Stiff Joints

What are Stiff Joints?

Stiff joints occur when there is difficulty in moving the joints, resulting in reduced range of movements. Stiff joints can be accompanied by joint pain (arthralgia), swelling, redness, warmth, tenderness, numbness or tingling sensation. The stiffness can occur as a result of injury or due to an underlying disease such as arthritis. Moreover, adjacent areas of the joints such as bursae may become inflamed (bursitis), which can radiate pain in and around the joints.

Structure and Function of Joints

There are several types of joints in the body. On the basis of the type of binding tissue connecting the bones (structural classification), these may be of the following types:

• Synovial Joint: This type of joint has the greatest mobility and it moves freely. It consists of two large, weight-bearing bones that are juxtaposed, such as the knee joint. The contact surfaces of these bones are covered by cartilage that acts as shock-absorbers. The whole joint is encased within a synovial capsule made up of fibrous connective tissue and ligaments to provide strength and support. The synovial capsule is filled with synovial fluid, that serves to keep the joint well lubricated. The knee joint, pelvic joint, elbow joint, and ankle joint are some examples of synovial joints.
• Cartilaginous Joint: These joint surfaces are covered with cartilage and are partially movable. Unlike the synovial joints, these joints do not contain synovial fluid. Intervertebral discs, manubriosternal joint, and the pubic symphysis are examples of cartilaginous joints.
• Fibrous Joints: These joints are essentially immovable and are also called fixed joints. Fibrous joints, as the name suggests, are connected by dense fibrous connective tissue, mainly collagen. There is no cartilage in between these joints. These are present in the skull, forming the cranial sutures.

What are the Causes of Stiff Joints?

Stiff joints can be caused by several factors. These are briefly highlighted below:

• Age: The normal aging process can lead to stiff joints. A lifetime of use can weaken the joints and associated cartilages and muscles, as a result of which stiffness can arise with advancing age.
• Rheumatoid Arthritis: This is an autoimmune disease, which means that the body's immune system, instead of protecting it, actually attacks it. In rheumatoid arthritis, the immune system predominantly attacks the lining of the joints of the wrists and fingers. A characteristic feature is that the same joints on either side of the body are affected. Rheumatoid arthritis is less common than osteoarthritis.
• Osteoarthritis: This is also known as a degenerative joint disease, which occurs as a result of general wear-and-tear in the weight-bearing joints such as the knee and hip joints. Disease progression occurs by wearing away of the cartilage at the contact point of the bones constituting the joint. As a result, the bones rub against each other, causing tremendous pain and inflammation.

• Other Types of Arthritis: These include ankylosing spondylitis, infectious arthritis or septic arthritis, and gout, which can cause stiff and painful joints with varying degrees of severity. Gonorrhea, a sexually transmitted disease (STD) can cause gonorrheal arthritis, which is a rare complication, if the condition remains untreated. The symptoms include painful, swollen joints and skin lesions. Lyme arthritis is a condition that arises due to the late treatment of Lyme disease, causing swelling and pain in one or both knees.
• Fibromyalgia: This is a complex condition that causes joint and muscle pain, changes in mood and sleep patterns, cognitive deficiencies, and increased fatigue. Fibromyalgia resembles rheumatoid arthritis, but the symptoms are not as severe. It usually occurs after illness, surgery, or extreme stress.
• Injury: The joints may be injured as a result of which they may become inflamed. Two types of injury-related joint pain include bursitis and tendinitis. Bursitis is the inflammation of the bursa, which are fluid-filled sacs that reduce the shock between the joints and other moving parts. Tendinitis is the inflammation of the tendons that join the muscles to the bones.

What are the Symptoms & Signs of Stiff Joints?

The major symptoms and signs of stiff joints are highlighted below:

• Loss of Mobility: This is the most obvious symptom of joint stiffness. Usually, great difficulty is faced in moving the joints, which is inevitably accompanied by pain.
• Joint Pain: This is medically termed as arthralgia and is one of the primary symptoms of joint stiffness. The quality of the pain may vary from intense throbbing pain to a mere tingling or numb sensation.
• Inflammation & Swelling: The joint may become inflamed and swollen, accompanied by redness, warmth, and tenderness. The pressure inside the joint may also increase, thereby aggravating the condition.

How do you Diagnose Stiff Joints?

Stiff joints can be diagnosed in the following ways:

• Clinical Examination: A thorough clinical examination of the affected joint will reveal the cardinal symptoms of inflammation i.e. pain, swelling, redness, tenderness, accompanied by stiffness, the principal clinical sign. Based on the initial clinical diagnosis, blood tests may be ordered to investigate the underlying cause.
• Blood Tests: The initial blood tests will include determination of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An elevated ESR and/or CRP will indicate that an underlying inflammatory condition is present. Further tests may then be ordered to pinpoint the exact cause. For example, if rheumatoid arthritis is suspected, a test for anti-cyclic citrullinated peptide (anti-CCP) antibodies will clinch the diagnosis.
• Imaging: Imaging techniques such as X-ray, ultrasonography (USG), or magnetic resonance imaging (MRI) may be used to visualize the internal structure of the joint, which will help to establish the extent of the damage. Proper imaging can help to plan appropriate corrective measures, particularly if surgery is required.

