INFO - Diagnostic Approach to Polyarticular Joint Pain

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American Family Physician

September 15, 2003

" Diagnostic Approach to Polyarticular Joint Pain " :

Identifying the cause of polyarticular joint pain can be difficult

because of the extensive differential diagnosis. A thorough history and

a complete physical examination are essential. Six clinical factors are

helpful in narrowing the possible causes: disease chronology,

inflammation, distribution, extra-articular manifestations, disease

course, and patient demographics. Patients with an inflammatory

arthritis are more likely to have palpable synovitis and morning

stiffness; if the condition is severe, they may have fever, weight loss,

and fatigue. Viral infections, crystal-induced arthritis, and serum

sickness reactions are common causes of acute, self-limited

polyarthritis. Because chronic arthritides may present abruptly, they

need to be considered in patients who present with acute polyarticular

joint pain. Joint palpation can help to distinguish inflammatory

synovitis from the bony hypertrophy and crepitus that typically occur

with osteoarthritis. Extra-articular manifestations of rheumatologic

disease may be helpful in arriving at a more specific diagnosis. Many

classic rheumatologic laboratory tests are nonspecific. A complete blood

count, urinalysis, and a metabolic panel may provide more useful

diagnostic clues. Plain-film radiographs may demonstrate classic

findings of specific rheumatologic diseases; however, radiographs can be

normal or only show nonspecific changes early in the disease process.

(Am Fam Physician 2003;68:1151-60. Copyright© 2003 American Academy of

Family Physicians.)

For the entire article, please see:

http://www.aafp.org/afp/20030915/1151.html

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