Basic Approach to Joint Pain

Basic Approach to Joint Pain is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • The first step is to differentiate between arthritis versus periarthritis. Arthritis is any process affecting a joint or joints, causing pain, swelling, and stiffness. Periarthritis, which mimics arthritis, involves the soft tissues surrounding the joint like tendons and bursal structures. Pain from arthritis is usually present in all directions of motion, whereas pain from periarthritis is usually evident at a single point or direction in the range of motion. In addition, pain occurs primarily with active movement in periarthritis, while it can occur with active and passive movements in arthritis.
  • The second step is to categorize arthritis as inflammatory or noninflammatory. This will depend on the pattern of joint involvement and the evidence of inflammatory findings on joint exam. Features of inflammatory arthritis include swelling, erythema, warmth over the joint, as well as the presence of prolonged morning stiffness of more than 1 hour that worsens with inactivity. Associated symptoms such as fever, weight loss, skin rashes, uveitis, scleritis, mouth ulcers, and serositis, among others, may give clues to an underlying systemic connective tissue disease (CTD).

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General Principles

  • The first step is to differentiate between arthritis versus periarthritis. Arthritis is any process affecting a joint or joints, causing pain, swelling, and stiffness. Periarthritis, which mimics arthritis, involves the soft tissues surrounding the joint like tendons and bursal structures. Pain from arthritis is usually present in all directions of motion, whereas pain from periarthritis is usually evident at a single point or direction in the range of motion. In addition, pain occurs primarily with active movement in periarthritis, while it can occur with active and passive movements in arthritis.
  • The second step is to categorize arthritis as inflammatory or noninflammatory. This will depend on the pattern of joint involvement and the evidence of inflammatory findings on joint exam. Features of inflammatory arthritis include swelling, erythema, warmth over the joint, as well as the presence of prolonged morning stiffness of more than 1 hour that worsens with inactivity. Associated symptoms such as fever, weight loss, skin rashes, uveitis, scleritis, mouth ulcers, and serositis, among others, may give clues to an underlying systemic connective tissue disease (CTD).

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