General Approach to Arthritis and Joint Pain

As many patients present with joint pain, having a framework to evaluate the complaint will prove helpful in practice. Identifying the cause of joint pain can be difficult because of the extensive differential diagnosis. A thorough history and a complete physical examination are essential. Factors that may be helpful for diagnosis include disease chronology, inflammation, distribution, extra-articular manifestations, disease course, and patient demographics. Exam maneuvers are generally very useful as well. For example, simple joint palpation can help to distinguish an inflammatory process from crepitus that would indicate bony hypertrophy in osteoarthritis.

Clinicians should let the history, the physical exam, and their clinical judgment dictate when to follow through with laboratory studies or imaging. A complete blood count, urinalysis, and metabolic panel may provide more useful diagnostic clues, but it is difficult to use these tests to narrow down to a specific diagnosis. It may be possible, in some instances, to see the classic radiographic findings of specific rheumatologic diseases; often, though, imaging can be nonspecific or even appear completely normal early in the disease process.