Joint pain caused by metabolism: conditions that may be behind it

September 29, 2026approx. 15 minutesby mybody®x Editorial & Expert Team

In this article

Can joint pain be caused by metabolism?

Yes. Joint pain has various causes, and a metabolic disorder is one of them. The best known is gout, a metabolic disorder that causes inflammation in the joints (IQWiG, 2022).

People with aching joints past middle age are quickly told that it’s just wear and tear. The objection is understandable. What matters, though, is whether the pattern of symptoms fits that explanation or whether something else could be behind them.

A pattern that does not look like wear and tear is described by the Institute for Quality and Efficiency in Health Care (IQWiG) for gout. An attack often begins at night or early in the morning with sudden, very painful joint swelling (IQWiG, 2022). The inflamed joint is tender to pressure, warm, and reddened (IQWiG, 2022).

In addition to gout, hereditary iron overload and diabetes are metabolic diseases for which studies describe joint symptoms (Nguyen et al., 2020; Zreik et al., 2016). For hypothyroidism, IQWiG lists muscle or joint pain as a possible symptom (IQWiG, 2024). If a test result is already abnormal, the question also arises of whether it could be related to the joints.

Stiff joints in the morning are a separate topic. The article on stiff joints in the morning and the blood values behind them covers morning stiffness; this article focuses on metabolic diseases as a cause of joint pain.

Whether vitamin B12 deficiency is linked to joint symptoms is a separate question. This article on vitamin B12 deficiency and joint pain explores it.

Which metabolic diseases cause joint pain?

The sources reviewed here cover four conditions: gout, hereditary iron overload, diabetes associated with frozen shoulder, and hypothyroidism (IQWiG, 2022; Nguyen et al., 2020; Zreik et al., 2016; IQWiG, 2024). They differ in which joints are affected and in how strong the evidence is.

Gout: uric acid crystals inflame the joint

In gout, joints become inflamed because tiny, needle-shaped uric acid crystals build up in them (IQWiG, 2022). Uric acid is a breakdown product of purines, a component of nucleic acids, which are among the body's essential building blocks (IQWiG, 2022). These crystals can form when there is too much uric acid in the body (IQWiG, 2022).

Gout is the most common inflammatory joint disease, medically known as arthritis, in industrialized countries such as Germany (IQWiG, 2022). An estimated 1 to 2% of the population is affected (IQWiG, 2022). Men develop gout about five times as often as women and at an earlier age (IQWiG, 2022). In men, gout usually develops from age 40 onward, while women generally develop it only after menopause (IQWiG, 2022).

Hemochromatosis: iron overload and the metacarpophalangeal joints

In hemochromatosis, a hereditary iron overload disorder, studies describe a distinct joint disease affecting the metacarpophalangeal joints, where the fingers meet the palm (Carroll et al., 2011; Nguyen et al., 2020).

Carroll et al. found hemochromatosis-related joint disease in the metacarpophalangeal joints from the index finger to the little finger, and in certain large joints on both sides, in 10 of 41 people with confirmed or probable hemochromatosis, or 24% (Carroll et al., 2011). Joint disease was more common with increasing age and was associated with ferritin levels above 1,000 µg/L (micrograms per liter) at diagnosis (Carroll et al., 2011). Ferritin is a protein in which the body stores iron, and it is measured in the blood. The authors therefore consider iron burden likely to be a major factor (Carroll et al., 2011).

Nguyen et al. studied 93 people with hemochromatosis, with an average age of 60, and found joint disease in the metacarpophalangeal joints of the index and middle fingers on X-rays in 37.6% of them (Nguyen et al., 2020). The finding was associated with older age and male sex (Nguyen et al., 2020). A specific genetic variant, C282Y, also played a role when present in two copies, one inherited from each parent (Nguyen et al., 2020).

The two studies disagree on the role of iron. Nguyen et al. consider a person’s characteristics and genetic makeup likely more important than the extent of iron overload (Nguyen et al., 2020). These two studies cannot determine which view is correct.

Diabetes and frozen shoulder

Frozen shoulder is significantly more common in people with diabetes than in those without diabetes (Dyer et al., 2023). Frozen shoulder, known medically as adhesive capsulitis, causes increasingly painful restriction of shoulder movement (Zreik et al., 2016).

