小结
定义
病史和体格检查
关键诊断因素
- presence of risk factors
- pain
- functional difficulties
- knee, hip, hand, or spine involvement
- bony deformities
- limited range of motion
- malalignment
其他诊断因素
- tenderness
- crepitus
- stiffness
- shoulder, elbow, wrist, or ankle involvement
- effusion
- antalgic gait
危险因素
- age >50 years
- female sex
- obesity
- genetic factors
- joint anatomy and/or malalignment
- physically demanding occupation/sport
- post trauma/injury
- high bone mineral density
诊断性检查
首要检查
- history and physical examination
需考虑的检查
- x-ray of affected joints
- serum CRP
- serum erythrocyte sedimentation rate (ESR)
- rheumatoid factor (RF)
- anti-cyclic citrullinated peptide (anti-CCP) antibody
- MRI of affected joints
- ultrasound scan
- CT
治疗流程
joint pain: medical management
persistent pain despite multiple treatment modalities or with severe disability
撰稿人
作者
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
利益声明
FB has received reimbursement from ANI Pharmaceutical for attending an advisory board meeting.
同行评议者
Amanda E. Nelson, MD, MSCR, RhMSUS
Associate Professor
University of North Carolina at Chapel Hill
NC
利益声明
AN serves on the OARSI Board of Directors, is an Associate Editor of Osteoarthritis and Cartilage, is medical advisor to the Osteoarthritis Action Alliance, and has received grant funding from NIH/NIAMS and the CDC.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-62.全文 摘要
National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. Oct 2022 [internet publication].全文
Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019 Dec;49(3):337-50.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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