APROACH TO A PATIENT WITH

JOINT PAIN
DR. AMIT WAZIB
FCPS (MEDICINE), MD (NEUROLOGY)
ASSOCIATE PROFESSOR & HEAD
DEPARTMENT OF MEDICINE
SHAHABUDDIN MEDICAL COLLEGE
JOINT PAIN : ARTHRALGIA

JOINT PAIN & SWELLING :

ARTHRITIS
ARTHRITIS : DESCRIPTION
 ACUTE / CHRONIC
 INFLAMMATORY /
MECHANICAL
 MONO / OLIGO OR POLY
 SMALL / LARGE JOINTS
 UPPER LIMB / LOWER
LIMB
 SYMMETRICAL /
ASYMMETRICAL
ARTHRITIS : DESCRIPTION
ACUTE
< 6 WEEKS

CHRONIC
≥ 6 WEEKS
 ARTHRITIS : DESCRIPTION
INFLAMMATORY
PAIN WORST AFTER INACTIVITY, IMPROVES
WITH MOVEMENT
SIGNIFICANT MORNING STIFFNESS (> 1
HOUR)

MECHANICAL
PAIN WORSENS AFTER MOVEMENT,
IMPROVES WITH REST
NO OR INSIGNIFICANT MORNING STIFFNESS
ARTHRITIS : DESCRIPTION
MONOARTHRITIS
1 JOINT

OLIGOARTHRITIS
2-4 JOINTS

POLYARTHRITIS
≥ 5 JOINTS
ARTHRITIS : DESCRIPTION
SMALL JOINTS
HANDS & FEET JOINTS

LARGE JOINTS
SHOULDER, ELBOW, WRIST
HIP, KNEE, ANKLE
ACUTE INFLAMMATORY
MONOARTHRITIS
1. SEPTIC
ATHRITIS
2. REACTIVE
ARTHRITIS
3. GOUT
4. PSEUDOGOU
T
 ACUTE INFLAMMATORY
SYMMETRICAL POLYARTHRITIS

 VIRAL ARTHRITIS
[CHIKUNGUNYA]
 ACUTE INFLAMMATORY
ASYMMETRICAL POLYARTHRITIS

 RHEUMATIC
FEVER
CHRONIC INFLAMMATORY
MONOARTHRITIS
1. TUBERCULAR
ARTHRITIS
2. REACTIVE
ARTHRITIS
 CHRONIC INFLAMMATORY
SYMMETRICAL POLYARTHRITIS

1. RHEUMATOID
ARTHRITIS
2. SLE
3. PSORIATIC
ARTHRITIS
4. JUVENILE
IDIOPATHIC
ARTHITIS
CHRONIC INFLAMMATORY
ASYMMETRICAL
OLIGO / POLYARTHRITIS

1. SERONEGATIVE
ARTHRITIS
2. JUVENILE
IDIOPATHIC ARTHITIS
ANY MECHANICAL
ARTHRITIS

 OSTEOARTHRI
TIS
 COMPARISON OF
INFLAMMATORY AND MECHANICAL
JOINT PAIN
TRAIT INFLAMMATORY MECHANICAL
EFFECT OF REST & INCREASES WITH REST INCREASES WITH MOVEMENT
MOVEMENT DECREASES WITH MOVEMENT DECREASES WITH REST

MORNING SIGNIFICANT INSIGNIFICANT

STIFFNESS >1 HOUR <1 HOUR

JOINT SWELLING PROMINENT NO OR MINIMUM

JOINT CREPITUS ABSENT PRESENT
INFLAMMATORY RAISED NORMAL
MARKERS
(ESR, CRP)
 LABORATORY INVESTIGATIONS
MANDATORY
1. COMPLETE BLOOD COUNT
2. C-REACTIVE PROTEIN
 SORRY
FOR THE BORING TIME