DIAGNOSIS CHECKLIST
for Joint pain

Why: to determine if acute or chronic.

Why: would suggest septic arthritis, gout, tuberculosis, hemophilia, sickle cell disease, trauma, avascular necrosis and pseudogout.

Why: i.e. joint pain moves from joint to joint? - may suggest rheumatic fever.

Why: Younger people may have sickle cell disease, hemophilia, trauma, rheumatic fever, Still's disease and gonococcal arthritis. Older people are more likely to have osteoarthritis, polymyalgia rheumatica and gout. There is however a significant overlap.

Why: e.g. throbbing pain may suggest inflammation of the joints and suggests Rheumatoid arthritis, psoriatic arthritis, Reiter's disease, ankylosing spondylitis; severe episodic pain may suggest gout.

Why: Inflammatory pain is worse at night and in early morning; mechanical joint pain due to injury or osteoarthritis is worse at the end of the day and after activity; Continuous pain present day and night is suggestive of infection or bone tumor.

Why: may indicate inflammation, bursitis or bone tumor.

Why: inflammatory joint pain causes pain at rest , relieved by activity ; mechanical joint pain due to injury is exacerbated by activity and relieved by rest ;osteoarthritis causes pain with or after activity and relieved with rest.

Why: may suggest viral arthritis including influenza, mumps, rubella, varicella, hepatitis A and B, infectious mononucleosis, cytomegalovirus, parvovirus, Ross river virus.

Why: may indicate joint strain, joint sprain, tendonitis or bursitis of the joint or secondary osteoarthritis ( osteoarthritis that follows injury and wear and tear).

Why: may suggest Ross river fever or dengue fever.

Why: may suggest Lyme disease (may present months or even years after a tick bite).

Why: systemic diseases that may predispose to or present with joint pain include psoriasis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, scleroderma, dermatomyositis, bleeding disorders, rheumatic fever, tuberculosis, hepatitis B, diabetes mellitus, Wegener's granulomatosis, HIV infection, lung cancer, hemochromatosis, sarcoidosis, hyperparathyroidism, Paget's disease.

Why: e.g. certain medications may precipitate gout including frusemide and thiazide diuretics; some medications may induce a Lupus syndrome including hydralazine, procainamide, phenytoin, chlorpromazine, isoniazid and methyldopa; other medications that may cause joint pain include cotrimazole, amoxicillin, mianserin, carbimazole and nitrofurantoin.

Why: may suggest septic arthritis, hepatitis B or C, HIV-associated joint disease, subacute bacterial endocarditis and serum sickness reactions.

Why: can determine risk of Reiter's syndrome, gonococcal arthritis, Hepatitis B or HIV viral arthritis.

Why: e.g. osteoarthritis, rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, psoriasis, gout, pseudogout, hemophilia.

Why: can provide information about the risk of dengue fever.

Why: may suggest septic arthritis, rheumatic fever, gonococcal arthritis, Reiter's syndrome, lupus erythematosus, Lyme arthritis, polymyalgia rheumatica, Still's disease and rheumatoid arthritis.

Why: would suggest Reiter's syndrome or gonococcal arthritis.

Why: would suggest rheumatoid spondylitis, ochronosis or gout.

Why: may suggest enteropathic arthritis (such as due to Ulcerative colitis or Crohn's disease) or Reiter's syndrome.

Why: may suggest psoriatic arthritis, gonococcal arthritis or HIV infection.

Why: may suggest Ankylosing spondylitis, Reiter's disease.

Why: e.g. usually symmetrical and can affect many joints. Pain is worse at the end of the day and aggravated by use and cold weather, relieved by rest. Usually associated with pronounced stiffness, especially after activity.

Why: e.g. usually starts with the gradual onset of pain and stiffness of the small joints of the hands and feet. Joint pain is worse on waking, nocturnal pain with disturbed sleep, pain is relieved with activity. Morning and rest stiffness can last for hours. May be associated with weakness, weight loss, malaise and fatigue.

Why: e.g. often excruciating pain in the great toe starting in the early hours of the morning, skin over the joint may be red, shiny, swollen and hot, joint is very tender to touch. Pain may be precipitated by alcohol excess, surgical operation, starvation and certain medications.

Why: e.g. symmetrical involvement of many joints, mainly of the hands and feet and is usually mild pain. It is caused by many viruses, including those causing influenza, mumps, rubella, varicella, hepatitis A and B, infectious mononucleosis, cytomegalovirus, parvovirus, Ross river virus.

Why: e.g. typically occurs in children and young adults, migratory polyarthritis (many joints are involved, joints affected alter with time), involves large joints sequentially, one becoming hot, red, swollen and very painful as the other subsides. It rarely lasts more than five days in any one joint. Associated with acute fever.

Why: e.g. fatigue, painful joints, impotence, bronze discoloration of skin. Joints involved are characteristically the second or third metacarpophalangeal joints (knuckles of the hand).

Why: e.g. typically occurs in ages 60-70 presenting with pain and stiffness in shoulder, hip and cervical spine; symmetrical distribution; early morning stiffness. May be systemic signs such as weight loss, loss of appetite and fatigue. Painful restriction of movement of shoulders and hips.

Why: e.g. conjunctivitis, urethritis (painful urination, penile discharge, vaginal discharge).

Why: e.g. months or years after a tick bite develop joint pain, usually of the large joints such as knee; typical rash (a dough-nut shaped red rash about 6cm in diameter) at the bite site; heart disorders (especially abnormal rhythms of the heart) or disease of the central nervous system (including weakness of the muscles in the limbs, muscular pain or evidence of meningitis).