Severe pain in muscles and joints – cause

Myalgia and arthralgia are pain in muscles and joints; these two painful conditions often accompany each other, despite the fact that they develop in tissues that are completely different in structure. Often the nature of the pain is so vague and undefined that the patient points to the joint, but in fact he has pain in the inflamed muscle.

More recently, a definition has appeared in medical terminology that is most suitable for describing simultaneous pain in muscles and joints – myoarthralgia; there are also more deeply studied nosologies with a similar clinic – rheumatoid arthritis (RA), polymyalgia rheumatica. It is these diseases that include all signs, symptoms, conditions relating to the musculoskeletal system and muscles.

In the 21st century, several completely unique areas of medical specialization have also appeared, including myology, so muscle pain should be dealt with by a specialist – a myologist, but there are only a few such doctors in the world, so myoarthralgia is still treated by rheumatologists.

The combination of painful symptoms in muscles and joints is considered a fairly common phenomenon; according to statistics, 90% of patients with rheumatism present precisely such complaints. With joint diseases, damage to the skeletal muscles surrounding the joint is inevitable. Following the pathology of the bone tissue, the muscle tissue also changes, causing pain, deformation, and sometimes contracture of the joint. All this makes it difficult to diagnose and timely recognize the root cause of the condition, since often the muscle symptom is the first to debut and predominates. This is due to the physiological and anatomical connection of skeletal muscles, ligaments, tendons and joints. There is another etiological version. Currently, some progressive specialists consider rheumatic pain as a symptom complex, in the pathogenesis of which muscles play a major role; modern scientists believe that their damage leads to joint pathology and manifests itself as myoarthralgia.

Causes of pain in muscles and joints

The true causes of pain in muscles and joints still remain a diagnostic mystery, since both myalgia and arthralgia are symptom complexes of unknown etiology. Modern microbiologists have identified several types of infections – provocative agents of all types of rheumatoid arthritis, which is considered the main disease with the clinical picture of myoarthralgia. Factors that cause acute polyarthritis, monoarthritis, polyarthritis and generalized myalgia primarily belong to the autoimmune category, and secondarily to the viral and bacterial categories, and only 15-20% of them can be considered traumatic.

The following causes of pain in muscles and joints are distinguished:

• Autoimmune pathologies – RA (rheumatoid arthritis), scleroderma and its types, all types of rheumatism, systemic lupus erythematosus.
• Metabolic disorders in the tissues of the skeletal system, cartilage – gout, osteoarthritis, osteoporosis.
• Traumatic damage to a joint or muscle – sprains, blows, fractures, bruises and ruptures of the synovial bursa (bursa). Any, even the weakest blow to a muscle will inevitably lead to minor trauma to the joint due to the unified blood supply system.
• Viral diseases – ARVI, influenza, TORCH infections. Hyperthermia (high temperature) causes the virus to spread through the bloodstream, where it is able to penetrate muscle tissue and even reach a joint. Retroviruses, Epstein-Barr virus, herpes virus, rubella virus, cytomegalovirus, mycoplasma, rubella virus are especially dangerous.
• Hypertonicity and pain in joints and muscles during physical overexertion and training.
• Osteochondrosis, deforming articular osteochondrosis.
• Neurological pathologies (muscular compression neuropathy, pinched nerves).
• Joint ganglia (bursa cysts).
• Congenital anomalies of the structure of the musculoskeletal system (achondroplasia, congenital dislocations of the hips).
• Physiological conditions that provoke transient arthralgia and myalgia, for example, pregnancy.

Rheumatologists pay special attention to the Epstein-Barr virus, since it is the indicator of its elevated titers that occurs in 85-90% of patients suffering from RA (rheumatoid arthritis). This is a polyconal cellular virus that activates the pathological synthesis of antigens, as a result of which the immune system becomes tolerant to external and internal harmful pathogens, resulting in the development of a systemic, chronic inflammatory process. Also dangerous are DNA-containing parvoviruses, retroviruses, mycobacteria, which provoke diseases, in the clinic of which pain in muscles and joints is noted.

Why do muscles and joints hurt?

One of the reasons why muscles and joints hurt may be a little-studied disease – fibromyalgia. Often it is its symptoms that “imitate” typical joint pain of rheumatic origin.

