Pain as a symptom has an important physiological meaning for the body, as it indicates the presence of a problem. It is an alarming sign that has a leading place among the various manifestations of a wide range of diseases. It is important to note that the intensity of pain does not always correlate with the severity of the disease process. In parallel, pain is a subjective symptom, and accordingly, the intensity of the pain symptom differs according to the individual pain threshold, as well as some behavioral responses.
The pain – its nature, expressed in intensity, provoking factors, and localization has a relation to the direction of the diagnostic process. By the specific characteristics of the pain, the differential diagnoses can be minimized and thus the diagnosis is facilitated
In the majority of cases, it is also a factor that shows whether there is an effect of the treatment and even allows monitoring of the course of the disease to a certain extent.
Rheumatic pain is caused by several main types of irritants. First of all – chemical, which is due to the mediators of inflammation, various inflammatory enzymes. Microcirculatory disorders also have a direct impact – venous stasis may also be present.
Due to the swelling and correspondingly increased joint pressure, neighboring structures are pressed. This, in turn, is related to the appearance of pain, expressed in varying degrees, directly related to the size of the swollen area.
Due to the presence of painful areas, the adjacent musculature reacts with a spasm, which is a protective mechanism of the body to protect the damaged tissues. It is possible that there is also so-called reflected pain, which is provoked by the changes in the joint, but manifests itself in more distant organs. This further complicates the diagnostic process.
Rheumatic pain can originate from the synovial sheath (a membrane that covers the inner walls of a joint), spastic muscles, tendons, and their respective sheaths, as well as the periosteum.
Daytime pain is characteristic of osteoarthritis and the involvement of the soft tissues around the joint (in insertions, tendinitis, tendovaginitis, bursitis, and others). Night pain is more characteristic of inflammatory joint diseases – rheumatoid arthritis, psoriatic arthritis, Bekhterev’s disease, and others.
Rheumatism is characterized by exacerbation of symptoms during the cold months. There is a dependence, in addition to the temperature, also to the humidity of the environment – in cool and humid weather, the pains are provoked and intensified, and in warm and dry weather, they are relieved and suppressed.
The pain is quickly affected by anti-inflammatory drugs. It is characteristic that even if the swelling is minimal, the pain can be of high intensity.
When several joints are affected, the condition is referred to as polyarthritis, and the polyarthritic form most often affects small joints – for example, those of the wrist and fingers. In contrast, with monoarthritis (affecting one joint), the changes are in the larger joints – elbow, and knee. Involvement of the cervical vertebrae is significantly less common.
The first symptom of acute rheumatoid arthritis is the growing sharp pain in the joints, which increases even with small movements. The pain is present even when touched, and the skin over the affected joint is red and warm. A characteristic symptom is the possibility of rapid attenuation of the process and the manifestation of the same symptoms in another joint – migrating inflammation.
When the disease becomes chronic, there is morning stiffness when moving and initial difficulty in movement.
Bibliography:
1. “Rheumatic pain”, A. Kolarov; GP News Magazine, Vol. 8/2004
2. Advancing Stiffness Measurement in Rheumatic Disease: Report from the Stiffness Special Interest Group The Journal of Rheumatology; 2018
