Joint Pain

Differential diagnosis of joint pain

• Infection
  • Reactive
  • Septic arthritis
• Inflammatory
  • SLE
  • Rheumatoid arthritis, psoriatic arthritis, enteropathic arthropathy
  • Crystal arthritis
• Mechanical
  • Trauma
  • Hypermobility
  • Osteoarthritis
• Fibromyalgia

History in joint pain

• History of presenting complaint
  • Which joints
  • Duration
  • Onset
  • Fever
  • Systemic features
  • Morning stiffness
  • Trauma
  • Rash
  • GU symptoms
  • Preceding illness
• Past medical history
  • Immunosuppression
  • Inflammatory bowel disease
  • Uveitis
  • Psoriasis
  • Gout
• Medications
  • Analgesia
  • Steroids and response
    • What’s worked so far
• Allergies
• Family history
  • Inflammatory joint disease
  • Psoriasis
• Social history
  • Smoking
  • Alcohol
  • Occupation
  • Effect on function

Examination of a painful joint

• Synovitis
• Tophi
• Rheumatoid nodules
• Rash
• Effusion
• Crepitus
• Deformities

Initial investigations of painful joint

• Bloods
  • FBC, U&Es, LFTs
  • CRP
  • ESR
  • Consider ANA (ENA if positive), RF, anti-CCP
• Joint XR
• US or MRI if concern about effusion or uncertain diagnosis