Fibromyalgia is a systemic, chronic disease of unknown etiology, which definitely does not belong to inflammatory or autoimmune pathologies. The diagnosis of diffuse muscle pain, which often extends to the joint area, is confirmed provided that the patient presents such complaints for 3 months and the possible disease cannot be cured with anti-inflammatory, analgesic and antirheumatic drugs. In addition, fibromyalgia is characterized by certain trigger points where pain is localized. These hones are identified by palpation and physical examination. Symptoms include complaints of specific morning weakness, stiffness, sensations of numbness in the extremities, transient but systematic diffuse pain in the back, neck, arms, lower back, and calf muscles. The clinic of fibromyalgia is very similar to the manifestations of rheumatism; often a person is being treated for it and cannot understand why muscles and joints hurt, despite various therapeutic methods, including traditional ones.

This applies, first of all, to self-medication, which is often present in our lives. No competent doctor will diagnose a rheumatic disease without examination, and in the case of fibromyalgia syndrome, studies do not determine the parameters of inflammation and other signs of rheumatic pathologies in the joints, bone and muscle tissue.

Also, the answer to the question “why joints and muscles hurt at the same time” can be elementary overexertion, when the constant tone of muscle tissue provokes the autonomous development of a spontaneous pain symptom. Pathogenetically, this process looks simplified like this: tension – hypertonicity – spasm – sensation of pain – new spasm and consolidation of hypertonicity. Such an abnormal muscle “corset” does not contribute to the normal nutrition of the bone and cartilage tissue of the joint, myogenic ischemia, microcirculation disorders, tissue acidosis, accumulation of cell breakdown products, and inflammation of the joint develop.

Why do joints and muscles hurt?

The human body includes more than 600 types of muscle tissue, each of which in turn performs important functions, including ensuring the motor and ligamentous function of the joints. All muscles are made up of many thousands of tiny thin muscle fibers. Any abnormal process in the muscles or their tissue can provoke pain symptoms. Among those who studied the relationship between muscle-joint diseases and pain was the great Greek healer, Hippocrates, who was the first to figure out why joints and muscles hurt. Several thousand years ago, he described an acute inflammatory process in the joints and called it “arthritis.”

Despite such a long history, doctors still cannot identify specific causes that explain the etiology of arthritis, but it has been established that dysfunction of muscles and joints is provoked in this way:

• Changes (systemic or situational, temporary) in the contractile function of muscles and skeletal muscles.
• Prolonged hypertonicity contributes to the development of local compactions in muscle tissue and disruption of joint nutrition.

In turn, overexertion, hypertonicity, muscle tightness, joint pain can be caused by the following factors:

• Various types of body posture disorders that cause joint deformities provoke muscle pain. This category also includes professional violations – constant work while sitting, wearing specific shoes (high heels), which violate all the laws of anatomically acceptable biomechanics.
• Autoimmune diseases, often genetically determined.
• All types of rheumatism, rheumatoid arthritis, polymyalgia rheumatica.
• Osteochondrosis is a degenerative process that gradually deforms the spine, therefore activating compensatory overload of both muscles and joints.
• Pathological deformation of the spine.
• Forced long-term stay in a horizontal position in chronically ill patients and people with severe injuries.
• Joint stiffness and myalgia can be caused by intense training and physical overload.
• Injury, regardless of severity, is in any case accompanied by microdamage to muscle tissue, disruption of microcirculation and nutrition of joints and muscles.
• Endocrine diseases.
• Vascular pathologies that provoke atrophy of muscle and bone tissue.

In short, it is quite difficult to determine why muscles and joints hurt; the accuracy and speed of diagnosis and the effectiveness of treatment are directly related to the timely visit of a sick person to a doctor.

When all muscles and joints hurt

As a rule, diffuse pain indicates either the degree of neglect of the pathological process, or certain diseases for which such a symptom is inherent.

All muscles and joints hurt – this is a sign of such pathologies:

• Polymyalgia rheumatica. The disease is rarely diagnosed, on average one patient per thousand who present with rheumatic complaints. Most often, polymyalgia rheumatica affects women over the age of 50-55 years, representatives of the stronger sex and young people; children suffer from this disease very rarely. As in the case of other rheumatic types, the etiology of RP is not fully understood, but statistical data suggest psychogenic factors in combination with autoimmune pathological processes. Clinical manifestations are nonspecific; patients complain of “all muscles and joints hurt.” During physical examinations, the localization of pain is specified, most often pain and stiffness are expressed in the hips and shoulder joints. X-rays do not reveal deformation, degeneration of the spinal column or joints; rather, polymyalgia rheumatica is an inflammatory disease. The main leading diagnostic criteria are muscle weakness (hips, buttocks, arms) and symmetry of symptoms, but initially, before the development of such atrophy, RP manifests as transient painful polymyalgia. The pain may intensify in the morning when you first try to move, but at night or at rest the pain subsides. The list of symptoms of RP includes elevated body temperature, weight loss, and depression.
• Fibromyalgia is a disease of unknown etiology, which most often affects muscle tissue, but diffuse pain can also be felt in the joints. Characteristic clinical criteria are certain trigger zones in which diffuse musculoskeletal pain is localized. Painful sensations are accompanied by stiffness, stiffness of joints in the morning, weakness, and decreased activity. Muscles, although they are the primary source of pain, do not become inflamed in the same way as joints; there is no irreversible damage or destruction, which makes it possible to differentiate fibromyalgia from a variety of rheumatological pathologies.

When the joints and muscles of the hands hurt

Myoarthralgia of the upper extremities can develop first in the area of ​​large joints, such as:

• Shoulder joint.
• Elbow joint.
• The wrist joint.
• Hand joint.
• Joints of the fingers.

In addition, the joints and muscles of the hands hurt due to damage, inflammation or injury to the periarticular, periarticular tissues, which primarily include the tendon-ligamentous apparatus, as well as bursae, fascia and muscles.

The reason why myoarthralgia develops in the hands may be as follows:

• Tenosynovitis.
• Tendinitis.
• Myotendinitis.
• Bursitis (inflammation of the synovial joint).
• Ligamentitis (inflammatory process in the ligament, with referred pain in muscles and joints).
• Enthesitis (inflammatory process in the area of ​​attachment of the joint and tendon).
• Fibrositis.
• Fibromyalgia.

What diseases cause pain in the joints, and then in the muscles of the arms:

• Rheumatoid arthritis is the most common disease.
• Osteoarthritis
• Brachial plexitis.
• Neuralgic amyotrophy.
• Hand joint injuries.
• Gout.
• Arthritis.
• Psoriatic arthropathy.
• Polyarthritis (pain in five joints of the hands at once).
• Carpal tunnel syndrome.

How to determine where the root cause is using motor tests?

Movement and pain. What gets damaged, gets inflamed

Abduction of the arm back, to the side – Compression syndrome of the capsule of the shoulder joint, subacromial impingement syndrome

The arm rises up as much as possible – Damage to the acromiocleidoclavicular joint

External rotation of the arm (combing) – Inflammation or damage to the infraspinatus tendon, teres minor

Internal rotation, when pain occurs when moving the arm back – Inflammation or injury to the subscapularis tendon

Pain when bending the elbow and supination when lifting weights – Damage, inflammation of the biceps brachii tendon

Almost all movements of the arm are impaired – Chronic inflammation, damage to the capsule of the shoulder joint or the joint itself

Pain in joints, shoulder muscles, arm at rest – Possibly – plexitis, all types of compressions included in thoracic outlet syndrome – scalene muscle syndrome, costoclavicular syndrome, cervical rib syndrome and others

In addition, myoarthralgia, that is, a combination of pain in the joints and muscles, is often a symptom of traumatic injuries – sprains, bruises, ligament tears. Such conditions can clinically manifest themselves as classic articular syndrome, but have a completely definite cause – trauma. Damage to the muscle-tendon structures is inevitably accompanied by pain both in the periarticular tissues and partially in the joints that they surround.

Why do the joints and muscles of the legs hurt?

For what reasons does myoarthralgia appear in the legs?

If the joints and muscles of the legs hurt, the following provoking factors and diseases can be assumed:

• Neuralgia, neuritis.
• Degenerative processes in the spine.
• Radiculopathy.
• Rheumatoid arthritis.
• Bursitis.
• Myotendinitis.
• Fasciitis.
• Myoenthesitis, paratenonitis.
• Injuries, bruises.
• Vascular pathologies – atherosclerosis, varicose veins, thrombophlebitis, lymphostasis, endarteritis.
• Hypertonicity from overload (training, strength activities).
• Crash syndrome.
• Fibromyalgia.
• Gout.

It should be noted that the joints and muscles of the legs often hurt due to an inflammatory process in the periarticular tissues, that is, the symptom itself does not relate to the joint, but is subjectively felt in it as a repercussion (reflected).

