JOINT PAIN


 JOINT PAIN can have multiple causes,areflection of the
diverse joint diseases,which arise from inflammation,
cartilage degeneration, crystal deposition,infection and
traum.a
PATHOPHYSIOLOGY

 ARTHRITIS. VS. ARTHRALGIA

Diagnosis. Symptom
Joint pain Joint pain
Inflammatory Non inflammatory
1. Swelling. Pain without swelling
2. Redness Achiness
3. Tenderness
Limitations in range of motion
Stiffness
1. Structures within the joint
Sources of pain- joint capsule,periosteum,ligaments,subchondral bone and
Synovium.
2.Structured adjacent or a Round to the joint
Bursa-Bursitis,tendon sheath-tenosynovitid,Tendon-tendonitis,extra-
articular disorders(eg:polymyalgiarheumatica,fibromyalgia)
3.Refered pain from more distant site(eg:Bone)
ETIOLOGY OF MONOARTICULAR PAIN

 Trauma(overuse-fractures-hemathtosis)

Meniscus injury/ligament tear.

 Infectious or septic arthritis
 Reactive arthritis
 Crystal induced disease(gout/pseudogout)
 Periarticular syndromes(eg: bursitis,epicondylitis,fasciitis,tendinitis,tenosynovitis)
 Uncommon cause-avascular necrosis,neuropathy,osteoarthritis,osteomyelitis,lyme
disease,pagets disease,tumor
ETIOLOGY OF POLYARTHRITIS

 Acute polyarticular arthritis:infection

 Chronic polyarticular arthritis: RA,Osteoarthritis.
Chronic polyarticular arthritis in children:juvenile idiopathic
arthritis.
Host factors:
1.Genetic traits
2.Obesity
3.occupation
Symptoms of joint disease

Pain
Inflammatory joint disease- presentvboth at rest and with
motion.
Noninflammatory joint disease-degenerative ,traumaticor
mechanical)-occurs during motion,improves by taking
rest,but advanced degenerative disease of hip,knee may also
having pain at rest and at night
Stiffness
It is a sedation of tightness when attempting to move joints
after a period of inactivity.
 Inflammatory disease stiffness is present in the early
morning and last for at least 1hour.
 Non inflammatory arthritis stiffness last only a few minutes
on movement
Swelling
Inflammatory arthritis,joint swelling is due to synovial
hypertrophy,synovial effusion,and/or inflammation of
periarticular structures.
 With no inflammatory arthritis, the formation of
osteophytes leads to bony swelling.
Limitation of motion
Loss of joint motion may be due to structural
damage,inflammation,or contracture of surrounding soft
tissues.
WEAKNESS
Muscle strength is often diminished around an arthritic joint
as a result of diSuse atrophy.
 FATIGUE:
With inflammatory polyarthritis,the fatigue is usually noted in afternoon or early evening.
ABRUPT ONSET-Trauma,crystalline,synovitis.
Insidious onset rheumatoid arthritis and osteoarthritis.
SYMMETRY OF JOINT –RA and SLE
Asymmetry-psoriatic arthritis,reactive arthritis and Lyme arthritis.
 Distribution of affected joint : distalphalangeal joints of the
fingers are usually involved in psoriatic arthritis , gout,or
osteoarthritis but usually spared in RA.
 Joints
of the lumbar spine are involving in ankylosing
spondylitis.
 Gout commonly involves tendon sheaths and
bursae,resulting in superficial inflammation
Extra articular manifestations:
Constitutional symptoms:suggests systemic disorder.
 Skin lesions-RA,SLE,scleroderma and psoriasis.
 Ocular symptoms:episcleritis and scleritis –RA.
Anterior uveitis –ankolysing spondylitis.
Iridocyclitis with juvenile RA
Conjuctivitis –reactive arthritis.
Physical examination:
General:general condition,fever,pulse,BP
Joint Examinations inspection,palpation,range of motion and special test.
Articular or extraartifular
 Joint inflammations swollen,redness,tender,hot.
 Functional impairment: passive and active movementCrepitus during active or
passive range of motion.
Instibility
Joint demormity
 INVESTIGATION:

Haematology: neutrophilia,neutropenia,lymphopenia,Hb
and platelets
Uric acid,ESR,CRP,RF,ANA,Joint aspiration-arthrocentesis-
3C‘s – Cell count,Crystals(gout),Culture(septic arthritis)
Diagnostic Imaging

Key indicators:
 Bony tenderness
 Inability to bear weight
 Skeletal immaturity
 Age
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