Treatments for Arthralgia

Treatment list for Arthralgia:

The list of treatments mentioned in various sources for Arthralgia includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

• Varies according to cause
• May include anti inflammatory drugs
• Steroid injections
• Surgery
• Treatment of underlying cause
• Analgesia

Treatments of Arthralgia: Online Medical Books

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Ankle Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• PRICE
  –Protection from additional strain/injury
  –Relative rest (stretching is okay) ±crutches
  –Ice for initial 24–48 hours after trauma
  –Compression (elastic wrap or ankle support)
  –Elevation of foot (higher than the pelvis)
• Casting is often indicated for fractures and significant ankle sprains
• Short-term bracing may reduce risk of reinjury
• Surgery may be indicated (e.g., bimalleolar fracture, trimalleolar fracture)
• Physical therapy referral to improve strength, range of motion, and proprioception
• NSAIDs or other analgesic

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Elbow Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• General principles of fracture management include immobilization, analgesia, NSAIDs, and elevation
• Immediate anatomic reduction is required in cases of neurovascular compromise
• Nondisplaced fractures should be immobilized with the elbow flexed at 90°
• Displaced or intra-articular fractures usually require open reduction with internal fixation
• Joint aspiration may relieve pain if effusion is present
• Epicondylitis is treated with rest, NSAIDs, and physical therapy
• Elbow dislocation requires reduction followed by splint immobilization
• Splinting may be beneficial
• Reduction of a subluxed radial head (nursemaid's elbow) is performed by placing the thumb over the radial head while supinating, then flexing, the forearm

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Jaw Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• Dental or periodontal pathology, oral lesions, salivary pathology, and oral neoplasms require specialized treatment by dental specialist or oral surgeon
• TMJ: Initial treatment includes pain management, bite block (night guard), cold/warm compresses, intra-articular steroid/lidocaine injections, and avoidance of jaw clenching and gum chewing
• Temporal arteritis: Temporal artery biopsy and high- dose steroids
• Headache: Pain relievers, stress reduction, migraine-specific therapy (e.g., triptans), and manipulation
• Neuralgia and neuropathies may be treated with NSAIDs, anticonvulsants (e.g., valproic acid, gabapentin), medical pain management and/or directed therapy (e.g., nerve block)
• Treat underlying systemic etiologies and behavioral disease as necessary

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Knee Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• Conservative therapy is usually sufficient
• OA: Lifestyle modification (e.g., weight loss, exercise); anti-inflammatory medications (e.g., NSAIDs, COX-2 inhibitors); joint injections may benefit some people (e.g. corticosteroids, hyaluronic acid); surgery may be necessary for those who fail conservative treatment
• Ligamentous injuries: ACL injuries may require definitive treatment via reconstructive surgery; PCL injuries are usually not repaired
• Meniscal tears may require repair or excision; however, most meniscus injuries are asymptomatic or mild and require no treatment
• Patellofemoral syndrome often responds to physical therapy and exercise
• Joint infection (e.g., septic arthritis) is a surgical emergency; irrigation, debridement, and antibiotic administration should be considered

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Low Back Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• In absence of red flag symptoms, return to activity as soon as possible; rest has not been shown to improve recovery
• Acetaminophen, NSAIDs, opioids, and/or muscle relaxants for pain; epidural corticosteroid injections may be indicated for resistant pain
• Patient education (weight loss, exercise, proper back biomechanics and ergonomics)
• Physical therapy, including pain relief modalities (ice, heat, ultrasound), stretching, strengthening, aerobic conditioning, and relaxation therapy
• Surgery may be indicated for refractory disease, large neurologic deficits, unbearable pain, or significant limitations

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Shoulder Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• Slings may be used for comfort but early range of motion (24–48 hours) is necessary to prevent adhesive capsulitis
• Conservative therapy is beneficial for most cases of shoulder pain: Rest, ice, NSAIDs, and opioid narcotics
• Subacromial cortisone injection if other anti-inflammatory methods fail; however, multiple injections are discouraged because of possible tissue atrophy
• Physical therapy is generally the mainstay of treatment
  –Conditioning and strengthening
  –Progressive range of motion exercises for adhesive capsulitis
• Full thickness rotator cuff tears may require surgical repair
• Adhesive capsulitis may require surgical lysis of adhesions
• Prevent future injuries by promoting strength and flexibility

