Joint Pain
Causes of a Painful, Swollen Joint
- infectious
- inflammatory
- connective tissue disease
- neoplastic
- vasculitis
- bleeding
- bone
Infectious
Septic infection
- Staph
- Strep
- H. influenza (in unimmunized)
- Gonorrhea
Viral infection (less common; a presumed virus of exclusion)
Fungal: especially in immunocompromised patients, or with direct puncture
TB
lyme disease
Reactive arthritis
- Shigella
- Samonella
- Campylobacter
- Yersinia
- Gonorrhea (septic or reactive)
- Chlamydia
- Streptococcus
Inflammatory
Juvenile inflammatory arthritis
- oligo-articular
- polyarticular (RF -ve or +ve)
- systemic
- enthesitis-related
- psoriatic
Connective Tissue Disease
systemic lupus erythmatosis
dermatomyositis
mixed connective tissue disease
Neoplastic
Important to address this possibility for parents
- leukemia
- lymphoma
- neuroblastoma (in children)
Benign or maligant
- oseoid osteoma
- osteosarcoma
- Ewing's sarcoma
- chondroma
- chondrosarcoma
- synovial sarcoma
- rhabdomyoma
- rhabdomyosarcoma
Vasculitis
Bleeding
Bone
Osteomyelitis
Mechanical or orthopedic
Signs, Symptoms, and Diagonsis
- history
- physical exam
- lab investigations
- diagnostic imaging
History
questions about joint pain
morning stiffness -
effect of activity
time of day
which joints are affected?
extra-articular symptoms
fatigue, fever, weight loss, night sweats
respiratory: shortness of breath, chest pain
skin:
look for pitting in the nails in psoriatic arthritis.
functional
self-care
cooking
dressing
distance walking
stairs
past medical history
- sexually transmitted infections
- URTI (transient synovitis)
Physical Exam
On physical examination, active and passive range of motion should be assessed, and the presence of tenderness, swelling, warmth, erythema, deformity, and effusions should be evaluated.
Range of Motion
A good quantifier of joint inflammation is grip strength.
Lab Investigations
CBC
ESR, CRP
blood culture
Diagnostic Imaging
X-ray
Bone scan or MRI, depending on institution
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