Polyarthralgia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of diffuse joint pain

Affected joints: ‍ ‍rightleftbilateral ‍symmetricalasymmetrical

Onset was ‍gradualsudden ‍new activity

Rated at ‍012345678910 / 10 ‍

Described as ‍dullaching

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍stiffness

‍swelling

‍warmth

‍redness

‍limited range of motion

‍crepitus

‍instability

‍weakness

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fatigue

‍myalgia

‍facial rash

‍mouth ulcers

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍photosensitivity

‍eye pain and redness

‍symptoms of STIs

‍temporal headache

‍amaurosis fugax

‍jaw claudication

‍finger/toe pain with change in color

‍paresthesias

‍sleep disturbance

‍poor concentration

‍tension-like headache

‍dysmenorrhea



Contributing factors:

‍obesity

‍overuse of joints

‍high purine diet

‍tick bite

no history of: ‍previous joint injury, ‍chronic infections, ‍rheumatoid arthritis, ‍systemic lupus erythematosus, ‍fibromyalgia, ‍gout, ‍osteoarthritis, ‍inflammatory bowel disease

no use of: ‍statin, ‍chemotherapy, ‍new medication

no family history of: ‍autoimmune diseases





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Cervical spine: ‍tenderness on ‍, range of motion ‍fulllimited

Shoulder: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Elbow: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Wrist: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Hand: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited

Hip: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Knee: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Ankle: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Foot: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Osteoarthritis ‍likelysuspectedpossible

DDx: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, viral arthropathy (e.g., parvovirus B19, hepatitis C), reactive arthritis, gout, pseudogout, fibromyalgia, ankylosing spondylitis, inflammatory bowel disease-associated arthritis, Lyme disease, sarcoidosis, hemochromatosis, polymyalgia rheumatica, medication side effect (e.g., aromatase inhibitors, fluoroquinolones), hypothyroidism, hyperparathyroidism, serum sickness, sickle cell disease, leukemia, multiple myeloma, Multiple mecanical pains, stress-related musculoskeletal pain





PLAN:

Investigations:

- Blood work: ‍CBC, ‍creatinine, ‍eletrolytes, ‍CRP, ‍ESR, ‍RF, ‍ANA, ‍anti-CCP, ‍uric acid

- X-ray of affected joints

- MRI of affected joints

Treatments:

- Encourage regular exercise

- Heat or cold therapy

- ‍Acetaminophen

- ‍NSAIDs

- ‍DMARDs

- ‍Glucocorticoids

- Physical therapy

- Occupational therapy

Further care:

- Referral to rheumatologist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as fever or unexplained weight loss, or if symptoms do not improve with treatment