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Toe Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• Gout: NSAIDs, corticosteroids, colchicines for acute attacks; colchicine, urate-lowering agents (e.g., allopurinol, probenecid) for chronic management
• Ingrown toenails: Warm soaks, removal of toenail if persistent
• Pseudogout: NSAIDs, corticosteroids, colchicines for acute attacks; NSAIDs, colchicine, urate for chronic management
• Trauma: Most closed toe fractures can be treated with stiff-soled shoes (to unload the metatarsal heads); “buddy-tape” immobilization may help relieve pain; rest, ice, NSAIDs, elevation
• Reiter's syndrome: Prednisone, indomethacin, sulfasalazine, methotrexate; local injection of steroid
• Septic arthritis: Treatment is based on clinical scenario and initial Gram stain; ceftriaxone for gram-negative infections, cefazolin for gram positives, add gentamicin for pseudomonal infections

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Wrist & Hand Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• Corticosteroid injection for carpal tunnel improves symptoms in more than half of patients; surgical intervention to release the transverse ligament and decompress the nerve entrapment may be indicated
• NSAIDs reduce inflammation and use of cock-up splints applied during activities and while sleeping reduces strain from repetitive use and reduces symptoms
• Corticosteroid injection along tendon sheaths and wearing a thumb spica splint treat tenosynovitis
• Ganglion cysts are treated by draining the thick fluid and injecting with steroid; surgical removal is occasionally necessary
• Casting of suspected fractures and repeat X-ray in 7–9 days prevents complications of occult fracture
• Antihistamines and steroids treat swelling from stings
• Treat rheumatologic and medical causes
• Biofeedback and relaxation may be beneficial in selected cases

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Arthritis – Multiple Joints: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Even though unlikely, if septic arthritis (such as with Neisseria gonorrhoeae) is a possibility, antibiotic treatment should be started immediately
• Appropriate treatment of malignancy
• NSAIDs for JRA and spondyloarthropathies as an initial therapy; disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate, and biologics (e.g., TNF blockers) are added depending on clinical response
• Specific treatments of other mixed connective tissue diseases depending on their severity
• Corrective and/or supportive medical/surgical interventions
• Supportive therapy such as PT and OT to increase range of motion and strength; insoles to correct leg length discrepancy
• Psychosocial support especially with chronic diseases

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Arthritis – Single Joint: Treatment
(In A Page: Pediatric Signs and Symptoms)

• If septic arthritis is a possibility, broad-spectrum antibiotic treatment should be started immediately
• Fractures and most internal derangements require orthopedics involvement
• Appropriate referral and treatment for malignancy
• JRA and SpA are usually treated with NSAIDs initially, DMARDs (e.g., sulfasalazine and methotrexate) and biologics (e.g., TNF blockers) are added depending on the degree of inflammation and the response of individual patient
• Supportive therapy such as PT and OT to increase range of motion and strength; insoles to correct leg length discrepancy
• Psychosocial support, especially with chronic arthritis

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Scrotal Swelling: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Hydrocele
  –Usually resolves spontaneously by 1 year of age
  –Surgery is indicated at 6–12 months if stable, sooner if hydrocele is tense or progressively enlarging
• Hernia
  –Inguinal hernias must be repaired surgically to avoid incarceration
  –Contralateral side is frequently explored surgically and closed if necessary
• Varicocele: Can be associated with infertility and may need to be surgically repaired
• Edema: Treatment of the cause of generalized edema
• Tumor and leukemia: Management by pediatric oncologist
• Men and teenage boys should be taught testicular self-examination to assist with early detection of testicular cancer

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Scrotal swelling: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

If severe pain accompanies scrotal swelling, ask the patient when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.

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Rheumatoid arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Salicylates, particularly aspirin, are the mainstay of RA therapy because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatory drugs (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), gold salts, penicillamine, and corticosteroids (prednisone). Immunosuppressants, such as cyclophosphamide, methotrexate, and azathioprine, are also therapeutic and are being used more commonly in early disease. (See Drug therapy for arthritis.)

Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program including range-of-motion exercises and carefully individualized therapeutic exercises forestalls joint function loss; application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.

Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty.

Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between the metacarpophalangeal and proximal interphalangeal joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and pain relief. Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of this disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses. Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. (See When arthritis requires surgery.)

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Neurogenic arthropathy: Treatment
(Professional Guide to Diseases (Eighth Edition))

Effective management relieves pain with analgesics and immobilization using crutches, splints, braces, and restriction of weight bearing to the affected joint.

In severe disease, surgery may include arthrodesis or, in severe diabetic neuropathy, amputation. However, surgery risks further damage through nonunion and infection.

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Juvenile rheumatoid arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Successful management of JRA usually involves administration of anti-inflammatory drugs, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. Both child and parents must be involved in therapy.

Aspirin is the initial drug of choice, with dosage based on the child’s weight. However, other nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. If these prove ineffective, gold salts, hydroxychloroquine, and penicillamine may be tried. Because of adverse effects, steroids are generally reserved for treatment of systemic complications, such as pericarditis or iritis, that are resistant to NSAIDs. Corticosteroids and mydriatic drugs are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated. (See Drug therapy for arthritis, pages 367 and 368.)

Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.

Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation. (See When arthritis requires surgery, page 369.)

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Psoriatic arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

In mild psoriatic arthritis, treatment is supportive and consists of immobilization through bed rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other nonsteroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. Gold salts and, most commonly, methotrexate therapy are effective in treating both the articular and cutaneous effects of psoriatic arthritis. Antimalarials are contraindicated because they can provoke exfoliative dermatitis.

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Septic arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Antibiotic therapy should begin as soon as a Gram stain has been done; it may be modified when drug sensitivity of the infecting organism is known. Bioassays or bactericidal assays of synovial fluid and bioassays of blood may confirm clearing of the infection.

Rest, immobilization, elevation, and warm compresses help with pain relief. Analgesics are given for pain, if needed. The affected joint can be immobilized with a splint or put into traction until the patient can tolerate movement.

In severe cases, needle aspiration (arthrocentesis) or surgery may be done under sterile conditions to remove grossly purulent or infected joint fluid. Late reconstructive surgery is warranted only for severe joint damage and only after all signs of active infection have disappeared, which usually takes several months. Recommended procedures include arthroplasty and joint fusion. Prosthetic replacement remains controversial because it may exacerbate the infection, but it has helped patients with damaged femoral heads or acetabula.

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Scrotal swelling: Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

If severe pain accompanies scrotal swelling, ask when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.

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Rheumatoid arthritis: Treatment
(Handbook of Diseases)

Salicylates, particularly aspirin, are the mainstay of RA therapy, because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatories (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), sulfasalazine, gold salts, and corticosteroids (prednisone). (See Drug therapy for arthritis.)

Immunosuppressants — such as methotrexate, cyclosporine, and azathioprine — are also therapeutic. They’re being used more commonly early in the disease process. Cox-2 inhibitors, such as rofecoxib and celecoxib, significantly reduce the risk of GI bleeding. Cyclophosphamide, which suppresses the immune system and is associated with toxic adverse effects, may be used in patients who have been unsuccessful with other therapies.

UNDER STUDY:  A number of new drugs are becoming popular for RA therapy:  

❑  Etanercept, an injectable, and infliximab, given I.V. every 2 months, inhibit the inflammatory protein tumor necrosis factor.

❑  Leflunomide blocks the growth of new cells.

❑  Anakinra, an injectable, blocks another inflammatory protein, interleukin-1.

Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program, including range-of-motion exercises and carefully individualized therapeutic exercises, forestalls loss of joint function.

Application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.

Treatment in advanced disease

Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty. (See When arthritis requires surgery, page 743.)

Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between MCP and PIP joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and relief of pain.

Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of the disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses.

Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. Apheresis may slow down RA or stop it from wor-sening.

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Neurogenic arthropathy: Treatment
(Handbook of Diseases)

Effective management relieves associated pain with an analgesic and immobilization, using crutches, splints, braces, and restriction of weight bearing.

In patients with severe disease, surgery may include arthrodesis or, in those with severe diabetic neuropathy, amputation. However, surgery risks further damage through nonunion and infection.

