Evaluating Adult Polyarticular Pain
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What is the primary approach for obtaining diagnostic information in patients presenting with polyarticular joint pain?

  • History and physical examination (correct)
  • Tissue biopsy only
  • Symptom assessment
  • Laboratory and imaging studies only

    • Which of the following is NOT a potential cause of polyarticular pain in adults?

  • Osteoarthritis
  • Fibromyalgia
  • Hypothyroidism
  • Fractures (correct)

    • Inflammatory arthritis typically presents with worsening joint pain with immobility.

    True

    What is a hallmark sign of synovitis?

    <p>Soft tissue swelling</p> Signup and view all the answers

    Which skin lesions may suggest that joint symptoms are due to infective endocarditis, psoriatic arthritis, SLE, viral infection, or Still's disease?

    <p>Keratoconjunctivitis sicca</p> Signup and view all the answers

    Laboratory studies are always necessary to make a diagnosis.

    <p>False</p> Signup and view all the answers

    What are nonspecific indicators of inflammation mentioned in the text?

    <p>Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)</p> Signup and view all the answers

    The antinuclear antibody (ANA) test has high sensitivity but low ______ for SLE.

    <p>specificity</p> Signup and view all the answers

    Which imaging technique is described as having high specificity for gout but is not available in all clinical settings?

    <p>Dual-energy computed tomography (DECT)</p> Signup and view all the answers

    What type of biopsy may be useful in the diagnosis of tuberculosis, fungal infection, and sarcoidosis in a patient with polyarticular pain?

    <p>Synovial biopsy</p> Signup and view all the answers

    A combination of clinical, laboratory, and imaging data can help differentiate patients likely to have self-limited disease from those likely to have persistent arthritis.

    <p>True</p> Signup and view all the answers

    Ultrasound may be useful in detecting subtle __________ in patients with polyarticular pain due to inflammatory polyarthritis.

    <p>synovitis</p> Signup and view all the answers

    Match the following features with the prediction of persistent and/or erosive disease in patients with early arthritis:

    <p>Duration of symptoms prior to presentation = High risk for persistent and/or erosive disease Older age = High risk for persistent and/or erosive disease Male sex = High risk for persistent and/or erosive disease High BMI = High risk for persistent and/or erosive disease</p> Signup and view all the answers

    ¿Qué enfermedades sugieren las lesiones cutáneas como causa de los síntomas articulares?

    <p>Todas las anteriores</p> Signup and view all the answers

    ¿Qué pruebas de laboratorio son útiles para distinguir entre condiciones inflamatorias y no inflamatorias?

    <p>Velocidad de sedimentación globular (VSG) y proteína C reactiva (PCR)</p> Signup and view all the answers

    La prueba de factor reumatoide siempre es altamente específica para el diagnóstico de artritis reumatoide (RA).

    <p>False</p> Signup and view all the answers

    ¿Cuáles son algunas de las posibles causas de dolor poliarticular en adultos?

    <p>Fibromialgia</p> Signup and view all the answers

    La presencia de articulaciones calientes o hinchadas puede sugerir infección.

    <p>True</p> Signup and view all the answers

    ¿Qué tipo de dolor suele acompañar a la artritis inflamatoria?

    <p>Dolor que empeora con la inmovilidad</p> Signup and view all the answers

    La ___ de las articulaciones en osteoartritis es generalmente aliviada por el reposo.

    <p>dolor</p> Signup and view all the answers

    ¿Qué método de imagen puede proporcionar más información específica que las radiografías convencionales para el diagnóstico de la gota?

    <p>Ecografía (ultrasound)</p> Signup and view all the answers

    La gota crónica puede causar erosiones en las articulaciones, pero estas a menudo tienen un borde 'colgante' que sugiere cambios reparativos, lo que las distingue de las erosiones debidas a la artritis reumatoide.

    <p>True</p> Signup and view all the answers

    ¿Qué tipo de biopsia puede ser útil en el diagnóstico de tuberculosis, infección fúngica y sarcoidosis en pacientes con dolor poliarticular?

    <p>Biopsia sinovial</p> Signup and view all the answers

    ¿Qué tipo de información generalmente proporciona la información diagnóstica más útil para los pacientes que presentan dolor en las articulaciones poliarticulares?

    <p>Historia y examen físico</p> Signup and view all the answers

    La presencia de fiebre sugiere un subconjunto de enfermedades infecciosas y reumáticas, pero no está asociada con otras condiciones.

    <p>False</p> Signup and view all the answers

    ¿Cuál es un ejemplo de otra condición que puede sugerir la presencia de disfunción neurológica relacionada con el dolor articular?

    <p>Ardor, entumecimiento o parestesia</p> Signup and view all the answers

    La _____ sugiere una enfermedad sistémica que afecta a múltiples sistemas en el cuerpo.

    <p>presencia de debilidad</p> Signup and view all the answers

    ¿Qué enfermedades se pueden sugerir a partir de lesiones en la piel en pacientes con síntomas articulares? (Selecciona todas las opciones que apliquen)

    <p>Enfermedad de Still</p> Signup and view all the answers

    El dolor o la rigidez axial sugieren la posibilidad de espondiloartritis axial o alguna otra espondiloartritis seronegativa. ¿Verdadero o falso?

    <p>False</p> Signup and view all the answers

    ¿Por qué es importante identificar los puntos de dolor muscular y síntomas somáticos en pacientes con poliartralgia?

    <p>Para detectar fibromialgia.</p> Signup and view all the answers

    ¿Qué técnica de diagnóstico puede identificar erosiones antes que las radiografías convencionales en pacientes con dolor poliarticular?

    <p>RM</p> Signup and view all the answers

    La __________ puede proporcionar información más específica que las radiografías convencionales para el diagnóstico de la gota.

    <p>ecografía</p> Signup and view all the answers

    ¿Qué técnica de diagnóstico tiene alta especificidad para la gota pero no está disponible en todos los entornos clínicos?

    <p>tomografía computarizada de doble energía (DECT)</p> Signup and view all the answers

    La resonancia magnética (RM) puede ser útil en la evaluación de pacientes con dolor poliarticular para detectar sinovitis sutil y cristales de pirofosfato de calcio.

    <p>True</p> Signup and view all the answers

    Relaciona los siguientes elementos con su uso principal en el diagnóstico:

    <p>Resonancia Magnética (RM) = Identificar erosiones antes que radiografías Ecografía = Evaluación de sinovitis en RA Tomografía computarizada de doble energía (DECT) = Alta especificidad para gout</p> Signup and view all the answers

    Study Notes

    Evaluation of Adult with Polyarticular Pain

    Introduction

    • Polyarticular pain in adults is a common clinical problem
    • Causes include self-limited illnesses and potentially disabling or life-threatening conditions
    • A complete history and physical examination are essential for diagnosis
    • Laboratory and imaging studies or tissue biopsies may be necessary for further evaluation

    Causes of Polyarticular Pain

    • Inflammatory polyarthritis (e.g., rheumatoid arthritis, spondyloarthropathy)
    • Viral arthritis/arthralgias
    • Postinfectious or reactive arthritis
    • Osteoarthritis
    • Fibromyalgia
    • Multiple sites of bursitis or tendinitis
    • Soft tissue abnormalities
    • Hypothyroidism
    • Neuropathic pain
    • Metabolic bone disease
    • Depression

    History

    • Important historical points include:
      • Hot or swollen joints suggesting infection
      • Constitutional symptoms (fe.g., fever, weight loss, malaise) suggesting infection or sepsis
      • Joint pain greater than expected from physical findings suggesting compartment syndrome
      • Burning pain, numbness, or paresthesia suggesting acute myelopathy, radiculopathy, or neuropathy
    • Quality of pain may help distinguish musculoskeletal from neurologic causes
    • Duration of symptoms may be helpful in diagnosis (e.g., synovitis <6 weeks may suggest viral arthritis or systemic rheumatic disease)

    Physical Examination

    • Joint examination important for establishing presence or absence of synovitis
    • Hallmarks of synovitis include:
      • Soft tissue swelling
      • Warmth over a joint
      • Joint line tenderness to palpation
      • Joint effusion
      • Loss of motion
    • General examination may reveal systemic conditions such as lymphadenopathy, parotid enlargement, oral ulcerations, heart murmurs, pericardial or pleural friction rubs, or fine inspiratory rales due to interstitial lung disease

    Laboratory Studies

    • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be helpful in distinguishing inflammatory from noninflammatory conditions

    • ESR and CRP may be abnormal in a variety of infectious, malignant, rheumatic, and other diseases

    • Antibody tests may identify exposure to potential pathogens or certain autoantibodies associated with rheumatic disease

    • Antinuclear antibody (ANA) test has high sensitivity but low specificity for systemic lupus erythematosus (SLE)

    • Rheumatoid factor has limited diagnostic value, but high titers may predict poor outcomes in rheumatoid arthritis

    • Antibodies to citrullinated peptides (ACPA) are more specific than rheumatoid factor for diagnosing rheumatoid arthritis

    • Serum uric acid concentration may be elevated in gout, but has limited diagnostic value

    • Synovial fluid analysis may be diagnostic in patients with bacterial infections or crystal-induced synovitis### Synovial Fluid Analysis

    • Synovial fluid analysis is valuable for classifying joint fluid into inflammatory or noninflammatory categories and identifying hemarthrosis.

    • In patients with established rheumatic disease, it may be difficult to distinguish a flare of the underlying disease from a new, concomitant disorder.

    • The American College of Rheumatology (ACR) suggests performing synovial fluid analysis in febrile patients with an acute flare of established arthritis.

    • Synovial fluid analysis can be recommended for any patient, with or without prior rheumatic disease, when the diagnosis is uncertain after history, physical examination, and standard laboratory tests.

    Imaging Studies

    • Imaging studies are expensive and not required routinely in the evaluation of polyarticular pain.
    • Imaging studies can be useful in specific situations, such as detecting erosions in rheumatoid arthritis (RA), chondrocalcinosis in calcium pyrophosphate deposition (CPPD) disease, and abnormalities in the sacroiliac joints in ankylosing spondylitis.
    • Magnetic resonance imaging (MRI) is more sensitive than plain film radiography in detecting early SI joint abnormalities.

    Tissue Biopsy

    • In rare instances, tissue biopsy may be necessary to establish a diagnosis in patients with polyarticular pain.
    • Synovial biopsy may be useful in diagnosing tuberculosis, fungal infection, and sarcoidosis.
    • Biopsy of other tissues may help establish the presence of rheumatoid nodules, Whipple's disease, vasculitis, and hemochromatosis.

    Disease Course

    • Prediction models can help differentiate patients likely to have self-limited disease from those likely to have persistent arthritis.
    • Factors associated with persistent and/or erosive disease include:
      • Duration of symptoms prior to presentation
      • Older age
      • Male sex
      • High BMI
      • Duration of morning stiffness
      • Number of tender or swollen joints
      • Involvement of lower extremities
      • Elevated acute phase reactants
      • Rheumatoid factor
      • Anti-cyclic citrullinated peptide antibody
      • Erosive change on baseline radiograph
      • Human leukocyte antigen (HLA)-DRB1 shared epitope alleles

    Evaluation of Adult with Polyarticular Pain

    Introduction

    • Polyarticular pain in adults is a common clinical problem
    • Causes include self-limited illnesses and potentially disabling or life-threatening conditions
    • A complete history and physical examination are essential for diagnosis
    • Laboratory and imaging studies or tissue biopsies may be necessary for further evaluation

    Causes of Polyarticular Pain

    • Inflammatory polyarthritis (e.g., rheumatoid arthritis, spondyloarthropathy)
    • Viral arthritis/arthralgias
    • Postinfectious or reactive arthritis
    • Osteoarthritis
    • Fibromyalgia
    • Multiple sites of bursitis or tendinitis
    • Soft tissue abnormalities
    • Hypothyroidism
    • Neuropathic pain
    • Metabolic bone disease
    • Depression

    History

    • Important historical points include:
      • Hot or swollen joints suggesting infection
      • Constitutional symptoms (fe.g., fever, weight loss, malaise) suggesting infection or sepsis
      • Joint pain greater than expected from physical findings suggesting compartment syndrome
      • Burning pain, numbness, or paresthesia suggesting acute myelopathy, radiculopathy, or neuropathy
    • Quality of pain may help distinguish musculoskeletal from neurologic causes
    • Duration of symptoms may be helpful in diagnosis (e.g., synovitis <6 weeks may suggest viral arthritis or systemic rheumatic disease)

    Physical Examination

    • Joint examination important for establishing presence or absence of synovitis
    • Hallmarks of synovitis include:
      • Soft tissue swelling
      • Warmth over a joint
      • Joint line tenderness to palpation
      • Joint effusion
      • Loss of motion
    • General examination may reveal systemic conditions such as lymphadenopathy, parotid enlargement, oral ulcerations, heart murmurs, pericardial or pleural friction rubs, or fine inspiratory rales due to interstitial lung disease

    Laboratory Studies

    • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be helpful in distinguishing inflammatory from noninflammatory conditions

    • ESR and CRP may be abnormal in a variety of infectious, malignant, rheumatic, and other diseases

    • Antibody tests may identify exposure to potential pathogens or certain autoantibodies associated with rheumatic disease

    • Antinuclear antibody (ANA) test has high sensitivity but low specificity for systemic lupus erythematosus (SLE)

    • Rheumatoid factor has limited diagnostic value, but high titers may predict poor outcomes in rheumatoid arthritis

    • Antibodies to citrullinated peptides (ACPA) are more specific than rheumatoid factor for diagnosing rheumatoid arthritis

    • Serum uric acid concentration may be elevated in gout, but has limited diagnostic value

    • Synovial fluid analysis may be diagnostic in patients with bacterial infections or crystal-induced synovitis### Synovial Fluid Analysis

    • Synovial fluid analysis is valuable for classifying joint fluid into inflammatory or noninflammatory categories and identifying hemarthrosis.

    • In patients with established rheumatic disease, it may be difficult to distinguish a flare of the underlying disease from a new, concomitant disorder.

    • The American College of Rheumatology (ACR) suggests performing synovial fluid analysis in febrile patients with an acute flare of established arthritis.

    • Synovial fluid analysis can be recommended for any patient, with or without prior rheumatic disease, when the diagnosis is uncertain after history, physical examination, and standard laboratory tests.

    Imaging Studies

    • Imaging studies are expensive and not required routinely in the evaluation of polyarticular pain.
    • Imaging studies can be useful in specific situations, such as detecting erosions in rheumatoid arthritis (RA), chondrocalcinosis in calcium pyrophosphate deposition (CPPD) disease, and abnormalities in the sacroiliac joints in ankylosing spondylitis.
    • Magnetic resonance imaging (MRI) is more sensitive than plain film radiography in detecting early SI joint abnormalities.

    Tissue Biopsy

    • In rare instances, tissue biopsy may be necessary to establish a diagnosis in patients with polyarticular pain.
    • Synovial biopsy may be useful in diagnosing tuberculosis, fungal infection, and sarcoidosis.
    • Biopsy of other tissues may help establish the presence of rheumatoid nodules, Whipple's disease, vasculitis, and hemochromatosis.

    Disease Course

    • Prediction models can help differentiate patients likely to have self-limited disease from those likely to have persistent arthritis.
    • Factors associated with persistent and/or erosive disease include:
      • Duration of symptoms prior to presentation
      • Older age
      • Male sex
      • High BMI
      • Duration of morning stiffness
      • Number of tender or swollen joints
      • Involvement of lower extremities
      • Elevated acute phase reactants
      • Rheumatoid factor
      • Anti-cyclic citrullinated peptide antibody
      • Erosive change on baseline radiograph
      • Human leukocyte antigen (HLA)-DRB1 shared epitope alleles

    Evaluation of Adult with Polyarticular Pain

    Introduction

    • Polyarticular pain in adults is a common clinical problem
    • Causes include self-limited illnesses and potentially disabling or life-threatening conditions
    • A complete history and physical examination are essential for diagnosis
    • Laboratory and imaging studies or tissue biopsies may be necessary for further evaluation

    Causes of Polyarticular Pain

    • Inflammatory polyarthritis (e.g., rheumatoid arthritis, spondyloarthropathy)
    • Viral arthritis/arthralgias
    • Postinfectious or reactive arthritis
    • Osteoarthritis
    • Fibromyalgia
    • Multiple sites of bursitis or tendinitis
    • Soft tissue abnormalities
    • Hypothyroidism
    • Neuropathic pain
    • Metabolic bone disease
    • Depression