How do you Treat Stiff Joints?

There are several options for treating stiff joints. These are briefly highlighted below:

• Cold Compress: Inflammation arising from stiff joints can be appreciably reduced by using a cold compress. A bag of ice will be just as effective.

• Heat Therapy: Depending upon the symptoms that are specific to the patient (individual needs), the doctor may recommend heat therapy, instead of a cold compress. Here, dry heat is usually recommended.
• NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, diclofenac sodium, and naproxen are effective in reducing the pain and inflammation associated with stiff joints.
• Steroids: Steroids are particularly useful if the pain and inflammation are due to autoimmune diseases like rheumatoid arthritis. For example, glucocorticoids such as prednisone and prednisolone are very effective and have a longer period of activity than other steroids. Moreover, recent research suggests that these steroids have an immunomodulatory function that reduces the symptoms of rheumatoid arthritis.
• Topical Creams: Topical (applied on the skin) creams containing drugs like diclofenac diethylamine and methyl salicylate can provide prompt relief from pain, swelling and inflammation arising from stiff joints.

Natural Remedies for Stiff Joints

Some natural remedies that can be used for stiff joints include the following:

• Turmeric: This is a very popular ingredient in the Indian cuisine and is used in almost all Indian dishes. Turmeric also has many health benefits. It is a powerful antioxidant and may help in preventing stiff joints. It also has anti-inflammatory properties and can help to reduce inflammation, stiffness and joint pain.
• Omega-3 Fatty Acids: Oily fish like salmon, mackerel, trout, and herring are very rich in omega-3 fatty acids, which help to reduce inflammation and swelling of joints.
• Vitamin D: The deficiency of vitamin D is quite common in arthritic patients, as a result of which calcium absorption is hampered, thereby affecting the bones and joints. A natural way of replenishing the body's vitamin D is by soaking in the sun. This is why this vitamin is also known as the "Sunshine Vitamin" and it's much better than taking vitamin D tablets.
• Bromelain: This is an enzyme that is present in pineapples and is absorbed without degradation in the gut. After absorption, the enzyme is very effective in reducing inflammation and pain. A combination of pineapple juice with aloe, ginger and turmeric is a very effective natural anti-inflammatory and analgesic remedy.
• Devil's Claw: This is a plant belonging to the sesame family that is native to southern Africa. The structure of its root resembles a claw, hence the name (although it has nothing to do with the Devil!). This plant is rich in iridoid glycosides, which help in relieving pain and inflammation in various musculoskeletal disorders like rheumatism, gout, arthritis, muscle, and joint pain.
• White Willow Bark: As the name suggests, it is the bark of the white willow tree. It contains a chemical called salicin that is very effective in relieving back pain as well as pain associated with stiff joints.

How do you Prevent Stiff Joints?

There are several ways by which stiff joints can be prevented or at least the symptoms can be delayed. These include the following:

• Weight Management: Reducing body weight is crucial for preventing the early onset of symptoms of stiff joints. The weight-bearing joints like the knee joints are particularly susceptible to developing pain and inflammation in the long-run. One-kilogram increase in body weight means that the knee joints will have to bear 4 times more weight i.e. 4 kilograms. For the same reason, obese individuals are particularly prone to developing knee and hip joint problems. Therefore, controlling the weight before it goes out of hand is very important for preventing stiff joints.
• Active Lifestyle: Activity is a prerequisite for preventing stiff joints. Changing a sedentary lifestyle to a more active one can go a long way to prevent early symptoms of diseases, like rheumatoid arthritis and osteoarthritis. Moreover, light exercise can actually strengthen the muscles around the joints, so in the long-run they will help to reduce the pressure on the joints.
• Pacing Exercise Activities: Performing active exercises that strain the muscles and joints are detrimental. There is a need to pace these activities by increasing and decreasing the intensity of the exercises gradually. Otherwise, this can result in damaged joints and pulled muscles, both of which are very painful conditions.

References:

1. Steroids for Rheumatoid Arthritis (Arthritis Research UK) - (https://www.arthritisresearchuk.org/arthritis-information/conditions/rheumatoid-arthritis/treatments/steroids.aspx)
2. Steroids in Rheumatoid Arthritis (National Rheumatoid Arthritis Society, UK) - (https://www.nras.org.uk/steroids-in-rheumatoid-arthritis)
3. 3 Ways to Prevent Joint Stiffness (Kaiser Permanente) - (https://wa-health.kaiserpermanente.org/three-steps-tips-protect-joints/)
4. Hamill J, Gruber AH, Derrick TR. Lower extremity joint stiffness characteristics during running with different footfall patterns. Eur J Sport Sci. 2014;14(2):130-6. DOI: 10.1080/17461391.2012.728249.
5. Kang SH, Ren Y, Xu D, Zhang LQ. Lower-limb multi-joint stiffness of knee and ankle. Conf Proc IEEE Eng Med Biol Soc. 2014; 2014: 4009-12. DOI: 10.1109/EMBC.2014.6944503.

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