READ BOOK EXCERPT ONLINE »

Juvenile rheumatoid arthritis: Treatment
(Handbook of Diseases)

Successful management of JRA usually involves administration of an anti-inflammatory, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. The child and his parents must be involved in therapy.

A nonsteroidal anti-inflammatory drug (NSAID) — such as aspirin, ibuprofen, or naproxen — is used to reduce pain and swelling. If this proves ineffective, a disease-modifying antirheumatic drug (DMARD), such as methotrexate, is a useful second-line agent. In addition, gold salts, hydroxychloroquine, auranofin, aurothioglucose, etanercept, or sulfasalazine may be considered. Responses to individual drugs may differ among the various subtypes of JRA. Because of adverse effects, systemic steroids are generally reserved for treatment of systemic complications that are resistant to NSAIDs and DMARDS, such as pericarditis and iritis. However, an intra-articular steroid can be effective in managing pauciarticular and polyarticular JRA.

CLINICAL TIP: Joint rest (by splinting) used for up to 3 days after joint injections with a corticosteroid may improve anti-inflamma-tory response.

Corticosteroids and mydriatics are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated.

Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.

Generally, the prognosis for JRA is good, although disabilities can occur. Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation.

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Psoriatic arthritis: Treatment
(Handbook of Diseases)

In mild psoriatic arthritis, treatment is supportive and consists of immobilization through joint rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other non-steroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs.

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Septic arthritis: Treatment
(Handbook of Diseases)

The goals of treatment are to provide oxygen and to treat respiratory distress, if present; to monitor and reverse shock through volume expansion; to treat underlying infections with antibiotic therapy; and to support poorly functioning organs.

Treatment begins with the administration of I.V. fluids and the insertion of a pulmonary artery catheter to check pulmonary circulation and PAWP. Administration of whole blood or plasma may be necessary to help raise the PAWP to a satisfactory level of 14 to 18 mm Hg. A urinary catheter allows accurate measurement of hourly urine output.

The patient may require endotracheal intubation and placement on a ventilator to overcome hypoxia. Adjustments are necessary to promote adequate cellular oxygenation and support hyperdynamic needs.

Antibiotic therapy

Treatment also requires immediate administration of I.V. antibiotics to control the infection. Depending on the organism, an antibiotic combination may be necessary.

Appropriate anti-infectives for causes of septic shock depend on the suspected organism. Other measures to combat infections include surgery to drain and excise abscesses and debridement.

Other drug therapy

If shock persists after fluid infusion, treatment with a vasopressor, such as dopamine, maintains adequate blood perfusion to vital organs. Other treatment includes correction of acidosis and, possibly, I.V. corticosteroids.

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Scrotal swelling: Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Keep the patient on bed rest and administer an antibiotic. Provide adequate fluids, fiber, and stool softeners. Place a rolled towel between the patient’s legs and under the scrotum to help reduce severe swelling. Or, if the patient has mild or moderate swelling, advise him to wear a loose-fitting athletic supporter lined with a soft cotton dressing. For several days, administer an analgesic to relieve his pain. Encourage sitz baths, and apply heat or ice packs to decrease inflammation.

Prepare the patient for needle aspiration of fluid-filled cysts and other diagnostic tests, such as lung tomography and computed tomography scan of the abdomen, to rule out malignant tumors.

Patient teaching

Encourage the patient to perform regular testicular self-examinations. Explain the importance of wearing a scrotal support for comfort and to decrease edema.

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Scrotal swelling: Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If severe pain accompanies scrotal swelling, ask when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.

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Scrotal swelling: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Place the patient on bed rest.

▪ Administer an antibiotic, if ordered.

▪ Provide adequate fluids, fiber, and stool softeners.

▪ Place a rolled towel between the patient's legs and under the scrotum for elevation to help reduce severe swelling.

▪ Apply ice packs to the scrotum.

▪ Administer an analgesic to relieve pain.

▪ Prepare the patient for needle aspiration of fluid-filled cysts and other diagnostic tests, such as lung tomography and a computed tomography scan of the abdomen, to rule out malignant tumors.

Patient teaching

▪ Explain the disorder and treatment plan.

▪ For mild or moderate swelling, advise the patient to wear a loose-fitting athletic supporter lined with a soft cotton dressing.

▪ Tell the patient to use a sitz bath and apply heat or ice packs to decrease inflammation.

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