Approach to Joint Pain
Mariana Gonzalez Trevino
| Syndrome | Joint Pattern | Presentation | Diagnosis | Treatment |
|---|---|---|---|---|
| Bacterial Septic Arthritis | Monoarticular (90%); knee most common; hip, ankle, shoulder | Acute onset; severe pain with minimal movement; fever (may be absent); risk factors: prosthetic joint, RA, DM, IVDU | Synovial fluid: WBC typically >50,000/μL (>90% PMNs); Gram stain; culture (gold standard); blood cultures | Urgent: IV antibiotics after cultures; empiric vancomycin + ceftriaxone; surgical drainage/washout; orthopedic consultation |
| Viral Arthritis | Polyarticular; symmetric small joints; migratory | Acute onset; self-limited (weeks); viral prodrome; rash may be present | Clinical diagnosis; viral serologies (parvovirus B19, HBV, HCV, HIV, chikungunya); synovial fluid: inflammatory but sterile | Supportive care; NSAIDs; typically self-limited within 6 weeks |
| Osteoarthritis | Weight-bearing joints (knees, hips); DIPs, PIPs, 1st CMC; spine | Insidious onset; pain worse with activity; morning stiffness ≤30 min; bony enlargement (Heberden’s and Bouchard’s nodes); crepitus | Clinical diagnosis; X-ray: joint space narrowing, osteophytes, subchondral sclerosis/cysts; synovial fluid: non-inflammatory (WBC <2,000) | Acetaminophen, topical/oral NSAIDs, IA glucocorticoids, PT, weight loss; joint replacement for severe disease |