When joints hurt

Joint pain can have different and mostly non-inflammatory causes. "The most common cause is overloading of the joints. This can be in the context of established osteoarthritis or after sporting activity," explains Prof Stephan Gadola, Head of Rheumatology and Pain Medicine at Bethesda Hospital.

Inflammation can also cause joint pain. "If joint pain no longer goes away, there is swelling or the fist can no longer be closed, then there may be an inflammatory disease behind it. The most common of these are so-called crystal diseases, which include the widespread disease "gout". In this case, uric acid crystals lead to inflammation of the joints and soft tissue. Even more common, but often unrecognised, is "pseudogout", in which calcium pyrophosphate crystals trigger the inflammation. Gout and pseudogout must be differentiated from an acute joint infection so that the correct treatment can be chosen. Somewhat less common, but no less important, is rheumatoid arthritis, which can lead to the destruction of joints if left untreated and is often referred to as "rheumatism" in common parlance. People with psoriasis can suffer from psoriatic arthritis, as Stephan Gadola explains. "There are other forms of inflammatory rheumatism that affect not only the joints but also the spine or the connective tissue of organs. These include ankylosing spondylitis and the autoimmune disease lupus erythematosus."

Who is mainly affected

Age is the greatest risk factor for osteoarthritis, pseudogout and rheumatoid arthritis. The risk of pseudogout increases almost linearly with age.

"In people over 80, around 40% have crystal deposits in their joints, and around 4% develop symptoms." The situation is somewhat different with rheumatoid arthritis, which typically occurs between 40 and 50. Women are generally seven to ten times more likely to be affected by autoimmune diseases because their immune system works slightly differently. On the other hand, they are somewhat better protected against certain viral diseases. "The development of osteoarthritis in weight-bearing joints such as knee or hip joints correlates strongly with body weight. With knee or hip osteoarthritis, every kilo counts," explains Gadola.

When you should see a doctor

A visit to the doctor is indicated if severe symptoms suddenly occur, such as a feeling of stiffness in the hands and/or feet in the morning, or if one or more joints swell considerably within a few days. "If you have gout, you automatically go to the doctor. In this case, the pain increases so much within a few hours that those affected see the proverbial 'fire of Holland'. A single joint is usually very swollen, reddened and extremely painful," says Gadola.

Good treatment options

There is now a wide range of effective medication available for the treatment of these diseases. "To support this, we inject anti-inflammatory medication directly into severely affected joints under ultrasound guidance. This enables us to achieve a high level of effectiveness," continues Gadola. In the case of osteoarthritis, the rheumatology department at Bethesda Hospital works closely with the orthopaedics department. The motto here is that all conservative options, such as physiotherapy and pain therapy, should be exhausted before surgery is considered.