From the Guidelines
The approach to diagnosing and managing joint pain should be guided by a patient-centred framework within a biopsychosocial perspective, considering the patient's needs, preferences, and priorities, as well as pain characteristics, inflammation, and joint damage 1.
Key Principles
- The health professional should have basic knowledge of the pathology, treatment, and sequelae of inflammatory arthritis and osteoarthritis and be able to differentiate between localised and generalised pain 1.
- A personalised management plan should be developed with the aim of reducing pain and pain-related distress and improving pain-related function and participation in daily life, guided by shared decision-making and evidence-based treatment options 1.
Treatment Options
- Physical activity and exercise interventions and psychological interventions have been shown to have the most uniformly positive effects on pain 1.
- Other treatment options may include education, orthotics, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management.
- A stepped-care approach may be used, starting with education and self-management support, followed by specialist treatment if indicated, and finally multidisciplinary treatment if necessary 1.
From the Research
Approach to Diagnosing Joint Pain
- The diagnosis of joint pain involves a comprehensive evaluation, including a thorough history and physical examination, to identify the underlying cause of the pain 2, 3.
- The history and physical examination are crucial components in evaluating and managing joint pain, and primary care providers use clinical factors such as patient demographics, presence of inflammation, acute/chronic duration, extra-articular manifestations, pattern of joint involvement, and disease chronology to guide the diagnosis 2.
- Laboratory tests, such as rheumatologic tests, may be nonspecific, but aspiration of the joint with synovial fluid analysis can provide diagnostic clues, especially to differentiate infection versus inflammation 2.
Use of Algorithms in Diagnosing Joint Pain
- The use of an algorithm can help improve the diagnostic approach to joint pain, reducing the high percentage of error in diagnosis by primary care physicians 4, 5.
- An algorithm can increase the proportion of correct diagnoses and reduce the number of laboratory and diagnostic tests requested, making the diagnostic process more efficient and effective 4.
- A diagnostic algorithm designed through an international consensus of experts can support primary care physicians in the clinical approach to patients with joint pain, improving the correct diagnosis and reducing the number of paraclinical tests requested 5.
Management of Joint Pain
- The management of joint pain consists of both pharmacologic and nonpharmacologic modalities, including medications specific for pain, inflammation, and adjuncts specific to the diagnosis 2, 6.
- Treatment of joint pain should proceed in a step-wise fashion, providing medications appropriate for treating the level of pain, and nonpharmacologic therapies such as protection, rest, ice, compression, elevation, and simple office procedures can also be effective 6.
- Physical therapy and education can assist in the recovery process and prevent recurrence, and primary care providers should strive to identify dangerous conditions and distinguish conditions with a disease-specific pathogenesis 6.