In a meta-analysis, a combined analysis of existing studies, Zreik et al. pooled 18 studies (Zreik et al., 2016). People with diabetes were about five times more likely to develop frozen shoulder than comparison subjects, with a range of 3.2 to 7.7 times (Zreik et al., 2016). The authors estimate that frozen shoulder affects 13.4% of people with diabetes, with a range of 10.2% to 17.2% (Zreik et al., 2016).

A second meta-analysis evaluated six case-control studies involving 5,388 people; such studies compare people with a condition with people without it (Dyer et al., 2023). It also concluded that people with diabetes are more likely to develop frozen shoulder (Dyer et al., 2023). Both studies describe a frequency, not a cause.

Hypothyroidism: Joint pain as a possible symptom

Hypothyroidism can also cause muscle or joint pain; IQWiG lists it as a possible symptom (IQWiG, 2024). When thyroid hormones are lacking, metabolism slows down, which can trigger a wide range of symptoms (IQWiG, 2024).

In countries such as Germany, about 5 in 100 people have hypothyroidism (IQWiG, 2024). IQWiG does not specify how often joint pain occurs or which joints are affected (IQWiG, 2024). That is why the symptom is included in this article as a possibility, not an explanation.

Which joints are affected by which metabolic condition?

The sources name different joints for each condition. With gout, the base joint of the big toe is usually affected during the first attack (IQWiG, 2022), while with hemochromatosis, the base joints of the fingers are affected, especially those of the index and middle fingers (Nguyen et al., 2020).

For diabetes, the focus is on the shoulder, specifically frozen shoulder (Zreik et al., 2016). For hypothyroidism, IQWiG mentions muscle or joint pain without specifying particular joints (IQWiG, 2024).

The table summarizes what the sources say. It can help you prepare for a conversation with a healthcare professional, but it is not a self-diagnosis: a painful big toe does not necessarily mean gout.

Joints by condition, according to the source

The list of joints that can be affected by gout is long. Other joints that can become inflamed include the midfoot and ankle joints, knees, elbows, and hand and finger joints; gout attacks in the shoulders and hips are rare (IQWiG, 2022). During the first attack, only one joint is often affected (IQWiG, 2022).

The two studies differ in the excerpt on hemochromatosis. Carroll et al. describe the base joints of the fingers, from the index finger to the little finger, and certain large joints on both sides. Nguyen et al. specifically assessed the base joints of the index and middle fingers in X-rays (Carroll et al., 2011; Nguyen et al., 2020). Both focus on the hand.

Which blood values help put joint pain into context?

Four blood values help put things in context: ferritin, long-term blood sugar, thyroid levels, and CRP as an inflammation marker. They cannot diagnose gout, and the uric acid level alone is not enough either (IQWiG, 2022).

A test result is a snapshot. It can point to something that can be investigated further in a discussion with your doctor's office. It does not establish a diagnosis. The following paragraphs look at each value in turn, explaining what a test result can and cannot show.

Uric acid: why one result is not enough to diagnose gout

According to IQWiG, measuring only the uric acid level in the blood is “not meaningful enough,” because it often drops into the normal range during a gout attack (IQWiG, 2022). Conversely, estimates suggest that only about one-third of people with elevated uric acid develop gout (IQWiG, 2022). Diagnosis should therefore be left to a doctor.

Uric acid is not measured by any blood test in the mybody®x (MYBODY Lab GmbH) range. If you suspect a gout attack, see your family doctor's office.

Ferritin: a clue, not proof

An elevated ferritin level alone does not prove hemochromatosis. The article Ferritin and iron: the difference explains how ferritin differs from iron in the blood.

Whether ferritin levels play a role in joint health is disputed: one study found an association with levels above 1,000 µg/l, while another considers iron load less important (Carroll et al., 2011; Nguyen et al., 2020). An abnormal ferritin result should therefore be assessed by a doctor, not interpreted on your own.

Long-term blood sugar (HbA1c): a clue to diabetes

Long-term blood sugar, listed on test results as HbA1c, is a blood value that reflects blood sugar over an extended period. It is relevant to the joints because people with diabetes develop frozen shoulder much more often (Dyer et al., 2023). The article HbA1c blood level explains what the value shows. The doctor's office determines whether diabetes is present.

Thyroid levels: TSH and the free hormones

TSH is the hormone the pituitary gland uses to control the thyroid; fT3 and fT4 are the free thyroid hormones triiodothyronine and thyroxine in the blood. Blood tests are performed because “many symptoms of an underactive thyroid can also have other causes” (IQWiG, 2024). The article TSH and thyroid levels explains how to read the results.

