02. Approach to Arthritic Joint Pain

1. Describe the arthritis accurately, by its chronicity and the number of joints involved.

Chronicity

Acute <1 week

Subacute 1-3 weeks

Chronic >3 weeks
  • Trauma
  • Infection: Staph, Strep, gonococcus
  • Crystalline: gout, CPPD
  • Rheumatic fever
  • Infection: GC, Lyme, viral (HBV, HCV, HIV, parvovirus), fungal (coccidiosis, candida), mycobacterial
  • Crystalline: gout, CPPD
  • Rheumatologic d/o: RA, other CTD
  • Rheumatic fever
  • Infection (indolent, see left)
  • Rheumatologic d/o: RA, SLE, other CTD
  • Osteoarthritis

Number of joints involved

Monoarticular

Oligoarticular

(2-5 joints)

Polyarticular

(>5 joints)
  • Infection: bacterial, fungal, GC, Lyme, mycobacterial
  • Trauma
  • Crystalline: gout, CPPD
  • Early spondyloarthropathy
  • Osteoarthritis
  • Crystalline: gout, CPPD
  • Infection: gonococcus
  • Sarcoidosis
  • Spondyloarthropathy: psoriatic, reactive, IBD-associated arthropathy, ankylosing spondylitis
  • Osteoarthritis
  • Rheumatic fever
  • Infection: viral (HBV, HCV, HIV, parvovirus), bacterial (endocarditis)
  • Rheumatologic d/o: SLE, RA, other CTD

2. The distribution of joint involvement can narrow the differential.

  • DIPs: OA, psoriatic arthritis, gout, CPPD (RA typically spares DIPs)
    • Typical OA locations: cervical spine, lumbar spine, knees, AC joint, 1st MTP, PIPs, DIPs, CMC
  • Wrist/MCP/PIP: RA, SLE
  • Lower extremity large joint: spondyloarthropathy, sarcoidosis, Lyme