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Arthralgia

  • Polyarthralgia ddx

    • common: RA, OA, parvo B19, gout, fibromyalgia
    • serious: endocarditis, gonorrhea, rheumatic fever, autoimmune disease, malignancy
    • viral infection: parvo B19, hepatitis, rubella, MMR vaccine
    • bacterial infection: lyme disease, endocarditis, gonorrhea, rheumatic fever
    • crystals: gout, pseudogout
    • rheumatic disease: RA, lupus, polymyositis, dermatomyositis, JRA, scleroderma, Sjögren’s syndrome, Behcet’s syndrome, PMR, autoimmune disease
    • vasculitis: HSP, Wegeners, temporal arteritis
    • other: ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, reactive arthritis, sarcoidosis, fibromyalgia, serum sickness, IBD, hemochromatosis
  • Monoarthralgia ddx

    • common: OA, gout,
    • trauma ddx: bursitis, tendonitis, strain, sprain, dislocation, fracture
    • don't miss: septic arthritis, gonorrhea, hemarthrosis
    • hip: avascular necrosis, SCFE
    • wrist: carpal tunnel
  • Migratory arthralgia ddx

    • gonorrhea, rheumatic fever, lyme disease, endocarditis, sarcoidosis, lupus, Whipple disease
  • Labs

    • CMP, CBC to dx infection
    • ESR, ANA to dx autoimmune
    • UA if GU symptoms
    • CK to dx myositis
    • joint aspiration if suspect septic arthritis
    • coags to dx hemophilia
    • iron panel to dx hemochromatosis
    • xray to dx osteoarthritis, fracture
    • MRI to dx tendinopathies
  • Admission orders

    • Admit: Floor
    • Diagnosis: Acute Arthritis
    • Condition: Serious
    • Vital Signs: Routine
    • Allergies:
    • Nursing: Elevate the affected extremity while supine
    • Diet: Regular, NPO if planned surgery
    • Activity: As Tolerated
    • Labs:
      • CBC with diff, Chem
      • ESR, CRP
      • uric acid
      • blood cultures x 2
      • Joint aspiration: cell count, diff, xtal, Gram stain and culture
    • IV: Heplock
    • Special:
      • If septic arthritis: Consult orthopedics or rheumatology
      • consult PT/OT
    • Medications:
      • Tylenol 650 mg PO q 4-6 hours prn
      • ibuprofen 600 mg PO q 6 hours prn
      • oxycodone 5-10 mg PO q 4 hours prn
      • docusate 250 mg PO bid
      • Empiric antibiotics after joint aspiration
        • Ceftriaxone 1 g IV qd
        • Nafcillin 2 g IV q 4 hours
        • Add Vancomycin 1 g IV q 12 hours if MRSA
      • If Gout: Indomethacin, colchicine, steroids. No Allopurinol during acute phase.
    • Discharge
      • criteria: inflammation improving, pain controlled
      • PICC line, outpt IV antibiotics if septic arthritis
      • f/u ID if septic arthritis
  • HPI

    • onset: acute vs chronic, new vs old
    • location, single vs multiple joints, migrating pains
    • quality: associated swelling, erythema, warmth, deformity
    • severity: mild vs keeps you awake at night
    • alleviation, aggravation
    • pain presently
  • ROS

    • fever, weight loss
    • rash
    • trauma
    • rash
    • cardiopulm: chest pain, dyspnea
    • GI: nausea, vomiting, diarrhea, blood in stool, abdominal pain
    • GU discharge
  • PMH

    • recent infection
    • lupus
    • arthritis
    • STDs
  • FH

  • SH

    • sick contacts
    • activities involving repetitive use of the joint
  • Meds

    • warfarin, anticoagulation
  • Allergies

  • General Px

    • vitals
    • gen impression
    • skin
    • cardio
    • pulm
    • abd
    • ext: splinter hemorrhage, MCP, DIP joints
  • Joint Px

    • inspection: location, rash, target rash, redness, swelling, warmth, deformity
    • palpation: tenderness, crepitus
    • ROM
    • strength
    • sensation
    • check joint above and below

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.