JOINT PAIN
Ask the Following Questions:
- Is the joint pain localized to a single joint? Localization to a single joint should suggest a septic arthritis, gout, tuberculosis, hemophilia, sickle cell disease, trauma, avascular necrosis, and pseudogout.
- Is there fever? The presence of fever should make one think of septic arthritis, rheumatic fever, gonococcal arthritis, Reiter's syndrome, lupus erythematosus, Lyme arthritis, polymyalgia rheumatica, Still's disease, and rheumatoid arthritis.
- Is there a urethral discharge? The presence of a urethral discharge should make one think of Reiter's syndrome or gonococcal arthritis.
- Is there low back pain? The presence of low back pain should suggest rheumatoid spondylitis, ochronosis, and gout.
- Is the arthritis migratory? The presence of migratory arthritis should make one think of rheumatic fever and rat-bite fever.
- What is the age of the patient? Younger patients may have sickle cell disease, hemophilia, trauma, rheumatic fever, Still's disease, and gonococcal arthritis. Older patients are more likely to have osteoarthritis, polymyalgia rheumatica, and gout. It should be noted that there is considerable overlap here.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, ASO titer, ANA, cross-reacting protein (CRP), urinalysis, chemistry panel, arthritis panel, and x-rays of the involved joints. It is also wise at times to order a bone survey. Synovial fluid analysis and culture should be done if there is sufficient joint effusion. A trial of therapy may be initiated at this point and will assist in the diagnosis. For example, a course of colchicine may be given to rule out gout.
If there is still doubt, a rheumatology consultation should be made. Other tests that may be done include a gonococcal antibody titer and a coagulation profile. If there is a urethral discharge, a smear and culture of the material should be made. If there is fever, febrile agglutinins, serologic tests for Lyme disease, brucellin antibody titer, blood cultures, and a Monospot test may be done. If collagen disease is suspected, antinuclear antibodies and anti-DNA antibodies may be sought. If sickle cell anemia is suspected, a sickle cell preparation should be done. A bone scan will help diagnose rheumatoid spondylitis and ochronosis. A urine for homogentisic acid will diagnose ochronosis also. An MRI may diagnose a torn meniscus and other condition.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Joint symptoms
Read excerpts from these other book chapters related to Joint symptoms:
Medical Books Excerpts
- JOINT PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Joint symptoms
» Next page: JOINT SWELLING (Algorithmic Diagnosis of Symptoms and Signs)
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