Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link
Some Causes and Features of Pain in More Than One Joint

Some Causes and Features of Pain in More Than One Joint


Common Features*


Disorders usually causing symmetric joint pain

Joints not inflamed

Chronic widespread pain and tenderness of muscles (that may involve joints and/or the back)


Sometimes irritable bowel syndrome or sleep disturbances

Usually chronic, often affecting women

Often depression or other mood disorders

Sometimes testing unnecessary

Joint pain with or without inflammation, typically developing over hours or days

Other symptoms of viral infection (for example, hepatitis B may cause jaundice, hepatitis C may cause purple blotches on legs, and HIV causes swollen lymph nodes)

Analysis of joint fluid

Blood tests to identify the virus (most often hepatitis C or B or parvovirus)

Chronic,‡ symmetric joint inflammation during childhood

Lower back pain

Swollen glands throughout the body or episodes of fever

An enlarged liver and spleen

Excess fluid around the heart or lungs

Rash or eye pain and redness

Blood tests for autoantibodies§

Pain in many joints with or without mild swelling

Blood tests for autoantibodies§

Chronic,‡ symmetric inflammation of small and large joints

Fatigue and morning stiffness

Eventually, deformity of joints (particularly the knuckles and wrist joints)

Sometimes hard swellings under the skin and carpal tunnel syndrome

More common among young adults but can affect people aged 60 or older


Blood tests for autoantibodies§

Serum sickness (a reaction by the immune system against large amounts of foreign proteins in the bloodstream)

Pain and inflammation in several joints

Fever, rash, and swollen glands

In people known to have been exposed to foreign proteins (for example, from a blood transfusion) up to 21 days before the start of symptoms

Sometimes blood tests

Usually pain in many joints

Joint inflammation very uncommon

Increased looseness (laxity) of skin

In people known to have a history of recurring joint dislocations or misalignment

In people known to have affected family members

Sometimes genetic testing

Joint pain‡ with or without inflammation that can occur when the disorder flares up

Other symptoms depending on specific autoimmune disease, such as skin changes; abdominal pain; muscle soreness; kidney disease; fluid around the lungs, heart, or other organs (serositis); or dry eyes and dry mouth

Blood tests for various autoantibodies§

Sometimes biopsy of skin, kidney, or other involved organs

Analysis of urine

Disorders usually causing asymmetric joint pain

Involvement of the large joints

Lower back pain in most people

Eye redness and pain (iritis)

Achilles tendinitis

Leakage of blood back through the aortic valve (aortic insufficiency)


Sometimes CT or MRI

Chronic‡ or recurrent mouth and genital ulcers

Sometimes eye pain and redness

Often begins in the 20s

Usually in parts of Asia and the middle east (relatively rare in the United States)

Sometimes testing unnecessary

Sudden and severe pain, warmth, and swelling (particularly in the big toe or knee, but can be almost any joint)

Sometimes fever

Often only one joint affected, but sometimes many

Tests of joint fluid

Joint pain and swelling

Fever, night sweats, rash, weight loss, and heart murmur are common

Blood tests


Chronic pain, most often in the knees and hips and small joints in the fingers, which may also be enlarged and slightly deformed

No redness

Often back and neck pain


Psoriasis (sometimes with few or no skin lesions)

Sometimes chronic,‡ symmetric inflammation of joints

Chronic deformities of fingers, toes, and nails


Eye redness and pain


Sudden pain, usually involving the large joints of the legs or feet, often 1 to 3 weeks after an infection of the gastrointestinal tract (such as gastroenteritis) or genitourinary tract (such as urethritis)

Sometimes involvement of the spine

Tests for sexually transmitted infections

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† X-rays are often unnecessary. If fluid is in the joint, the fluid often needs to be removed for testing.

‡ Symptoms may begin suddenly, but the disorder is typically chronic or comes and goes.

§ Autoantibodies are antibodies directed against a person's own tissues. Examples include antinuclear antibodies, anti–double-stranded DNA, anticyclic citrullinated peptide, and rheumatoid factor.

CT = computed tomography; MRI = magnetic resonance imaging.