6. Step - 1
Articular and Extra-articular
Anatomic structure:
Painful site:
Painful site:
Pain on movement:
Swelling
Crepitus
Diffuse,
deep tenderness
Point tenderness
Active and
passive
Active only
Common
Uncommon
7. Step - 2
Arthralgia or Arthritis
• Arthralgia-SYMPTOM
• Joint pain withouts obvious
inflammation
• Non specific
• Non rheumatological
conditions like
haematoligical diseases’
post viral fever’
hypothyroidism, statins use
• Arthritis-DIAGNOSIS
• demonstrable features of
joint inflammation(joint
swelling, redness, joint
tenderness)
• Increased temperature
• Rheumatological conditions
like RA, SLE
9. Recognizing inflammation in the Joint
History (80% diagnostic)
• Significant early morning stiffness IMPROVING with activity
• Constitutional symptoms (weight loss and loss of appetite)
• Low grade Fever and night sweats
• Fatigue
Examination (15% diagnostic)
• Inflammed Joint(erythematous and indurated appearance)
Lab (5% diagnostic)
• High ESR, CRP, Platelet
• NN anemia
NOT specific for inflammation
• Hard bony swelling
• Tenderness due to
structural damage deformity
• Functional incapitation
15. Pattern-sequence wise
Intermittent arthritis
-episodic and patient may be totally asymptomatic in between the episodes
(gout behcets syndrome reactive arthritis palindromic rheumatism
Additive arthritis
-one or more joints are involved with time
(RA SpA Psoriasis OA)
Migratory polyarthritis
-pain and swellinfg in a specific joint starts rapidly and subsides in 24 -36 hrs,arthritis then
Picks up new joints
(rheumatic fever gonococcal arthritis and viral diseases)
32. Joint Aspiration
Arthrocentesis (Synovial Fluid Analysis)
• Indicated when there is warm, red joint with effusion, especially
when there is no history of trauma
• Aspirated synovial fluid should be sent for 3Cs:
1. Cell count
2. Crystals: for Gout and Pseudogout
3. Culture (gram stain): for Septic arthritis
Before beginning with Joint pain, it is important to know about the MSK pain as it may arise from various tissue other than Joint itself.
Paint arising from………
Head to toe examination is very important as this young female presenting with polyarthritis and fever has alopecia, malar rash and ecchymosis in leg as may be due to vasculitis.
These features are very common in Seronegative arthritis
Many rheumatologival disease present with NN anemia, and its important to do other test for drug adjustment
