A Rheumatologist’s Approach to Joint Pain/Arthritis
There are many different causes of arthritis and joint pains. Examples include osteoarthritis, inflammatory arthritis such as rheumatoid arthritis and other autoimmune connective tissue diseases, psoriatic arthritis and other diseases in the spondyloarthropathy category, crystalline arthritis such as gout and pseudogout, reactive arthritis such as post viral or other post infection causes, metabolic causes such as thyroid disease, infectious or septic arthritis, lyme arthritis and trauma related arthritis.
When Dr. Jain of Magnolia Rheumatology sees a patient for the first time with joint pain, there are a few steps she takes to better understand the cause of the problem. Understanding the cause will allow for a better treatment plan.
Steps to Understand the Cause of a Rheumatology Patient’s Joint Pain:
Is the pain truly arising from the joint, or is it from other close structures such as tendon, ligaments, muscles or bursa?
Once a rheumatologist feels certain that the problem is arising from the joint, there are key questions to ask:
a. Pattern of joint involvement:
How many joints are involved? Monoarthritis means 1 joint, oligoarthritis mean 1-4 joints, and polyarthritis means 5 or more joints are involved.
How long has the pain been present? Less than 6 weeks is considered an acute arthritis, longer than 6 weeks is considered a chronic arthritis.
Is the joint involvement symmetric? Which joints are predominantly involved (small joints such as the hand/foot joints, medium joints such as the elbows/wrists/ankles or large joints such as the knees/hips/shoulders)?
b. Is the arthritis more consistent with an inflammatory cause or non inflammatory cause?
Inflammatory clues: pain that is often worse in the second half of the night and morning (lasting ~ 45 minutes or more); improvement with activity, warmth/swelling/redness of the joint.
Non inflammatory clues: pain that is worse with movement, if swelling is present is the joint still cool to touch?
c. Are there other underlying medical conditions that the patient may have that may explain the current symptoms (i.e. thyroid disease, ulcerative colitis or crohn’s disease, psoriasis, lupus)?
d. Does the patient have other systemic symptoms/clues aside from the joint pain (such as any rash, lung or heart, gastrointestinal, or nervous system symptoms)?
While this may seem overwhelming, pursuing a systematic approach to arthritis/joint pain is important in establishing the cause of the symptoms. Taking a detailed history and conducting a thorough exam are vital steps in the process. Certain lab tests and imaging studies may also be employed to aid in the investigation. Once the cause is understood, finding the best management plan can be decided.
We look forward to helping you with your joint pain at Magnolia Rheumatology. Contact us today to schedule a rheumatology appointment at our Scarsdale, NY office!