiotic known as ciprofloxacin/Cipro, commonly prescribed for urinary tract infections and diarrhea, can cause irritation and even rupture of muscle tendons. The risk is highest during exercise. Try to slow down your exercise regime until the pills are finished. If you experience sudden-onset pain in or near a joint while taking this medication, call your doctor right away.
You recently walked around in the woods or in tall grasses, and now you have new-onset joint pain. Lyme disease results from infection with Borrelia burgdorferi, a kind of bacteria transmitted by deer ticks. In most people, the first sign of Lyme disease is a rash that looks like a bull’s eye (or the Target logo): a large red spot surrounded by a red circle, with normal skin in between. Other symptoms include fever, chills, and body aches. Over the following weeks to months, many people experience pain that moves from one joint to another. Your doctor can diagnose Lyme disease with blood tests. Antibiotics are very effective but need to be taken for several weeks.
You have pain in a few joints and some new skin lesions a few days or weeks after a night (or day) of unprotected passion. Gonorrhea can spread beyond your naughty bits to involve your joints and skin. The skin lesions usually look like small pimples scattered on your arms and legs, and the pain can affect multiple joints at once. You may not have the usual signs of a sexually transmitted infection, like discharge from your nether regions. Your doctor will test your urine, blood, and joint fluid for gonorrhea and start you on antibiotics. (You’ll have to let your partner or partners know they need treatment too.)
Your muscles constantly feel sore and tender, even after rest. You may have a condition known as fibromyalgia, which causes widespread muscle pain that gets worse with stress, exertion, poor sleep, and exposure to cold. Additional symptoms include fatigue, numbness and tingling, headache, insomnia, poor concentration, and depression. A regular exercise program and the frequent use of relaxation techniques (like meditation) may significantly improve your symptoms. If they don’t, your doctor may prescribe medications. Some antidepressant medications (duloxetine/Cymbalta, amitriptyline/Elavil) and antiseizure medications (gabapentin/Neurontin, pregabalin/Lyrica) are particularly effective.
You have sudden-onset pain, redness, and swelling in your big toe. You may be experiencing a gout attack. In this condition, tiny crystals of uric acid form in a joint and trigger the immune system. Gout usually affects the big toe but can also occur in the knee, ankle, wrist and elbow. Get a same-day appointment if possible. If it’s your first episode, your doctor may remove some fluid from your joint to confirm the diagnosis.
Gout attacks are treated with pain relievers and, in some cases, steroids. Your doctor may prescribe medications (colchicine/Colcrys, allopurinol, febuxostat/Uloric) to help prevent further attacks. If you take diuretics to lower your blood pressure, they can increase the risk of attacks, so your doctor may swap them out with other medicines.
People with gout should reduce their intake of foods that increase the risk of future attacks, like meat, seafood, fruit juice, high-fat dairy (whole milk, ice cream), nondiet sodas, and candy. They also need to stay hydrated and try to lose weight, if possible. Of note, eating fresh cherries on a regular basis may help prevent attacks. (You should hold off on the ice cream sundaes, though.)
Get to the E.R.
One of your joints recently became swollen, warm, red, and very painful. You may be experiencing a gout attack (see previous section) but could also have a bacterial infection inside your joint. In the latter case, the joint can sustain severe damage if it isn’t promptly cleaned out and treated with antibiotics. To determine the correct diagnosis, a doctor may need to use a needle to withdraw fluid from the joint.
You have pain in your thighs or shoulders, and your urine has turned dark red or brown. You may have widespread muscle breakdown, a condition known as rhabdomyolysis, which causes pain and swelling in your muscles. The broken-down bits of muscle fiber can turn your urine dark red and plug up your kidneys, causing kidney failure. The many causes of rhabdomyolysis include crush injuries, prolonged immobilization (people who can’t walk and get stuck in a certain position), excessive exercise, seizures, heat stroke, certain medications (statins, colchicine), alcohol, and drugs (like cocaine, heroin, and amphetamines).