The cause of pain in the periarticular tissues can be the following pathologies of the rheumatic category:

• Periarthritis of the hip joints, when the tendons of the buttock muscles and at the same time the synovial bursa of the femoral joint become inflamed. The combination of pain in the joint and muscles intensifies with any movement, especially when walking, and goes away at rest.
• Periarthritis of the knee, when pain develops in the area of ​​the inner surface of the knee. The symptom increases when walking, in motion, and gradually subsides at rest.
• Baker’s cyst or popliteal bursitis, the disease is a continuation of almost any deformity of the knee joint. The cyst, descending to the back of the lower leg, provokes muscle pain (in the calf muscle), and the joint hurts at the same time due to its inflammatory nature.
• Aponeurositis, heel tendonitis, calcaneal bursitis – these conditions are characterized by severe pain localized at the site of inflammation and damage.
• Fibromyalgia is a chronic musculoskeletal pain of unknown etiology, often subjectively affecting the joints.

Symptoms of muscle and joint pain

Clinically, the pain of myarthralgia is a symptom of rheumatoid arthritis, since it is this disease that demonstrates a combination of pain in the joints and muscles. Symptoms of pain in muscles and joints may depend on the location of the sensation and which pain symptom came first – muscle or joint. For the diagnosis of myoarthralgic symptoms, an accurate description and description of pain from the patient is very important, therefore, for reference, we present a list of some parameters proposed in the international classification of pain:

• Clinical course by time, duration:
• Acute and short-term pain (shooting pain, lumbago).
• Acute and recurrent pain.
• Chronic long-term pain.
• Chronic constant, ongoing pain.
• Progressive pain.
• Non-progressive pain.
• Definition of myoarthralgia depending on the type of disorder:
• An epicritic pain symptom that develops due to a violation of the integrity of barrier tissues, in this case the joint capsule. Epicritical pain is a signal of damage and disruption of differentiation and isolation of internal structures. This type of pain is felt in a specific place, it is easy to recognize and differentiate, it is usually acute, short-lived and not too intense.
• A protopathic symptom is a pain signal of oxidative dysfunction in tissues, and in this case, in muscles. The pain is aching, dull in nature, perceived as diffuse, diffuse, poorly differentiated and defined in terms of localization.

A specific symptom of rheumatoid arthritis is myalgia; in addition to characteristic joint pain, almost all patients complain of muscle pain. The statistics are as follows:

• 82-90% of RA patients complain of pain in muscles and joints (muscles of the legs and arms, less often in the muscles surrounding the hip joint).
• 58-60% of patients note the onset of pain in the joints, and then, against the background of arthralgia, pain in the muscle tissue appears.
• 31-35% complain of simultaneous pain – myoarthralgia.
• 35-40% of patients with rheumatoid arthritis suffer from morning stiffness in both muscles and joints.
• 45-50% of patients have clinically significant weakness and atony of skeletal muscles.
• Progressive wasting of muscle tissue in RA is observed in 80% of patients.

Symptoms of pain in muscles and joints are characterized by moderate intensity, but they are usually persistent and recurrent. The intensity of pain can vary throughout the day depending on body position, temperature and methods of pain relief. In general, the symptoms of myoarthralgia can be divided into two types – inflammatory and mechanical:

• Myoarthralgia of inflammatory etiology is most often observed in the case of chronic arthritis. The pain intensifies at night and in the early morning, accompanied by morning stiffness and stiffness. The pain gradually disappears after warming up the muscles and joints.
• Myoarthralgia of mechanical etiology is pain caused by degenerative processes in the joints, most often with osteoarthritis. The pain intensifies in the evening and subsides in the morning. Also, a pain symptom can develop due to physical stress, stress, and the pain goes away with rest.

Pain in the muscles of the hip joint

The hip joint is considered one of the most vulnerable to various types of damage, both degenerative and inflammatory. Pathology that provokes pain in the muscles of the hip joint can be localized in the joint itself, but also in the tissues surrounding it. Most often, a pain symptom in this area is provoked by such factors and diseases that relate to pathologies of the skeletal system:

• Traumatic injury to a joint, accompanied by pain in the muscle tissue.
• Trauma to periarticular tissues.
• OA – osteoarthritis.
• Rheumatoid arthritis.
• Perthes disease is a dissecting osteochondropathy of the femoral head, more often diagnosed in children.
• Tuberculous coxitis.
• Osteomyelitis.

