This document provides guidance on evaluating joint pains through a clinical approach. It outlines how to distinguish between articular vs non-articular pain and inflammatory vs non-inflammatory causes based on characteristics like duration and type of stiffness, presence of inflammation, and acute phase reactant levels. It describes taking a thorough patient history regarding factors like age, sex, family history, duration and pattern of joint pain, number and symmetry of affected joints, location of joints involved, and associated symptoms. The document concludes with instructions on performing a full examination of all 28 joints to assess range of motion, tenderness, swelling, stability, and other physical findings that can help determine the underlying condition.

1. CLINICAL
APPROACH TO
JOINT PAINS
BY
DR MAHESH
GANDHI HOSPITAL
GENERAL MEDICINE

3. ARTICULAR VS NON ARTICULAR
ARTICULAR NON ARTICULAR
1.DEEEP PAIN
2.PAIN ON BOTH ACTIVE AND
PASSIVE MOTION
3.SWELLING
4.CREPITATION
5.INSTABILITY,LOCKING,DEFOR
MITY
1.PAIN ON ACTIVE MOTION
ONLY
2.TENDER POINT ADJACENT TO
JOINT STRUCTURES
3.PHYSICAL FINDINGS REMOTE
FROM JOINT CAPSULE

4. INFLAMMATORY VS NON
INFLAMMATORY
INFLAMMATORY N0N INFLAMMATORY
1.SIGNS OF
INFLAMMATION{ERYTHEMA,WARMT
H,PAIN,SWELLING}PRESENT
2.PROLONGED STIFFNESS
3.STIFFNESS IMPROVES WITH
ACTIVITY
4.RAISED ACUTE PHASE REACTANTS
1.SIGNS OF INFLAMMATION ABSENT
2.SHORT DURATION STIFFNESS
3.INTERMITTENT STIFFNESS(GEL
PHENOMENON)
4.NO RISE

5. HISTORY
1.AGE:YOUNG -SLE,REACTIVE ARTHRITIS
MIDDLE- FIBROMYALGIA,RA
ELDER- OA,POLYMYALGIA RHUEMATICA
2.SEX: MEN-GOUT,Spondylo Arthritis
FEMALE-RA,FIBROMYALGIA,SLE
3.FAMILY H/O: GOUT,ANKY.SPONDYLITIS
4.DURATION: ACUTE-GOUT,SEPTIC ARTHRITIS
CHRONIC-RA,OA
MIGRATORY-RF,GONOCOOCAL,VIRAL
ADDITIVE-RA,PSORIATIC ARTHRITIS

6. 5.NO OF JOINTS:
MONO(1)/OLIGO(2 TO 3)-
SEPTIC ARTHRITIS,CRYSTAL INDUCED
POLY(>4)- RA
MONO OR POLY-OA,PSOR ARTHRITS
6.SYMMETRY:
SYMMETRICAL-RA
ASYMMETRICAL-Spn.arthritis,REACTIVE
ARTHIRTIS,GOUT
SYMM OR ASYMM-OA,PSOR ARTHRITIS

7. 7.MANNER:
UPPER EXTREMITY-RA,OA
LOWER EXTREMITY-REACTIVE ARTHRITIS,GOUT
AXIAL SKELETON-OA,ANK SPONDYLITIS,ONLY
CERVICAL SPINE IN RA
8.PRECIPATATING FACTORS
9.COMORBIDITIES:
GOUT-RENAL FAILURE
MYELOMA-BACK PAIN

8. 10.FEVER-INFECTION,SLE
11.RASH-SLE,PSO ARTHRITIS
12.NAIL CHANGES-PSORIATIC,REACTIVE
ARTHRITIS
13.EYES-BEHCETS,SPO.ARTHRITIS
14.GIT-SCLERODERMA,IBD
15.GENITO-URINARY-REACTIVE
ARTHRITIS,GONOCOCCAL
16.CNS-LYMES,VASCULITIS

9. EXAMINATION
EXAMINE TOTAL 28 JOINTS
1.Count number of tender joints
2.Count number of swollen joints
3.For swellings differentiate between joint
effusions and bursal effusions by bulge sign
4.Assess joint stability by stabilising proximal
joint and applying stress to distal appendage
5.Identify any subluxation/dislocations

10. 6.Inflammatory etiology will cause limited
extension and joint will be in partial flexion (to
decrease articular pressure).this results in
flexion contractures.
7.Active and passive range motion of each joint
should be done.
hypermobility-marfans,EDS
limited mobility -
inflammtion,effusion,pain,deformity
8.Minor joint crepitus is common,but coarse
crepitus is seen in OA
9.Look for joint deformity,muscle strenth