CRP: an inflammation marker with no joint name

CRP, short for C-reactive protein, is a marker of inflammation in the blood. It can indicate that inflammation is occurring in the body, but it does not show which joint is affected.

A suddenly swollen, hot joint should first be seen by your family doctor, not assessed using a table of blood test results. Your family doctor’s office is also the first place to go if you have pre-existing conditions or are taking medication.

What can you do about unexplained joint pain?

Write down the pattern of your symptoms and bring it to your doctor’s office. A blood test can help prepare for the conversation with some results, but it cannot replace it.

Note which joint hurts, what time of day it starts, how long it lasts, and whether it is swollen or hot. These details fit with what the sources distinguish: a gout attack often begins at night or early in the morning (IQWiG, 2022), whereas frozen shoulder involves a gradually increasing restriction of movement (Zreik et al., 2016).

Bring any existing test results, including older ones. A previous ferritin or long-term blood sugar result provides a point of comparison that helps your doctor see whether anything has changed. Ask specifically whether your pattern is more consistent with inflammation and which values are still missing from your test results.

If you want to gather your own results before your appointment, you can also collect the blood sample at home. mybody®x offers the Women’s Wellness Check for this purpose, a blood test for women that measures ferritin, long-term blood sugar, thyroid values, and CRP together. The comparison shows whether it is right for your question.

Limitations: What a blood test cannot tell you about joint pain

A blood test gives you a snapshot, not a diagnosis. It shows only the results listed on the report.

The Women’s Wellness Check does not measure uric acid. For iron, it measures only ferritin; iron itself and transferrin, the protein that transports iron in the blood, are not included in the results. So it cannot assess gout or detect hemochromatosis.

The available studies also have limitations. Carroll et al.’s study was small: 41 people with hemochromatosis, recruited through a newspaper ad (Carroll et al., 2011). Nguyen et al. examined their 93 patients at a clinic at a single point in time, in what is known as a cross-sectional study (Nguyen et al., 2020).

Both meta-analyses describe how common frozen shoulder is in people with diabetes, not what causes it (Zreik et al., 2016; Dyer et al., 2023). Dyer et al.’s review included more studies than the six in the meta-analysis; the authors rated the risk of bias, meaning the risk that a study’s design could skew its results, as high in seven studies and moderate in one (Dyer et al., 2023).

The IQWiG health information on gout dates from 2022 and is older than the information on the thyroid (IQWiG, 2022; IQWiG, 2024). In addition, muscle or joint pain is listed only as a possible symptom of an underactive thyroid (IQWiG, 2024). So a normal test result does not rule out a problem in a painful joint; you should still discuss your symptoms with your doctor.

What does the pattern of your joint pain tell you?

More than a single blood test result. The pattern of which joint is affected and how symptoms develop points your doctor in the right direction; blood test results add to the picture.

The metabolic conditions in this article do not follow one common pattern. A gout attack starts suddenly, often at night or early in the morning, and the first attack often affects only one joint (IQWiG, 2022). Frozen shoulder, by contrast, develops as a gradual loss of mobility (Zreik et al., 2016).

Your notes give your doctor clues that a single blood test cannot. The test results come later: An abnormal ferritin level or HbA1c is a reason to ask a question at your appointment, not an answer.

“It’s just wear and tear” may be true. Only an assessment can tell you whether it is.

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Sources

1. IQWiG: Gout, gesundheitsinformation.de (as of 2022) – gesundheitsinformation.de
2. Nguyen et al.: Bone and joint complications in patients with hereditary hemochromatosis, Therapeutic Advances in Musculoskeletal Disease (2020) – europepmc.org
3. Zreik et al.: Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence, Muscles, Ligaments and Tendons Journal (2016) – europepmc.org
4. IQWiG: Hypothyroidism, gesundheitsinformation.de (as of 2024) – gesundheitsinformation.de

The information on gout and uric acid is based on [1], that on joints in hemochromatosis on [2] and additionally on Carroll et al. (Arthritis and Rheumatism, 2011), that on frozen shoulder in diabetes on [3] and additionally on Dyer et al. (BMJ Open, 2023), and that on hypothyroidism on [4]. All sources were accessed on 29.09.2026; the product information for the Women’s Wellness Check is current as of 29.09.2026.