Summary
Definition
History and exam
Key diagnostic 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
- joint anatomy and/or malalignment
- physically demanding occupation/sport
- post trauma/injury
- high bone mineral density
Diagnostic investigations
1st investigations to order
- history and physical exam
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
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 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
NC
Disclosures
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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- Bursitis
- Gout
- Pseudogout
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