Polyarticular Arthritis

Excerpt

Clinicians frequently encounter patients with complaints of "all my joints hurt." Diffuse joint pain has a broad differential diagnosis. A thorough clinical assessment narrows the differential, and confirmatory tests then aid in determining the underlying etiology. Although laboratory studies, imaging modalities, and other advanced diagnostic techniques are all components of polyarticular arthritis evaluation, a detailed clinical history and physical examination are the most crucial for an accurate diagnosis. Moreover, avoiding misdiagnosis is critical to prevent extensive and unnecessary testing.

The evaluation of polyarticular arthritis should begin with determining the location of pain. Nonarticular and periarticular pain, including muscle pain, is common and often confusing, frequently radiating to the joint. If the source of pain originates from the joint itself, it may be characterized as either inflammatory or noninflammatory. Noninflammatory etiologies, eg, osteoarthritis, are usually chronic and mild, and do not exhibit prominent indicators of inflammation, including redness, warmth, swelling, and generalized body aches. If an inflammatory disease process is suspected, diagnostic studies are performed to help confirm the diagnosis. Additionally, the differential diagnoses are guided by the number, pattern, and chronicity of the joints involved, as well as the patient's age and any systemic symptoms identified through a thorough review of systems.