- Musculoskeletal complaints are extremely common in outpatient medical practice and are among the leading causes of disability and absenteeism from work.
- Joint pain and swelling may be manifestations of disorders affecting primarily the musculoskeletal system or may reflect systemic disease.
Joint pain can be an outcome of both localized and systemic reason. The evaluation of joint pain can be a difficult one. This includes
- Investigation of joint versus non-joint: Is the pain located in a joint or in a periarticular structure such as soft tissue or muscle?
- Investigation of Inflammatory versus noninflammatory features: Inflammatory disease is suggested by local signs of inflammation (erythema, warmth, swelling); systemic features (morning stiffness, fatigue, fever, weight loss); or laboratory evidence of inflammation (thrombocytosis, elevated ESR or C-reactive protein).
- Investigation of type of pain: Acute (≤6 weeks) versus chronic.
- Investigation of reasons behind the pain: Whether the pain is due to localized or systemic reason.
To evaluate the joint pain there are some factors which need to be evaluated.
- Age, sex, race, and family history
- Symptom onset (abrupt or indolent), evolution (chronic constant, intermittent, migratory, additive), and duration (acute versus chronic)
- Number and distribution of joins: one joint, 2–3 joints, >3 joints.
- Other joint features: Morning stiffness, effect of movement, features that improve/worsen
- Other complication: e.g., fever, rash, weight loss, visual change, dyspnea, diarrhea, dysuria, numbness, weakness
- Recent events: e.g., trauma, drug administration, travel, other illnesses.
Special attention should be paid to identifying the presence or absence of:
- Warmth and/or erythema
- Synovial thickening
- Subluxation, dislocation, joint deformity
- Joint instability
- Limitations to active and passive range of motion
- Periarticular changes
- Muscular changes including weakness, atrophy
- Suspected chronic joint or bone infection
- Progressive joint disability
- Monarticular involvement
- Baseline assessment of a chronic articular process
- When therapeutic alterations are considered (such as for rheumatoid arthritis)
- Additional imaging procedures, including ultrasound, radionuclide scintigraphy, CT, and MRI, may be helpful in selected clinical settings.