In such cases, pain in the hip area begins in the joint and then moves to the muscles. However, there are also periarticular diseases in which pain in the muscles of the hip joint is an independent symptom:

Bursitis of the iliopectineal bursa

Swelling and pain in the inner thigh, lower abdomen in the groin area, pain radiates to the thigh muscles when walking, squatting

Inflammatory process in the bursa of the greater trochanter of the hip bone

Inflammation is a consequence of osteoarthritis, pain is localized in the greater trochanter and radiates to the thigh muscles

Trochanteric bursitis, trochanteric enthesitis

The pain develops in the supine position, the patient cannot turn on his side, pain in the thigh muscles appears when the hip is abducted

Femoral adductor tendinitis

A typical sports injury, pain is localized in the groin area, aggravated in the muscles of the thigh and leg when the hip joint is abducted.

Inflammation of the ischial bursa, sciatic bursitis

Pain in the gluteal muscles develops when squatting, if a person sits on a hard surface, the symptom intensifies when flexing the hip

Periformis syndrome, piriformis syndrome

Pain in the muscles of the hip joint is localized in the buttock or lumbar muscles; it can also develop in the sacroiliac joint, in the muscles of the posterior thigh. Pain worsens at night, when getting out of bed or from a sitting position

Pain in the muscles of the elbow joint

The following muscles control the movement of the elbow joint and may cause pain:

• Triceps muscle – extends the elbow (supination).
• The internal brachialis and biceps muscles – bend the elbow (pronation).

Pain in the muscles of the elbow joint may not be associated with pathological processes. Thus, those who are intensely involved in fitness and develop muscles may experience incomplete supination (extension) of the elbow due to hypertonicity of the forearm flexors, which is accompanied by a transient pain symptom.

Those people who, on the contrary, do not pay any attention to strengthening muscle tissue, may feel pain in the elbow muscles during pronation (flexion) up to excessive hyperextension due to muscle weakness.

There are many reasons why pain occurs in the muscles of the elbow joint, some of them relate to physiological, reversible factors, others are associated with pathological processes, most often in the joint itself. To clarify the diagnosis of the disease, in addition to general clinical studies, functional tests are performed to determine the position of the elbow joint and the nature of pain during the test. If the flexion of the affected elbow becomes constant (compensatory slight flexion in any position of the body), this indicates the accumulation of exudate due to thickening, inflammation of the synovium, and degeneration of the joint. When the elbow hurts, but bends with difficulty, it is easier for a person to keep his arm straight; this may indicate true muscle pathologies of the elbow – myositis, polymyositis and other diseases of muscle tissue.

Pain in the elbow muscles. Diseases of the musculo-ligamentous apparatus:

• Epicondylitis of the joint. A degenerative inflammatory process in the muscles and tendons surrounding the elbow joint. Most often, epicondylitis occurs in musicians, tennis players, and those whose professional activities involve constant hand movements. Symptoms – pain appears with exertion, mainly with rotation or supination (extension) of the arm. Passive movements of this kind, performed by a doctor with the patient’s hand, do not cause pain, which makes it possible to quickly exclude arthrosis or arthritis of the joint.
• Myotendinitis of the elbow is an inflammatory process in the tendon, gradually spreading to the muscle tissue of the forearm. The causes of myotendinitis are also associated with professional activities, performing rhythmic, monotonous hand movements. In addition, rheumatic diseases, injuries, sprains, and gout can be provoking factors. Symptoms – myotendinitis caused by rheumatism is characterized by constant pain, even at rest. Other types of tendinitis are characterized by pain when performing active movements, but painlessness of passive movements. Possible hyperemia of the skin, a characteristic “crunching” sound when moving.
• Ulnar nerve entrapment – ​​cubital tunnel syndrome. This is essentially traumatic ischemia of the ulnar nerve caused by a blow. Such sensations are familiar to many who have hit the corner of their elbow. If such an injury occurs during a fall (a strong blow) or is repeated with enviable consistency, the ulnar nerve, which passes through the injured canal, is compressed. The cause can be not only injury, but also professional activity – drivers (constantly switching levers, workers operating machines in factories, and so on. Symptoms of chronic trauma are numbness of the hand, little finger and ring finger, pain gradually increases. The blow provokes a sensation of shooting pain (Tinel’s symptom) The ulnar nerve innervates the flexor of the hand, fingers, and palmar muscles, that is, the pain most often “shoots” into the hand.
• Eosinophilic diffuse fasciitis of the elbow is a systemic fibrotic disease of the fascia, connective tissue, as well as subcutaneous tissue and muscles adjacent to it. Diffuse fasciitis is considered one of the types of scleroderma; therefore, its etiology has not been sufficiently studied and is not specified. Symptoms are a gradual thickening of the dermis, subcutaneous tissue, and soft tissues, which provokes a noticeable limitation of the mobility of the elbow joint, contracture, flesh to flexion contracture of the fingers. A specific symptom is spontaneous muscle pain in areas of thickening tissue, uneven “orange” skin.
• Bursitis is an inflammation of the synovial bursa of the elbow process (bursa), most often of traumatic origin. Symptoms are enlarged bursa, swelling, swelling, pain, but without limitation of range of motion. Progressive inflammation, purulent, phlegmon can provoke symptoms similar to those of myositis.

