JOINT SWELLING
Ask the Following Questions:
- Is it painless? The presence of joint swelling without pain, especially on motion, would suggest Charcot's disease.
- Is the involvement primarily in small or large joints? Involvement of the small joints is characteristic of rheumatoid arthritis, gonococcal arthritis, and Reiter's syndrome. Involvement of the larger joints is more characteristic of gout and osteoarthritis. However, osteoarthritis and rheumatoid arthritis may involve both.
- Is the involvement symmetrical or asymmetrical? Asymmetrical involvement is more typical of gout, rheumatic fever, hemophilia, neoplasm, septic arthritis, and trauma. Symmetrical involvement is more characteristic of rheumatoid arthritis and osteoarthritis.
- Is there fever? The presence of fever should make one think of rheumatic fever, gonococcal arthritis or other types of septic arthritis, Reiter's syndrome, rheumatoid arthritis, and lupus erythematosus.
- What is the age of the patient? The younger patients with joint swelling most likely have gonococcal arthritis, lupus erythematosus, rheumatoid arthritis, and hemophilia. Gout, osteoarthritis, and neoplasm are more common in older patients. However, there is considerable overlap here.
DIAGNOSTIC WORKUP
Routine tests include a CBC, sedimentation rate, ASO titer, CRP, ANA, urinalysis, chemistry panel, arthritis panel, and x-rays of the involved joints. It is also wise to do a bone survey when there is multiple joint involvement. A synovial fluid analysis and culture may be done if there is sufficient joint fluid. A trial of therapy can be initiated and may be diagnostic. At this point, it is wise to refer the patient to a rheumatologist for further evaluation. Additional tests that may be ordered are found on
page 279
. Polarized microscopy may reveal positive birefringent crystals of pseudogout.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Joint symptoms
Read excerpts from these other book chapters related to Joint symptoms:
Medical Books Excerpts
- JOINT PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Joint symptoms
» Next page: Arthritis – Single Joint (In A Page: Pediatric Signs and Symptoms)
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