When joints swell it's always because fluid has accumulated in the joint. Most often the fluid is watery and yellowish – a bit like the fluid in a blister. Sometimes the swelling may be due to bleeding within the joints, usually from trauma but haemophiliacs may bleed into their joints.
Joint swelling is usually painful at least initially: joints contain many pain receptors and the skin over the joint will of course be stretched. Swollen joints have limited movement and this makes everyday activities difficult.
Conditions Which Cause Joint Swelling
These fall into four categories: trauma, arthritis, infections and immune reactions.
Trauma
Any damage to joint structures such as the ligaments, joint capsule or cartilage can set off an inflammatory reaction which will cause swelling. This type of of injury is most often seen as a result of sporting activity such as a knee injury from skiing or football, for example.
If the injury is severe enough, blood will fill the joint and this needs to be drained quickly as the presence of the blood in a joint can initiate further damage to the joint.
A variant of the trauma cause is micro-trauma. This is due to repeated action of a joint (from an unaccustomed DIY project, for example), most frequently seen in the wrist, fingers or elbows. It's often insidious in onset being quite developed by the time it's noticed. Anyone who works primarily with their hands is at risk of finger and wrist joint problems.
Arthritis
Osteoarthritis is the most common cause of joint swelling with fingers being the most frequently affected. The joints are initially painful when they become swollen but the swellings eventually settle down to become painless and permanent. Other joints can be affected particularly the knees, the shoulder and ankle joints are rarely affected unless they have undergone previous injury.
Gout produces short bouts of intensely painful swelling, often of the big toe but other joints be involved. The joint is normally hot and red. The condition is due to uric acid crystals being deposited in the joint.
Rheumatoid arthritis, although often manifesting in the joints, is really an immune disorder and will be dealt with later.
Infections
Infection can arrive at a joint in one of two ways: through a wound or carried in the blood from an infection elsewhere. Joints contain large amounts synovial membrane – folds of thin tissue which secretes the fluid which provides nutrients and lubrication to the joint. This membrane provides an excellent breeding ground for infecting organisms.
The usual infecting organisms are staphylococci and streptococci and sometimes the gonorrhoea bacterium. Rarely nowadays joints can be infected by the tuberculosis bacterium.
Immune Reactions
The synovial membrane that is so great for bacteria is also a good medium for immune reactions. Anything that brings about a strong immune response such an allergy, reaction to a drug, infection or an autoimmune response can play out in the joints setting up an inflammatory reaction on the joint membranes.
Rheumatoid arthritis is the most common autoimmune disease to affect the joints – in the acute phase the affected joints are red hot and swollen.
Management of Swollen Joints
This of course will vary according to the underlying condition and the intensity of inflammation. If the joint is not hot then non-steroidal anti-inflammatory drugs will be used to ease pain and inflammation. Joints which are red and hot suggest a considerable degree of inflamation which, in addition to producing intense pain will cause damage to the joint structure. Treatment in these cases would more than likely involve the use of steroids or in the case of infection, antibiotics.
The initial treatment of traumatically injured joints is provided by the RICE regime - Rest, Ice, Compression and Elevation.
This article is for information only. If you have any health concerns you should consult your doctor.
Source:
ABC of Rheumatology Ed. M. Snaith Pub. BMJ Publishing 2004
John Richard Roberts - I am a practicing osteopath and acupuncturist living and working in the UK. I hold a Master's degree in Clinical Neuroscience. I have ...
