Ravi Singh K @rav7ks
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Academic Hospitalist and Program Director @SinaiBmoreIMRes, Medicine clerkship director GW School of Medicine and Health Sciences RMC at Sinai, Clinical reasoning,Simulation and POCUS enthusiast - https://twitter.com/rav7ks
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Approach to Joint Pain - Diagnostic Framework

1) Chronicity
2) Inflammatory vs Non-Inflammatory
3) Number of Joints Involved

1) Chronicity:
Approach to Joint ... 3) Number of Joints ... ), RA, crystal disease ... Number of Joints ... Inflammatory, crystalline disease
Approach to Joint Pain

History:
Is the pain from:
	• Joint
	• Adjacent bursa
	• Tendon
	• Ligament
	• Bone
	• Muscle
	• Referred from
Approach to Joint ... pain from: • Joint ... Disease: • Pain ... disease must be ... necrosis, and Paget disease
Extra-articular and Other Conditions Associated with Joint Pain

Eyes
  • Iritis or uveitis - Spondyloarthropathies, Sarcoidosis,
Associated with Joint ... IBD, Whipple's disease ... Heberden's nodes (DIP joints ... Bouchard's nodes (PIP joints ... Extrarticular #conditions #joint
Skin Conditions Associated with Joint Pain

Rash
	• Human parvovirus B19 infection

Malar rash
	• SLE
	• Human parvovirus B19 infection
	•
Associated with Joint ... infection • Lyme disease ... migrans • Lyme disease ... Sarcoidosis • Crohn's disease ... #dermatology #joint
SAPHO Syndrome Summary

What?
SAPHO syndrome is a rare chronic inflammatory disorder of bone, joint, and skin characterized
disorder of bone, joint ... inflammation of the joints ... bone • Bone and joint ... lower-extremity joints ... osteoarticular and skin disease
Approach to Joint Pain - Arthritis Differential Diagnosis Framework

Inflammatory Versus Noninflammatory Pain
 • Is it inflammatory
Approach to Joint ... • How many joints ... Rheumatologic Disease ... whippleii (Whipple's disease ... burgdorferi (Lyme disease
Lyme Disease - Diagnosis and Management Summary

Lyme Disease Epidemiology:
- Spirochete
- Reservoir: small mammals & birds
- Transmitted
Lyme Disease - Diagnosis ... Summary Lyme Disease ... months Lyme Disease ... Arthritis: - Large joints ... - Joint swelling
Leg Pain - Differential Diagnosis Framework

Bone/Joint Causes of Leg Pain:
 • Fracture
 • Arthritis
 • Gout/pseudogout
Framework Bone/Joint ... Legg-Calve-Perthes disease ... - HIV - Lyme disease ... onset - Intense joint ... Inability to move the joint
Dermatologic Manifestations of Granulomatosis with Polyangiitis (GPA)

Skin involvement in granulomatosis with polyangiitis (GPA) is common and
presentation of the disease ... GPA causes disease ... Usually parallel the disease ... surfaces of the joints ... ) • Castleman disease
Causes of Knee Effusions - Differential Diagnosis Framework

Knee Effusion Red Flags:
1. Fever/Chills/Joint pain/Night sweats/Weight loss
	- DDX:
		-
Fever/Chills/Joint ... - Systemic disease ... Gonorrhea - Lyme’s disease ... SLE - Behcet Disease ... - Sickle cell disease