Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- pain
- functional difficulties
- knee, hip, hand, or spine involvement
- bony deformities
- limited range of motion
- malalignment
Other diagnostic factors
- tenderness
- crepitus
- stiffness
- shoulder, elbow, wrist, or ankle involvement
- effusion
- antalgic gait
Risk factors
- age >50 years
- female sex
- obesity
- genetic factors
- knee malalignment
- physically demanding occupation/sport
- post trauma/injury
- high bone mineral density
Diagnostic investigations
1st investigations to order
- x-ray of affected joints
- serum CRP
- serum erythrocyte sedimentation rate (ESR)
Investigations to consider
- rheumatoid factor (RF)
- anti-cyclic citrullinated peptide (anti-CCP) antibody
- MRI of affected joints
- ultrasound scan
- CT
Treatment algorithm
joint pain: medical management
persistent pain despite multiple treatment modalities or with severe disability
Contributors
Authors
Fadi Badlissi, MD, MSc

Assistant Professor
Harvard Medical School
Attending Physician
Director of the Musculoskeletal Medicine Unit
Department of Orthopedics & Division of Rheumatology
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
FB declares that he has no competing interests.
Peer reviewers
David Hunter, MD
Assistant Professor of Medicine
Boston University Clinical Epidemiology Research and Training Unit
Boston University School of Medicine
Boston
MA
Disclosures
DH declares that he has no competing interests.
David L. Scott, MD, FRCP
Professor of Clinical Rheumatology
Department of Rheumatology
King’s College
London
UK
Disclosures
Not disclosed.
Differentials
- Bursitis
- Gout
- Pseudogout
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