From the Guidelines
The approach to diagnosing and managing arthralgia (joint pain) involves a thorough clinical evaluation, including a complete history and examination, as well as laboratory tests such as serum inflammatory markers (ESR, CRP) and autoantibody panels (ANA, RF, and anti-CCP) 1.
Key Steps in Diagnosis
- History and examination: to identify symptoms and signs of arthralgia, such as joint pain, swelling, and stiffness
- Laboratory tests: to evaluate inflammatory markers and autoantibodies, and to rule out other causes of joint pain
- Imaging: such as x-rays, ultrasound, and/or MRI, to assess joint damage and rule out other conditions
Differential Diagnoses
- Degenerative joint disease or osteoarthritis
- Soft tissue rheumatic disorders, such as rotator cuff tendinitis, crystal arthropathies (gout and pseudogout), and septic arthritis
- Inflammatory myositis, fibromyalgia, statin-induced myopathy, and other types of arthritis or soft tissue rheumatic syndromes
Management
- NSAIDs: may be used to control symptoms, but are often not sufficient
- Corticosteroids: may be required to control symptoms, especially in cases of severe arthritis
- Synthetic or biologic disease-modifying antirheumatic drugs (DMARDs): may be required in cases of persistent or severe arthritis
- Intra-articular corticosteroid injections: may be an option for patients with arthritis affecting only one or two joints
- Referral to a rheumatologist: should be considered if symptoms persist for more than 4 weeks or if there is joint swelling (synovitis) 1.
From the Research
Diagnostic Approach
The diagnostic approach to arthralgia (joint pain) involves a combination of clinical evaluation, laboratory tests, and imaging studies. The initial evaluation should include a detailed history of the patient's symptoms, with a focus on inflammation, location of pain, duration of symptoms, the presence of systemic symptoms, and any exposures to pathogens that could cause arthritis 2. A systematic approach to the physical examination that assesses for a pattern of joint involvement and presence of synovitis can help narrow the differential diagnosis.
Key Considerations
Key considerations in the diagnostic approach to joint pain include:
- Identifying the presence of inflammation, which can suggest synovitis and joint inflammation 2
- Assessing for a pattern of joint involvement, which can help narrow the differential diagnosis 2
- Using laboratory tests, such as rheumatoid factor and cyclic citrullinated peptide antibody tests, to confirm a suspected diagnosis 2
- Utilizing imaging studies, such as conventional radiography and magnetic resonance imaging, to evaluate the joint and confirm a diagnosis 2
Management of Joint Pain
The management of joint pain consists of both pharmacologic and nonpharmacologic modalities. Pharmacologic therapies may include medications specific for pain, inflammation, and adjuncts specific to the diagnosis 3. Nonpharmacologic therapies may include protection, rest, ice, compression, elevation, and simple office procedures 3. Treatment of pain should proceed in a step-wise fashion, providing medications appropriate for treating the level of pain 3.
Algorithm-Based Approach
An algorithm-based approach can be an effective tool in the diagnostic approach to joint pain. A study found that the use of an algorithm by primary care physicians increased the proportion of correct diagnoses and reduced the number of tests requested 4. The algorithm was designed through an international consensus of experts and integrated four rheumatic diseases into one tool with one common symptom: joint pain 5.
Benefits of Algorithm-Based Approach
The benefits of an algorithm-based approach to joint pain include: