Approach to Rheumatic Disease

Approach to patient with joint pain

  • Articular vs. periarticular (bursitis, tendinitis) source of pain: typically active ROM more painful than passive ROM in periarticular process
  • Inflammatory vs. noninflammatory pain: features of inflammatory pain include swelling, warmth or redness in specific joint, prolonged morning stiffness (>30 min), improvement of pain/stiffness w/ motion/exercise. Assess for extra-articular features.
  • Physical exam: localize complaint, identify objective signs of inflammation, and assess number and pattern of affected joints
  • The physical exam is only 50–70% sensitive for detecting inflammatory arthritis
Key Physical Exam Findings in Joint Pain
Articular Joint) Disease