Doctor: Where is the pain?
Patient: Pain pain everywhere!
❔How do we approach a patient with multiple joint pains❔
(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter
Patient: Pain pain everywhere!
❔How do we approach a patient with multiple joint pains❔
(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter
1️⃣ Is it polyarthritis?
First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING
& NOT 🚫
🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain
Let's deal with polyarthritis ⏬
(2/12)
First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING
& NOT 🚫
🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain
Let's deal with polyarthritis ⏬
(2/12)
2️⃣ Is it acute or chronic??
Acute<6 weeks
🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral
🔹Elderly RA, ANCA vasculitis, paraneoplastic
(3/12)
#MedTwitter
Acute<6 weeks
🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral
🔹Elderly RA, ANCA vasculitis, paraneoplastic
(3/12)
#MedTwitter
Chronic >6 weeks
🔹Rheumatoid arthritis
🔹Lupus, Sjogren's, other systemic rheumatic diseases
🔹Still's disease
🔹CPPD/ sometimes polyarticular gout
🔹Psoriatic arthritis
🔹Osteoarthritis
(4/12)
🔹Rheumatoid arthritis
🔹Lupus, Sjogren's, other systemic rheumatic diseases
🔹Still's disease
🔹CPPD/ sometimes polyarticular gout
🔹Psoriatic arthritis
🔹Osteoarthritis
(4/12)
3️⃣Temporal pattern
📈📉📊
(5/12)
📈📉📊
(5/12)
4️⃣ What is the nature of the pain?
🔹Inflammatory: pain worse at rest, relieved with activity, with early morning stiffness>30min
🔹Non-inflammatory: pain worse with activity, relieved with rest
This is important to figure out the plausible etiologies!
(6/12)
🔹Inflammatory: pain worse at rest, relieved with activity, with early morning stiffness>30min
🔹Non-inflammatory: pain worse with activity, relieved with rest
This is important to figure out the plausible etiologies!
(6/12)
5️⃣ Next, what is the joint distribution??
This 📷 has the classic bilateral symmetrical polyarthritis seen in
🔹Rheumatoid arthritis
🔹Lupus
🔹Sjogrens & other systemic rheumatic diseases
(7/12)
This 📷 has the classic bilateral symmetrical polyarthritis seen in
🔹Rheumatoid arthritis
🔹Lupus
🔹Sjogrens & other systemic rheumatic diseases
(7/12)
📷 is showing asymmetric polyarthritis seen in
🔹Polyarticular psoriatic arthritis (note the 'ray' sign with involvement of MCPs, PIPs DIPs in a line & asymmetric sacroiliitis)
(8/12)
🔹Polyarticular psoriatic arthritis (note the 'ray' sign with involvement of MCPs, PIPs DIPs in a line & asymmetric sacroiliitis)
(8/12)
🔹 Osteoarthritis pattern with knee, hip, 1st MTP, 1st CMC, PIP, DIP involvement
(9/12)
(9/12)
6️⃣ Extra articular features
🔹Fever 💭 of infection, lupus, still's disease, autoinflammation
🔹Nodules 💭 of RA, gout, rheumatic fever
🔹Rash 💭 lupus, dermatomyositis, sjogren, still's disease, viral infection, psoriasis
(10/12)
🔹Fever 💭 of infection, lupus, still's disease, autoinflammation
🔹Nodules 💭 of RA, gout, rheumatic fever
🔹Rash 💭 lupus, dermatomyositis, sjogren, still's disease, viral infection, psoriasis
(10/12)
🔹 Raynaud's 💭 of Scleroderma spectrum, lupus, Sjogren
🔹 Others: sicca, skin thickening, weight loss, anorexia, organ specific symptoms 🫁🫘🫀
(11/12)
🔹 Others: sicca, skin thickening, weight loss, anorexia, organ specific symptoms 🫁🫘🫀
(11/12)
And always remember,
History & clinical examination will give you the diagnosis in most cases.
An arthritis panel will only confuse you & make the lab owner richer 😏
(12/12)
History & clinical examination will give you the diagnosis in most cases.
An arthritis panel will only confuse you & make the lab owner richer 😏
(12/12)
Loading suggestions...