Miscellaneous Joint-related Disorders

Fibromyalgia is a chronic pain syndrome characterized by widespread body pain, chronic fatigue, mood disturbance, and cognitive disturbance. It also presents with other comorbid symptoms such as migraine headaches, depression, sleep disturbance, and irritable bowel syndrome. Diagnosis is clinical with laboratory exams and imaging reserved to rule out other causes for the spectrum of symptoms. Management is centered around education and lifestyle modification, with both pharmacotherapy (e.g., antidepressants, anticonvulsants) and non-pharmacotherapy (low-impact exercise, cognitive behavioral therapy) showing efficacy.

Sarcoidosis is a multisystem inflammatory disease that causes noncaseating granulomas. The exact etiology is unknown. Sarcoidosis usually affects the lungs and thoracic lymph nodes, but it can also affect almost every system in the body, including the skin, heart, and eyes, most commonly. Acutely, sarcoidosis presents with lymphadenopathy, fever, malaise, joint pains, a panniculitis on the shins known as erythema nodosum, and occasionally cough and shortness of breath. Chronic pulmonary sarcoidosis presents with an insidious onset of dyspnea, cough, chest pain, and a variety of other symptoms depending on the organ systems involved. Diagnosis often requires a biopsy of the granulomas. Management includes observation, NSAIDs, glucocorticoids, and potentially one of several steroid-sparing agents. Acute sarcoidosis is usually self-limiting with an excellent prognosis, but chronic sarcoidosis can lead to severe pulmonary fibrosis.

Dyspnea is the subjective sensation of breathing discomfort. Dyspnea is a normal manifestation of heavy physical or psychologic exertion, but also may be caused by underlying conditions (both pulmonary and extrapulmonary). The medical history and physical exam of a patient presenting with dyspnea should be used to rule out certain conditions or suggest the most likely cause of the respiratory discomfort. Management focuses on treating the underlying condition.