Approach to Joint Pain History: Is the pain from: • Joint • Adjacent bursa • Tendon • Ligament • Bone • Muscle • Referred from a visceral organ or nerve root Symptoms of Joint Disease: • Pain • Stiffness • Swelling • Limitation of motion • Weakness • Fatigue Joint - Following 3 broad categories of joint disease must be differentiated: • Inflammatory arthritis: - Pain is present both at rest and with motion - Stiffness is present upon waking and typically lasts 30-60 minutes or longer - Fatigue is usually noted in the afternoon or early evening • Noninflammatory arthritis: - Pain occurs mainly or only during motion and improves quickly with rest - Stiffness is experienced briefly (e.g., for about 15 minutes) upon waking in the morning or after periods of inactivity • Arthralgia: - Joint tenderness - No joint deformity Synovitis: • Site of inflammation in persons with rheumatoid arthritis (RA) and many other inflammatory arthritides Crystal Deposition: • Monosodium urate • Calcium pyrophosphate dihydrate • Basic calcium phosphate (including hydroxyapatite) • Calcium oxalate Infectious Arthritis: • Acute or chronic infections related to bacterial, fungal, or viral organisms Structural or Mechanical Joint Derangement: • Previous joint trauma (e.g., meniscal tears) • Congenital or developmental joint alterations (e.g., congenital hip dysplasia and slipped capital femoral epiphysis) • Alterations of the subchondral bone (e.g., osteopetrosis, avascular necrosis, and Paget disease) • Alterations of supporting structures (e.g., hypermobility) • Cartilage derangements (e.g., ochronosis and crystal deposition) Enthesitis: • Site of pathology in the seronegative spondyloarthropathies #Joint #Pain #MSK #rheumatology #approach #workup #differential #diagnosis #arthritis