    History

    • Important historical points include:
      • Hot or swollen joints suggesting infection
      • Constitutional symptoms (fe.g., fever, weight loss, malaise) suggesting infection or sepsis
      • Joint pain greater than expected from physical findings suggesting compartment syndrome
      • Burning pain, numbness, or paresthesia suggesting acute myelopathy, radiculopathy, or neuropathy
    • Quality of pain may help distinguish musculoskeletal from neurologic causes
    • Duration of symptoms may be helpful in diagnosis (e.g., synovitis <6 weeks may suggest viral arthritis or systemic rheumatic disease)

    Physical Examination

    • Joint examination important for establishing presence or absence of synovitis
    • Hallmarks of synovitis include:
      • Soft tissue swelling
      • Warmth over a joint
      • Joint line tenderness to palpation
      • Joint effusion
      • Loss of motion
    • General examination may reveal systemic conditions such as lymphadenopathy, parotid enlargement, oral ulcerations, heart murmurs, pericardial or pleural friction rubs, or fine inspiratory rales due to interstitial lung disease

    Laboratory Studies

    • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be helpful in distinguishing inflammatory from noninflammatory conditions

    • ESR and CRP may be abnormal in a variety of infectious, malignant, rheumatic, and other diseases

    • Antibody tests may identify exposure to potential pathogens or certain autoantibodies associated with rheumatic disease

    • Antinuclear antibody (ANA) test has high sensitivity but low specificity for systemic lupus erythematosus (SLE)

    • Rheumatoid factor has limited diagnostic value, but high titers may predict poor outcomes in rheumatoid arthritis

    • Antibodies to citrullinated peptides (ACPA) are more specific than rheumatoid factor for diagnosing rheumatoid arthritis

    • Serum uric acid concentration may be elevated in gout, but has limited diagnostic value

    • Synovial fluid analysis may be diagnostic in patients with bacterial infections or crystal-induced synovitis### Synovial Fluid Analysis

    • Synovial fluid analysis is valuable for classifying joint fluid into inflammatory or noninflammatory categories and identifying hemarthrosis.

    • In patients with established rheumatic disease, it may be difficult to distinguish a flare of the underlying disease from a new, concomitant disorder.

    • The American College of Rheumatology (ACR) suggests performing synovial fluid analysis in febrile patients with an acute flare of established arthritis.

    • Synovial fluid analysis can be recommended for any patient, with or without prior rheumatic disease, when the diagnosis is uncertain after history, physical examination, and standard laboratory tests.

    Imaging Studies

    • Imaging studies are expensive and not required routinely in the evaluation of polyarticular pain.
    • Imaging studies can be useful in specific situations, such as detecting erosions in rheumatoid arthritis (RA), chondrocalcinosis in calcium pyrophosphate deposition (CPPD) disease, and abnormalities in the sacroiliac joints in ankylosing spondylitis.
    • Magnetic resonance imaging (MRI) is more sensitive than plain film radiography in detecting early SI joint abnormalities.

    Tissue Biopsy

    • In rare instances, tissue biopsy may be necessary to establish a diagnosis in patients with polyarticular pain.
    • Synovial biopsy may be useful in diagnosing tuberculosis, fungal infection, and sarcoidosis.
    • Biopsy of other tissues may help establish the presence of rheumatoid nodules, Whipple's disease, vasculitis, and hemochromatosis.

    Disease Course

    • Prediction models can help differentiate patients likely to have self-limited disease from those likely to have persistent arthritis.
    • Factors associated with persistent and/or erosive disease include:
      • Duration of symptoms prior to presentation
      • Older age
      • Male sex
      • High BMI
      • Duration of morning stiffness
      • Number of tender or swollen joints
      • Involvement of lower extremities
      • Elevated acute phase reactants
      • Rheumatoid factor
      • Anti-cyclic citrullinated peptide antibody
      • Erosive change on baseline radiograph
      • Human leukocyte antigen (HLA)-DRB1 shared epitope alleles

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    Related Documents

    Evaluation of Adult with Polyarticular Pain PDF

    Description

    This quiz is based on the UpToDate article on evaluating adults with polyarticular pain, covering the diagnosis and management of this condition. It includes information on the causes, symptoms, and treatment options.

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