Task 1
A 35-year-old lady presents with joint pains. How will you approach it?
1) What are the relevant history points you will cover in order to reach differential
diagnosis?
Which joints are involved ? How many joints are involved?
to see the pattern
either symmetrical or asymmetrical involvement
Since how long has this
complaint been raised
To find acute or chronic status and also course of the
disease i.e any remission and flare history
What is the severity of pain? Any
history of joint trauma /surgery? Character of pain? Dull, aching, sharp or throbbing, continous or intermittent
Only pain or with swelling, any redness for any inflammatory changes
Any associated symptoms
Any morning stiffness ? for how long and duration of stiffness
Does the pain happen both during active and passive movement?
to
differentiate arthralgia with arthritis
Is the pain relieved with rest and increased with action
is it localized or
radiating in nature
What are the relieving /aggravating factors
to differentiate inflammatory or
non inflammatory joint
Are there any systemic sign and symptoms eg Fever, nausea, vomiting etc etc?
How does this complaint impact your daily activities?
Medication history and its effectiveness on the problems
List of medicine use
and its duration
Dietary/ Lifestyle/ Daily routine history? Occupational history?
Family history for any similar illness
-Any comorbidity to see any extra skeleton symptoms
-Any extra articular
manifestations to rule out connective tissue disorder
2)List the broad differential diagnosis
1- Connective tissue disease/SLE/MCTD
Based on S/S, lab findings i.e ANA, Anti ds DNA, Anti Sm antibodies and anti cardiolipin antibodies. Also extra articular findings support further conclusion.
2- Rheumatoid Arthritis
Labs including ESR, RF/ Anti CCP and presence of extra skeletal manifestations also fulfill required criteria.
3- Osteoarthritis
X-Ray, MRI, Arthroscopy
4- Arthralgia/ Inflammatory Arthritis
Localized/ Generalized, need to evaluate clinically
5- Gout/ Pseudogout
X-Ray and Labs including Uric Acid, CBC, TSH, PTH, Ca, P, Mg, Fe, Rare but need to exclude as its monoarticular involvement
6- Soft Tissue Disorders:
Bursitis and Tendinitis
7- Traumatic Injuries
Sports related injuries, Overuse injuries
8- Infectious Arthritis: Reactive Arthritis
9- Autoinflammatory Syndromes: Adult Onset Still's Disease
10- Metabolic Arthropathies: Lyme Disease
11- Musculoskeletal Pain Syndromes: Fibromyalgia
Contributors:
Dr. Naveed Taufiq,
Dr. Rabia Anwer.
Algorithm made by Dr. Maheen Batool