Referred pain in the muscles of the elbow joint can also be caused by osteochondrosis of the cervical spine; in this case, the symptoms are localized throughout the forearm in the biceps muscle.

Diagnosis of pain in muscles and joints

Muscle and joint pain are not considered independent diseases in medicine; rather, they are complex, multicomponent symptoms. If we consider that arthralgia and myalgia almost always “neighborhood”, then determining the root cause of the pain can be extremely difficult.

Diagnosis of pain in muscles and joints depends on the accuracy of identifying the anamnestic and clinical characteristics of the symptom, on when and under what circumstances it develops, as well as on a set of physical examinations. As a rule, the diagnosis of combined pain (articular and muscle) is the prerogative of a rheumatologist. In order to differentiate possible pathological causes, a whole diagnostic complex is prescribed, the main indicator of which is a standard clinical and biochemical analysis of blood serum, as well as serological reactions. To confirm or exclude the suspected diagnosis, radiography, tomography, podography, ultrasound of joints are prescribed, arthrography is also possible, and punctures are used to collect intra-articular fluid for microbiological and cytological examination.

Diagnosis of pain in muscles and joints in more detail:

• Basic analytical blood tests, which are not specific, but provide direction in the diagnostic search for the root cause of the symptom and show the degree of activity of the process. Indicators of ESR, protein metabolism, the content of acidic enzymes (proteinase, phosphatase, cathepsins, deoxyribonuclease) make it possible to look for the onset of symptoms in ankylosing spondylitis, rheumatism, and polyarthritis. It is these pathologies that are manifested by combined myalgic and arthralgic symptoms:
• A blood test serves as an indicator of the ESR level as a parameter of the inflammatory process. An elevated erythrocyte sedimentation rate (ESR) with normal leukocyte boundaries is always evidence of rheumatic lesions. If the white blood cell count is also increased, this may be a sign of a focal infectious process in the spine or joints. •
• A biochemical blood test for myalgia and arthralgia is an indicator of CRP – reactive protein. Biochemistry also reveals the DPA test, a definylamine reaction that determines the quantity and quality of DNA – deoxyribonucleic acid as one of the indicators of the type of rheumatic disease. The analysis shows the presence of fibrinogen, cholesterol, AST and ALT-ferase, sulfurglycoids and many other elements
• Immunological tests help identify many diseases of the musculoskeletal system at an early stage, for example, ankylosing spondylitis, rheumatoid arthritis, infectious bacterial inflammation (streptococcal infection) and so on:
• If the Valera-Rose reaction is positive, the doctor continues the diagnosis in the direction of rheumatoid factor. Also, its indicator is the presence of an antiglobulin body in the blood serum.
• The ASL-O test, a blood reaction with antistreptolysin, shows the immune response to a suspected streptococcal infection (infectious inflammation of the joints, infectious polyarthritis).
• The HLA system is an indicator of the early stage of ankylosing spondylitis, when HLA complexes are detected in the blood (in cell membranes).
• Determining the rate of inhibition of movement (migration) of leukocytes helps to identify rheumatoid arthritis and other types of rheumatism.
• Synovial fluid puncture is necessary for combined symptoms – pain in joints and muscles – to determine the type of joint damage – degenerative, traumatic or inflammatory. The puncture involves immunobiological and histochemical studies of the exudate of the synovial membrane of the joint.
• If pathological diseases of the spine or skeletal system are suspected, an x-ray is mandatory, which is an important differential diagnostic method. Radiography helps to identify the severity of the disease, the stage of the process and build treatment prospects, including prognosis.
• Tomography is needed to clarify the localization of suspected focal inflammations and deformities, usually in the spine. Also, diagnosing pain in muscles and joints in the area of ​​the spinal column involves myelography, a contrast method for examining the spine.
• Angiography is needed to determine the extent of suspected atherosclerotic changes in the vascular system, which primarily provoke muscle pain.

In addition, the patient may be prescribed tests such as:

• Phlebography, including intraosseous.
• Arthroscopy for joint diseases, especially the knees.
• Contrast arthrography.
• Contrasting discography.
• Biopsy.
• Radionuclide