Last reviewed: 23 Aug 2023
Last updated: 07 Sep 2023



History and exam

Key diagnostic factors

  • pain
  • functional difficulties
  • knee, hip, hand, or spine involvement
  • bony deformities
  • limited range of motion
  • malalignment
More key diagnostic factors

Other diagnostic factors

  • tenderness
  • crepitus
  • stiffness
  • shoulder, elbow, wrist, or ankle involvement
  • effusion
  • antalgic gait
Other diagnostic factors

Risk factors

  • age >50 years
  • female sex
  • obesity
  • genetic factors
  • joint anatomy and/or malalignment
  • physically demanding occupation/sport
  • post trauma/injury
  • high bone mineral density
More risk factors

Diagnostic investigations

1st investigations to order

  • history and physical exam
More 1st investigations to order

Investigations to consider

  • x-ray of affected joints
  • serum CRP
  • serum erythrocyte sedimentation rate (ESR)
  • rheumatoid factor (RF)
  • anticyclic citrullinated peptide (anti-CCP) antibody
  • MRI of affected joints
  • ultrasound scan
  • CT
More investigations to consider

Treatment algorithm


joint pain: medical management


persistent pain despite multiple treatment modalities or with severe disability



Fadi Badlissi, MD, MSc
Fadi Badlissi

Assistant Professor

Harvard Medical School

Attending Physician

Director of the Musculoskeletal Medicine Unit

Department of Orthopedics & Division of Rheumatology

Beth Israel Deaconess Medical Center




FB has received reimbursement from ANI Pharmaceutical for attending an advisory board meeting.

Peer reviewers

Amanda E. Nelson, MD, MSCR, RhMSUS

Associate Professor

University of North Carolina at Chapel Hill



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.

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